medical practice business

Special Judy Capko webinar event: The Secret to Strategic Planning – Making the Most of Your Practice’s Future (May 8, 2014)

Join Judy Capko, author of Secrets of the Best-Run Practices, for a special, 90-minute webinar for physicians on strategic planning. A strategic plan will provide your practice with a strategy to respond to key regulation like the Affordable Care Act and secure your future in times of rapid change.   A strategic plan will help you clarify where you are, help you understand your needs and determine what strategies will help you achieve your goals. By participating in this webinar you will learn how to: Overcome challenges and obstacles that hinder performance; Understand the essential requirements in preparing a strategic plan; Take concrete steps that capitalize on your strengths; and Develop a plan that positions your practice for success. Regardless of practice size or specialty, a strategic plan is essential in guiding a practice to achieve its objectives, stay competitive, and be profitable without compromising the quality of care and service you provide. This course covers the key elements required in developing and structuring a strategic plan – and how to get everyone on board – so you can guide your organization in this time of unexpected change. To learn more about this webinar and enroll, visit this link: https://www.greenbranch.com/store/index.cfm/product/1405_20/secrets-to-strategic-planning-making-the-most-of-your-practices-future.cfm

By |2022-01-01T22:52:08-08:00April 14th, 2014|
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Thinking portals and Meaningful Use Stage 2? Join my free webinar

Does Meaningful Use Stage 2 have you thinking (perhaps worrying) about offering a patient portal to your EMR?  Or do you have a portal, but wonder if it's getting the use that it should -- and whether it's really helping to engage your patients? Next Wednesday, 4/16/14, I present a free webinar on successfully implementing your portal as part of Kareo's webinar program.  I'll take a look at: Why patient engagement matters -- and how portals fit in Keys for a successful portal roll-out Tips for promoting your portal to patients How portals satisfy Meaningful Use -- and why it's not just about Meaningful Use! Please join me on 4/16 to explore this important and exciting topic. Click to sign up for the free webinar on Patient Engagement, Patient Portals and Meaningful Use  

By |2016-03-04T11:54:55-08:00April 10th, 2014|
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“We are not a bank” — Lessons from CNBC’s “The Profit”

I just got around to watching the episode of  The Profit focused on A.Stein Meats. Now, you may be wondering why on earth I'd be posting about a meat business here -- what could that have to do with medical practice management?  Well, The Profit deals with a variety of small businesses, and there are often take-aways that apply to almost any business, but the A.Stein Meats episode really hit some notes that are so important for managing the business side of a physician practice -- especially the under-appreciated perils of poor management of accounts receivable. When Marcus Lemonis arrives at A.Stein Meats, he learns that the 75-year-old company is losing $400,000 per year -- despite $50MM in annual revenue.  He's initially confused about how the company's expenses could be exceeding their revenues.  But he soon figures out that the biggest missing piece lies in the back office: accounts receivable.  The office manager -- who nominated the business for the show -- reveals that the receivables are more than $4MM.  And Lemonis quickly notes, many are so old, they'll likely never be collected.  The owners, meanwhile, seem almost unaware of why they should be concerned about accumulating A/R -- after all, they're just trying to "work with" customers, many of whom are "friends." But, as the old saying goes, with friends like that, who needs enemies? The business's inattention to collecting the money they're owed was putting their solvency at risk; revenue is almost irrelevant if it isn't realized as cash coming into the business promptly.  Moreover, the business was essentially financing its customers -- without getting paid to do so.  Lemonis stated clearly, "we are not a bank" -- the same message we give our medical practice clients when they're too quick to say, "sure, we'll bill you" instead of asking patients for a credit card at the time of service, or a credit card on-file for procedures that need to be paid for over time. Medical practices are perhaps a bit luckier than a business like A.Stein Meats in that insurance payments still usually provide the biggest portion

By |2022-01-01T22:52:08-08:00March 31st, 2014|
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Patient use of physician ratings sites increasing — not waning

If you've been among the practice managers and physicians ignoring the 'fad' of physician ratings sites, hoping they'll just fade away eventually, there's bad news for you in last month's JAMA: more people than ever are aware of the existence of physician ratings sites.  And more people than ever are using them. As has long been the trend, though, patients aren't flooding sites with rants of disgruntlement; positive views continue to heavily outweigh negative ones. The most important take-away from this new research?  If you haven't started taking control of your listings on ratings sites, the time to act is now.  Hiding won't help ... and taking charge is easy, once you learn a few key steps. Interested in learning more about online reputation management?  I will be publishing a new Management Rx ebook on this subject in the next few weeks.  To be notified (and take advantage of free review copies if you're interested), sign up here: Subscribe to the Management Rx interest list by Email

By |2014-03-24T16:37:12-08:00March 24th, 2014|
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Bullying can be a problem at medical practices

Yahoo! reports that a recent study by the Workplace Bullying Institute showed that bullying -- defined as "abusive conduct that is threatening, intimidating, humiliating, work sabotage, or verbal abuse" -- is a problem at nearly half of all US workplaces.  They also found that 27% of all adult Americans have directly experienced it, 21% have witnessed it and 56% of perpetrators are bosses. More discouraging, the study found that employers are doing little to combat bullying. Among employers who had received complaints about bullying, only 12% established policies to combat bullying, and only 6% reported a zero-tolerance approach to eliminating it.  And, the researchers also found that all this bullying has a high cost in employee turnover: 61% of employees who were victims of bullying either quit, were fired or were forced to quit. Medical practices exist to help patients, and usually most of the employees in a practice were attracted to the field for that reason -- so you wouldn't think that bullying could be a problem in the practice workplace. But bullying is something we often uncover in working with practices, especially when we're brought in because of high turnover or operating problems that the physician owners are having trouble solving. Despite being rooted in a caring profession, medical practices often have characteristics that make it possible -- even easy -- for bullying to take hold.  These include: Physician owners are most often with patients and have little time to observe ordinary interactions between staff Physicians often dislike the management side of their practices and become too trusting of and over-reliant on one or a few key managers -- who then have too much power Managers spot the opportunity to seek excess power from uninvolved physicians -- becoming expert at managing upward and hiding the true nature of their relationships with staff* Physicians may have experienced very demanding, bullying (or quasi-bullying) environments throughout their medical training -- and may adopt the same management style almost automatically, without appreciating the costs When our analysis of a practice suggests that a manager, supervisor or physician colleague may be creating a threatening

By |2023-05-23T17:23:30-08:00March 17th, 2014|
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Outsource your practice management pain

It’s a common error for physicians to think their manager and the staff can do anything they ask of them.  Although it’s admirable, it may place an unfair burden on everyone.  And if the practice has grown, but the staff hasn’t, you may be expecting too much. If you have major projects that get put on the shelf or get derailed, you may be missing out opportunities or losing your competitive edge. And, if you find yourself picking up the slack for staff that is inundated with their workload demands and things just aren’t getting done, it may be time to outsource your pain.  Even if staff has enough time, you might be asking someone to take on a responsibility they don’t have the acquired skill set required to get the best outcome. Physicians and managers also face tremendous demands that sometimes cause them to put off important projects that would help the practice become more robust and put you in control of your future. For example, most practice leaders don’t have time to take on something as important as a developing a strategic plan. Such a project requires tremendous upfront research and analysis, prepare the report and plan the strategic planning retreat?  Hire an expert to do the leg work and facilitate the retreat and you will not only get the job done, but you’ll get it done on time. And how about using a payroll service with automatic deposit to the employee’s account? You can select a service designed to track accumulated paid time off, and allows you to download the employee time records, which is a real relief to managers. This is a cost effective way to get a reliable outcome and allow the manager’s time to deal with other pressing issues that need attention. Whether it’s outsourcing a specific one time project, ongoing responsibilities like revenue cycle management or an important daily task like seeking a technology partner to electronically manage appointment reminders, you can find a good match for your needs.  Check with your colleagues, do research on-line and take advantage of those annual conferences

By |2022-01-01T22:52:09-08:00March 13th, 2014|
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Windows XP: a potential HIPAA risk — and an opportunity to boost productivity

Microsoft recently announced it will end support for the Windows XP operating system on April 8, 2014 -- and this may have HIPAA implications for your practice. What could 'support' have to do with your HIPAA compliance? The biggest implication is that hackers could discover new ways to breach XP security -- and no support means Microsoft will no longer issue patches to plug the holes.  That means you'll potentially expose protected health information to hackers if you continue using the unsupported operating system. Even if you're using cloud-based EMR and other systems, your office PCs may still contain protected information -- for example, if documents are scanned and saved to their drives. The good news is, PC prices are lower than ever, and upgrading can make your team more productive.  (In virtually every practice we visit, we find at least a couple of computers that are so slow that they are adding to patient wait times at check in, check out and while scheduling on the phone -- and cutting into staff productivity.  Inevitably, the practices believe they're saving money by not upgrading, but at today's prices, faster computers would likely pay for themselves very quickly.) If you act fast, you might even be able to get Windows 7 machines -- you'll miss out on the pizzazz of the new Windows 8 interface, but also skip the longer learning curve when transitioning from XP.

By |2022-01-01T22:52:09-08:00March 10th, 2014|
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Using benchmarks wisely: staff, staff expense per provider

Our work with medical practices often involves analyzing a practice's data against benchmarks from sources like MGMA, NSCHBC, specialty society surveys, etc.  But, it's not enough just to compare against the averages and percentiles; you have to know whether meeting or beating a benchmark is a good thing.  Believe it or not, this is not always obvious. Among the benchmarks most subject to misinterpretation are staff per provider and staffing expense per provider.  Most physicians and practice managers we work with are very focused on keeping headcount and staffing expense low -- and so they're pleased to learn they're in the lower tiers for headcount and staff expense ratios.  The pleasure shifts to confusion, though, when we explain that squeezing staffing down to the lowest possible expense is not usually a path to higher profitability -- and can often be associated with lowering profitability! There are several reasons for this.  The most important is that well-trained, well-paid, motivated staff -- and enough of them -- free up providers to focus all their attention on the tasks only they can do.  Coincidentally, the tasks that only providers can do are almost always also the only tasks that generate revenue for the practice.   Increase provider time spent on revenue generating activities (and not on unpaid tasks that don't require their training), and you're on the way to more profitability. Consider that an additional medical assistant might cost a practice about $100-$150 per day.  If that additional assistant allows a practice to see as few as 1-2 more patients per day, that's a profitable addition.  Often, one additional assistant can help more than one provider -- and help the practice quickly generate more revenue than is needed to make the addition a profitable one. When a practice is focused primarily on expense control and minimizing headcount, sometimes that results in providers doing too many tasks that could be handled less expensively by staff -- an opportunity cost for the practice and a direct hit to revenue potential.  What's more, when a practice is too reluctant to add headcount, existing staff can quickly become

By |2022-01-01T22:52:09-08:00March 3rd, 2014|
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What’s the payoff for being patient-centered?

The buzz about being patient-centered is not just hype, the patient-centered movement is very real and there is much to gain.  The primary premise of the patient-centered movement is that by building stronger relationships with patients they will be healthier.  Healthier patients mean a healthier population.  A healthier population reduces healthcare expenses which have soared in the United States over the past few years. Reducing these expenses is a goal that health plans are increasingly willing to pay practices to help achieve. Understanding what it means to be patient-centered is a complex process as it intends to recognize patients in terms of their own social worlds.  This means throughout the patients’ healthcare experience they should be respected, listened to, informed and involved in their care.  It is believed that shared decision-making results in better compliance and reduces health risk factors.   Focusing on individual patient’s needs an applying evidence-based medicine is meant to improve the healthcare population. Insurance companies, recognizing these factor,s are in the process of implementing financial incentives and bonus structures based on key elements that improve the delivery of health care and manage costs by reducing complications and emergency room visits, and by complying with best preventive practices. Your intentions to be more patient-centered can be reached by: Strengthening the patient clinical partnership; Promoting communication about things that mater to the patient; Helping patients know more about their health and healthcare needs; Facilitating patients’ and caregivers involvement in the patient’s care; and Setting metrics to measure improvement. Being patient-centered is rewarding for your practice in so many ways: happier patients, potential financial upside, and stronger relationships between providers and patients. All of these themes are discussed in greater depth in my and Cheryl Bisera’s new book:  The Patient-Centered Payoff (click the link to see the book's page on Amazon).

By |2014-02-24T11:21:01-08:00February 24th, 2014|
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Internal chart audits, the basics, part 2: conducting the audit

Conducting an internal chart audit require team effort to plan, execute and analyze the results.  You will get far more out of the audit by involving team members from different departments and presenting it as an exciting time to learn more about the inner works of the clinic visit and their implications on practice finances.  A team of five is perfect; a receptionist or scheduler, a biller, a nurse or medical assistant, a medical records or data entry person and a physician or other provider. Begin by gathering five random patient records per each provider and selecting one date of service for each patient; the date of service should be three to six months prior.  This allows adequate time for insurance processing and receipt of third party payment on the records being reviewed.  Staff should break into teams of two – preferably one administrative staff and one clinical staff person.  Each team should review a minimum of five charts and document discrepancies.  When the review is completed, they should analyze the results to determine if the same errors are recurring or if there are different areas of the practice or service where problems occur.  They should then calculate the potential cost of the errors over a twelve month period.  The next step is to make a recommendation on how to approach correcting the deficiencies for long term benefit. Common problems detected: Discrepancy in evaluation and management level of service (E&M code) Wrong diagnosis Missing dictation Incomplete charge slip Missed office charges:  Procedures, lab, x-ray Missed hospital charges:  ER visits, consultations Insurance write offs taken that are not justified  (payment overlooked or discounted by payer) Patient balances written off on Medicare patients All of these problems have the potential to both cost your practice money in the short term (e.g., by causing denials or delays or down-coding) or in the long term by triggering an audit by Medicare or a private payer.  By conducting your own internal audit, not only will your staff learn what kinds of mistakes you've unwittingly been making (and be able to correct them), everyone will understand

By |2022-01-01T22:52:09-08:00February 20th, 2014|
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Internal chart audits: the basics, part 1

Auditing charts is nothing new; Medicare has been doing such audits for years. They are looking for coding irregularities within a practice to determine if they want to do a more extensive audit. That's when a practice gets the dreaded notice to prepare and submit charting documentation on a selected number of charts and submit them to CMS for a detailed review. Often when this happens the stakeholders in the practice have no idea what they have done to trigger the audit. We suggest you take a proactive approach to understand your coding patterns and whether you are coding appropriately based on the services rendered and the documentation essential to support the codes you billed for. Here are steps you can take to prepare for a practice-wide internal audit, which may help you avoid the dreaded Medicare audit – or at least be ready to pass with flying colors. Empower staff to understand the importance of their individual actions in helping the practice get paid for the services performed. A mini audit involves everyone in analyzing charge and payments for services rendered.  The staff teams up to examine documentation of services rendered, diagnostic coding for encounters and the payment received for those services. Increase the staff’s awareness of the significance of accurate documentation and its relationship to revenue generated in the practice.  By examining charts and billing information the staff will begin to understand how important it is to account for every single service rendered. With reduced reimbursement no office can afford to drop a charge or to neglect following up on an inappropriate reduction in reimbursement.   For example if you missed charging for one EKG and one Urinalysis a day, it would add up to as much as $12,000 a year in lost revenue.  If you missed charging for one hospital consultation a month per doctor in a four doctor practice, you would take an annual hit of $6,000. Increase the reimbursement IQ of reception and nursing staff, as they examine EOB’s and see a 30 to 40% adjustment in the payment rendered by third party payers. This will

By |2016-03-04T11:56:39-08:00February 14th, 2014|
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Patient payments: In 2014, it’s ‘pay as you go’

2014 will be a winning or losing game for medical practices – depending on their patient payment policies and efficiency with collecting patient payments. Patient responsibility has spiked over the years and has taken a quantum leap in 2014 with annual deductibles of $5,000 and more.  Patient share of responsibility beyond the deductible can be as much as 20%.  So if you haven’t already done so, it’s time to beef up your patient collection procedures and track performance to ensure you are collecting at the time of service.  Here are a few key ways to get paid sooner rather than later. Train staff on how to ask for money.  Give them scripts and practice so they are comfortable.  Help them understand it is appropriate to expect payment at time of service. I mean, like where else do you go and not pay for services at the time you receive them? Start at the beginning.   Staff should explain your payment policies when they are scheduling a new patient.  For established patients that are scheduling appointments on the phone, remind them of an existing balance and inform the patient that payment of an existing balance must be paid at the time of their scheduled visit – if not paid in advance.  You might even consider asking the patient to pay their previous balance with a charge card at the time they are scheduling their appointment and be ahead of the game. Plan ahead.  Every day assign someone in the office the responsibility of reviewing the next day’s schedule  to verify insurance coverage and plan for Use technology.   Automate confirmation phone calls or text messages to be placed 48 hours before a patient appointment.  The script used should include a message reminding the patient that any balance remaining on their account must be paid at the time of the visit. Avoid exceptions.   Keep providers out of the payment discussion.   Help physicians by giving them the script for a reply to patients that want to talk about payments.  Something as simple as “Mary, my main concern is your health, our billing department manages collection. 

By |2022-01-01T22:52:09-08:00February 14th, 2014|
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Position your practice for growth: free webinar tomorrow

There's still time to register for my webinar tomorrow with Kareo and Physicians Practice.  "Position Your Practice for Growth" will explore tactics to ready your practice to handle more patients without sacrificing patient service.  Whether you're hoping for or expecting growth from the ACA, whether you're aiming for it with increased marketing, or whether you just want to learn some ideas for increasing efficiency and profitability, there's something in this webinar for you! To join us at 9AM Pacific/12Noon Eastern tomorrow (Feb 6), register at the following link: Free webinar: Position Your Practice for Growth

By |2022-01-01T22:52:09-08:00February 5th, 2014|
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Dashboards: Practice performance at a glance

A medical practice performance dashboard is a great time-saver to help keep your finger on the pulse of practice performance and understand your position in real time. It is similar to the one in your car – a set of indicators  provide a simple, practical way to know what’s going on and to let you know when you’re headed for trouble. The dashboard is a metric reporting tool that makes it easy to look at business performance so you know when the practice is doing well and are alerted when something is wrong.  Dashboards provide a layered interface that conforms to the way you work.  When performance dashboards are aligned with the practice’s operations, productivity, finances and strategic plan, managers and physicians begin to work more efficiently and effectively toward achieving shared objectives. Typical indicators revealed on the dashboard focus on practice productivity and finances. However, the power of the dashboard can be extended to include other data. For example, if a new provider was added recently or you opened a new satellite clinic, monitoring growth and financial progress of this entity can be added to the dashboard. The dashboard can be designed to compare internal performance from the prior year or to look at how you compare to your colleagues across the nation. Medical Group Management Association’s (MGMA) has conveniently packaged a set of dashboard metrics with its Cost Survey on disc.  This enables the user to create a dashboard based on six indicators that are benchmarked against other practices in a few short minutes. The spreadsheet used to prepare the dashboard shows your ranking when compared to the MGMA database. If you find yourself on information overload with management and financial reports screaming for attention, think about implementing dashboard technology to monitor your practice's business performance at-a-glance.   With web-embedded technology some applications can update information automatically eliminating the need to repopulate the spreadsheets.  Charts and tables can be configured to support drill-down capabilities. Keep in mind, though, that dashboards are only as good as the data that supports them.  Success is dependent on the quality and flexibility of

By |2022-01-01T22:52:09-08:00January 31st, 2014|
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Managing includes developing practice staff

Sometimes, the business of medical practice management is a fuzzy science.  Managers have to keep the patients, and their bills, moving through the practice.  Most often, physicians are satisfied if their managers accomplish that much. But managing optimally includes softer skills, like bringing out the best in staff.  Recently, we've worked with several practices with managers who do a great job of managing upward -- reinforcing the confidence their physicians feel for them -- but who don't have much insight into really managing their own teams effectively. Keeping an eye on the team, and making sure everyone's doing what they're supposed to do, is a huge chunk of a manager's role.  But it's not the entire role of a truly effective manager.  A truly effective manager helps each member of the team develop his/her skills, understanding each person's strengths and weaknesses, and figuring out how each direct report can contribute more and be challenged and grow.  This is not just key to helping the practice improve its short-term results, it is critical to retaining the best staff and successfully completing growth initiatives. Turnover alone can be so costly to practices.  Hiring and replacing employees is a time-and-money sink.  And while critical jobs stay unfilled, mistakes can happen -- and patient service can suffer. This recent Harvard Business Review article delves into this issue -- and makes the important point that a poor relationship with their direct manager is a primary reason (if not THE primary reason) employees quit.  We see it every day! Medical practices often pay a great deal of attention to provider education -- partly by necessity. And managers can often attend conferences and find other paths to learning and development.  But staff are often left out of the equation.  And if managers aren't finding out what staff career goals are -- and how they can help them learn, grow and achieve them -- then the practice will suffer as a result.  Make sure you're evaluating your managers on this important skill!

By |2022-01-01T22:52:10-08:00January 28th, 2014|
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Trade shows – there’s so much to gain

There are lots of reasons to spend time in the exhibit hall when attending practice management and other medical conferences. By visiting the exhibit hall you will learn a lot about what’s going on in the industry, how vendors are seeking to meet your future needs and what technology changes have emerged that can make a practice more efficient and profitable, while improving service and outcomes. Yes, there are lots of reasons to get down to the exhibit hall, but it's also important to plan how you can do this without being overwhelmed or wasting your valuable time.  Forget about seeing everything – it’s just not possible and can lead to unnecessary frustration. However, with thoughtful planning you can see those things that can make a difference in your very own practice. Get off to a good start. Conference materials at the convention will include a list of all the vendors that are exhibiting. Match these with your interests. Then check-out their location on the exhibit floor. This will allow you the opportunity to plot your course.  Visit your selected vendors, by covering one section of the floor at a time. It’s a strategic move that will get you off to a good start. Refer back to your vendor list as you move through the convention. You might want to take photos using your mobile phone or make notes. This will be valuable for follow-up and decision-making when you get back to the office. Pace yourself.  Be realistic in evaluating how much time must be spent on the floor of the exhibit hall to achieve your goals and meet with the different vendors you have targeted.  Allow an average of 5 minutes for each of the vendors on your list. When you meet with an exhibitor, it’s important to be a good communicator and get right to the point.  Let the sales representative know what information you want and why.  At the same time, if the sales rep is not a good listener you could be wasting valuable time.  Don’t allow him or her to lead the conversation to information

By |2022-01-01T22:52:10-08:00January 21st, 2014|
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Will the ACA bring a wave of new patients? Prepare for the best

Will the ACA bring a big increase in patients to your practice? For most of the practices we've been working with, the ACA's impact on patient volume is still pretty unclear.  Since we're less than a month into the new coverage year for ACA exchange plans, and the open enrollment period continues through March 31, we're still at the very early stages; the actual impact is hard to gauge at this point.  Moreover, the impact may vary widely based on local demographics, practice type, and state participation in the Medicaid expansion. But we're still advising practices to take steps to prepare for more volume -- whether it comes from the ACA or their own marketing.  Readying your practice for growth is good business.  Better processes not only allow you to handle more volume, they help you serve all of your patients more effectively. Preparing your practice to handle more patients is the subject of my upcoming webinar sponsored by Kareo and hosted by Physicians Practice.  Join me on Feb 6 for this free presentation entitled "Position Your Practice for Growth: Responding to the Dynamic Healthcare Market."  I plan to share some ideas that can help almost any practice prepare from and profitably realize more growth -- whether from the ACA or their own internal marketing efforts.  Plus time for your questions!

By |2022-01-01T22:52:10-08:00January 20th, 2014|
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The cost of poor decision-making

We were recently called into a group practice where the physician owners of Struggles Medical Group were disillusioned with the practice of medicine. Their concerns were typical, shrinking reimbursement, dismal profits and the threat of new competition, as a large urban academic faculty practice was beginning to penetrate this suburban community.  Sound familiar?  This is happening around the country as a response (or reaction) to healthcare reform, where larger healthcare organizations see new opportunities to get a bigger piece of the revenue pie.  Struggles timing was perfect for bringing this consulting team in and here’s why. We performed a detailed practice assessment, examining the implications of past decisions and analyzing the current state of Struggles Medical Group in primary areas of performance including practice structure, finances, human resources, billing, clinic operations and work flow and marketing.  One physician owned this practice and the other physicians and providers were employed.  We soon discovered the physician owner had a history of making bad decisions. They did not analyze return on investment (ROI) before making investment decisions that would impact the practice operations, finances and possibly patient care. A perfect example of Struggles poor decision-making was buying very costly diagnostic equipment that they were unable to use because payers were contracted with a lab to provide these services.  This meant the investment was rendered useless to the practice. Besides this, with new models on the market every six month,s there was no way to attract another buyer for the equipment.  There were other equally disastrous investments Struggles made over the past two years. The most recent strategic error was changing the direction of the entire practice.  In their quest for new revenue opportunities the practice decided to focus on expanding its service to workers compensation patients.  Attracted solely by somewhat higher gross reimbursement rates, they went ahead with this in this in 2013 without thinking of the implications with would have on staff, workflow and profit.  This was a costly error. Workers compensation is a practice model that is significantly different from other payers and requires specific expertise in report writing and tremendous

By |2022-01-01T22:52:10-08:00January 10th, 2014|
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Resolve to give better feedback to staff in 2014

Turnover and hiring are costly.  Staff are so important to your practice's patient service, financial performance and overall functioning.  Given these things, one of the best investments you can make in your own leadership abilities as a physician owner or practice manager is to develop the skill of delivering effective feedback to employees. The importance of giving effective feedback to staff really can't be overstated.  Your ability to nurture better performance and address inadequate performance impacts everything from employee skill development, to team morale, to legal risk. Every aspect practice performance depends on getting the best from your staff, and that depends on giving the right feedback at the right time(s) and in the right way. Giving employee feedback is not easy, and getting really good at it requires effort and focus. But your efforts will be rewarded many times over. One of the best recent summaries I've seen lately on delivering effective feedback comes from the Stanford Graduate School of Business -- a summary of a lecture by Carole Robin.  It's a short list of seven pithy tips, and you can act on it now!  Highly recommended reading.  (A couple of previews: "Do it now" and "Stay on your side of the net."  Read the piece for quick explanations of these ideas -- and five more.)

By |2013-12-24T10:06:33-08:00December 28th, 2013|
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Will 2014 be a better year for your medical practice?

This is certainly a reasonable question to ask considering the rapid-fire change, threats and unknown factors medical practices face due to the Affordable Care Act.   But here are a few things you can do to deal with all of this. First, keep your eye on the ball.   Don’t throw up your hands in frustration, but follow the news and the legislation that is likely to impact the way you practice medicine, your future stability and the care and service offered to your patients.   Read everything you can and keep your cool. In other words, don’t throw your hands up in despair.  Put the emotions aside and be prepared to respond.  If you know what’s coming down the pike you can be practice-ready and take strategic actions rather than wait, feel the panic and be reactive, which typically leads to poor, costly decisions.  Well thought out decisions will explore not only the potential threats, but the opportunities that are available to you and your colleagues without compromising your integrity or patient care and service. Next, look at the numbers.  How well did your practice perform compared to prior year and compared to other practices in your specialty?  Benchmarking will help you examine the trends so you can examine areas where performance was disappointing and seek ways to bolster them for next year.   The numbers tell the story of past performance and give you an opportunity to set future goals that keep the practice stable and on financially solid ground. Don’t make squeezing cost a primary focus.  Sure, it’s normal to focus on costs when reimbursement is tight and may get tighter, but in reality you can only squeeze costs so much.  If you focus most of your efforts on costs you are likely to reduce quality and service. The highest expense for a medical practice is staffing, but the old saying: “You pay peanuts, you get monkeys” is true.  Hire well – highly skilled and experienced people; respect them, pay them well and set high expectation goals and staff well help your organization to me more profitable.  Physicians  and managers can

By |2022-01-01T22:52:11-08:00December 23rd, 2013|
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Six steps physician leaders and practice managers can take to improve the patient experience

Leadership sets the tone for the entire practice.  Staff will model your commitment and follow your expectations.  Much of the manager’s role focused on managing practice finances, maintaining practice viability, and keeping a highly motivated and efficient staff that is respectful and trustworthy.  Add to the list a new yardstick that changes how physicians get paid based on a patient experience that improves compliance to result in better outcomes. Develop a plan and set up programs to help staff understand how the patient experience relates to both outcomes and practice finances. Show your commitment through continued communication and actions that reveal a consistent effort to improve the patient experience. Give staff the education and tools to succeed in delivery consistency in your customer service organization-wide. Coach staff to improve performance.  Provide them with the support and encouragement with implementing essential changes on the road to being more patient-centered. Manage progress well.  This means conducting a baseline patient satisfaction study based on key performance areas and periodic follow-up to be sure targeted areas of improvement results in satisfactory results. Set your goals for becoming a best practice. Be explicit in what you expect and intend to achieve.  Honor each person’s contribution and celebrate successes that achieved along the way. Leaders have the ability to set the stage for success, instill a sense of pride and hope within the organization, and meet the challenges of strengthening the relationship between the clinical practice and the patients they serve.  In the end, we seek to improve the health of our patients, enjoy the relationship we have with patients and be among the best.  

By |2022-01-01T22:52:11-08:00December 14th, 2013|
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Upcoming webinar: know what patients really think

I will be conducting a webinar called “Nothing but the Facts: Find out What Your Patients Really Think, hosted by Kareo, on January 15th, 2014.   Physicians and staff typically focus on what’s clinically the matter with patients and how to make them better. No question this is paramount, but there’s more to the patient experience. It’s time to find out if you are really meeting the patient’s expectations.  This webinar will talk about the importance of conducting patient surveys to get the real facts about your patients’ level of satisfaction. You will discover key factors that influence the patient experience, and why healthcare reform is making this a priority.  You will discover the impact of patient satisfaction on the overall practice performance. You will learn the technical details involved with conducting surveys that tell you what your patients need from you, and how to get the most out of the feedback information you gain.   You cannot assume how patients feel about your practice.  Your patient service performance depends on getting facts and learning what it takes to be a best-practice when it comes to the patient experience.

By |2013-12-07T14:54:59-08:00December 12th, 2013|
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ACA out-of-pocket costs: Vindication isn’t always sweet

The New York Times reported today that "On Health Exchanges, Premiums Maybe Be Low, But Other Costs Can Be High." This is something we've been talking about for a couple of months now -- often getting skeptical looks here in our super-blue home-town.  But it's not about partisanship.  The ACA is simply accelerating the trend of payers pushing more responsibility onto patients -- a trend that has been gathering momentum for many years.  It's not unexpected if you've been watching how health plans have been evolving. Still, it is discouraging if you had hoped the exchange plans would offer better patient protection against big out-of-pocket costs -- and it also means that the burden that practices face to collect more of their revenue from patients keeps growing. The AMA's 2013 National Health Insurer Report Card (NHIRC), published earlier this year, revealed that health plans across the country were placing about 25% financial responsibility for cost of care onto patients: Aetna Anthem Cigna UHC Medicare 20.40% 23.10% 25.90% 23.40% 24.60% The target 2014 patient responsibility proportions that were set for all ACA plans skew even higher than this -- even the "silver" level, where subsidies are targeted, pegs patient responsibility at 30%: ACA Bronze ACA Silver ACA Gold ACA Platinum 40% 30% 20% 10%   These "actuarial values" were fairly widely reported prior to the exchanges even opening (here's one link from MSN), so it's a bit of a mystery why the Times is reporting this as news at this point.  It's critical that consumers understand what they're getting into when they sign up for coverage, and the media should have been on top of this key information.  (Especially if you've not purchased coverage before, the terminology behind patient responsibility payments -- co-insurance, deductibles, copayments, out of pocket -- can be very confusing. Many new patients are likely to be confused and possibly quite disappointed.) We expect that this means practices will need to be even more careful and sensitive in dealing with privately insured patients, especially in January, when deductibles re-set.  Some patients will be more confused than ever --

By |2022-01-01T22:52:11-08:00December 9th, 2013|
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Does your staff treat patients well?

Healthcare reform is placing the relationship between the patient and the medical practice front and center in hopes of improving compliance and clinical outcomes.   It’s all about strengthening the relationship between patients, their physicians and the entire practice and making patients feel valued.  Although physicians are working hard to strengthen their relationship with the patients, the staff seems to fall short. In 2013 Capko & Morgan conducted a patient satisfaction survey that spanned five metro areas of the U.S.  It revealed staff is falling short on making patients feel valued by their practices.  37% of the respondents felt the staff performed only adequately in terms of making them feel valued and respected, another 7% rated staff poorly, and suggesting there is much room for improvement.  So what can you do to get staff on board with providing a better patient experience? Talk about it.     Help staff understand that they are a reflection of the practice to every patient. It is an important role and they hold the key to making patients feel valued. Build in accountability.   Schedule a customer service planning meeting with staff to collectively set some performance standard dealing with staff-patient interaction. New Patients:  Every employee is expected to honor new patients and making them feel comfortable Get rid of the sign-in sheet. Introduce yourself and make a statement that welcomes them or thanks them for choosing your practice. Don’t just hand patients a clip board, explain why you need them to provide information and let them know you appreciate their cooperation. Thank them when they are finished. When rooming the new patient give some information about her new physicians to provide important reassurance that she is in good hands. All patients: Greeted with a smile and by name within one minute of arrival for a visit Kept informed of expected wait time in reception room and exam room Before ending the conversation with a patient ask “Is there anything I can help you with?” On the phone Staff will identify themselves by name. Callers will not be kept on hold more than 30 seconds without further communication

By |2022-01-01T22:52:12-08:00December 7th, 2013|
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An embezzling story to learn from

A marketing director for Castle & Cooke, a mortgage firm, is believed to have stolen almost $200K from her employer in less than a year of employment -- until she was caught and charged with fraud. While the case does not involve a medical practice or healthcare organization, it does offer some reminders about protecting a small office from internal theft. The employee allegedly ran up large false expense reimbursements and forged company checks -- both possible in any small business with inadequate controls, including medical practices. Practices can learn from this incident.  Check stock should be protected, and managed by a physician owner.  No one should be allowed to sign checks except a physician owner -- no signature stamps!  And owners should reconcile the bank statement monthly, so that any unauthorized checks could be spotted. Unauthorized expense reimbursements or charges are common routes to embezzlement in medical practices.  Be cautious about allowing employees -- even a manager -- unsupervised control of a credit card or an expense account with a vendor.  Review purchases "for the office" carefully -- make sure that everything on the Costco or Amazon bill can be accounted for in the office. Remember, not allowing temptation is the best way to prevent embezzlement -- and the best way to maintain a relaxed, family like atmosphere in your office, because you have less need to be suspicious of anyone.  Internal controls are a gift to your practice -- they protect against profitability loss while also helping to support trust and morale.

By |2022-01-01T22:52:12-08:00December 3rd, 2013|
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50% off Judy’s books: Secrets; Patient-Centered Payoff

Judy's publisher, Greenbranch, is offering a special holiday discount of 50% on all books through midnight (EST) on Monday, 12/2/13. If you were considering buying Judy's best-seller, Secrets of the Best-Run Practices, or her new book, The Patient-Centered Payoff, now is your chance to get them both at half off!  (The links go to the print edition, but ebooks are available, too.) Click here to shop at the Greenbranch site -- and use the code "Green" when you check out.

By |2022-01-01T22:52:12-08:00December 1st, 2013|
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The threads of payment reform and quality programs are coming together

It seems like forever now that practices have been dealing with multiple, complex, incentive and penalty initiatives from the federal government: Meaningful Use, PQRI/PQRS, eRx, PCMH and, more recently, "value-based" programs (value-based purchasing for hospitals, and the upcoming value-based purchasing modifier for physicians). If you're like us, the onslaught of these programs has seemed more like a series of separate carrots and sticks (amplified by private payer programs that have built on the government's pay-for-performance approach) than a coherent strategy for driving change.  Rarely do notices about these programs include helpful guidance as to how they're interrelated.  (Perhaps it would just be to hard to fit those details in amongst the deadlines, bureaucratic details and confusing specs!) That is why it is at least helpful to finally be seeing -- after years of programs popping up and interrupting practice operations, demanding attention without saying why (except when why was 'get a bonus' or 'avoid a penalty') -- the outlines of inter-connectedness among all of the government's many programs. For example, Medicare's Physician Compare website provides information about a physician's participation in various quality initiatives, like PQRS and ePrescribe.  (This is perhaps a good opportunity to remind you to check this -- and all -- the directories in which you or your providers are listed.  There are often errors -- if contact, specialty or location data is incorrect on a key directory, it can cost you patients.  And if the CMS has incorrect data about your participation in important incentive programs, you'll want to follow up on that immediately to remedy their data or your submissions.  As we say all the time, this need to check goes for payer directories (!) and public directories like Healthgrades and Vitals.) Anyway, a sample of quality participation data as it is displayed on the Medicare site appears below.  For some patients, knowing you're participating in these programs could make the difference in selecting your practice: Besides PQRS participation, the Physician Compare site shows participation in ePrescribe and Meaningful Use as well. Of course, the integration of this data into directories is just the beginning. 

By |2022-01-01T22:52:12-08:00November 26th, 2013|
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Reduce medical ID theft risk: check patient IDs at your front desk

Are your front desk staff members verifying ID and insurance cards when checking patients in?  If not, they should be.  Here's why: Checking ID is your first line of defense against medical identity theft -- and your patients'.  By checking ID and comparing against the name in the record, you can confirm you are actually treating the patient (and not someone who stole or "borrowed" their insurance card).  By asking for ID, you protect your staff against accepting fraudulently presented insurance, and protect your patients from medical identity theft.  (Besides the hassle and financial consequences of medical ID theft for patients, there can be clinical consequences, too, because their records will be updated with the health information of the person using their insurance.  The consequences of this can potentially be deadly -- and very difficult to fix.) Checking ID provides a convenient way to verify address at the same time.  Patients may have moved and not realize how important it is to let your staff know.  Invalid address information can cause claims to be denied -- especially from the CMS.  This is an entirely avoidable hassle.  Checking ID gives your staff a chance to ask the patient, "is this your current address?" While your staff should always check ID, it's not necessary -- or desirable -- to scan or photocopy the ID; it is best not to store this personal information in your systems.  (Plus, if it is scanned one time, that might discourage your staff from checking the ID itself next time.)

By |2022-01-01T22:52:12-08:00November 26th, 2013|
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Still time (but not much!) to avoid a PQRS penalty in 2015

There is still time for providers to avoid the PQRS penalty for 2013 reporting, which will mean a 1.5% deduction from Medicare reimbursements in 2015 (ouch!).  The following two methods still apply for individual providers: -Submit via a qualified EHR vendor -- if your EHR is provided by a vendor that has been permitted by the CMS to submit directly, submitting data could be much easier than you think.  Be sure to contact your vendor to find out what their capabilities are.  Even if not qualified to submit directly, your vendor may be able to help you submit via a registry -- the second method available to not just avoid the 1.5% penalty in 2015, but also earn a .5% incentive for 2013. -Submit a single, valid measure via a single claim.  You can do this!  This approach will not permit you to earn an incentive this year, but you will avoid the penalty in 2015 -- and you'll have gotten your feet wet for more comprehensive compliance in 2014.  (Do it now -- don't delay -- to be sure your claim is accepted and qualifies.)      

By |2013-11-24T17:46:46-08:00November 24th, 2013|
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The faulty statin risk calculator: more on using your website and EMR to communicate

Well, the new, evolving, confusing statin news appears to be a gift that keeps on giving.  (Only practices that are fielding loads of calls from confused patients are probably considering it just the opposite.  An anti-gift that keeps on giving perhaps?) In case you haven't heard yet, the New York Times reports today that the risk calculator provided by the American Heart Association and the American College of Cardiology appears to be flawed.  The calculator may be significantly overstating patient risk and suggesting that millions of people who don't need statins should be considered candidates to take them.  (I won't get into the details here -- the Times article does a nice job of simplifying what might have caused the problems with the calculator.) But I will take the opportunity to point out, as I did last week, that confusing and unnerving media stories like this create an opportunity for your practice to use technology to help manage contacts from confused or nervous patients while also reinforcing your practice's bond with them.  Your website or social media presence can be a great way to remind people not to change their own treatment plans without advice from their physician (for example, if this is the message your physicians feel should be emphasized).  And your EMR can become a helpful tool to quickly identify your subset of patients who might be confused so that you can reach out to them proactively. Imagine how grateful an anxious cardiac patient might be to hear from your practice with clarification about this news, and whether he needs to worry about it.  Your EMR can make reaching out like this a lot easier (yes, an EMR can make something easier!) -- and you can possibly meet a needed Meaningful Use measure at the same time.

By |2016-08-19T17:37:29-08:00November 18th, 2013|
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