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
The iPhone, Android or other cell phone you depend on for everything – besides texts and calls your phone is likely keeping you busy with games; productive with email, to-do lists and calendars; in touch with Facebook, LinkedIn and Twitter; and convenienced with applications as straightforward as a simple flashlight. But how much do you really know about this rapidly growing library of applications? How well do you read the obligatory user-agreement before you install the application? Well, of those “free applications” that most of us have installed more than a few represent some potentially serious risks, especially if you have HIPAA data on your phone. Most free applications can access your contacts, calendar and other data on your phone – and for purposes of convenience, there are perfectly legitimate reasons for this, but can you be sure the publisher will only use this data for legitimate reasons? One shocking example came from a flashlight application for Android that, once installed, had access to nearly all the data on the phone. The potential threat from applications, malware and viruses is very complex within a BYOD environment – even the basics of keeping device system software current can be a nightmare when one is facing a multitude of different hardware and operating system platforms. Naturally, risks of this sort should be thoroughly defined in your HIPAA risk assessment that is a requirement of meaningful use. Regularly updating and refining your risk assessment alone could become overly burdensome very quickly. Accordingly, it's worthwhile, given the complexity and ever-changing nature of technologies, to consider a very conservative approach – we recommend practices own and manage all devices accessing patient and other critical data.
Let's take a few moments to consider what risks you may be carrying around with your phone. One common vulnerability is stored passwords on your phone, e.g. within a “notes” program. Imagine the harm that could come of a thief having access to your banking accounts or practice management software. Your firm could suffer an immediate financial hit, malicious mischief or a potentially devastating breach of patient data. The start of such grief can be your unattended phone meeting with a disgruntled employee or dissatisfied patient. These risks mean that phone security justifies your consideration. Phone security starts with maintaining disciplined control over the physical device. Naturally, your phone should not be left untended in your office, on a shared counter-top or anywhere else where it might be easily stolen. While it seems obvious, it’s very common to see busy administrators leaving their phones behind as they scurry about the office. Luckily, most phones have security features that can significantly mitigate your risk – although many of these features are not enabled by default. In many phones, a four-number passcode can be readily “cracked” by a thief. Better is a quality passcode (avoid common English words) that uses letters and numbers – with iPhones this can be changed under settings/general/passcode lock. Keep you phone’s software updated, as security vulnerabilities are fixed as they are discovered. If you use an iPhone, make sure you have the application Find My iPhone installed (and updated) and enabled. iOS 7, the latest iPhone operating system, security has been greatly improved – potentially making your phone valueless to a thief, but you must first have an Apple ID (and remember it!). Phones using Android 2.2 or greater have a built-in application that can help locate or your phone and/or completely delete the contents of your phone and any installed memory (SD) cards. You’ll need to make sure these features are enabled on your phone (settings/security/device administrators). Regardless of what device you use, be careful when accessing sensitive information when you’re out and about as your phone may connect to an insecure Wi-Fi connection, allowing others
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,
Most practices have an underutilized resource - namely, their employees' ability to identify and solve problems. As practices deal with the day-to-day business, it's all too easy to fall into a routine-inspired complacency. To establish some positive momentum, make a point to ask each of your staff to identify problems and possible improvements - and give everyone an opportunity to contribute their ideas during your regularly scheduled staff meetings. We think you'll be surprised at the sources and quality of ideas that emerge. Be generous with your appreciation and praise and you'll see a staff that is happier and more motivated than ever.
A recent UC Davis study revealed a surprising finding - an inverse relationship between patient satisfaction scores and health outcomes. In other words, those most satisfied with their healthcare providers were, on average, sicker and more likely to die than their less satisfied counterparts! As might be expected from these findings, healthcare costs were also higher - by about 9% - among highly satisfied patients. The study compared health outcomes and patient satisfaction scores of over fifty thousand adult respondents of the Medical Expenditure Panel Survey, a product of the Agency for Healthcare Research and Quality under the U.S. Department of Health and Human Services. The survey is designed to be representative of the U.S. adult population and is the most comprehensive data set of its kind. Response rates for the survey have varied between approximately 60% to 70% over the last decade. Among the possible explanations is that physicians, motivated in part by physician compensation structures that consider patient satisfaction, stray from standard treatments and instead meet patient expectations. Under this scenario, patients are satisfied because tests and procedures are viewed in a more-is-better light, but clinical outcomes suffer, e.g., patients receive treatments that carry risk as a result of false positive lab results. The trend toward elevating patient ratings in measures of quality of care are likely to continue with the Center for Medicare Services (CMS) starting this past December with its initial phase of 1% rewards or penalties for hospitals under Value Based Purchasing. One-third of the evaluation process relies on patient data, i.e., survey data. These intriguing study findings certainly call for further research to solidify our understanding of the value of patient satisfaction ratings. This study and our firm's experience especially calls into question the value of very broad measures of patient satisfaction, e.g, how satisfied are you overall, because patients are notorious for confusing bedside manner with the quality of clinical care. The implications of this study may be far reaching, but enterprising providers can take simple steps to educate their patients, preferably long before they see them in the exam room. With email and social media making communication easier and less expensive,
Joe Capko did a webinar with Medical Practice Management Web Advisor earlier this week on how effective leadership translates to more productivity from your staff -- and vice versa. One of his themes was establishing trust by listening and treating people fairly, and letting them know they are valued. People give more to their jobs when they know you care! Aptly, today's email tip from Harvard Business Review was called "Engage Your People," and featured some of the same ideas Joe offered. Basically, less top down, more listening, more working together. To read the HBR tip, click here.
Do you have conflicting personalities in your office? Do such differences result in petty squabbling? While inter-office conflicts are common, there are a few things an administer can do to greatly reduce conflict in the workplace. It's important to address conflicts before they affect the professionalism of your practice, the morale of your staff, and your practice's productivity. Most of what is attributed to personality conflicts in the workplace can be traced to a just a handful of sources for which you most likely are responsible! Job descriptions: It's all too easy for disputes to emerge when responsibilities are not well defined. In today's changing medical field, jobs change -- don't let those job descriptions lead to finger-pointing in the office. Clearly delineated responsibilities allow staff to both receive credit and take responsibility for tasks. Without clear definitions it's too easy for misunderstandings (of differences in performance) to escalate into personal resentments. Cross-training: The counterpart to clearly job descriptions is that your staff should be well cross-trained and able and willing to fill-in where they are needed. Cross-training has the benefit of helping everyone in the office truly appreciate what important roles the others are fulfilling. Additionally, it shows that you are interested in the well-being and career and skill advancement of your staff. There's a fine line between a groove and a rut! To the extent you are able, provide variety in the work environment so that your staff doesn't fall into an abyss of boredom. Fairness: If your staff perceives that some receive preferential treatment, morale will suffer and, with falling morale, it's only to be expected that friction will increase. An under-appreciated fact is that perceptions of fairness and openness to communication go hand-in-hand. If your staff feels they can approach you to complain because you have a sincere interest in their well-being, you are well on your way to resolving squabbles among your staff. Challenge yourself to hear that which is difficult for you to hear. No one is free from biases and your staff can serve as a mirror to your own policies -- it's important
Here are three simple strategies your practice can take to attract more referrals, gain visibility and be the doctor of choice in your specialty. Forge Alliances: You can't build your network of referrals by sitting in your office, so get out and meet the other health care providers and potential referral sources. You can maximize the time spent and the gains in this endeavor by hiring a marketing director or consultant to go out and meet people of interest on your behalf. And remember, your competition is not the enemy - So forge relationships with other physicians in your specialty, as well. Build Allegiance: By providing the best service, you can to both the referring sources and the patients that are referred you will strengthen their allegiance to you. Feedback is an important part of the process so it is wise to develop an on-line survey to send to your referring sources to be sure you are on the mark and meeting their needs. It also keeps your name in front of them - and this is a very good thing! Express Appreciation: Honor your referrals by sending a thank you note and offering value add services. For example, you can offer a lunch and learn program at their practice to educate the entire staff about your specialty and your commitment to their patients. It is another opportunity to thank them for their allegiance. You'll want to thank both staff and physicians and this is a good way to do it. The three A's will have a powerful impact on building the kind of practice you want and gaining an enviable reputation as the "go to" doctor in your specialty. Capko & Company - your source for building a practice that shines. www.capko.com
Solving work flow problems is among the biggest challenges medical offices face on a daily basis. Work flow issues can be caused by a lack of defined work processes and individual responsibilities or poor training. It may seem like an oxymoron but too little or too much staff can also be a contributor to poor work flow. Regardless, it will result in unhappy patients and diminished profits. It's time to get serious about creating a lean operating machine. Here's some tips to help you get started: Take a critical look at workflow bottlenecks. Map work flow: Examine processes throughout the office to identify and eliminate those that don't provide added value to the customer or the practice. Involve staff in seeking solutions to problem areas of work flow. Everyone needs to give a valid reason for the various steps they go through to complete a task as a first step to eliminate processes that are redundant or duplicated. Examine errors or tasks that are completed to find the cause and develop the right solution. Develop a written plan to implement the best solution, including target dates for incremental progress. Communicate throughout the entire change process. There will be times when you will want to refocus and perhaps change directions. Celebrate your success along the way!
I've seen too many practices go through one, two and even three associates over a short period of time. They get sour and think young doctors just aren't what they use to be. Maybe, but maybe you aren't the same either. Physicians and administrators are so busy these days and have so much going on that they sometimes fail to give Dr. Newbie the tools to succeed. It's your job to provide Dr. Newbie with a good orientation, clear expectations, an understanding of the schedule, documentation requirements, billing processes and what support staff he or she can depend on. In other words you need to plan ahead, communicate well and be there when Dr. Newbie needs help. Then everyone wins and the team gets stronger! That's doing your job right. So look in the mirror when you have an associate physician that jumps ship after year one or two and think about what you might have done to make things turn out differently.Judy Capko is one of America's leading practice management and marketing consultants, and author of the runaway top-selling book Secrets of the Best Run Practice. Check it out by clicking on the book icon at www.capko.com
Power-up your website If you don't have a website get one. If you do have one, enhance it and make it all it can be! It will save staff and physicians time. Most patients already use the Internet. They use it to make airline reservations, check the weather, follow their investments and get information. Better service, better communication The website is the perfect vehicle to tell patients about the practice, physicians and staff. It can provide directions to the office, seasonal reminders and lead patients to the appropriate sources to obtain reliable clinical information about medical conditions. This will result in more efficiency. Patient portals Websites can be designed to be more interactive through a patient portal that is HIPAA compliant. By establishing designated parameters your patients can register on-line. You can also set up a patient management system so patients can review certain portions of their medical record. And why not provide patients with convenient pay-on-line capabilities to improve cash flow and staff efficiency? Reduce telephone madness Patients can also communicate with your office through e mail, reducing the volume of incoming phone calls to the office. It allows a staff member to read and respond to the e mail at their convenience; provides timely documentation and tracking; and reduces those in-bound phone calls. Websites are only limited by the imagination. Announcing the release of the 2nd edition of the runaway to-selling book by Judy Capko: Secrets of the Best-Run Practice. Check it out by clicking on the book icon at www.capko.