medical practice business

New phishing emails pose as official OCR audit communications

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.

By |2016-12-18T14:48:18-08:00December 18th, 2016|

Q: How can you foster more productivity, better morale, and better service — at no extra cost?

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.        

By |2016-12-11T18:01:39-08:00December 11th, 2016|

A few “extra” staff—used the right way—can make all the difference

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

By |2022-01-01T22:51:54-08:00December 11th, 2016|

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.

By |2016-11-28T16:02:55-08:00November 28th, 2016|

Technology’s magic trick: making duplicate effort disappear

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

By |2022-01-01T22:51:54-08:00November 10th, 2016|

White paper: Automated on-call scheduling

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"]

By |2022-01-01T22:51:54-08:00November 8th, 2016|

Specialty associations for administrators and managers: are you in the loop?

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

By |2022-01-01T22:51:55-08:00November 1st, 2016|

When business problems trigger emotions, facts and data are paramount

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

By |2022-01-01T22:51:55-08:00October 29th, 2016|

Deductible reset: you have choices

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!

By |2022-01-01T22:51:55-08:00October 2nd, 2016|

Upcoming free webinar: Choosing and Managing an Outsourced RCM Service

Considering outsourcing your medical billing? Not sure you know all you need to know to choose wisely? This upcoming free webinar will help you refine your screening strategy as you look for the perfect billing partner, and prepare to set a productive relationship. Some of the topics we'll hit on: why technology matters; what's the best type of service (small, large, local, national); what to look for in contracts; and other important decision elements. This webinar is free -- sponsored by Care360. It's happening September 20, 2016 at 9AM Pacific. To sign up,visit: http://page.care360.questdiagnostics.com/K0000GJ00Il94na0003G0P0 For more information on choosing your next (or first) medical billing service, check out my ebook "Get the Best from Your Medical Billing Service." A new edition (with 40% new content) was released just this week.

By |2016-09-09T09:06:55-08:00September 9th, 2016|

Good for patients, good for your practice: Winning Cigna ad promotes check-ups

This amusing television ad from Cigna is bound to attract a bit of attention from fans of Grey's Anatomy, Scrubs, House, ER, and MASH. It's cute. If you recognize any of these tv docs, you'll likely enjoy it. And it has a message that can help patients get more out of their insurance, and help your practice, too. The gist: we'll use our skills as fake doctors to urge you to go see real ones for preventive services. Nice recommendation. Preventive services give your practice a reason to reach out to patients -- a gentle way to remind them your practice cares, and to keep them engaged. And it's a great way to get more use out of the EHR your invested so much time and money in implementing. With the deductible reset just over one quarter away, if you're a primary care practice (or other practice that offers a qualifying preventive service), you might also think about booking annual check-ups in Q1 of 2017. If your practice is among the many that see a slowdown in Q1, your patients will appreciate being able to come in when it's less busy. And deductible-free visits are good for your cash flow and cash-strapped patients' wallets after the holidays.

By |2022-01-01T22:51:55-08:00September 8th, 2016|

Appreciating the art of the possible

I stumbled upon this quote by Facebook CEO Mark Zuckerberg recently: I think a simple rule of business is, if you do the things that are easier first, then you can actually make a lot of progress. This makes so much sense for any enterprise. If you're stuck, try chipping away at the easiest part of a problem. It also strikes me as especially relevant to front office tasks and automation in medical practices. The need to embrace automation, to use technology better, to provide more self-service, etc., is, I think, becoming more understood in practices of all sizes. But that doesn't make the thought of these things any less daunting! Practice managers and physicians may hear "technology" and immediately think, "Oh no, not that again." Visions of EHR implementations that wreaked havoc are vivid and pretty easily recalled. It can be hard to imagine an ROI large enough to make reliving that pain seem worthwhile. But in the front office tech space, many solutions are emerging that are easy to implement -- either wholesale or in parts. And ticking off just one box at a time can give your practice business a boost, even if you're not ready to take on a full-scale automation overhaul. For example, payment portals and email statements have become much easier to implement. Many PMS vendors offer these as built-in tools. Activating these features may (literally) take only a few moments. And if even just one patient finds the convenience encourages him to pay more promptly, the effort you and your team invested will likely be repaid. One of the very best things about how technology for the front office is evolving is that there are more and more targeted solutions to specific, costly problems. You usually don't have to engage in a massive conversion to a new platform to take advantage of any one solution. Chipping away at front office inefficiencies by trying one or more new technologies is a very realistic way to tackle problems that seem very complicated and daunting when taken as a whole.

By |2022-01-01T22:51:55-08:00July 21st, 2016|

Copays are declining, but that’s not good news

A recent Peterson-Kaiser Health System Tracker study revealed an interesting finding: average copayments are declining. Their study, which analyzed claims data from Truven MarketScan, found that average copay amounts paid by patients decreased by 26% from 2004 to 2014. Seems like a positive trend for patients and practices ... except that it's not. It's part of a shift that's actually making out-of-pocket costs harder for patients to prepare for and understand. That makes them harder for practices to collect. The Peterson-Kaiser analysis found that while copays declined by 26%, coinsurance increased by much more, 107%.* Payers may be emphasizing coinsurance because it is assumed, like deductibles, to be a more powerful tool to discourage unnecessary utilization of services. But for patients who need care, coinsurance can be another cause of 'surprise' obligations, since it's not always easy to calculate the amounts due. Patients may also easily confuse copays -- which are standard amounts for services like office visits, prescriptions, or the ER -- with coinsurance, which can only be calculated after determining what services are needed. This difference can lead to reluctance to pay, or fear of being incorrectly charged, especially when the amounts are significant. Here's a chart from the Peterson-Kaiser report: Coincidentally, but not surprisingly, the report also found that total cost-sharing continued to rise steadily and steeply. The analysis found that total out-of-pocket costs rose 77% from 2004-2014 -- much faster than wages. Besides the 107% coinsurance increase, deductibles increased 256%(!). For practices, this means that effective patient collections continues to be crucial to profitability. Not only are patients accounting for an ever more significant proportion of earned revenue, their payment responsibility will almost certainly continue to be confusing. It's crucial to help patients understand and prepare for the amounts they will be expected to pay. Be sure you also offer options like credit-card-on-file, mobile payments, payment portal, and payment plans to encourage their compliance. *I also wonder how much of the decline in copayments is due to patients using more preventive services, which carry no copay by law under the ACA. This could bring the average

By |2022-01-01T22:51:55-08:00July 10th, 2016|

On Facebook? Get verified!

If you've been on Facebook a while, either solely as an individual or with a practice business page, you have probably noticed that it's a lot rarer for business page posts to show up in users' newsfeeds. This is a frustrating problem for businesses that previously relied on Facebook to reach their communities with regular updates.  But there is a way to restore a bit of that connection: verifying your page. Not sure if your page is verified already?  If it is, you'll see an encircled check mark next to your page name, like ours has, below. Verifying your page is easy.  Go to "settings, general" and choose page verification. The standard approach is to receive a phone call with a pin code sent to your public number, but this may be unworkable if your practice has a phone tree. So choose the 'verify with documents' option to verify using a business document such as a utility bill or business license.

By |2016-06-03T16:40:52-08:00June 3rd, 2016|

The connection between people and practice profit is not as simple as it may seem

When we work with practices that are not as profitable as planned, or that are even struggling financially, the managers and owners almost always ask, "Are we overstaffed?" And almost always -- contrary to expectations -- our opinion is that they're not. In fact, when we work with practices that are struggling, it's more likely that we will end up recommending more staff. It seems counter-intuitive, I know.  The costs of staff are so visible, and sometimes seem so burdensome, it's no surprise that managers and physicians instinctively want to minimize the size of their teams.  But this overlooks the value that staff can bring -- value that can go right to your bottom line. This isn't just happy talk or a kinder, gentler management approach.  If you've been consciously driving your own practice's headcount lower and lower, there's a good chance you've cut enough that you're actually reducing your income. Staffing optimal requires attention to the details that drive practice profitability.  It's more complicated than just figuring out how to get by with less.  But the rewards for staffing better are manifold: not just more money in  your pocket, but less stress for everyone, and happier patients, too. My new ebook, The People-Profit Connection: Smarter Staffing for Practice Profitability, explores these ideas in detail.  It presents case studies drawn from our experiences with real practice clients, with actual problem-solving examples you can apply to your practice today. To check it out, visit this page on Amazon.com.  

By |2022-01-01T22:51:55-08:00May 23rd, 2016|

The power of managing details

I'm working on an ebook right now about medical practice staffing. More specifically, it's about how the instinct to cut staff, to be as leanly staffed as possible, can backfire*. There are dozens of little details that any practice can explore to improve profitability. These small changes can be made with much less risk than eliminating a job or cutting staff hours. And because they improve the profitability of your processes, they are a gift that keeps on giving, making your bottom line a little bit bigger every day. Here are just a few of the possibilities I explore in the ebook. Are you taking full advantage of these opportunities to improve your bottom line? Reduce no-shows: Take a quantitative look at your no-show rate. Are you tracking both true no-shows and last minute cancelled slots that can't be refilled? Audit your reminder process and results. Is your timing right? Experiment with reminding further ahead or closer to the appointment. Remind people using the technology they prefer. Capture email and cell info: Being able to reach people electronically opens the door to multiple efficiency improvements, including more effective reminders and better collections. And your patients that want to be emailed or texted, not called, will appreciate the option. Win-win! Train patients on portals: Too many practices make portal adoption a low priority, or abandon the effort altogether, because they find it hard to get patients engaged. It is hard! But it's still very worthwhile. As more patients use your portals, you have more ways to reach them for marketing. Portals make other key tasks more profitable, too. Notice I said "portals," plural?  If you don't have the ability to collect payments through your EHR portal, investigate the option to set up a payment portal with your PMS vendor.  Patients want to help themselves -- and they want to pay without having to write a check or find a stamp. They'll reward you by paying faster and more reliably. If you cut staff before checking out all the possibilities to improve your operations, you may not have the people you need

By |2022-01-01T22:51:56-08:00May 8th, 2016|

The legal risks of waiving copays are very, very real

Effectively collecting copays (or coinsurance for procedures) has become much more important in recent years. One reason is that they've become a bigger proportion of total reimbursement. Once just a token $5 or $10 payment, office visit copays have increased to $30, $40, or even $60 in many cases. They now often account for a third or more of the revenue your practice can receive for these services. Not collecting them reliably is a threat to your profitability. Besides ensuring full reimbursement, there's another, equally compelling reason for your practice to master time-of-service copay collections: Your payer contracts almost certainly require it. If you've been in the habit of waiving copays or billing for them, you are probably violating these agreements. Health plans view copays differently than you probably do. Copays are not just a way to reduce their portion of your fees; they're designed to discourage patients from receiving services they don't need. Copays are supposed to help keep patients on the side of the payer in the battle to reduce costs. That's why your contracts will usually state that you agree to collect them, and often further state you should do so at the time of service. (Some waivers may be allowable, but only when certain hardship conditions are verified.) Contracts also often contain language about the plan being entitled to the same discounts you give other parties -- so that if you give the patient a discount by waiving any amount they owe, you need to give the plan the same discount. (This might mean you owe the plan 100% off if you waived a patient's full copay!) For these reasons, routinely waiving copays can lead to serious problems in the event your practice is audited. If your practice frequently waives these payments -- or if some of your clinicians choose to -- it's important to get everyone up to speed on why you need to collect as you've agreed to in your contracts. I've written quite a few papers recently on front office technology that can help you collect more easily and reliably, while keeping the focus

By |2022-01-01T22:51:56-08:00April 29th, 2016|

Toast, workflow, and the quest for practice productivity

Looks better than mine, even w/o butter.* I observed something this morning when making toast.  I don't make toast often, but when I do, I tend to let it go for a few minutes before heading back into the kitchen to check on it, hovering outside the toaster oven to make sure I grab it when it's "just right." Now, like you (I suspect), I tend to be a little annoyed by wasted time. Standing next to the toaster oven, tapping my foot impatiently, that's definitely wasted time.  So I have developed a habit of "prepping" for the toast by scooping up the butter I'll use on it and putting it on my plate.  But today it finally dawned on me that this prep routine (which I've done for years) really saves no time at all. It's no quicker to pick the butter up off plate and put it on my toast than it would be to just take the butter out of its own container and spread it; the step of transferring it to the plate in advance is meaningless.  (In fact, when I do this the entire process usually ends up taking longer, since I rarely get just the right amount of butter on my plate -- a mistake I wouldn't make when just buttering the bread from the tub.) Of course, I do get a personal payoff from this little activity: I am less bored while I wait for my toast. But even though I feel like I'm doing something, it actually makes me no more (and usually a bit less) productive. Naturally, when I realized this, my mind immediately jumped to practice workflow, and how easy it is to be deceived by activities that feel like progress but actually have no effect -- or even slow things down. My favorite one of these, a subject that we wind up discussing with almost every practice we work with, is the central vitals station. Transferring patients from the reception area to the vitals station, then from the vitals station to the exam room, is one of

By |2022-01-01T22:51:56-08:00March 1st, 2016|

Filling the appointment schedule chat — Storify

Did you miss our Kareo-led tweet chat this morning on Filling the Medical Practice Appointment Schedule? It was fun and there were a lively group of commenters sharing ideas.  You can see the highlights by clicking this link.

By |2022-01-01T22:51:57-08:00January 21st, 2016|

Filling your physicians’ schedule in Q1: Five Ways (webinar)

Whether you've got the deductible reset blues or have simply resolved to keep your schedule as full as it can be in 2016, I've got some ideas to share in my new webinar, "Five Tips to Fill the Schedule in 2016." It's free (sponsored by Kareo). Some highlights of what will be covered: Reputation management -- why it's more valuable and powerful than ever, and also easier than ever; The key segment of reputation management that must be your top priority -- and most reputation management experts never even mention it; How preventive services can help you cope with the deductible reset this year -- and for years to come; How embracing technology can become its own form of (painless) marketing, even as it gives your practice other big benefits. Of course, if you sign up, you'll have access to the recording a day or two after the presentation, so don't hesitate to register even if you think you might not make it for the live presentation. (But I hope you can join us live, because I really look forward to your questions and comments.) Here is the sign-up link.  

By |2022-01-01T22:51:58-08:00January 13th, 2016|

Deductible reset blues? We’ve got a few medicines for you to try.

Ahhh, January. We're already six days in, and it's still hard to believe we're a week into a brand new year.  Perhaps especially so if low volume has you moving through your days more slowly -- and worrying about what your revenue numbers will be at month- and quarter-end. The January effect on medical practices can be a source of stress, but it's not too late to do something about it if you're worried about lower revenue in the first part of the year. In fact, with patients changing up plans and making health-related resolutions, the beginning of the year can offer opportunities for growth, even if the patient financial responsibility features of modern health plans are working against you. Join me for a fun, fast-paced webinar on January 14 to learn a few tricks to help you improve your volume at the start of 2016. Even if you've been caught off-guard and unprepared, there's still a lot you can do -- and the ideas I'll share are both easy and mostly free. To sign up (for free!), visit this link at our sponsor Kareo's website.

By |2016-03-04T11:25:21-08:00January 7th, 2016|

Your practice may be unintentionally turning new patients away

It's almost a new year -- woohoo!  Resolution time!  Fresh start!  And for many patients, brand new insurance! For many patients with new insurance, it's also time to shop for new doctors.  When they do, will they find you? By now you probably already know that there are many resources out there to help you with online reputation management (including lots of software products, and publications like this book by yours truly). But an often-overlooked part of online reputation management is especially important early in the year: payer directories. Patients rely on payer directories both when they shop for a new plan (if they want to keep their doctor(s), they'll want to be sure they're in the new plan) and when they start to use the plan (to choose a new doctor(s)). Both of these moments are among your very best opportunities to attract a patient who has just secured a plan you accept -- just the kind of patient you want. But if you're not listed in the directory, or not listed properly, your chance to attract that patients just slipped through your hands.  It's just as if your practice intentionally turned the patient away -- if your payer directory listings are not correct, the effect is no different. It may seem to you (as a sensible person) that payers should make sure their directories are accurate. And indeed they should. But, unfortunately, errors abound. Maintaining directories, it turns out, is a very difficult job.  While it shouldn't be your job, unless you assume some responsibility for monitoring these listings, you can't be sure they're correct; if they're wrong, it's  your business that pays the price. Plus, in some cases, online payer directories are adding features like photos and website links that can give your practice a promotional boost. You can't access these new features unless someone at your practice is engaging with these directories and keeping them updated and polished. Make checking and updating the directories of all your payers a top priority for the New Year. Finding and fixing even one erroneous entry can make a significant difference in

By |2022-01-01T22:51:58-08:00December 15th, 2015|

Ready for the deductible re-set?

It's almost that time again: deductibles re-set in less than a month. Got your game face on? For many practices, the end of the year is so busy, it's hard to think about planning for slow business in January, February and March.  Ironically, the cause of the busyness in Q4 is related to the cause of slower demand in January: deductibles. At year end, patients are eager to bring any known problems or elective procedures in to practices, because their deductibles have been met or nearly so; in January, many patients delay care because their deductibles re-set to their original amounts (or even higher amounts in many cases). It may also seem like there's little you can do to deal with the deductible re-set. But you do have options, and making even a small dent in the downturn can make a big difference in overall profitability. So isn't it worth trying? If you're in a pediatrics, adult primary care, or OB/GYN practice, of course one of the best steps you can take to smooth your revenue is to let patients know you have availability for preventive services in the beginning of the year. Let them know that your practice may be less crowded (barring, of course, a wave of flu or another virus coming through your neck of the woods).  Make sure patients are aware that preventive services usually come with no copayment or deductible.  (It can be helpful to create a list of common tests and vaccines that are preventive per the USPSTF, to avoid confusion.) Here's where your EHR can shine: use list-generating capabilities to identify patients that are due for preventive services, or who have chronic conditions are overdue for a regular visit.  For example, it's usually easy to isolate healthy patients you rarely see that are overdue for pap smears, hepatitis screening or check-ups. Tapping your system a little more creatively, you can identify patients that have just crossed a threshold to qualifying for a preventive service such as herpes zoster, pneumococcal pneumonia vaccine or cancer screening. Patients that turned 65 in 2015 may also be identified and offered an

By |2022-01-01T22:51:58-08:00December 8th, 2015|

It’s everyone’s responsibility, yet no one’s doing the job

Are some jobs at your medical practice just too urgent or important to assign to specific people? That's the argument some practice managers and physicians make, e.g: "Phones need to be answered by the first available person, whatever their job" "Everyone should keep an eye on the fax machine, and deliver faxes they see piling up" "Let's all keep an eye on the reception area, to make sure no one's waiting too long" "It's the entire team's job to make sure the patient bathrooms are clean and stocked" When the entire team is engaged on these important, urgent tasks, the theory usually goes, there will always be someone available to do them, right when the need arises. Everyone will have an equal stake in making sure they'll get done -- right? Alas, no. Have you ever heard the amusing little story about four people named Everybody, Somebody, Anybody and Nobody? It goes like this: There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that, because it was Everybody's job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done.* There is a lot of organizational insight packed into that little verse. When something is everybody's job, it's effectively nobody's job. Nobody is actually accountable to do the work, and everybody can rationalize that they thought someone else would do it. When everyone has other work to do that they believe is important, they'll be more likely to assume someone else will take care of the group responsibility. We have worked with several practices that have applied this "everyone's job" idea and been very unhappy with the results. Laurie, they say, why aren't the staff answering the phones? We tell them over and over that everyone has to answer the phones! Instead, our messages are piling up, patients and other doctors are complaining, and nobody's getting the help they need when they call.

By |2022-01-01T22:51:58-08:00November 29th, 2015|

The upside of staff downtime, the downside of multitasking

Employees who are not always busy working are frequently a source of consternation to physicians. Sometimes, practices attempt to remedy the situation by restructuring staff jobs -- not always with good results. Consider the front desk, for example. In almost any practice, front desk workload will ebb and flow.  Depending on variables like patient punctuality, the mix of appointment types, and the number of new patients, the front desk might be swamped or slow on any given day or during any clinic session.  Sometimes, front desk receptionists may have no one needing their help or attention at all.  Physicians and managers may be tempted to rectify the situation by, say, having the phones ring first at the front desk. For a typical, busy practice, that's a foolproof way to increase staff busyness! But does it improve productivity? In my view, usually not. One reason people appear busier when you ask them to switch back and forth between tasks -- or do multiple jobs at once -- is that it's harder to do any of them properly. They're more active, but not necessarily more productive. This makes intuitive sense, no?  But we don't need to rely on intuition, thankfully.  With multitasking so prevalent in modern offices, researchers have good reason to study it -- and the results suggest that multitasking is even more of a productivity drain than your gut would tell you. One study found that people lose as much as 40% of their productive capacity when trying to constantly do multiple tasks at once. When front desk staff are required to answer phones while also helping the patients that are standing in front of them, service suffers. Either the patient on the phone or the patient at the desk feels like they're in second place. And switching back and forth means the employee has to mentally regroup -- adding to the length of time it takes to complete each task. More effort is required to do the same tasks -- yet the patients staff deal with will perceive less effort made on their behalf. Lose-lose for both of the two patients being

By |2015-11-23T16:13:16-08:00November 23rd, 2015|

Obsessing about front office technology

Anyone who encourages me knows they'll get an earful about front office technology tools -- they've become a passion of mine.  I'm referring to things like: Patient responsibility payment estimators (e.g., Wellero, Navicure, Zirmed) Check-in tablets and kiosks (e.g., Phreesia) Online patient payment tools like portals and pre-payment sites (e.g., SpendWell) Patient payment apps (e.g., Wellero) Online scheduling (e.g., Zocdoc, DoctorBase, EHR portals in some cases) Basically, I'm talking about add-on tools that work mainly with practice management systems and/or on the Internet to improve your practice's likelihood of getting paid by patients, reduce steps in front office workflow, and even make patients happier in the process. I am a big fan of these kinds of tools, for all kinds of reasons. One is that they're unshackled from the government's goals for EHR -- they basically live only to serve practices and patients -- and I think that's what makes this segment of the market so much dynamic than the EHR segment.  The players have competition, and it drives them to innovate more; you see these vendors experimenting with many different ways (and platforms) to solve these problems. And these tools really make a difference in the workflow and collection rates of the practices that embrace them. I recently wrote a white paper that delves into the important role technology can play -- and is starting to play -- in front office operations.  It's called "Technology to the Rescue: Putting the Flow Back into Front Office Workflow."  Wellero sponsored it, and you can download it free on their site. I hope you'll check it out -- and get in touch if you'd like to talk about any of the ideas in it.

By |2022-01-01T22:51:58-08:00November 3rd, 2015|

Ready to take the CCM plunge?

As you may know already, I've been working on a series of papers on Medicare's chronic care management reimbursement program (CCM) for the Medical Product Guide. (Click on 'resources' after visiting the Medical Product Guide link if you're interested -- they're free.) Talking to practices that have already started working on CCM, along with others that have held back, has been a learning experience.  The ability to take on CCM quickly depends a lot on your current practice set-up and, especially, your EHR. On the current set-up side, if you're working on or already have set up a medical home (PCMH), and have one or more case managers in place to support it, you may find it easy to use the same staff structure for CCM. Your case managers could become the coordinators for CCM as well -- perhaps personally contacting patients and doing the other care management tasks that contribute to the required 20 minutes per month for billing. Perhaps there will be overlap between the PCMH and CCM that could be beneficial -- if, for example, you're looking at a similar mix of conditions, that might allow for some standardized communications or tracking tools.  Or perhaps you could add a group visit program that would serve patients from both programs. (A group visit program wouldn't contribute to the CCM monthly time requirement, since that's strictly non-face-to-face time, but it still could be well received, and fit with the patient engagement goal of the program.) On the other hand, if your practice hasn't yet taken on PCMH, CCM could be a stepping stone. Many primary care practices believe they're already doing many of the tasks that are meant to be compensated by CCM -- they're just not tracking them, and they haven't had a way to bill for them, either.  That last problem is expressly addressed by CCM -- the key is solving the former problem of tracking. EHR vendors vary dramatically in this area. Some have already created dedicated modules that allow for templates for clinical staff contacts to be tracked, and for the time to be calculated. Others

By |2022-01-01T22:51:58-08:00October 31st, 2015|

Medley of creative practice models for physicians emerges – is one right for you?

The concierge practice emerged more than 10 years ago and centered on family practice and internal medicine. Since then, practices have adapted the model to suit their preferences and styles, and the concierge approach has even moved beyond primary care as private practice physicians of different specialties search for a more profitable and fulfilling career path. The concierge approach aims to improve patient care while collecting all or most of the practice’s revenue directly from the patient.  Patients are attracted to more personalized service and less harried exams. Patients and physicians both feel better care is given and physicians find more satisfaction in their chosen career. Another practice model that evolved from the concierge approach is direct pay primary care (sometimes also called ‘direct primary care’). In this model, physicians collect all their fees directly from the patient Patients pay a subscription fee that covers most primary care services.  For the practice, by eliminating the costs of dealing with private insurers such as complying insurance regulations, claims submission and managing the accounts receivable costs can be significantly reduced and services enhanced. This approach generally offers fewer frills than a true concierge practice, and so the monthly subscription fee is lower, too – usually $100 or less. The appeal of direct pay primary care is that many patients have high deductible plans and seldom, if ever, reach the threshold level where insurance kicks in each year. In effect their insurance is more like catastrophic coverage -- they pay for their doctor visits and diagnostic studies as part of their deductible. For these patients, a direct primary care subscription can offer greater access and better care for the same or even lower out-of-pocket expense. For physicians, having more time to spend with their patients allows them to develop strong bonds with them, improving communication and patient compliance with their treatment plan. It’s a win-win proposition for doctors, patients and caregivers. There are attractive benefits to alternate practice models, but converting an existing practice requires careful planning. If you are considering an alternative practice style that is not reliant on insurance payment, there

By |2022-01-01T22:51:59-08:00October 19th, 2015|

How empowered is your medical billing service?

Outsourcing your medical billing to a billing service has the power to make your practice much easier to manage.  It can also increase your profitability. But as the world of reimbursement continues to evolve, it's important to stay involved with the process.  If you've adopted a "that's off my plate now" approach to using a medical billing service, it's possible your service is too empowered. A properly utilized medical billing service will be an extension of your team.  Your office staff must work well with them in order to maximize the benefit you gain from outsourcing.  When everything billing-related is dropped into the billing service's lap, it's impossible for them to do their best work for you.  And they may feel compelled to make decisions for you that they really shouldn't be taking on unilaterally. Here are a few examples we've seen over the past few years of billing services believing it was left up to them to make key decisions on behalf of practice clients -- leading to sub-optimal decisions as a result: A billing service for a primary care/infectious disease practice with predominantly older patients with multiple chronic conditions received documentation about the chronic care management (CCM) reimbursement opportunity from the CMS (i.e., code 99490).  But the billing service already had trouble getting properly prepared claims and sufficient documentation from providers, even for office visits. Plus, the practice manager was inexperienced with billing, and typically deflected the service's questions with "you decide - that's your job." The service owner decided for the practice that pursuing CCM "wasn't worthwhile." She felt that the providers wouldn't have been willing to do additional documentation. The physician owner was unaware that the practice was likely leaving at least $120,000 of revenue on the table in 2015 -- revenue which could have helped the practice repair its difficult financial position; A pediatric practice assumed its billing service would "handle" all payer contracts. The billing service thought "handling" them meant simply dealing with information requests from payers, and alerting the practice when something needed to be done -- they certainly didn't expect to be negotiating new contracts, since that was far

By |2022-01-01T22:51:59-08:00October 11th, 2015|
Go to Top