If you've followed us for a while, you know I've been urging practices of all sizes to take their payer directory listings more seriously for years now. It's not that insurers shouldn't do a better job. It's just that (as someone who once owned a directory company) I know how hard it is to keep directories accurate, especially if it's not your core competency (like, when your actual job is providing health insurance). It's also something that requires effort on both sides to be done properly. There's just no way around this. The insurer can't be expected to know when anything changes on your side unless you inform them. And while insurers should do a better job of accurately publishing information you provide them, mistakes are inevitable. It's up to you to catch them and make sure they're fixed. And it's absolutely worth monitoring and correcting your listings! I can think of few marketing tasks that are more directly connected to attracting new patients. Patients want to know that you're (1) in their network (2) accepting new patients and (3) convenient to them before deciding to contact you. If you're not listed accurately in their health plan directory, you're basically turning them away at your door. More on the latest study showing directories just haven't gotten any easier to maintain: https://www.healthcaredive.com/news/inconsistent-physician-directories-no-surprises-act/645307/
A new PAMF (Palo Alto Medical Foundation) study on the connection between EMR and physician burnout is getting a lot of attention. The study has limitations (e.g., it focuses on one organization, one EMR and set of workflows, and it aims to infer much from a single question). But despite the need for caveats, the study is valuable because it confirms what intuition suggests about EMRs and physicians' stress. What's more, the authors tested workflow modifications and found they helped alleviate EMR-related burnout at PAMF. You can read about the study here. To summarize it, the study validated that when EMRs encourage message overload, they significantly increase physician stress. The study found that about half of all messages the physicians in the PAMF study received were EMR-generated--i.e., things like health maintenance alerts and medication reminders that the system generates automatically. The researchers found that many of these messages could be handled, or at least triaged, by other members of the care team. For example, medication messages could be routed first to a pharmacist, who would involve the physician only if needed. Nurses and MAs could also handle much of the automated message volume, such as follow-up appointment reminders. Not surprisingly, when PAMF experimented with diverting these lower-complexity messages to others, the burden (and stress) on physicians decreased substantially. Can PAMF's solution work in your practice? PAMF is a large, integrated healthcare organization. Healthcare Dive reported that PAMF launched an initiative called MIST--Multi-Disciplinary Inbox Support Team--to test the idea of sharing the message workload. One year in, MIST seems to have helped reduce physician message loads (and stress) substantially. But what if your practice is not a huge organization with IT and workflow experts or pharmacists on staff? In our consulting work, we often recommend practices involve staff in more meaningful work. To enable physicians to focus as much as possible on tasks that only they can do (working at the top of their licenses), everyone else needs to do as much as they can. Expanding the roles of staff -- within their skills and scope, of course -- can help
Working in a medical practice, whether on the clinical or the administrative side, amplifies any tendencies one might have to try to do and control everything personally. Given the potential for serious consequences (to both health and finances), it’s not surprising that responsible healthcare professionals focus intensely on getting every detail right. The problem is that trying to do it all yourself has serious consequences of its own. It can even lead to the very problems you’re trying to avoid. When an employee first takes on management responsibility – such as when workload grows, and staff are added to handle it – personally doling out tasks may seem like the best way to utilize a new staff resource. But it’s not scalable. As the team expands, it gets harder and harder for a supervisor to manage the workflow while overseeing tasks so closely. That puts a hard limit on the amount of work the team can accomplish – and it puts the supervisor at high risk for burnout. The staff in these roles will also find them stifling – which can lead to poor morale and turnover that cut productivity. Designing jobs so that employees feel a sense of growth, independence, and accomplishment is a key competency for new managers who want to become leaders. The goal should be to help all employees reach their potential through work. Allowing employees to stretch and learning to trust them with critical jobs can be challenging for managers who’ve been promoted because they have been the best in those same roles. But if managers don’t learn to do this, they hurt the practice. They will also limit their own professional growth. Planning for succession is an essential part of managing well. If your practice or a key department would fall apart if the manager leaves, that’s a management failure. A strong manager always adds value in the job, but also organizes their team so that work gets done without micromanaging. If you’re a practice owner or a practice leader who manages other managers, give some thought to how well-prepared your teams are to
We recently worked with a smart, energetic practice administrator who was very motivated to improve his practice’s bottom line. He’d already found significant savings by switching billing and phone services (even getting better billing results, to boot). Spurred on by those successes, he’d turned his attention to clinic staffing. While the physicians in his practice mostly used conventional medical assistants (MA) for support, a few of the doctors and non-physician providers (NPPs) had opted to use “scribe assistants.” These hybrid staff help clinicians by both scribing during the visit and handling typical MA tasks like test orders and scheduling follow-up care. Because of the extra duties, and because they were hired through an agency, their hourly cost was a bit higher than for the MAs – a 15-20% differential that caught the administrator’s attention. The administrator estimated the hourly cost of hiring a new MA would be about $20, including taxes and benefits. The scribe assistants, meanwhile, cost the practice about $24 per hour. The scribes did some tasks the MAs weren’t trained or expected to do – notably, scribing. But the administrator believed that at least one of the NPPs who was currently using a scribe assistant could do just fine with an MA (she was a recent grad and tech enthusiast). So the administrator decided to suggest gradually switching some of the contracted scribes with employed MAs – and was surprised that his idea met with resistance. (After all, 18% would be a significant cost savings – yet even some of the partners resisted the idea!) As the administrator repeated his idea at a few monthly meetings in a row, the resistance grew into a testier conflict. Was the conflict a sign the administrator was wrong to bring up the idea of saving money on clinical staff? We wouldn’t say “wrong” per se – but we might have not have prioritized this particular cost-saving avenue. It’s natural for clinicians to be wary of any changes to clinic staffing. Clinical support staff is essential to physicians’ productivity. Anything that disrupts clinic flow can make it harder for physicians to
Practice management literature often offers advice about cutting expenses – advice that promises cost-cuts improve margins and “directly boost the bottom line.” Many physician owners and practice managers seem to have internalized the idea, so they’re always on the lookout for things to trim. But is this the best way to strengthen your practice business? Some expenses do nothing to improve your practice. Paying more for identical supplies or credit card processing, for example, won’t serve patients better or boost efficiency. Once you start routinely cutting staff, technology, marketing, or materials, though, the risk of undermining productivity or the patient experience increases. It can creep in so slowly, you might not notice until profitability turns sharply south – when it can be much harder to turn things around. For example, if you’re busy, it may seem like you can “get by” without marketing. But today’s new patients probably reflect marketing efforts started months or even years ago. Cut marketing and you may see little difference – at first. By the time you notice a slowdown, you may be facing a year or more of significant investing before your volume returns. Staffing is another common focus of penny-pinching. Even a little bit of staff downtime can seem wasteful. Trying to trim staff so that employees are busy 100% of the time risks bigger problems, however. Without a bit of “excess” capacity, the impact of disruptions like employee resignations, sick time, or unexpected increases in demand can be much more expensive than the cost of a few “extra” employees. What’s more, too little support also undermines physician productivity, which has a much bigger impact on profit. Global consultants McKinsey & Company published an excellent study showing how continuous efforts to improve margins – rather than build the business – can actually undermine profitability after a few years. Their advice: consider whether expense cuts you’re contemplating will negatively impact customers (patients), your ability to compete with other practices, or both. If you’ve been focusing on expense cuts for a while, you could be in the danger zone. Be sure to give building the
“Fix the problem, not the blame” is a well-known Japanese proverb. It sounds like common sense – isn’t fixing problems what we all ultimately want? But when mistakes happen, the search for culprits instinctively begins – and with it often comes demoralization and tension. Worse, the search for a scapegoat usually won’t keep problems from recurring. Bad systems create more problems than bad employees. When workflow is faulty, the mistakes are built into the process. Figuring out who was working the process when it failed does nothing to prevent failure in the future. As organizations grow and silos (i.e., departments) form, so do opportunities for workflow inefficiencies to masquerade as staff incompetence. We’ve worked with medical practices that have grown so fast, they haven’t noticed their processes aren’t keeping up. But even more than growth, market evolution has put new tasks on everyone’s plate. These tasks may not fit well with jobs as originally configured – and that may mean more errors. Here’s a common example. Insurance has become increasingly complex for patients and staff alike. Higher deductibles have also made front desk collections a priority, but it’s a new priority added on top of everything else. Are front desk employees already trying to answer phones, check patients in, answer questions, collect demographic information, and verify insurance? When patients are seen and it turns out they weren’t covered or aware they owe a deductible, it may seem “obvious” that the front desk staff is to blame – especially to your billers, who must deal with the errors. But more likely, front desk employees are simply juggling too much. As jobs evolve, mistakes may increase. Resentments can fester between departments. But the answer isn’t to find someone to blame – it’s to find out where the process breaks down. In the case of the front desk, a better response would be to reconfigure roles, to let staff focus on the tasks in front of them, without multitasking. As work gets more complex, making people feel embarrassed and afraid won’t help them do their jobs better – retraining staff and refining their
(c) Sheri Swailes - fotolia.com No-shows can be a huge drain on medical practice finances. Time that is booked but ultimately generates no revenue is a loss that comes right out of your bottom line. It’s similar to what airlines experience when they have an unsold seat – which is why airlines so often resort to overbooking, and some practices do, too. But if you've seen the negative media coverage about the impact of flight overbooking on passengers, you already know what a stressful gamble the double-booking “solution” is. It's all but impossible to predict which patients will fail to show up -- so you could end up with too many arriving at the same time. Even when overbooking helps reduce lost revenue, it can create other problems -- like long waits, rushed visits, and stressed out physicians -- that lead to unhappy patients and higher marketing costs. Practice managers and physicians often throw up their hands in frustration about how to deal with no-shows, especially if they’re already taking steps to remind patients, or perhaps even charging a no-show or late-cancel fee. There’s no doubt about it, trying to improve your practice no-show rate can be challenging. But there are a few ways to look at the problem that practices sometimes miss. Consider if any of these ideas might help you reduce the cost of no-shows to your bottom line. Reevaluate Your Appointment Slots Practices often have standard appointment slots that they haven’t reviewed in a while. We recently worked with a practice that had used only two slots for over a decade: 30 minutes for established patients and 45 minutes for new patients. When we looked at how long visits were actually taking, we found that more time was usually set aside for the visit than was necessary. Besides reducing the overall number of productive slots the practice had available, these over-long slots amplified the impact of any no-shows. Even a single no-show usually left a 45-minute hole in the middle of the schedule – ouch. By tweaking the timings just a bit (30 minutes for
It’s easy to monitor your employees’ every move with modern technology. So should you? The temptation is understandable. The key question is: Are employees motivated to do a good job? Or does getting the most from them require constant oversight? Intuition might suggest the latter – but experience says otherwise. In the early days of business theory, the idea that management was primarily about surveillance (and “cracking the whip”) was popular. But over time, managers learned that employees aren’t just a cost – they’re an asset. Beginning in the 1980s, lessons from Japanese companies illuminated the value engaged employees bring to an enterprise. Toyota, in particular, found that by encouraging employees to be more involved in decision-making, they could improve product quality and productivity. Toyota’s success at improving manufacturing quality – which endures today – started with trusting employees. A culture of trust and respect tells employees their contributions matter – in turn, encouraging and empowering them go beyond the rote requirements of their job descriptions. With engagement tied to higher productivity, lower absenteeism, and better customer service, it’s easy to see how engaged employees can uplift a medical practice. But it won’t happen without trust – and electronic monitoring is a sure-fire way to communicate that you don’t trust your employees at all. Rather than trying to control your employees with surveillance, consider setting goals and incentives that encourage the behavior you want. Rely on reports and data, not constant monitoring, to evaluate how employees are doing. Start by hiring carefully, so you don’t have doubts about trust right out of the gate. And relax a little: Most people want to contribute and do their jobs well. Give them the structure to do it, and you won’t need to watch them all the time. Another thought to consider: If the huge potential benefits of an engaged staff aren’t enough to make you rethink surveillance, remember that every minute a practice owner or manager spends on monitoring is one that can’t be invested elsewhere. Surveillance is very time-consuming (read: costly). Odds are there are more valuable ways to use that
Personalized, customized service has become the norm in our lives as consumers. We've come to expect even everyday items like coffee and sandwiches to made to our specific preferences. But when we're talking about the administrative side of the patient experience, customizing can seem like a much bigger deal. With so many other demands on our medical practice processes, is the idea of personalizing beyond our reach ... or even a little nuts? It may seem that way, but it doesn't have to be. The wonderful thing about offering more choices in how to do business with your practice is that so many of the options patients seek can be cost-saving for you. For example, studies have shown that consumers prefer to pay bills electronically over sending checks. The trend towards paying online, on-the-go, at any hour of the day has become so pervasive, many people don't keep stamps or even checks on hand. If you're not allowing your patients to exercise this preference, instead hoping they'll mail a check (or only taking credit card payments by phone or in person at the office), you're making it harder for patients to pay. That probably means you're getting paid more slowly -- and at higher cost to your practice. But what happens if you do offer patients the ability to receive statements electronically and make payments that way, too? When patients can pay electronically, it's easy for them to do it immediately -- even if they receive your bill at 10:00PM. They avoid the unpleasant feeling of being behind on their bills, and your staff avoids the more unpleasant task of calling them to collect. And you'll get paid faster -- at less expense, since staff won't have to spend time on the phone with the patient or stuff an envelope with a statement. Best of all, when you implement an option like a payment portal or automatic debit, your patients will thank you for it, even as they're paying you more promptly and reliably. Electronic patient payments are just one of several examples of technology-enabled services that conserve staff resources
(c) Michael Jung-fotolia.com Summer's here! If the change of the season has you thinking about reading on a beach, a back porch, a dock, or a hammock, we've got the reads that you need. Judy and Laurie have both published new books. They're both easy reads packed with intriguing case studies of real practices -- the furthest thing from a dry textbook. And you'll find they're full of practical ideas you can readily implement to make your practice run more smoothly and profitably. (We'll understand if you want to wait until fall for that.) In celebration of Judy's latest edition of Secrets of the Best-Run Practices (released just in time for summer), we've got a special offer. Buy both Secrets and Laurie's book, People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business, and we'll send you a $5 Starbucks card you can use for the perfect cold (or hot) beverage of your choice. Here's how it works: Buy Secrets of the Best-Run Practices (3rd Edition) Buy People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business Send us proof of purchase: your emails from Amazon or other retailer, or even a photo of the two books will work (email "info" at capko.com) We send you your $5 Starbucks card! If you bought either book in 2017 and can provide proof of purchase, that works; you don't have to buy them at the same time. And if you want to buy the books for someone else (like your practice manager), you can tap into the promotion up to three times. This promotion runs through Labor Day 2017 -- you must purchase both books by then. Prefer ebooks? Visit this page for the ebook version of this promotion. Questions? Feel free to contact us.
Recently, the check-in automation company Phreesia invited me to write an ebook on one of my favorite topics: the patient-centered practice. It's called "Beyond Five-Star Reviews: Why the Patient Experience Matters, and How to Improve It," and it's available free with registration -- just click on this link. The idea of being more patient-centered and creating a better patient experience attracts more controversy and confusion than it should. The bottom line is that being more patient-centered fits with clinical goals as well as business ones, because it may help patients become more engaged and more receptive to clinical advice. "Patient-centered" is not about chasing positive reviews, and it's not about being patient-led. It's about understanding the patient perspective and communicating that you do, while also maintaining your practice's clinical integrity and mission. And it's about focusing on administrative processes patients interact with every day that can make your practice more or less welcoming and convenient for patients. The ebook contains some ideas that any practice can implement to improve the patient experience. I hope you'll check it out -- download it here.
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
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
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!
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.
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.
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
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
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.
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
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.
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
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.
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
What's the worst thing that can happen when you staff aren't trained to manage patient deductibles and collect up front? It's not that you won't ultimately get paid. There is something worse that can happen, and it's not that uncommon: your practice can end up losing the revenue for the service and losing the patient. Here's how it can happen. An ill patient comes in for a service and doesn't realize she's financially responsible for the entire cost. No one who interacts with the patient ahead of the service -- not the scheduler, not the person who calls her to remind her -- lets her know she'll be financial responsible, or estimates her costs. The patient arrives, hopeful she'll be paying just a copayment. And the front desk makes her day by charging only a copayment! "You might have a balance, we're not sure. Don't worry. We'll bill you," the receptionist assures her cheerfully. The patient relaxes. But when the patient receives the bill -- six weeks after that service she really needed -- she's shocked to find out that she owes hundreds of dollars more. Her insurance didn't cover any of her visit or her tests, because she has a $3,000 deductible to meet first. By now, though, this patient needs another visit for follow-up care. She calls to schedule the appointment. "WARNING: PAST DUE" pops up on the scheduler's screen. "Oh! I need to alert you that you'll be expected to pay your past due balance in full when you come in for your visit," the scheduler reminds the patient seriously. The patient is embarrassed -- and worried that she can't pay that full amount at her next visit. She needs the care, but, on the day of her appointment, she thinks about the prospect of being confronted at the front desk for an amount she can't pay in one lump sum -- and about the fact that she'll be adding to the balance due. She weighs her options -- and no-shows on her appointment. She needs to be seen, but the embarrassment outweighs that need in that
How many times do you walk down the hall and see empty exam rooms or alternatively, how often are they filled but you still have patients waiting to be roomed and the doctors are running behind? If nothing is going on in the exam rooms there is a financial cost to the practice; whether the room is empty or is occupied by a patient that is kept waiting. Ideally, if you have three rooms for each provider, this results in the physician in one room, the nurse rooming another or giving post visit patient instructions and a third room in transition by patient getting undressed or dressed and nurse preparing room for the next patient. It takes efficient and consistent facilities and processes, and optimizing the clinical staff’s time to make this happen. Depending on the specialty it may also require additional triage space or diagnostic space for pre-visit care such as cast removal, x-ray or blood work. The first step to finding out how efficient you are with your exam rooms requires taking a critical look of the use and function of space and human resources. Most EMRs now have the capability to track a patient through their visit from the time of check-in, when roomed and when the provider enters and leaves the room and when the patient is checked out. Use this information to analyze the variables and establish reasonable standards for the patient flow process that addresses how much time is needed for: Rooming a patient and preparing them for the visit; Clinical time each provider needs to spend with the patient; and Post-visit instructions and documentation Going through this assessment offers the practice an opportunity to identify which processes are efficient and standardized, and which ones have little or no value and can be eliminated or automated. It also allows you to explore how well you are using your resources and how to optimize them. For example, do you have the nurses doing everything their skill level permits to support the provider and is the provider consistently delegating processes to the staff that don’t require
If you missed Laurie’s webinar, “Front Desk Collections: the New Linchpin of Profitability,” here’s how to watch it now
If you missed Laurie's webinar, "Front Desk Collections: the New Linchpin of Profitability" (sponsored by Wellero) -- one of her most popular webinars ever! -- you're still in luck. Sign up here and watch it whenever you like. This practical presentation hits on some ways you can immediately increase profitability while avoiding pitfalls that can erode your practice's financial health. Take a look (it's free to sign up), and, if you have questions or comments after watching, please don't hesitate to contact Laurie. [yks-mailchimp-list id="87d94b707e" submit_text="Submit"]
Medical practices are taking note of the importance of strategic planning, as they tread the unknown waters of healthcare reform and adapt to changes they may not have invited if given a choice. But do the key stakeholders of most private medical practices really understand what it takes to succeed with efforts to create and successfully execute a strategic plan? Do they know the importance of developing an authentic and that in order to be authentic it must be driven by the practice mission? If the strategic plan is not authentic in consistently delivering on the mission it is likely to fail. But if it is authentic, it will guide the practice in achieving its strategic goals. Start on your path to strategic success by keeping these essentials in mind while going through the strategic planning process. Begin the strategic planning process by making sure the plan encompasses what the practice is all about and what it represents to the community. This means the goals and the decisions outlined in the strategic plan must be aligned with the practice’s mission and vision. It is important to articulate the significance of this from the onset and revisit it as you go through the many processes of strategic brainstorming, goal-setting and formulating the written plan. This helps ensure that the decisions and actions identified in the strategic plan are authentic to your very purpose in being a medical practice. Next, identify what differentiates your practice from its competition. It is critical to examine market data to understand external factors that may impact the practice now and in the future. It is also critical to take an objective look at the practices strengths and weaknesses, exploring what opportunities this presents and what obstacles must be overcome. Sometimes, this is referred to as a "SWOT" analysis, for "strengths, weaknesses, opportunities and threats." These analytical steps help the practice address issues it must contend with and make appropriate strategic decisions based on the reality of your market position. Practice-wide engagement is needed to succeed with implementing a strategic plan. This means communicating your strategic goals
The Patient-Centered Medical Home is so much more than just a payment innovation -- it's an idea that appeals for clinical reasons to so many physicians and practice managers, who were already aiming to provide the higher level of care-coordination and patient engagement that is the foundation of the PCMH. But many small practices we work with have been nervous about the hurdles for certification -- is it too much for a solo or two-physician practice to take on? A recent AAFP blog post offers a wonderful idea for smaller practices daunted by the prospect of tackling the PCHM checklist on their own: form an informal network with other, like-minded practices in your area, and divvy up the research and learning. What a great solution -- and a great way to expand your connections with other professionals in your community. Read about it here.
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!