medical practice business

Should you buy the practice down the street? [on-demand webinar]

In recent years, many of our clients and friends have been involved in practice acquisitions or mergers. In many of these cases, a practice in a nearby area has come up for sale, perhaps due to retirement or death of a physician owner. These can be exciting opportunities, but stressful, too. There is usually pressure to respond quickly. And, of course, the decision usually involves a significant investment. The need to move fast often makes it hard to even think through all the questions you want to ask -- much less get answers to all of them. When the pressure's on, fear of missing the opportunity may take over. But if you move too fast, you may "win" the opportunity without realizing what it really costs. "Buying the practice down the street" may be a fantastic way to quickly expand your practice, but it's not without significant pitfalls. Information and a solid plan are your best tools for protecting your interests. In this short webinar (about 30 minutes), Laurie Morgan outlines some of the key questions to consider when deciding whether to buy a nearby practice. To view the recording, click the link. You'll be asked to register on the video page. Once you've watched, we'd love to hear from you if you have questions. And, of course, we're at-the-ready to help you with consulting services before you make a purchase decision (or before you put your practice on the market). Use the contact form to email us or give us a call.   "Should You Buy the Practice Down the Street?" [on-demand recording - registration required]  

By |2022-01-01T22:51:44-08:00March 14th, 2019|
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Ask us anything!

Ever wonder how a practice management consultant might respond to the questions that come up every day in your business? With our new Ask Us Anything website feature, you send us your questions, and we'll share our thoughts on them here -- where you and other physicians and practice managers can see how we think about management ideas and challenges.It's free, and it's anonymous. Check it out at our Ask Us Anything page.

By |2018-12-28T18:44:49-08:00December 28th, 2018|
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Don’t believe the hype: patient portals aren’t “largely unused”

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

By |2022-01-01T22:51:45-08:00December 20th, 2018|
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Credentialing: is it time to upgrade your process with software?

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

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

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

By |2022-01-01T22:51:45-08:00November 21st, 2018|
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How will you make the most of year end — and prepare for the deductible reset?

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

By |2022-01-01T22:51:45-08:00November 16th, 2018|
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Cost-cutting: pick your battles wisely

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

By |2022-01-01T22:51:45-08:00October 15th, 2018|
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Creative ways to support more services — and more patients

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

By |2022-01-01T22:51:45-08:00September 20th, 2018|
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When communication becomes overwhelming, the web and social media can lighten the load

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

By |2022-01-01T22:51:46-08:00August 21st, 2018|
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Responding to external trends that threaten practice profitability

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

By |2022-01-01T22:51:46-08:00July 21st, 2018|
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You can’t cut your way to growth [practice management tip: financial management]

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

By |2022-01-01T22:51:46-08:00July 6th, 2018|
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Fix the problem, not the blame [practice management tip: operations and workflow]

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

By |2018-06-11T16:36:02-08:00June 27th, 2018|
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Reducing the cost of no-shows at your medical practice

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

By |2022-01-01T22:51:46-08:00June 11th, 2018|
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Cutting long-term staff to improve profitability? Not so fast [practice management tip: human resources]

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

By |2022-01-01T22:51:46-08:00June 1st, 2018|
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Don’t confuse personal finance and business finance [practice management tip: financial management]

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

By |2022-01-01T22:51:47-08:00April 17th, 2018|
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Technology for patients: Think good, not perfect

(c) Barclays PLC* A few days ago, the ATM turned 50. The first ATM in the world debuted in London in 1967; we got our first one in the US in 1969. Wow! I bet that the ATM has been around longer than many of you reading this. It's hard to imagine a time when this technology wasn't on every street corner. Yet when the ATM was first introduced, it was slow to catch on. In fact, it took about 30 of those 50 years for the ATM to be used by 2/3 of consumers -- and even as recently as 2013, more than 10% of consumers still had yet to pick up the ATM habit. The ATM's slow-but-steady path to everyday use got me thinking about technology in the medical practice. Technologies to connect patients and practices, especially on the administrative side, have emerged at a fantastic pace in the past few years. But many practices we've worked with have hesitated to implement them, for fear that the majority of their patients won't use them. Some practices that have implemented, say, a patient portal or online scheduling, have been disappointed because only a portion of patients seem excited to use it. "Laurie," they say, "we tried that. Only 20% of our patients used it. It was a failure, so we abandoned it." But when the ATM was first introduced, the adoption rate was much slower even than a 10% or 20% utilization your practice might see on its new payment portal or online schedule. So why didn't the banks give up? After all, implementing an ATM network is a massive, risky, very costly undertaking. So why were the banks undeterred by their meager initial results? And what can we learn from it for our own technology initiatives? The key is to focus less on the people who don't try the technology, and more on the people who do. For every one of those few customers who used the ATM in those early days, the bank could declare a victory. The consumer who wanted to use an ATM

By |2022-01-01T22:51:48-08:00July 4th, 2017|
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Need to load up your Kindle for summer? We’ve got you covered — and we’ll even provide a beverage.

Image (c)Goir-fotolia.com Summer's here! If the change of the season has you thinking about reading ebooks on a beach, a back porch, a dock, or a hammock, we've got new reads to fill the bill. They're engaging reads, with stories of real practices, that are also filled with fresh ideas you can easily implement in your own practice. Plus, in celebration of Judy's latest edition of Secrets of the Best-Run Practices (released June 2017), we've got a special offer for ebook buyers. Buy both the ebook edition of Secrets and any three ebooks from Laurie's Management Rx series ($2.99-$9.99 each), and we'll send you a $5 Starbucks card you can use for the perfect cold (or hot) beverage of your choice. Here's how it works: Buy Secrets of the Best-Run Practices (3rd Edition) ebook edition Buy any three of the following Management Rx ebooks: Less Work, More Money ($3.49); Workflow Hacks ($4.99); The People-Profit Connection ($8.99 Summer sale! $4.99); Patient Flow Mistakes Smart Managers Make -- and How to Avoid Them ($6.99 Summer sale! $4.99); Workflow (bundle) ($8.99 Summer sale! $6.99); The Quick Guide to Online Physician Reputation Management ($9.99 Summer sale! $6.99) Send us proof of purchase: your emails from Amazon or other retailer (email "info" at capko.com) We send you your $5 Starbucks card! If you bought any of these items in 2017 and can provide proof of purchase, that works; you don't have to buy them at the same time.  And if you want to buy the ebooks for someone else (like your practice manager), you can tap into the promotion up to three times. This promotion runs through Labor Day 2017 -- you must purchase both books by then. Prefer print books?  We've got a similar promotion for print books -- visit this page. Questions? Feel free to contact us.

By |2022-01-01T22:51:48-08:00June 11th, 2017|
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Need a summer read? We’ve got you covered — and we’ll even provide a beverage.

(c) Michael Jung-fotolia.com Summer's here! If the change of the season has you thinking about reading on a beach, a back porch, a dock, or a hammock, we've got the reads that you need. Judy and Laurie have both published new books. They're both easy reads packed with intriguing case studies of real practices -- the furthest thing from a dry textbook. And you'll find they're full of practical ideas you can readily implement to make your practice run more smoothly and profitably. (We'll understand if you want to wait until fall for that.) In celebration of Judy's latest edition of Secrets of the Best-Run Practices (released just in time for summer), we've got a special offer. Buy both Secrets and Laurie's book, People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business, and we'll send you a $5 Starbucks card you can use for the perfect cold (or hot) beverage of your choice. Here's how it works: Buy Secrets of the Best-Run Practices (3rd Edition) Buy People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business Send us proof of purchase: your emails from Amazon or other retailer, or even a photo of the two books will work (email "info" at capko.com) We send you your $5 Starbucks card! If you bought either book in 2017 and can provide proof of purchase, that works; you don't have to buy them at the same time.  And if you want to buy the books for someone else (like your practice manager), you can tap into the promotion up to three times. This promotion runs through Labor Day 2017 -- you must purchase both books by then. Prefer ebooks? Visit this page for the ebook version of this promotion. Questions? Feel free to contact us.

By |2022-01-01T22:51:48-08:00June 8th, 2017|
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Is someone stealing from your practice?

© Oleg Shelomentsev - Fotolia.com Most physician practice owners we work tell us they believe it is very unlikely that any employee would steal from them. But when you consider that an MGMA study found that 83% of members had worked in a practice where embezzling had occurred, it seems quite probable that some of those physicians will eventually employ a thief (or would-be thief) -- and that some don't realize they are being stolen from right now. Embezzling is easily missed by physicians and administrators for many reasons. One of the most common is that honest people, people who tend to respect protocols and rules, don't always consider the possibility that others don't share their boundaries. Physicians and practice managers who use a CPA to handle accounting and/or bookkeeping may assume those professionals can spot embezzlement, even though the tracks are almost certainly well-hidden in details that aren't part of a CPA's calculations (and usually aren't even accessible to them). The modern medical practice embezzler can also be an extremely creative thinker. We've worked with practices where the owners believed that embezzling couldn't happen in their practice because they don't accept cash or because the payroll and accounts payable aren't handled by any employee -- but physicians and administrators would be astounded (as we are) by the number of schemes that can tap into any flow of money in or out of the practice.  New schemes are also constantly being devised by clever, determined thieves. Of course, for physician owners, another huge obstacle is the fact that most of their time is focused on patient care. This leaves less time and less energy for business details. Doctors need to trust people to manage most administrative matters for them. Unfortunately, embezzlers take advantage of that trust, often presenting themselves as the most loyal, hard-working employees in the practice, cultivating a "halo" that helps them get away with their crimes. Administrators and practice managers, the most trusted individuals in the practice, are generally among the employees with the most opportunity to steal, if they are so inclined. In some

By |2022-01-01T22:51:50-08:00May 30th, 2017|
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Confusion about insurance terms shouldn’t be your problem, but it is

Did you know that a study in 2013 by the American Institute of CPAs found that more than half of Americans surveyed didn't know the meaning of at least one of three key health insurance terms (deductible, copay, premium)? And that more than a third thought that premiums were paid directly to doctors? Considering that health insurance is such an important part of personal finance, these results are rather shocking. But if you work in a medical practice, they're probably not surprising, especially if you happen to be a medical biller. If you're a biller, odds are that handling questions and misunderstandings about deductibles and other amounts billed to patients has come to occupy a significant chunk of your time. It doesn't seem like explaining health insurance terms should be your practice's responsibility. Shouldn't the vendor (i.e., the payers) take the lead in making sure the consumer knows how the product works? And what about employers who offer these products as benefits -- shouldn't they explain what their employees are receiving? In an ideal and logical world, practices wouldn't wind up having to explain how someone else's product works to their patients. But, unfortunately, the fact that patients don't understand how their financial responsibility is calculated (or even why they are being asked to pay) can have steep consequences for your practice. When patients don't understand what they owe, they're more likely to resist paying. The bottom line is that when patients don't understand their financial obligations, they are less likely to meet them. Even when patients do pay, collection costs rise when payment is delayed by misunderstandings. Even though educating patients about their payment obligations shouldn't be your practice's job, you must make it your practice's job if you want to be paid more reliably. Educating patients about their financial responsibilities should start before they arrive at your door. Working financial education into your practice workflow is more important than ever as deductibles keep rising. Learn more about the why and the how of clearing up misunderstandings about insurance in my webinar on 4/26. It's free -- hosted by

By |2022-01-01T22:51:51-08:00April 25th, 2017|
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Distrust of medical bills: another obstacle in collecting from patients

Did you happen to catch this New York Times Magazine article last month? It begins with a moving story of an uninsured patient who suffers a terrible brain hemorrhage. Thankfully, she gets timely, effective treatment -- but her condition requires many expensive services, including an air ambulance. Her bills totaled about $500,000. Although the patient had assets like a vacation home and savings, the amount she owed was greater. As the article describes the patient's profound stress in dealing with huge, unexpected bills while recovering, it seems clearly headed toward a case for single payer. However, it takes a rather astonishing twist along the way. The twist? The piece proclaims that little-known villains are secretly contributing to skyrocketing patient bills and healthcare costs: medical coders. "The guerrilla tactics of providers' coders," the article argues, involve deliberately manipulating physicians' codes -- i.e., diagnosis codes -- to create higher bills. If you are a practice manager, biller, coder, or independent physician reading this for the first time while sipping your coffee, perhaps you just spit it out in shock (like I did). Because while there may be billers and coders out there who have been urged to make up diagnoses to generate higher bills, I've never encountered one. I can only imagine "guerrilla coders" are exceedingly rare. The billers and coders we work with have enough to do just trying to get their physicians properly paid for the work that they've actually done (!). Physicians, billers, and coders have to work with the codes our entire industry uses to determine payment based on services rendered. If they aren't careful and don't check that all services are properly coded, practices (and hospitals) will receive less than payers have promised them for the work that they do. This is the problem billers and coders are trying to solve: Making sure their physicians and organizations aren't underpaid for services performed. That a trusted voice like the New York Times is promoting such a sinister impression of medical coding (among other inaccuracies in the piece) really bothered me. But something else bothered me more. Among the

By |2022-01-01T22:51:51-08:00April 24th, 2017|
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“The Patient of the Future” — free recorded mini-webinar

Phreesia recently invited me to present a short (20 min) webinar on "The Patient of the Future," and how practice managers can anticipate emerging preferences to do a better job attracting and retaining patients. We have an interesting advantage in our field in that we have a bit of a lag before the trends of today become cost-of-doing-business requirements. (Except, perhaps, for pediatrics and other specialties that serve millennials -- you've got to try harder to stay ahead of the curve. Lots of interesting data shows why.) I think you'll enjoy listening to it (I'm biased, of course :)). It's a little headier than our typical tactical webinar -- nice to have a little variety.  And it's available on-demand, for free. Here's the link to sign up and view/listen on demand. If you do check it out, I'd love to discuss it or hear your feedback. Visit this page to contact me or any of us at C&M via email or phone.  

By |2017-04-03T10:45:20-08:00April 3rd, 2017|
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Despite punishments, health plan directory errors persist

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.

By |2017-02-13T10:02:18-08:00February 13th, 2017|
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Laurie’s new book is the top new release in practice management

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.

By |2022-01-01T22:51:51-08:00February 6th, 2017|
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Avoid payment confusion while maximizing the service advantages of preventive care

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

By |2022-01-01T22:51:53-08:00January 26th, 2017|
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It’s job-hunting season. Don’t discourage your best prospects.

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.

By |2017-01-15T13:41:45-08:00January 18th, 2017|
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2016 “Straight Talk” blog year in review

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"

By |2022-01-01T22:51:53-08:00January 15th, 2017|
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Patient rudeness affects physician performance — what should practices do about it?

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

By |2022-01-01T22:51:53-08:00January 15th, 2017|
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Physicians’ views on burnout: survey research with Kronos and MedData

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.)

By |2022-01-01T22:51:53-08:00December 22nd, 2016|
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