My new column this month gave me a chance to share some anecdotes about really interesting, high-performing medical practices that have achieved their success by breaking a few rules! One of my favorites, because it's so much fun to think about how these doctors and practice managers inspired us and taught us quite a few new tricks. Repertoire Magazine
Practice managers and physician owners might look at the media attention focused on Yahoo! CEO Marissa Mayer's decision to end work-from-home at her company and think, well, that doesn't apply to me. And it's true, with only a few exceptions (say, billing), medical practice staff members are unlikely to be able to do their work from home -- not just because they need to be where the patients are, but also because of the privacy risks of bringing documents out of the office. That doesn't mean, though, that the controversy and discussion that Mayer's decision engendered (and now Best Buy CEO Hubert Joly's as well) are completely irrelevant to physician practices. Because even though working at home is an option that won't often make sense for medical office staff, the media frenzy about one company's HR decision does illustrate how challenging it can be to make management changes without unintended consequences, even when the need for the change seems obvious. Change sparks fear One of the theories that immediately emerged about the Yahoo! telecommuting ban was that Mayer was simply implementing "backdoor layoffs" -- i.e., that she'd determined that forcing everyone into the office would be an easy way to encourage telecommuters to quit to achieve needed cost reductions. Naturally, this theory provokes fear in all staff -- what if there aren't enough quitters to bring costs down, and my job ends up on the chopping block? There are mixed reports of how the end of telecommuting is actually playing with Yahoo! employees -- despite the ongoing outrage of bloggers, there are also reports that many current Yahoos understand the need for and actually support the change. But, certainly the situation is a good reminder about how important it is to communicate effectively with employees, to help prevent unnecessary fears from taking hold -- otherwise, you risk losing your most valued employees, who will begin job hunting in earnest when they sense trouble. (I have seen changes as small as eliminating free coffee to save a few bucks lead to swirling rumors that bankruptcy is imminent! When communication is missing,
Today I dug further into the Healthgrades/hospital listing hijacking issue. I tested the phone numbers for two of the practices we've worked with on listings, one in Southern California and one in Northern California; both of these practices have had their listings heavily branded by local hospitals (without consent or even notification from the hospital or Healthgrades to the practice). In both cases, the practice's phone number was replaced with a referral line number. My experiences testing these numbers out illustrates why it is so problematic for the practices and so wrong for it to have been done without their consent. ===== Test #1 -- SoCal Dial number ... recorded greeting, "please hold for the next available agent" [AGENT?] Operator: Hello? How can I help you? [Not even the lame, generic "doctor's office" you usually get with an answering service] Me: Oh...er...I thought I was calling my doctor's office? Operator: Oh, I'll have to transfer you. Are you an existing patient? Yes: Okay, please SPELL your doctor's last name, so I can make sure I transfer you to the right place [Spell? Really? Didn't I just call his office?] ===== Test #2 -- NorCal Dial number ... same recorded greeting, "please hold for the next available agent." Hold for 25 seconds. Operator: Hello, can I help you? [Again, not even an indication you're calling a doctor.] Me: Oh, whom have I reached? Operator: Um, you've reached a call center for XXXXX Health. [That's the hospital system] Me: Oh, I thought I was calling a doctor's office? Operator: Oh, um, XXXXX Health is using us to verify patient information -- can I update your information? [Really? How do you know I'm a XXXXX patient?] Me: So, I haven't reached the doctor's office. I've reached someone from XXXXX Health? Operator: Well, XXXXX Health has us gathering patient information and tracking calls from HealthGrades. Operator: So, are you concerned about this? We've been getting a lot of complaints. [Wow! That was fast. I didn't think I'd indicated a complaint yet. They really must be getting a fair number.] Operator: I can pass your information on
Those of you who check in here regularly or have heard me speak on online reputation management already know that I'm an advocate for working with the major physician directories and taking advantage of their high profile rather than hiding your head in the sand. I've long appreciated the ability these sites offer to easily identify yourself as a physician or practice administrator and correct and customize your listings on Vitals and Healthgrades -- which is not just beneficial but really crucial because these sites are so well-optimized on Google, it's likely that some of your prospective patients and even current patients will end up landing there looking for contact information and other details. I've never had trouble with claiming or managing listings on behalf of a client until this past fall, when I ran into some really frustrating difficulties that are still not resolved, despite numerous attempts to contact both sites' customer service people through multiple channels. I'll describe what's happening here both in the hope that practices can benefit from this as it unfolds, and in the hope that perhaps some individuals from these sites will see this posting and provide some assistance. Starting with the most shocking problem: Healthgrades and the hospital listing hijack incident. Last fall, I attempted to claim two additional listings for a private practice we work with that just added two new docs. (I had previously claimed the physician owner.) There were all sorts of unanticipated technical problems in the process -- including the system failing to delete an obsolete address (2500 miles away!) for one of the doctors. I was also unable to de-link myself from another practice I'm done working with, so that they could take control of their own listings; the problems seemed to be technically related. I wrote in again and again -- about ten times! -- for help to support. Generally, I got no answer. On one occasion, I was told that they were having system problems that might take weeks to resolve, but that they would take care of all the changes for me if I would document everything that was
A few months back, we shared a link to HARO ("Help a Reporter Out"), a wonderful service that distributes daily inquiries from journalists from all sorts of publications -- we've seen everything from American Medical News, Medical Office Today, to national magazines like Parenting and Best Health, to national television outlets like CNN and Fox News. The service also features queries from local news stations, websites and publications, too. Are you thinking, so what? Well, the wonderful thing about HARO is that, unlike ordinary PR work -- i.e., the slog of pitching, pitching, pitching to reporters -- when you respond to a query on HARO, you are actually helping the reporter. Meaning the reporter wants to hear from you and hear what you have to say. Getting your name and your practice's name and point-of-view out in the media has tremendous value. The audience will perceive you as an expert selected by the journalist to comment on the subject. This can elevate your image versus others medical practices in your specialty in your area. And don't let lack of time during the day hold you back from responding! At least when the story is for print or web, the reporter will usually allow you to answer via email, instead of by phone or in person during business hours. We do email 'interviews' all the time with reporters here at Capko & Company. This also gives you more time to think about your answer -- if you're concerned about coming up with your best response on-the-spot. We often share items from HARO that we think will help our client practices and other friends -- if you don't want to receive the daily HARO emails (3x), join our email list (see sidebar) and you'll receive the tidbits we send out that are relevant to your practice.
The Harvard Business Review has a great tip today, entitled "Always Say Yes to Networking." I love this tip because it emphasizes how important it is to maintain personal connections with the friends and associates in your network -- and to think of networking as the process of keeping in touch and maintaining relationships, not just meeting up for the purpose of job-hunting or other goals. Most of the physicians and medical office managers and staff we work with do little or no networking at all. This is such a missed opportunity. Staying in contact with your network is great for your morale and your perspective -- not just your job prospects. It's harder, perhaps, for medical professionals to break away for coffee or lunch with a friend or colleague. But, social networking can help -- I'm personally so grateful for the friendships I've rekindled using Facebook. Find whatever ways work for you to keep in touch with the people you've met along your journey. Read the HBR tip here.
If you haven't had a chance to read all of our 13 tips for 2013, here is the full list: Master the deductible re-set [commit to less bad debt in 2013!] Analyze your E/M code distribution [reduce audit risk, bill for what you've earned] Cash management quick tip [copays are not petty cash!] Patient service=patient care [the dreaded patient service conflation situation] Review maintenance contracts [don't let auto-pilot become auto-overpay] Get educated [lifelong learning: not just for clinicians] Reach out to local employers [you've got more than one customer] Manager's report card [everyone needs feedback, goals and recognition] Analyze payer performance [remember that you decide which payers you will accept] Engage staff with better meetings [such a simple idea, so much opportunity for upside!] Review payer contracts [it's okay to admit they've been stuffed in a drawer -- just pull them out and read them] Review your directory listings [don't miss out on free promotion -- or let errors online impact your revenue] Make haste slowly [take on important challenges with care -- and get help to jumpstart your planning!]
Do you find yourself and your medical practice in a state of emergency when changes in the market arise? Do you have long-term personal, professional or financial goals that are in your head, but no plan to make them real? Are you relying on gut -- rather than metrics -- to know if your practice is on track or in decline? Too many private practices are winging it -- leading to bad decision-making and unnecessary panic in response to market events, and under-performance and delayed goals because there was no road map to achieving them. Don't let this be your practice. Make 2013 the year you take control of your practice by developing a strategic plan. It's easier than you think, and operating from clear planning will not only help your practice become more stable and more profitable, it will improve the morale of everyone on your team. Get started with an honest, data-driven assessment of your practice. Tools and activities that can help: SWOT (strengths, weaknesses, opportunities, threats) analysis Benchmarking Modeling (i.e., scenario testing) Mission and goal-setting -- for one year, five years, ten years If you've got team members that are experienced and currently underutilized, these activities can be a great way to improve your practice. On the other hand, if you're barely keeping up with your day-to-day activities, but understand the value of strategic activities - including how it can free up your time - Capko & Company can help. Furthermore, while our tailored consultations improve financial performance, they're also fun for physicians and staff - resulting in an improved work environment and better morale. We look forward to hearing from you.
If the doctors in your practice have been practicing for a while, odds are you've already got listings in the Vitals.com and Healthgrades.com, the largest online physician directories. However, there's no guarantee that those listings are correct -- in fact, it is not unusual for these sites to contain incorrect details such as defunct addresses and phone numbers grabbed from older public resources. The listing for one physician we worked with recently even had the medical school he attended incorrect. The good news is, it is usually easy to 'claim' your listings on these sites using their automated self-identification processes. Once you've claimed your listing, you can change all the details -- and add others that can help promote your practice, such as a photo and a link to your website. Besides checking out your physician rating site listings, the start of a new year is a great time to review your health plan directories as well. Make sure that you're listed properly in all the plans you accept -- including verifying the 'accepting new patients' information. And, don't forget to check that you've been removed from directories of plans that you've dropped -- to avoid any out-of-network surprises for patients that can turn into uncollectible bills for your practice. And don't forget about Google+ (aka Google Places) -- this easy to use listing process is a great way to get additional exposure for your practice and its website, with a link back, space for photos and the opportunity to add custom text about your practice and your philosophy. Customized listings stand out dramatically versus unedited ones -- and it's all free!
So, if we asked you where your payer contracts are, you could tell us, right? And you'd know when you last reviewed them -- and when the next renewal period comes up? Or, are they ... at home, in a closet, where they've been (untouched) for several years? Are they ... 'somewhere around here'? Well, we're not surprised. Many of our clients have tucked their payer contracts in a drawer, only to forget about them. So, don't feel TOO bad about this -- but, feel just bad ENOUGH to resolve to change your habits now! Reviewing your payer contracts annually -- before they end/automatically renew -- is more important than you think. Many contracts have evergreen provisions that can make extension of your current rates mandatory -- even if you would have been eligible for an increase. We've worked with practices that have foregone years of increases because they didn't realize their rates would remain unchanged if they failed to contact the payer at renewal time. (Even when rate increases seem negligible, several years worth of them add up to significant foregone profit.) There also may be provisions in your contracts that you've forgotten about that can lead you to inadvertently fall out of compliance -- which can lead to unexpected reimbursement problems down the road. Bottom line: set a tickler to review each of your contracts a month or so before they renew. (And, if you can, try to reset your contracts so that they all renew around the same time -- so that you can do your review in one fell swoop.)
Many medical practices we work with focus their marketing efforts (if they do marketing at all!) on physicians who refer to them and direct communication with their existing patients. Yet there is another marketing channel that can be extremely effective for physicians that is often overlooked: your area's major employers. It's common to assume that simply participating in an employer's health plan is sufficient to reach the potential patients that work there. But, if you're in a competitive area, you might need to differentiate yourself against dozens of other physicians -- personal outreach to employees is a way to help them choose you. Moreover, you can't necessarily count on the health plan to promote itself effectively to your patient base. Many employers will also consider wellness programs in the coming year, because the Affordable Care Act promises to provide financial incentives for qualifying programs by 2014. Practices that create wellness programs for local employers can simultaneously market themselves to employers and prospective patients, provide valuable wellness information and training to their community, and position themselves as key wellness program providers as attention and support for this type of effort grows. (What kinds of programs might qualify? Some possibilities include non-discriminatory diagnostic or health improvement programs like tools for coping with and preventing repetitive strain injuries; healthy weight management; voluntary health screenings.)
New year, new budget, new goals? Now is the time for practice managers to review their skills-building strategies for 2013 -- and to make the case for joining general practice management organizations like PAHCOM, MGMA and POMAA or specialty-specific groups like NERVES and Bones. The world of healthcare is changing. The colleagueship and educational programs offered by established practice management organizations can be invaluable in helping you and your practice stay on top of the changes -- and gather new ideas for managing change. And, these groups can also often help you make crucial connections to vendors who can help your practice, often at discounted rates. The certification programs can help you advance your own career -- and, if your practice's growth requires you to make some key hires, being part of one of these organizations can help you find qualified candidates.
Physicians only need to peek at their ratings on sites like Yelp, Healthgrades and Vitals to realize the unfair truth: patients lump every aspect of their interactions with your practice into their view of your "care." Worse, at times it seems like their reviews give more weight to things like staff courtesy and billing hassles than to their clinical outcomes! The good news is, however, is that this also means that making people feel cared for is a team effort at your practice -- and that means that the burden doesn't fall entirely on the physicians' shoulders. The key, though, is to make sure the importance of patient service is understood by everyone on the team, and that everyone takes responsibility for it. Some steps in the right direction: Educate your staff about the importance of patient service, and reward them for their good work. Let them know that your practice's reputation depends on their contributions -- and that you value it! Invest in training if improvement is needed. Survey your patients. Learning what's on their minds -- before they vent on a social media site or medical directory -- will allow you to address issues before they become problems. And, some patients will perceive your service to be better simply because you took the time to ask their opinion. Strive for a personal touch. Medicine is becoming bigger and more impersonal -- and that trend is only worsening with consolidation. But, this spells opportunities for small practices to stand out! Be sure your clinical routines allow for a bit of personal interactions with patients -- even just stating the patient's name at the start of the encounter conveys a touch of caring. Bring in outside help. If you're not 100% sure of how patients view your service and care, an objective analysis can be very valuable. Contact us* if you're ready for a comprehensive, cost-effective service review and action plan. When it comes to patient service problems, and ounce of prevention is worth a pound of cure! *our San Francisco office works on patient service projects -- contact us via email at "info" at capko.com,
We've been working on patient service training this month, so this great post on Physicians Practice got our attention. Too many physicians and practice managers still misunderstand how patients perceive their quality of care: it's not just about the results. Patients make judgments about their quality of care from the moment they arrive at your practice. The article on Physicians Practice includes some great advice -- some of our favorites that we frequently share with our client practices include: Don't room patients far in advance. Waiting in the exam room is more stressful and annoying than waiting in the reception area. Warn patients about long wait times. If they're aware they'll need to wait 30 minutes, they'll be less upset about the delay. Use warm greetings, including the patient's name, to establish a connection and convey that you care. Check out the full story by clicking here.
For most practices, E&M codes represent a significant portion of billings -- and, for some practice types like pediatrics and other primary care, E&M codes can approach 100% of billings. Physicians and non-physician providers are often so sensitive to the risk of down-coding, denial or audit that they develop a bad habit of 'defensive' E&M coding -- i.e., sticking to the lower range of the codes for virtually every patient. Far from being an effective defense, though, this type of habitual coding may actually create more audit risk, since it leads to a distribution of codes that is skewed rather than the expected bell-shaped curve. And, it does so while also leaving thousands of the practice's dollars on the table! The end of one year and the beginning of another is the perfect time to analyze your practices E&M coding patterns -- and set new habits for the new year. Run a report for each physician by code for the full year, and you can create a table like this that totals how many times each provider used each code: code 99201 code 99202 code 99203 code 99204 code 99205 Total Anderson 12 252 900 12 24 1200 Buford 0 132 996 348 0 1476 Cochrane 12 996 96 0 0 1104 Delaney 0 36 732 432 120 1320 Elliott 12 48 1092 156 24 1332 From this data, you can easily calculate percentage utilizations to get a clearer idea of distribution -- and from there create a chart to spotlight any skewed coding: E&M Distribution Chart E&M Distribution Chart Notice the skewed utilizations of Cochrane, Anderson and Elliott? It's unlikely these codes are accurate -- especially Cochrane, who appears to be habitually and defensively under-coding. (Note, also, the addition of the CMS averages to the chart -- available from the CMS website. This is a great double-check to see the typical coding mix based on all practices billing Medicare -- and to get a sense if your coding patterns will look odd (or audit-worthy) to the CMS.) Next step: identify the number of instances of
We launched something new for 2013 -- just in time for our "13 for 2013" practice management quick tip series. You can now receive our blog posts directly via email. Just scroll down the right hand column to "receive email updates via FeedBurner," add your email to the green box, and click submit -- that's it. If you're a frequent visitor here, you already know that you won't receive tons of mail -- just an update or two per week, always aimed at helping your healthcare business shine. And we'll never share your email with any outside party.
Too often, patients and practices alike are caught off guard by the resetting of deductibles on January 1. When patients forget they'll be responsible for a larger portion (or all) of the cost of their services, it can be difficult for front desk staff to handle the situation if they're not prepared -- and even physicians and managers find it hard to refuse a request to "please just bill me." The best solution to the problem is to prevent it. Make sure everyone in the practice knows that more patients will be responsible for payment until their new deductibles are met -- and that patients need to be informed and reminded before their visit. That means mentioning that deductibles have re-set when they set appointments, and checking patient responsibility amounts and outstanding balances before reminder calls -- and alerting patients to what they'll be expected to pay at visit time. Knowing that patients have been informed about their responsibility should make it easier for the front desk to collect in a matter-of-fact way. ("How will you be paying today, Ms. Jones?")
All of us at Capko & Company want you to start 2013 off right! We're rolling out a series of quick tips -- short bites that will take just a minute to read -- to help you make the most of all the opportunities of a brand new year. First up: don't let the deductible re-set short-change your first quarter revenue.
We often post here about the opportunity directory sites present to get extra exposure and add inbound links (great for SEO) to your website. Recently, we learned of a hospital system that is not just taking advantage of free directory listings by fleshing out physician profiles, they've actually partnered with the team at Vitals.com to get even more value out of the site. This hospital works with the team at Vitals.com to upload correct information for its hundreds of doctors -- to ensure that all its physicians are represented and appear with accurate contact information, background, specialty and insurance information. What's more, they use call center phone numbers for each physician that are assigned only to Vitals.com profiles, so that they can track exactly how many calls come in via the site. Web click-throughs are also tracked, using Google Analytics on the hospital's own site. While this extensive relationship with a directory may be overkill for (and beyond the reach of) independent practices, it speaks volumes about the changing internet directory landscape. When a major hospital system -- with a dedicated team of marketing professionals on staff -- chooses to rely on a directory as a critical marketing source and partner with them, it suggests that this form of internet marketing really has come of age. This hospital understands that a significant number of prospective patients will visit online medical directories every day for physician information. Practices cannot afford to online physician directory and rating sites for the same reason.
Recently, we worked with an OB/GYN practice that had taken some big steps to reduce staff costs. In particular, the practice was concerned about their long-standing process of providing new maternity cases a lengthy consultation with an RN -- covering all the information a newly pregnant woman would need, and offering her a relaxed opportunity to ask questions. Because the RNs were paid at $22-$25/hour, the practice manager and managing physician partner felt that these consults were an extremely wasteful expense. They reasoned that the consults could be easily incorporated into the initial physician visit -- adding 15 or 20 minutes to the visit, instead of paying for 30-45 minutes of RN time for the consult. The maternity visit with an OB would be included in the patient's global payment -- no additional revenue would be generated by adding 15-20 minutes of physician time to the visit. But, the practice reasoned, they would no longer be incurring the RN costs of $15-20 per consult -- and, since the revenue was the same either way, the impact would be bottom-line positive, right? Wrong. What the practice failed to consider was the opportunity cost of tacking 15-20 uncompensated minutes onto the physician visit. While the practice no longer had to pay an RN $15 to discuss pre-natal vitamins and exercise with maternity patients, the practice was giving up 15-20 minutes of provider appointment time -- time which could potentially be billed out at much more than $15 if it were used for an additional patient visit. Provider time is a practice's most precious resource -- it's the only means the practice has to generate revenue. Using providers to do tasks that can be done by an RN or MA almost never makes economic sense for a practice. Plus, taking higher level tasks away from your RNs and MAs deprives them of the satisfaction they get from those activities. Keep everyone -- especially your providers -- utilized at their highest potential, and you'll keep everyone more satisfied with their roles and your practice more profitable.
Simple steps to improve patient service -- here's the link. http://www.ama-assn.org/amednews/2012/11/05/bica1105.htm
It might be the toughest message a practice management consultant has to deliver to a physician client: you're just not working hard enough. When doctors bring us in to analyze their practices' profitability problems, they usually expect us to find they're over-staffed, or that their building expenses are too high, or that their billing service is inadequate. And, to be sure, we do often find those problems. But, it's just as often the case that we find that the physicians are seeing many fewer patients than they thought. And, when we show the doctors data comparing their visit volume against other practices in their specialty, we'll hear, "but we're so busy!" How is it possible that we can walk into a practice and see underutilized exam space and know immediately that visit volume is an issue, while the physicians simultaneously feel -- truly believe -- that they're operating at capacity? This is the phenomenon I like to call 'faux busyness.' The physicians feel busy -- fully occupied -- but the real number of patients they're seeing tells a different story. The sad thing about faux busyness is that it's just as tiring as the real thing, but a lot less profitable. What are some of the causes of faux busyness? Here are a few: Provider calendars with gaping holes -- so that the physician is in the office all day, but not seeing patients much of the time Providers scheduled in multiple places for partial days -- adding transit time and scheduling hassles to every day Layout issues, inconsistently prepped exam rooms, and other issues that require physicians to be moving around the office too much -- cutting into possible visit time Is faux busyness cutting into your practice's profitability? There's only one way to find out: start digging into data. Analyze your scheduling processes to determine if they include unnecessary complexity. Make sure your staff understand the importance of booking next-available appointments. And look to benchmarks to reality test your patient volume against comparable practices.
Did anyone else catch the recent This American Life episode called "What Doesn't Kill You?" It featured a story about comedian Tig Notaro and her four months of sheer hell -- which included a harrowing, life-threatening bout with C. difficile, a breast cancer diagnosis, and the unexpected, accidental death of her mother. Ms. Notaro turned the experiences -- amazingly -- into a highly personal comedy set that has come to be regarded as a legendary performance. There was much to love in the segment. But, there was one small aspect of it that really made me the practice management consultant in me wince: the hospital survey that was sent to Notaro's mother after her death. Notaro made great comic lemonade out of the survey that asked her deceased mother if her hospital stay was comfortable, and if all procedures were clearly explained in language she could understand (Notaro's mom was unconscious during her entire visit, and died at the hospital). But, the comedy reflected the pain that the survey caused. We're all for surveying patients -- it's a wonderful way to learn what you need to know to improve your operations, and many patients will feel that you care more about them just because you asked for their feedback. But, a mistake like mailing a survey to a deceased patient is really inexcusable -- especially because it's so easily avoided. Did the hospital's database fail to either track or remove deceased patients? If you're mailing or emailing surveys or newsletters and tips to your patients to improve your practice and build on your patient relationships, good for you! But, be sure you have processes in place to segment your lists and exclude specific patients from mailings that might upset them. And be sure you have a routine in place to clean your lists periodically to remove patients who've moved or passed on.
The Harvard Business Review recently shared a wonderful tip about employee motivation: It's not all about the money. This is a great reminder for medical practices. For the most part, practice budgets don't allow for relying on salaries and benefits in order to attract talent; thank goodness remuneration is not the only thing that drives employee loyalty! The HBR newsletter noted that flex time, recognition of contributions and a result-oriented culture are all powerful influences on employee satisfaction. Your practice may not be able to offer flex time to all employees, but imagine the benefits of allow some employees to work part-time, or evenings and weekends - you might be surprised how many roles can fit non-traditional hours. (We recently recommended a cardiology practice add a weekend scheduler, for example -- a great solution for preventing piled-up appointment requests on Monday mornings, and for increasing the odds that appointment phone calls will actually reach the patient.) Even more important, that family atmosphere that exists at many practices encourages loyalty. Given your medical practice staff just a little room for growth, combined with some flexibility and encouragement, and you'll be rewarded with lower turnover -- without busting the compensation budget.
I've been reading the (fascinating and fun) book Moneyball. It's amazing how it exposes that any business -- even the $7 billion professional baseball industry -- can be guided by market mythology that is intuitively satisfying but not entirely accurate. The book tracks the efforts of the Oakland A's in the early 2000s to become more data-driven in choosing new players. The A's were motivated by their relatively puny player budget. They hoped to somehow assemble a winning roster even though they didn't have enough financial resources to bring on a single superstar. Historically, dozens of statistics were regularly tracked about baseball, but only a certain few favorites got all the attention. The A's dug into the data, and arrived at the surprising insight that the stats that got all the attention weren't the ones that actually correlated with team performance. One of my favorite parts of the book is when the general manager finds that the lure of the old, 'gut feel' approach to managing a baseball team was so powerful, he couldn't watch the games live without risking incorrect decisions driven by emotion. Only by looking at data alone -- and not observing the quirks and ups-and-downs of actual play -- can he trust himself to decide correctly. What a powerful idea for managers of all sorts. In the daily pace of a medical practice, how often do emotion, misperception or unquestioned assumptions get in the way of good decision-making? In our work, we bring surprises to our practice management clients all the time, by simply analyzing data as objective outsiders. Are you operating under assumptions, or emotional conclusions, such as: - "I've always coded like this, and never had a problem" - "Our no-show rate is about average" - "Saturday clinics wouldn't be popular around here" - "We couldn't make more money in the current reimbursement environment" - "No one on our staff would ever steal from us -- we're like a family" - "We don't use outside collections - I'm confident our receivables will be paid eventually" Are unchallenged assumptions hurting your practice? Just like baseball, medicine is a combination of passion, talent, art
We've contributed a bi-monthly column to Repertoire magazine for the past several years. Our goal is to give some insight into the challenges of medical practice management to reps who sell devices, pharmaceuticals, EMR and other services to physicians. For September, we looked at the surprising ways physician practices are vulnerable to theft, overcharging and fraud. Read it here: How Doctors Get Ripped Off
A new study from the Center for Public Integrity has identified a trend towards higher coding of Medicare visits over the last decade -- and suggests this increased utilization of higher codes could signal increasing, habitual abuse. The study also notes that medical groups representing doctors assert that treating seniors has gotten more complex over the last ten years -- both because Medicare patients tend to have multiple, complex conditions and because EMR and coordination of care make treating them more time-consuming and make documentation and coding more accurate. A few tidbits from the report that stood out: The report cites the seemingly alarming statistic that "more than 7,500 physicians billed the two top paying codes for three out of four office visits in 2008, a sharp rise from the numbers of doctors who did so at the start of the decade." But, 7,500 is less than 1% of the total number of practicing physicians in the US (829,673, per the Kaiser Family Foundation). Even if every one of these physicians is coding fraudulently, this is a pretty small proportion of physicians who are 'cheating' -- compare that with, for example, the 15% of Americans who've admitted to cheating on their taxes. The report reveals that the lowest code, 99211, typically pays only about $20. Will the reality of how paltry this is -- considering this figure not only compensates the doctor, but pays for the office, technology, clinical and business staff -- be lost in the outrage over more evidence of 'greedy doctors'? (If every single minute of an hour were dedicated to 99211 visits -- ignoring the need for administration, transition and documentation time between patients, late and no-show patients -- that still only amounts to $240/hour. Not much to pay a doctor, cover her overhead, and compensate staff.) The report also notes that, "the number of doctors who billed at least half of their office visits at one of the two most expensive codes more than doubled to at least 17,000 practitioners...[and] those who quit using the two least expensive codes rose 63 percent, climbing to more than 13,000 in
I recently heard about a classic book from the eighties that apparently was all the rage among business students and aficionados back in the day, but that somehow slipped by me. Since it was about operations management, and presented in an unusual format -- a novel -- I felt compelled to check it out. Now that I have, I think medical practice managers should, too. It's called The Goal, by Eli Goldratt, and it tells the story of a plant manager named Alex Rogo who must turn around abysmal performance in his manufacturing plant. Despite achieving 'efficiencies' in many steps of production, the plant's productivity overall has deteriorated to the point where orders are backed up for weeks, and the company's salespeople can't reliably forecast when orders can be delivered (and so can't really sell any new orders, either). If Alex can't fix the plant, it will be shut down. Alex is mentored in the book by a professor named Jonah, who guides him in the process of understanding the plant's constraints -- bottlenecks -- and how to increase their throughput. By analyzing what really drives (or holds back) production in his plant, Alex learns that many of his most relied-upon assumptions aren't correct -- and develops a better way to improve his plant's productivity. I happened to be reading this book while working with a medical practice that was having workflow problems, and the parallels were striking. This practice was proud of its wonderful system for triaging patients -- but, the system was so efficient, patients were waiting for ages in exam rooms for their providers. The practice had over-optimized in triage, creating huge bottlenecks down the line at the exam rooms -- and, no benefit whatsoever to patients and no improvement at all in the number of patients seen! They needed to look at their "plant" with fresh eyes, just like Alex did, to see that overall process efficiency is dependent on the performance of the slowest link in the chain.
A recent New York Times article and follow-up blog post discuss the challenges patients have understanding medical bills, through the eyes of a consultant named Jean Poole who has made a career of deciphering (usually highly erroneous) medical bills and helping patients recoup incorrect charges or reduce their outstanding bills. Billing is so challenging for practices -- even though specialized staff are usually handling the task, they have to contend with constant changing rules, reluctance of some payers to address issues, and the myriad of payment schemes with varying patient responsibility. But imagine how it is for patients -- who don't have any specialized knowledge to help them deal with the strange language and calculations of their bills. Ms. Poole's service would seem to be a godsend for patients who find themselves unexpectedly owing thousands of dollars (as the article points out, patient out-of-pocket obligations and opaque hospital fee schedules can lead to big surprises). It's great that she offers this service, for sure -- but how frustrating that it's so needed. The frequency of errors and lack of transparency in insurance company documents to patients is a big source of difficulty for practices. When patients feel they've been incorrectly charged or can't understand their bills, it undermines the trust they have in their physicians and other care providers. When your practice provides services in conjunction with a hospital, their billing clarity and accuracy (or lack thereof) can rub off on your patient relationships. While you can't control how hospitals manage their side of billing, you can at least make sure you're communicating as clearly and directly as possible with patients about what your practice will bill and how much of that bill their payer has declared to be the patient's responsibility.
Will your practice be taking part in this eight-state pilot? Requirements will include EHR, flexible hours, various preventive and individualized care activities. http://www.innovations.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/index.html