When we work with physicians and managers who've found their financial results have inexplicably declined, they often wonder why the profit numbers changed when the practice is still managed in the same careful way as before. It's a puzzle and a disappointment and a huge source of frustration! But therein lies the rub: As managers, our job is often to respond to changes that happen outside our business. Doing things the same way, even when executing perfectly, is often not enough to assure good results. Things are happening in the broader market that affect our patients and their behavior. It's our job to recognize when trends that have nothing to do with medicine still require a response from our industry. One really powerful example of a completely external trend that is nonetheless affecting every practice business is the rapid adoption of online payments by consumers. If your practice hasn't responded to this trend, it's probably already affecting your collections negatively. The shift in payment behavior by consumers has been dramatic. I created the chart to the left using USPS data showing that single-piece stamped mail has declined more than 50% in the past decade. The Post Office attributes this decline to shifting consumer preferences, especially for bill payment. The days when it was normal behavior for consumers to sit down once a month and review paper statements, write stacks of checks, stuff the checks in return envelopes, then stamp the envelopes and drop them into the mail are rapidly disappearing. Patients' strong preference for paying electronically is both an opportunity and a threat to your practice business. Give patients an easy way to pay online -- better yet, give them electronic statements, too -- and you'll get paid faster, with less labor required, and reduced paper and postage costs, all while making patients happier. Now that's some serious upside! But if you don't make online payments possible, you're also risking getting paid more slowly, with higher collection costs. That's because it's not just a matter of patients preferring to pay online. They're organizing their budgets and managing their money in
Practice management literature often offers advice about cutting expenses – advice that promises cost-cuts improve margins and “directly boost the bottom line.” Many physician owners and practice managers seem to have internalized the idea, so they’re always on the lookout for things to trim. But is this the best way to strengthen your practice business? Some expenses do nothing to improve your practice. Paying more for identical supplies or credit card processing, for example, won’t serve patients better or boost efficiency. Once you start routinely cutting staff, technology, marketing, or materials, though, the risk of undermining productivity or the patient experience increases. It can creep in so slowly, you might not notice until profitability turns sharply south – when it can be much harder to turn things around. For example, if you’re busy, it may seem like you can “get by” without marketing. But today’s new patients probably reflect marketing efforts started months or even years ago. Cut marketing and you may see little difference – at first. By the time you notice a slowdown, you may be facing a year or more of significant investing before your volume returns. Staffing is another common focus of penny-pinching. Even a little bit of staff downtime can seem wasteful. Trying to trim staff so that employees are busy 100% of the time risks bigger problems, however. Without a bit of “excess” capacity, the impact of disruptions like employee resignations, sick time, or unexpected increases in demand can be much more expensive than the cost of a few “extra” employees. What’s more, too little support also undermines physician productivity, which has a much bigger impact on profit. Global consultants McKinsey & Company published an excellent study showing how continuous efforts to improve margins – rather than build the business – can actually undermine profitability after a few years. Their advice: consider whether expense cuts you’re contemplating will negatively impact customers (patients), your ability to compete with other practices, or both. If you’ve been focusing on expense cuts for a while, you could be in the danger zone. Be sure to give building the
“Fix the problem, not the blame” is a well-known Japanese proverb. It sounds like common sense – isn’t fixing problems what we all ultimately want? But when mistakes happen, the search for culprits instinctively begins – and with it often comes demoralization and tension. Worse, the search for a scapegoat usually won’t keep problems from recurring. Bad systems create more problems than bad employees. When workflow is faulty, the mistakes are built into the process. Figuring out who was working the process when it failed does nothing to prevent failure in the future. As organizations grow and silos (i.e., departments) form, so do opportunities for workflow inefficiencies to masquerade as staff incompetence. We’ve worked with medical practices that have grown so fast, they haven’t noticed their processes aren’t keeping up. But even more than growth, market evolution has put new tasks on everyone’s plate. These tasks may not fit well with jobs as originally configured – and that may mean more errors. Here’s a common example. Insurance has become increasingly complex for patients and staff alike. Higher deductibles have also made front desk collections a priority, but it’s a new priority added on top of everything else. Are front desk employees already trying to answer phones, check patients in, answer questions, collect demographic information, and verify insurance? When patients are seen and it turns out they weren’t covered or aware they owe a deductible, it may seem “obvious” that the front desk staff is to blame – especially to your billers, who must deal with the errors. But more likely, front desk employees are simply juggling too much. As jobs evolve, mistakes may increase. Resentments can fester between departments. But the answer isn’t to find someone to blame – it’s to find out where the process breaks down. In the case of the front desk, a better response would be to reconfigure roles, to let staff focus on the tasks in front of them, without multitasking. As work gets more complex, making people feel embarrassed and afraid won’t help them do their jobs better – retraining staff and refining their
(c) Sheri Swailes - fotolia.com No-shows can be a huge drain on medical practice finances. Time that is booked but ultimately generates no revenue is a loss that comes right out of your bottom line. It’s similar to what airlines experience when they have an unsold seat – which is why airlines so often resort to overbooking, and some practices do, too. But if you've seen the negative media coverage about the impact of flight overbooking on passengers, you already know what a stressful gamble the double-booking “solution” is. It's all but impossible to predict which patients will fail to show up -- so you could end up with too many arriving at the same time. Even when overbooking helps reduce lost revenue, it can create other problems -- like long waits, rushed visits, and stressed out physicians -- that lead to unhappy patients and higher marketing costs. Practice managers and physicians often throw up their hands in frustration about how to deal with no-shows, especially if they’re already taking steps to remind patients, or perhaps even charging a no-show or late-cancel fee. There’s no doubt about it, trying to improve your practice no-show rate can be challenging. But there are a few ways to look at the problem that practices sometimes miss. Consider if any of these ideas might help you reduce the cost of no-shows to your bottom line. Reevaluate Your Appointment Slots Practices often have standard appointment slots that they haven’t reviewed in a while. We recently worked with a practice that had used only two slots for over a decade: 30 minutes for established patients and 45 minutes for new patients. When we looked at how long visits were actually taking, we found that more time was usually set aside for the visit than was necessary. Besides reducing the overall number of productive slots the practice had available, these over-long slots amplified the impact of any no-shows. Even a single no-show usually left a 45-minute hole in the middle of the schedule – ouch. By tweaking the timings just a bit (30 minutes for
Cutting long-term staff to improve profitability? Not so fast [practice management tip: human resources]
A practice we worked with recently was struggling to improve profitability. The practice’s new manager wanted to make an impact fast, so she decided to try replacing longer-term staff with less expensive newbies; since staffing was such a big practice expense, she reasoned that this was the best way to improve profitability. The physician owners were surprised not just that the strategy hadn’t worked, but that we questioned the decision. “Isn’t that the kind of thing you practice management consultants recommend?" they asked. But cutting experienced staff members who perform well just to save a few dollars isn’t something we’d recommend trying. Those exiting employees will take with them all the knowledge they’ve accumulated – knowledge that is easily taken for granted. While cuts might boost profits temporarily, it likely won't take long for patient service to deteriorate. Service will also be undermined by the panic felt by the rest of the staff. When employees see their most loyal colleagues being shown the door, they’ll wonder if – or when – the axe will swing their way. Once those doubts creep in, your most energetic and ambitious employees will begin job-hunting in earnest. Swapping out older workers for younger ones may draw a charge of age discrimination as well. Worst of all: the potential upside is probably small. Differences in pay for experienced versus new staff are typically large enough to cause a big swing in profitability. For example, a $5 per hour difference translates to $10,000 per year. The costs of recruiting and on-boarding a replacement could easily exceed these small savings. It’s natural to look critically at expenses when profitability is flagging. But insufficient revenue is often the main reason profits disappoint – and cutting your best people will severely impact your ability to fix that problem. Instead of cutting valued but ‘expensive’ employees, look for ways to refocus staff and make the practice more productive.
When presented with ideas to update your medical practice’s technology, better support your clinicians, or market your practice in a new way, is your go-to reaction “we don’t need that” or “we’re doing fine without it”? Is your financial management approach simply to always minimize expenses? (Perhaps because you remember the old maxim of taking care of the pennies and the dollars will take care of themselves – or, its more modern cousin, “the latte factor”?) If you’re thinking about business spending in the same frugal way personal finance experts recommend you run your household, you may be missing out on opportunities to grow and increase your profits. Keep it up long enough and you may jeopardize your practice’s future profitability. The good advice to skip a few lattes and pocket the money simply doesn’t correspond to many business expenses. While a latte is a fleeting pleasure, upgrading practice technology is an investment that can increase productivity for months or years to come. Similarly, keeping headcount at the number needed to “get by” may mean your physicians, NPs, and PAs will be less productive – an opportunity cost that quickly outpaces the “savings” from bare-bones staffing. Just because a business investment requires a decision doesn’t mean it is analogous to that forgone latte that puts money in the bank. Not pursuing an investment may actually cost more in terms of lost revenue and profit. Over time, under-investing in productivity tools, visibility for your practice, and modern, convenient patient service can make it harder to attract patients and retain staff. Rebuilding from that sort of decline can end up being much more difficult and costly than investing in keeping your practice up-to-date and well-staffed would have been. Before rejecting investments in your practice’s infrastructure, marketing, and staffing out of habit, be sure you’ve considered whether the upside you’ll pass up is greater than the savings.
(c) Barclays PLC* A few days ago, the ATM turned 50. The first ATM in the world debuted in London in 1967; we got our first one in the US in 1969. Wow! I bet that the ATM has been around longer than many of you reading this. It's hard to imagine a time when this technology wasn't on every street corner. Yet when the ATM was first introduced, it was slow to catch on. In fact, it took about 30 of those 50 years for the ATM to be used by 2/3 of consumers -- and even as recently as 2013, more than 10% of consumers still had yet to pick up the ATM habit. The ATM's slow-but-steady path to everyday use got me thinking about technology in the medical practice. Technologies to connect patients and practices, especially on the administrative side, have emerged at a fantastic pace in the past few years. But many practices we've worked with have hesitated to implement them, for fear that the majority of their patients won't use them. Some practices that have implemented, say, a patient portal or online scheduling, have been disappointed because only a portion of patients seem excited to use it. "Laurie," they say, "we tried that. Only 20% of our patients used it. It was a failure, so we abandoned it." But when the ATM was first introduced, the adoption rate was much slower even than a 10% or 20% utilization your practice might see on its new payment portal or online schedule. So why didn't the banks give up? After all, implementing an ATM network is a massive, risky, very costly undertaking. So why were the banks undeterred by their meager initial results? And what can we learn from it for our own technology initiatives? The key is to focus less on the people who don't try the technology, and more on the people who do. For every one of those few customers who used the ATM in those early days, the bank could declare a victory. The consumer who wanted to use an ATM
Image (c)Goir-fotolia.com Summer's here! If the change of the season has you thinking about reading ebooks on a beach, a back porch, a dock, or a hammock, we've got new reads to fill the bill. They're engaging reads, with stories of real practices, that are also filled with fresh ideas you can easily implement in your own practice. Plus, in celebration of Judy's latest edition of Secrets of the Best-Run Practices (released June 2017), we've got a special offer for ebook buyers. Buy both the ebook edition of Secrets and any three ebooks from Laurie's Management Rx series ($2.99-$9.99 each), and we'll send you a $5 Starbucks card you can use for the perfect cold (or hot) beverage of your choice. Here's how it works: Buy Secrets of the Best-Run Practices (3rd Edition) ebook edition Buy any three of the following Management Rx ebooks: Less Work, More Money ($3.49); Workflow Hacks ($4.99); The People-Profit Connection ($8.99 Summer sale! $4.99); Patient Flow Mistakes Smart Managers Make -- and How to Avoid Them ($6.99 Summer sale! $4.99); Workflow (bundle) ($8.99 Summer sale! $6.99); The Quick Guide to Online Physician Reputation Management ($9.99 Summer sale! $6.99) Send us proof of purchase: your emails from Amazon or other retailer (email "info" at capko.com) We send you your $5 Starbucks card! If you bought any of these items in 2017 and can provide proof of purchase, that works; you don't have to buy them at the same time. And if you want to buy the ebooks for someone else (like your practice manager), you can tap into the promotion up to three times. This promotion runs through Labor Day 2017 -- you must purchase both books by then. Prefer print books? We've got a similar promotion for print books -- visit this page. Questions? Feel free to contact us.
(c) Michael Jung-fotolia.com Summer's here! If the change of the season has you thinking about reading on a beach, a back porch, a dock, or a hammock, we've got the reads that you need. Judy and Laurie have both published new books. They're both easy reads packed with intriguing case studies of real practices -- the furthest thing from a dry textbook. And you'll find they're full of practical ideas you can readily implement to make your practice run more smoothly and profitably. (We'll understand if you want to wait until fall for that.) In celebration of Judy's latest edition of Secrets of the Best-Run Practices (released just in time for summer), we've got a special offer. Buy both Secrets and Laurie's book, People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business, and we'll send you a $5 Starbucks card you can use for the perfect cold (or hot) beverage of your choice. Here's how it works: Buy Secrets of the Best-Run Practices (3rd Edition) Buy People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business Send us proof of purchase: your emails from Amazon or other retailer, or even a photo of the two books will work (email "info" at capko.com) We send you your $5 Starbucks card! If you bought either book in 2017 and can provide proof of purchase, that works; you don't have to buy them at the same time. And if you want to buy the books for someone else (like your practice manager), you can tap into the promotion up to three times. This promotion runs through Labor Day 2017 -- you must purchase both books by then. Prefer ebooks? Visit this page for the ebook version of this promotion. Questions? Feel free to contact us.
How knowledgeable are you about theft inside medical practices -- and preventing it? This quiz is designed to get you thinking about how you can protect the money you've worked so hard to earn. Embezzlement always leaves practice owners feeling violated. In some cases, when the amounts are large, a practice's profitability can even be jeopardized by an embezzler. Take the quiz -- it only takes about five minutes -- and feel free to get in touch with us if you have questions about the information. We're offering a free 15-minute call to any practice owner who takes the quiz and wants to discuss any concerns it brings to the surface.
© Oleg Shelomentsev - Fotolia.com Most physician practice owners we work tell us they believe it is very unlikely that any employee would steal from them. But when you consider that an MGMA study found that 83% of members had worked in a practice where embezzling had occurred, it seems quite probable that some of those physicians will eventually employ a thief (or would-be thief) -- and that some don't realize they are being stolen from right now. Embezzling is easily missed by physicians and administrators for many reasons. One of the most common is that honest people, people who tend to respect protocols and rules, don't always consider the possibility that others don't share their boundaries. Physicians and practice managers who use a CPA to handle accounting and/or bookkeeping may assume those professionals can spot embezzlement, even though the tracks are almost certainly well-hidden in details that aren't part of a CPA's calculations (and usually aren't even accessible to them). The modern medical practice embezzler can also be an extremely creative thinker. We've worked with practices where the owners believed that embezzling couldn't happen in their practice because they don't accept cash or because the payroll and accounts payable aren't handled by any employee -- but physicians and administrators would be astounded (as we are) by the number of schemes that can tap into any flow of money in or out of the practice. New schemes are also constantly being devised by clever, determined thieves. Of course, for physician owners, another huge obstacle is the fact that most of their time is focused on patient care. This leaves less time and less energy for business details. Doctors need to trust people to manage most administrative matters for them. Unfortunately, embezzlers take advantage of that trust, often presenting themselves as the most loyal, hard-working employees in the practice, cultivating a "halo" that helps them get away with their crimes. Administrators and practice managers, the most trusted individuals in the practice, are generally among the employees with the most opportunity to steal, if they are so inclined. In some
Did you know that a study in 2013 by the American Institute of CPAs found that more than half of Americans surveyed didn't know the meaning of at least one of three key health insurance terms (deductible, copay, premium)? And that more than a third thought that premiums were paid directly to doctors? Considering that health insurance is such an important part of personal finance, these results are rather shocking. But if you work in a medical practice, they're probably not surprising, especially if you happen to be a medical biller. If you're a biller, odds are that handling questions and misunderstandings about deductibles and other amounts billed to patients has come to occupy a significant chunk of your time. It doesn't seem like explaining health insurance terms should be your practice's responsibility. Shouldn't the vendor (i.e., the payers) take the lead in making sure the consumer knows how the product works? And what about employers who offer these products as benefits -- shouldn't they explain what their employees are receiving? In an ideal and logical world, practices wouldn't wind up having to explain how someone else's product works to their patients. But, unfortunately, the fact that patients don't understand how their financial responsibility is calculated (or even why they are being asked to pay) can have steep consequences for your practice. When patients don't understand what they owe, they're more likely to resist paying. The bottom line is that when patients don't understand their financial obligations, they are less likely to meet them. Even when patients do pay, collection costs rise when payment is delayed by misunderstandings. Even though educating patients about their payment obligations shouldn't be your practice's job, you must make it your practice's job if you want to be paid more reliably. Educating patients about their financial responsibilities should start before they arrive at your door. Working financial education into your practice workflow is more important than ever as deductibles keep rising. Learn more about the why and the how of clearing up misunderstandings about insurance in my webinar on 4/26. It's free -- hosted by
Did you happen to catch this New York Times Magazine article last month? It begins with a moving story of an uninsured patient who suffers a terrible brain hemorrhage. Thankfully, she gets timely, effective treatment -- but her condition requires many expensive services, including an air ambulance. Her bills totaled about $500,000. Although the patient had assets like a vacation home and savings, the amount she owed was greater. As the article describes the patient's profound stress in dealing with huge, unexpected bills while recovering, it seems clearly headed toward a case for single payer. However, it takes a rather astonishing twist along the way. The twist? The piece proclaims that little-known villains are secretly contributing to skyrocketing patient bills and healthcare costs: medical coders. "The guerrilla tactics of providers' coders," the article argues, involve deliberately manipulating physicians' codes -- i.e., diagnosis codes -- to create higher bills. If you are a practice manager, biller, coder, or independent physician reading this for the first time while sipping your coffee, perhaps you just spit it out in shock (like I did). Because while there may be billers and coders out there who have been urged to make up diagnoses to generate higher bills, I've never encountered one. I can only imagine "guerrilla coders" are exceedingly rare. The billers and coders we work with have enough to do just trying to get their physicians properly paid for the work that they've actually done (!). Physicians, billers, and coders have to work with the codes our entire industry uses to determine payment based on services rendered. If they aren't careful and don't check that all services are properly coded, practices (and hospitals) will receive less than payers have promised them for the work that they do. This is the problem billers and coders are trying to solve: Making sure their physicians and organizations aren't underpaid for services performed. That a trusted voice like the New York Times is promoting such a sinister impression of medical coding (among other inaccuracies in the piece) really bothered me. But something else bothered me more. Among the
Phreesia recently invited me to present a short (20 min) webinar on "The Patient of the Future," and how practice managers can anticipate emerging preferences to do a better job attracting and retaining patients. We have an interesting advantage in our field in that we have a bit of a lag before the trends of today become cost-of-doing-business requirements. (Except, perhaps, for pediatrics and other specialties that serve millennials -- you've got to try harder to stay ahead of the curve. Lots of interesting data shows why.) I think you'll enjoy listening to it (I'm biased, of course :)). It's a little headier than our typical tactical webinar -- nice to have a little variety. And it's available on-demand, for free. Here's the link to sign up and view/listen on demand. If you do check it out, I'd love to discuss it or hear your feedback. Visit this page to contact me or any of us at C&M via email or phone.
Kaiser Health News, citing a new California Department of Managed Care analysis, has reported that health plan directories in California are still plagued by errors. In fact, it appears that health insurers' lists of physicians may actually be getting less accurate. The author of the state report said that 36 of the 40 insurance directories she evaluated had inaccuracies that will lead to fines. Last summer, California introduced legislation mandating that insurers keep these directories up-to-date. The state is concerned about incorrect directories because patients rely on these listings to choose doctors who accept their coverage. Inaccuracies are hassle for consumers. Worse, if a patient inadvertently chooses a physician who is not in-network for an expensive service, the patient can end up owing a large balance. More fines may be appropriate for the health plans who've failed to keep their directories current, but I'm doubtful they will improve directory accuracy -- at least not immediately. Inaccurate directories have long been a problem that causes trouble not just for patients, physicians, and health systems, but for the payers themselves. The challenge is maintaining directory data when managing a directory is not you core business -- as is the case with health plans. I've said it before, and I'll say it again: maintaining health plan directory data accuracy shouldn't be the job of practices, but you nonetheless must take responsibility for it. Otherwise, you risk missing opportunities to serve patients who can't find you if you're improperly excluded, and you risk inadvertently seeing patients who aren't covered when you're improperly included. It's a bit labor-intensive, but reviewing and fixing directories is not difficult. I explain out to do it in my ebook and my new print book. It's a great task to delegate to one or more staff members to work on a bit at a time during down-time.
We're all excited because Laurie's new book just picked up the "#1 New Release in Medical Management and Reimbursement" on Amazon.com. Wahoo! We love her book, and we think you will, too*. You can read an excerpt for free -- just visit managementrx.biz and fill in the form on the home page. Or look inside on her Amazon page. *We're not the only ones. Check out the editorial reviews on Amazon to see what some physicians who previewed the book had to say about it.
When we work worth practices in adult primary care, OB/GYN, and pediatrics, we often recommend they consider proactively recalling patients for preventive visits. Because preventive visits are usually reimbursed entirely by insurance with no patient cost-sharing, helping patients stay current with preventive care can be a win-win for patients and the practice. A preventive visit recall effort can also help your practice address challenges like: Lower demand and productivity during the first quarter of the year, when patient deductibles reset Summertime revenue shortfalls because of lower visit volume Excess demand for pediatric check-ups during back-to-school and back-to-camp seasons Disengagement of patients who have lost touch with the practice and aren’t monitoring their own health Uncertainty about whether some patients are still connected to the practice Recalling patients for preventive visits allows you to better balance the demand for your clinicians’ time. If you add more preventive slots and book them during times when your practice is slower, you’ll also add predictable revenues. Your patients will benefit, too, because they’ll see their physicians when the practice is less hectic and more appointment options are available. When practices reach out to patients to book an overdue preventive visit, it’s usually a marketing effort that is well-received. Often patients hold off on booking a check-up because they are unaware that many preventive services are covered without a copay—so they’re delighted to hear that an annual physical is something that won’t cause financial pain. There is one avoidable snag in booking preventive care that often trips practices up, however, and it’s a pitfall that puts patient relationships at risk: Not all services that could be provided in a typical check-up are considered preventive from a billing perspective. That can lead to “surprise” patient costs and bills. These unexpected costs can be very upsetting. Even though the causes are usually just innocent oversights, some patients will feel they’ve been cheated or deceived. One way unexpected out-of-pocket costs occur is when a problem is discovered or revealed by the patient during a preventive visit. If the problem requires additional work or tests, that usually means an
Every January, employees around the country secretly resolve that this will be the year they find a better job. If you're hunting for new employees, this burst of interest in job-hunting is good news for you. But are you missing out on some of the best candidates for jobs in your medical practice? Candidates who are currently employed are often the best prospects. But in our world, getting out of the office for an interview during normal work hours can be a significant obstacle. This is especially true for employees at the lowest levels. While we've all occasionally used "doctor's appointment" excuses to depart early for an interview, that can be more difficult to do in a practice setting. Certainly, it's not usually easy to do that more than once in a while, making it hard for employees to take on multiple interviews. As a manager looking to bring on the best talent, one way to sell your opening more effectively is by making it less stressful to apply for it. Initial screenings that can be done by phone or Skype, in the evening or on the weekend, will accommodate more candidates who are currently employed -- and will allow them to speak with you without tipping off their employers about their job-seeking. When final candidates are identified, consider setting aside a Saturday or Sunday afternoon to meet with everyone they'll need to interview with at your practice. Working on free time is not everyone's idea of a good time, but it will help ensure you can speak with every great candidate. And if doctors need to be involved with the interviewing, they won't have to sacrifice appointment time during the week. If your process allows you to be more flexible in interviewing candidates, mention it in your postings, so people know they might have a shot at your job, even if they've held back on other opportunities because they worry about getting time off from work.
2016 was a busy blogging year for us. Here's a rundown of our top five most-read posts of '16: "It's everyone's responsibility, but nobody's doing the job" "Are you missing out on excellent solutions to front office challenges?" "The upside of staff downtime, the downside of multitasking" "Copays are declining, and that's not good news" "Office squabbles? Three areas to look for a fix"
A new study from the University of Florida found that patients' rudeness towards their physicians can have a "devastating" impact on medical care. Patient rudeness may play a critical role in medical errors, which by some analyses are now the third leading cause of death in the US. The Florida researchers determined that patient rudeness causes more than 40% variability in hospital physician performance. (By contrast, poor judgment due to lack of sleep led to a 10-20% variance.) The reason for the huge variance is that despite intentions to 'shake it off,' experiencing rudeness disrupts cognition, even when physicians are determined to remain objective. The researchers found that key cognitive activities such as diagnosing, care planning, and communication are all affected -- and the effects last the entire day. The study suggests that patients need to understand the potential for rude behavior to undermine their care, even when clinicians try their best to be patient and understanding, and even when the rudeness is driven by understandable frustration. But I think the results are also a reminder to practices to try to limit patient frustrations in the first place. Doctors often bear the brunt of patient rudeness when aggravation and anxiety boil over, even though most of what bothers patients happens before they even see their physician. Because administrative issues are frequently the source of dissatisfaction, it's possible for practice staff to prevent or ameliorate many blow-ups. Doing so may help patients have more productive visits with their clinicians, while also helping to protect the practice's reputation and maintain a pleasant work environment for the entire team. If you're concerned about emotional patients disrupting your practice, here are a few ideas to consider: Evaluate, minimize your wait times. A long, unexpected wait in reception is a sure-fire source of patient frustration. When it happens in your practice, is it a rarity or SOP? If running significantly behind is an everyday occurrence your practice, consider a review of your scheduling processes, to come up with a schedule that is attainable. And make sure your front and back office staff are working together
Last month, Capko & Morgan prepared a white paper on physician burnout for Kronos, drawing on survey research we helped Kronos field with MedData Group. Using MedData Group's national database, we were able to survey physicians in more than 25 different specialties, in locations all over the country. In some ways, the results were unsurprising: more and more data are pointing to burnout as a very real risk for physicians, and our survey was no exception. But our research offered a few new data points. For example, we asked physicians about whether burnout is a problem in their practices, not just for themselves personally (87% said yes). And we also asked physicians to identify possible contributors to burnout, with the goal of looking for potential solutions. The idea to survey physicians about burnout came from Kronos's own experiences implementing physician on-call scheduling solutions, and how their customers learned that automating that process could help ameliorate one source of physician stress. To read the white paper: [ddownload id="5167"]. (It's free, no registration required.)
In case you missed it ... Fake emails featuring HHS letterhead and the "signature" of the director of the OCR are circulating. These emails aim to fraudulently draw clicks with a message that the recipient be included in a HIPAA "rules audit." Like many phishing schemes, the emails are very convincing. They even include a "from" address (OSOCRAudit@hhs-gov.us) that looks quite a bit like the actual OCR/HIPAA audit address (OSOCRAudit@hhs.gov). Alert your employees of this possible scam. More information is available here.
More productivity, better morale, and better patient service, with no extra costs? It may sound like a dream (or maybe an illusion?), but that's the idea behind employee engagement. Engaged employees go above and beyond the objective requirements of their job. They're observant about ways to provide better service to your patients, and take steps to do so -- without being asked. You can also count on engaged employees to bring you ideas for how to improve the practice -- ideas that are often spot-on, because the employees who suggest them are closest to problems you might not see. Sounds wonderful,right? So how do you foster engagement? This is a subject I'll be delving into in detail in my upcoming webinar on Tuesday, Dec 13 at 10PST (sign up for free at this link). I hope you'll join me. But in the meantime, here's a preview: Employee engagement goes beyond morale. It's an emotional connection to and sense of responsibility for the organization. The feeling of a shared mission, of providing valuable services, is essential to engagement. (Because of the nature of their work, medical practices have a head start on fostering this sense of mission.) Communication is key. When leaders communicate regularly, that helps employees feel like they're part of a team that works together towards shared goals. Encouragement is invaluable. Employees spend a huge proportion of their time at work. They want to feel like they're succeeding. By focusing on employees' strengths and accomplishments, leaders encourage their teams to continue to give more. We'll explore more specific ways to engage employees in the presentation -- plus we'll look at the research that shows that employee engagement is not just a fluffy idea, but rather a proven way to improve your practice, without spending a penny. To register for the webinar, visit this link.
When Judy, Joe, and I begin consulting engagements with practices around the country, we're almost always asked, “Do you think our practice could be overstaffed?” Usually, the administrator or physician leader who asks seems to assume that overstaffing is a terrible mistake, one that will surely undermine the organization’s profitability. Oddly enough, I don’t think I can name a single occasion when a physician owner or manager wondered anxiously if there were too few people employed in their organization. When it comes to staffing in healthcare, the worrying seems pretty tilted towards overstaffing. It’s easy to see why. Staffing is typically one of the biggest expenses in any healthcare organization. Employees are easy to see, and if they’re not fully utilized at all times, that’s easy to see, too. Cutting staff (or expenses related to staff) may not be simple or painless, but it’s much easier than trying to reduce other overheads like rent or other building costs. In fact, most other large expenses are fixed, or nearly so; staffing may be the only area where cuts can readily be made. And if you can see that there’s slack in the system, isn’t it smart to try to tighten it up? Perhaps—but it depends. For example, are you sure you’d have no trouble accommodating an unexpected surge in demand with fewer staff? Would you still be able to maintain your service standards with a smaller team, even if some members unexpectedly needed to miss work? And are you sure that every important task is already being done? It’s easy to overreact to idle time because it’s so easy to spot. But a little bit of idle time may simply reflect the occasional unpredictability of clinic workload. If you overreact to it, you can end up with bigger problems than a bit of staff under-utilization. When our clients are concerned about staff sometimes seeming unproductive, we suggest they consider whether any important tasks were dropped off the priority list in recent years. In many healthcare organizations, tasks related to patient collections have crowded out valuable non-essentials. For example, receptionists probably spend
Upcoming webinar (free): “Engage Your Employees for Practice Profitability and a Standout Patient Experience” (Dec 13)
Committed, well-trained employees can make all the difference in patient service. After all, your employees are usually the first point of contact for your patients. Your employee costs are also probably one of your largest practice expenses (if not the largest). So how can you be sure your investment in staff is delivering the kind of patient experience you're aiming to provide? Employee engagement is a concept that aims to address this question. When employees feel a strong connection to their place of employment, that can lead to more confidence and more motivation to do a great job. So how do you cultivate that sense of engagement? Join me for my next complimentary webinar (sponsored and hosted by Phreesia) on December 13 at 10AM PST, and we'll explore what factors encourage or detract from employee engagement, best practices for engaging your team, and the ways that culture and hiring impact engagement -- among other intriguing, related themes. Use this link to register.
Technology for the medical practice front office has many benefits. It can speed up processes, keep critical data safe from fire and flood, allow practice staff to tap resources from other organizations via the Internet, and so on. The list is long and growing. But my favorite front office technology benefit by far is the ability to eliminate duplicate effort, especially duplicate data entry. The reason is simple: eliminating duplicate effort is like money in the bank! When you cut down on duplicate data entry, you don't just eliminate the cost of repeating steps; you also reduce errors, which can be even more costly to find and fix. Some errors -- like mistakes in patient demographics or coding -- cause a direct hit to the bottom line, since they affect billing and reimbursement. Get those demographics right the first time, and your likelihood of getting paid promptly just went up -- and the effort required to make it happen just went down. There are many technology tools that medical front offices can use to reduce duplicate effort. Here are just a few that most practices should explore, if you're not taking advantage of them already. EHR/PMS integration. When a practice moves from separate billing and EHR systems, or from paper charts to an EHR that integrates with the billing/practice management system, the gain in billing efficiency is profound. An integrated EHR/PMS set-up allows physicians and other clinicians to transmit superbills electronically from the EHR into the PMS. This means no data entry of CPT and diagnosis codes from paper tickets -- a huge time savings. But even more important, the data that's transferred over to the billing system is exactly what the physician or non-physician provider intended -- not what the biller guessed at based on a handwritten superbill. And if there are any doubts about the services provided or diagnosis codes, the chart note is right there in the system to provide clarification. EHR/PMS integration means faster, more accurate billing -- for faster, more reliable reimbursement. Fewer delays to clarify what's supposed to be billed, and no risk that
I recently authored this white paper for Kronos on automated on-call scheduling. This is a critical task that has long begged for a reliable technology solution; thankfully, technology innovation is finally catching up to that need. Click the download button to check it out. [ddownload id="5140"]
Does your specialty have an association just for practice administrators and managers? Specialty practice management associations like the AOA (for ENT administrators), ADAM (for dermatology managers), and others are some of the most lively and valuable networking and education groups around. If you haven't looked into whether your specialty has a practice management association, it's definitely worth your while to investigate. Not only do these groups offer the chance to network with other managers in your specialty (who understands your world better than someone else in the same role?), they often have other benefits to help you succeed in your career, such as: Benchmarking and compensation surveys Discounts on products and services Specialty focused coding help Annual conferences and regional meetings Online education, webinars, and certification programs for skill-building Job boards To save you the time of investigating, here are some of the specialty focused administrator and manager groups that we're aware of. (If you're a member or representative of a specialty practice management group we've omitted here, please contact us so we can add your group to our list.) Specialty Association Website Dermatology ADAM (Association of Dermatology Administrators & Managers ada-m.org Emergency Department EDPMA (Emergency Dept Practice Managers Association) edpma.org ENT AOA (Association of Otolaryngology Administrators) aoanow.org Neurosurgery NERVES (Neurosurgery Executives Resource Value & Education Society nervesadmin.org Oncology AOPM (Association for Oncology Practice Management) oncpracticemanagement.com Ophthalmology ASOA (American Society for Ophthalmic Management) asoa.org Orthopedic AAOE (American Association of Orthopedic Executives) aaoe.net Pain Medicine SPPM (Society for Pain Practice Management) sppm.org Podiatry AAPPM (American Association of Podiatric Practice Managers) aappm.org Radiology RBMA (Radiation Business Management Association) rbma.org Reproductive Medicine ARM (Association of Reproductive Managers) asrm.org/arm Rheumatology NORM (National Organization of Rheumatology Managers) normgroup.org Urology AUAPMN (AUA Practice Managers' Network) auanet.org
It's a fact of medical practice management life that unilateral decisions by other organizations can show up out of the blue and negatively affect the practice business, such as when a payer changes reimbursement terms or stops paying for a code that was previously reimbursed. In situations like these, practices have no obvious short-term option but to accept the decree or perhaps vow (through gritted teeth) to drop the payer at the next opportunity. These episodes can be understandably frustrating, even downright infuriating. Sometimes, though, the emotions triggered have the potential to turn a third party's adverse decision into an even more harmful one you make yourself, if you're not careful to take a breath and evaluate all the data you can get your hands on before responding. A recent case in point: a client of ours found that Medicare had suddenly decided that a particular CPT code for administration of a biologic drug was inappropriate and could no longer be billed for that purpose; the substitute code pays only about 20% of the one the practice (and others across the country) had been using for several years. At the same time, a national health plan that is the practice's top payer announced that it will continue to pay the higher-value code, but will only permit one use per patient per day. This is a problem for the practice because the medication in question often has to be administered twice during a single treatment, and each administration requires that the medication be individually mixed and prepped. The practice has found this therapy to be increasingly important and beneficial to a growing proportion of its patients. More staff time has been allocated to it as demand for it has climbed steadily over the past few years. Because of this, these unhappy reimbursement surprises sparked a strong reaction from the physician owner and his practice manager. With respect to their national payer, they were all-but-ready to drop the plan entirely."If we can't bill twice when we administer two shots," the manager was immediately certain, "we'll lose money! We're going to have to
Q4 is here! For many practices, it's the busiest time of the year, as patients who've been timing their care to maximize the value of their insurance coverage or their tax deductions are now ready to schedule. During this period, a greater proportion of reimbursement will usually be collected from health plans, rather than patients. That means it's a good time to maximize productivity and generate revenue that can be collected more easily -- both to close the year out on a high note, and to prepare for Q1, when the pattern reverses. In January, patients are more likely to put off services if they feel they can, thanks to the double whammy of the deductible reset and holiday bills coming due. Looking out over the coming five-six months, it may seem like much is out of your control. And it's true that the hard deadline of December 31 isn't something you can change. But you do have choices to make. When you consider how you'll prepare for the deductible reset, will you fight the slowdown with marketing? Or will you plan to use the downtime in other ways? If you decide to go to combat the deductible reset slowdown with marketing, much depends on your specialty and your local market. And if you decide instead to go with the flow, you'll still need to start planning now, to be sure your opportunity isn't wasted. Either way, your first step should be a thorough analysis of how the deductible reset has affected your practice's workload in the past, and a projection for the impact in Q1 2017. Then if you're planning to try to boost volume, you'll need to consider your strategy (preventive care? elective services?). And if you want to take advantage of an anticipated slowdown, be strategic about it and plan for scheduling adjustments now. In my upcoming webinar (October 20, 10:00 Pacific), I'll delve into some of these ideas and possibilities. It's free, thanks to my generous host and sponsor, Kareo. Click this link to sign up. Look forward to your participation and questions!