medical practice business

Join our founder, Judy Capko, for a free webinar sponsored by Kareo: "How to Implement a Successful Patient-Centered Program."  The focus of the webinar is the Patient-Centered Medical Home (PCMH) -- how to implement it and what it means, revenue-wise, for your practice.  Among the topics Judy will cover are: The seven guiding principles of the PCMH Key program standards and metrics used to determine and measure success How technology contributes to efficiency and reporting needs Appropriating payment based on value-added components To register -- for free! -- visit this page: http://go.kareo.com/webinar-info-web-20130821.html

Today's Physicans Practice blog has a great tip for primary care and urgent care practices: negotiate with payers for higher after-hours reimbursement.  A key negotiating point: compare costs for seeing the patient versus referring them to the ER (that ought to get some payer attention!). It's important to understand the differences between several different codes that apply (99050, 99051, 99053) to properly bill for services, and to establish a pattern -- read the full post to learn how: How to Code, Negotiate After-Hours Reimbursement at Your Practice  

The Washington Post has a great article today about criminals capitalizing on uncertainty and confusion about Obamacare to defraud patients, especially elderly Medicare patients. Scams involve contacting patients and claiming to be navigators from Obamacare calling to "set up your Obamacare card" or collect information "required to maintain Medicare."  Fraudsters make these claims to persuade victims to reveal financial and medical identity information. Read the complete article here.

A new Harvard Business Review blog post spotlights the benefits of friendships between team members in increasing employees' commitment to their work and their organization's mission.  A wide range of organizations -- from Southwest Airlines, to Google, to Zappos -- were noted as examples of companies that had achieved a high degree of comradeship, even a family-like culture, by instilling a sense of shared mission and purpose.  In turn, this creates higher performance and lower turnover -- not to mention a workforce that gets excited about showing up every day and contributing. The idea that a shared mission can enhance teamwork and performance is great news for medical practices! Employees are often drawn to the healthcare field because they share a sense of service to patients.  This common sensibility gives practices a big head-start on building bonded teams. Choosing employees who connect with your practice's culture and mission -- whether it be integrative medicine, leading-edge research, superstar surgery, sports medicine, community service, a high-touch, concierge model, or any other defining practice identity -- is the first step to creating a team that gels naturally.  From there, the key is allowing teamwork and bonds to form, and encouraging them as they develop.  Creating projects that allow staff to participate actively in extending your practice's objectives -- special clinics, marketing programs, patient satisfaction goals, etc -- is a great way to extend and build on natural connections between team members.  Be sure your team feels they have both the means to contribute to the mission and a voice, and you're on your way to creating the esprit de corps that is a hallmark of a high-functioning team.  

Turns out that even Google finds it difficult to hire the right people.  Google has a history of being notoriously single-minded in its quest to hire "the best and brightest."  In Google's case this meant that only applicants that had advanced degrees from elite institutions and graduated at the top of their classes need apply.  In a recent interview published in the New York Times, Google's Laszlo Bock, Senior Vice President of People Operations, discussed some surprises that emerged from studying Google's hiring techniques. If Google is right, virtually nobody is better than anybody else at interviewing prospective employees. High GPAs, test scores and skill in brain teasers are all practically useless.  According to Laszlo, the best interviewing questions are those that uncover both how a prospective employee behaved in a situation and their attitude toward a particular work challenge.  Using a consistent set of questions that probe an applicant's behavior - such as how they solved a problem - and attitudes seems to be most useful. Google now asks all employees to assess their management twice a year. In our experience far too few practices take the time review the performance of managers from the perspective of those that they manage. Employees should have an opportunity to rate their managers on their transparency, clarity and fairness. Providing honest feedback to managers is essential if they are to improve their performance. Performance in this case means increased staff morale, lower turnover, higher patient satisfaction and, of course, higher profitability. Leadership is often a week area within medical practices. Key leadership attributes are fairness, consistency and predictability. With a challenging day-to-day workload, many practice administrators and physician leaders fall short on these measures. These shortcomings affect not only staff morale, but also the bottom line since staff often disengage from refining office procedures that can improve patient care and profitability. Read the short interview here: http://nyti.ms/1cOFANS        

We give a lot of webinars, and we watch a lot, too!  It can be so tempting to do other things while the webinar 'plays in the background' -- but, then you pop your head up and realize you missed one of the more valuable tidbits.  You also realize that you're neither attending the presentation nor really doing a great job on your other work.  A bit of a lose-lose, as opposed to the multi-tasking you were aiming for. One of the best things about the internet is that so many great people are sharing their knowledge with the world -- often for free or at a fraction of the cost of a conference.  But, the information loses its value if you don't fully engage with the material. Today's Harvard Business Review tip discusses this very problem -- with a few great tips to get more out of any webinar.  Really, it all comes down to taking it seriously -- just as you would any presentation you weren't able to watch while writing emails or wearing your pajamas. By the way, the HBR tips focus on turning a webinar into an event -- inviting colleagues, distributing notes, etc.  But, if you're not able to do that, we have another tip for you:  Watch the recorded version of webinars that contain really important data -- either on a weekend or after the workday (i.e., at a time when you can put other things aside). Here's the link to the HBR tip.

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Recently, we worked with a practice that had been victimized severely by internal theft.  This theft was facilitated by the practice's failure to take advantage of EFT of payer reimbursements -- instead receiving checks from many of their contracted plans. The physicians had trusted the practice manager when she said that EFT had been elected whenever available (naturally, embezzlers always rely on goodwill from their employers!).  But, had the physicians been on top of HIPAA rules regarding EFT -- intended to standardize and encourage EFT by January, 2014 -- they might have been more skeptical of the manager's claims that EFT either "wasn't available" or "was in process." Checks received at your office can be a temptation for would-be embezzlers.  It's unfortunately not all that difficult to deposit checks made out to your practice to a different account (ATMs, for example, can be a way to deposit checks to an account with an entirely different name -- and, of course, some embezzlers are crafty enough to set up a new account for themselves with a similar name to your practice's). It's rare that a payer won't pay your practice electronically, direct to your account, if you ask them to -- and, in a few short months, there will be a standard for all payers to pay this way.  Be skeptical if an employee claims that it is difficult or impossible to avoid receiving checks in the office.  Even if you prefer to receive checks -- say, because you're concerned about matching up advice notices with payments, or because you're worried about direct deduction of payment retractions or other unexpected adjustments -- remember that a lockbox service at your bank can help keep temptation (and access) at bay.

Last week at the Florida MGMA conference, I had the pleasure of presenting to their lively group on a decidedly unpleasant subject: embezzlement and medical identity theft at physician practices.  While internal theft is such a disillusioning topic -- embezzlement has frankly become part of far too many of our engagements recently! -- presenting ideas for preventing and spotting it to motivated practice administrators does at least have the upside possibility of helping administrators thwart would-be criminals before they get too far with their nefarious intentions. In fact, I was reminded by a participant that the very best way to stop an embezzler is not to hire him or her in the first place!  When I put up a slide showing article clips and pictures of medical practice employees who'd recently been arrested and charged in FL for stealing from their organizations, one of the attendees raised her hand to say she'd actually interviewed one of them recently for a job.  Thankfully, this administrator had noticed that reference checks were fishy -- references were unwilling to discuss the candidate for the most part -- until one person simply revealed, 'check arrest records.'  This was all the clue the savvy administrator needed to dig deeper and find out what she needed to know to avoid hiring someone who'd recently been fired for stealing. It's stunning to realize that that the candidate was apparently interviewing for the job while out on bail (and charged with stealing over $1MM over several years from her prior practice), without, of course, admitting this fact.  Kudos to the administrator for persisting when references were reluctant to talk.  There is a common misconception that it is better to say nothing than to tell the truth of why an employee was dismissed -- even when not revealing the reason exposes others to potential harm.  (What if the employee had been dismissed for stealing patient identities?  Not alerting other practices to the risk could jeopardize patient information at the next practice that hires her -- and even expose the first practice to liability for not fully responding to the

A friend of mine recently shared a pretty disappointing experience she recently had with her primary care practice when she sought treatment for a painful, infected spider bite.  Or, perhaps I should say, an experience she had with her former primary care practice, since the practice refused to see her -- stating that she was no longer a patient because she hadn't been in for a visit for three years, and therefore "couldn't be seen" until she scheduled a new patient wellness exam. My friend was told that this was the policy of the IPA that the practice was part of -- and that she had "no choice but to go to urgent care."  In this context, urgent care was presented to my friend almost as sort of a downgrade -- like, "go wait in line at urgent care." It felt to my friend -- who was already a bit nervous about her injury -- like the practice really didn't care about her at all. Luckily, the urgent care center they recommended was friendly and appealing, and a doctor saw her quickly and treated her infection (which turned out to be spreading alarmingly fast) carefully and attentively.  Not surprisingly, the doctor at the urgent care center was happy to let her know that he could also act as her PCP -- and, my friend is considering making the switch, even though she had been with her prior practice for nearly 20 years! Why did the PCP risk losing such a valuable patient?  (Besides being a long-term patient herself, my friend has two teenaged children who will soon need to graduate from their pediatricians.  So, that's three patients potentially sacrificed for lack of a recent wellness visit.  Moreover, my friend is the ideal patient for primary care: pays her bills at time-of-service and is always diligently compliant with advice.) One guess is that the IPA doesn't want to miss out on the chance to bill for a new patient wellness visit at a higher rate.  (The practice may not even realize this is an underlying motivation.)  But, is that $50 or

Since I started my career in the publishing world, Marketo's post today about their "Facebook Editorial Calendar" caught my eye.  While the idea of calling Facebook posts "editorial" is perhaps a tad grandiose, the concept they're describing is really helpful for the idea-challenged social media maven. Their basic idea is to assign a post type for each day of the week -- famous quotes on Monday, statistics/infographics on Tuesdays and Thursdays, etc.  A medical practice using Facebook could adapt this idea -- say, copy the motivational quote idea on Monday, have a nutrition tip on Tuesday, explore or debunk a news item on Wednesday, have a link to a helpful site on Thursday, etc. Have you experimented with the idea of organizing your posts into assigned daily categories like this?  We'd love to hear about it! Here's a link to Marketo's idea.

I used to do a lot of work on airplanes.  But, that was back in the olden days when I flew for work internationally -- I had elite status and so almost never flew coach.  It's a lot easier to get something done when you can actually fit your laptop on the tray-table in front of you (pretty difficult in coach these days -- especially if the person in front of you tilts back even a little). Besides the shrinking seat-space problem, Bloomberg Business Week adds a few medical reasons to skip cracking open the laptop: you're headache-y, you're forgetful, your heart's working harder, etc.  (I'm still confused about why they seem to assume most people have hangovers, however.) But, they left out one reason that I think might trump them all: no privacy.  Recently, I was on a flight and the person in the row in front/across from me opened up her laptop, clicked onto the plane's WI-FI, and began working in her practice's Practice Fusion EMR.  (Yes, I could clearly see it was Practice Fusion.)   Potential privacy violation?  I wondered how many records the people directly next to her could see -- and what a morally challenged individual might do if she left her computer open while in the bathroom line.  You really never know who you're sitting next to on a flying bus, after all.

Given the maze that is healthcare today, it makes sense that navigators to help patients understand the path to care would be a wonderful way to improve outcomes -- especially for the critically ill and under-insured.  Research from Accenture shows they also improve the bottom line. Read the post on the Harvard Business Review blog.

Regarding my post of a few days ago about the marketing webinar Judy and I did for Kareo -- apparently a technical glitch has prevented Kareo from posting it.  They're working on it and hope to have it up within a week.  If you want to access it via an alternative source (gotomeeting's archive -- requires registration), send a message to our "info" email and I'll send you the details.

Branded thumb drives: isn't it great when you get one at a conference?  They're so handy to have around!  But, that handiness also makes them a risk for your practice. Even having a policy against downloading patient records to an external drive may not be enough to make thumb drives worth the risk: as this story from the Salt Lake Tribune   illustrates, just having a policy isn't enough if people aren't aware of it (or choose to ignore it).  Although the employee in the story -- who downloaded 6,000 patient records to a thumb drive, and then lost it somewhere en route between UT, CO and DC -- was fired, the missing records could still be found by someone with less-than-honest intentions.  And, the woman's employer, a Medicaid claims processor,  did have a policy against downloading patient records -- the "star employee" just didn't know about it. Of course, while this fired downloader seems to have had purely innocent intentions, the story also illuminates how easy it would be to download thousands of records onto a drive and slip it into a pocket -- and later sell those records to criminals.  Some estimates put the value of patient medical identity data at $50/patient or more on the black market. That's why you probably won't see a Capko & Company branded thumb drive as a gift any time soon.  Even though they're irresistible!

Just published a new long-form piece in PracticeLink magazine -- it includes so many great ideas contributed physicians and marketers from a wide variety of specialties (e.g., OB/GYN, rheumatology, radiology, urology, and more).  Really creative ideas like forming your own networking group, using charitable work to expand your business, and bolstering your confidence about thinking outside the box.  Real solutions from the trenches! Check it out at magazine.practicelink.com.

Judy Capko and Laurie Morgan presented a webinar on "Marketing for Medical Practice Profitability" sponsored by Kareo last week.  If you missed out on the chance to join in, Kareo very kindly makes all their webinars available on their website at: http://www.kareo.com/resources/webinars -- this one should be available by the end of the day on Friday, March 29.  

For those of you following the Healthgrades situation we've been working on -- i.e., hospitals 'claiming' individual physicians' listings without the physicians' permission, rebranding the pages with hospital logos and information, and diverting calls to a call center for the benefit of the hospital -- here is an update. On the plus side, Healthgrades did respond to our request to remove the hospital branding from our doctors' listings -- they referred to this as removing the hospital 'module.'  The listings now show with the physicians' numbers only, and the hospital-branded wallpaper and other artifacts have been removed. Regarding our questions about why Healthgrades allowed this takeover of listings to happen in the first place, the response from them was less satisfactory. They asserted that "just like Facebook," they "own all the content" and "have a right to sell advertising against it."  I pointed out that Facebook -- despite all the privacy criticism it generates -- does not actually do anything approximating diverting people to a third party's phone center. (!)   Additionally, when I asked them why this was done without the physicians' permission, their answer was that "the hospitals all contacted the physicians" -- but, I know for a fact this is untrue.  And, if Healthgrades "owns all the content," then why would it be the responsibility of an advertiser to validate Healthgrades' content? As an aside, I do have some personal experience that is quite relevant to this situation.  I worked in media for more than 15 years, and even owned and published a yellow pages-style directory.  It's simply not the case that diverting a prospect who is looking for a particular person or business to a call center for the benefit of a third party (or the directory) is typical revenue-generating practice in media.  It is one thing to take public information to build directory listings -- that's acceptable and reasonable, and if the physician gets extra exposure and awareness from it, that's a good faith type of trade-off.  But, leveraging the physician's own awareness generating efforts and referral pipeline development to drive callers to a hospital's call