practice improvement

New EMR/burnout study: Can your practice benefit from its findings?

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

By Morgan|2022-01-01T22:51:44-08:00July 7th, 2019|

From manager to leader [practice management tip: leadership]

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

By Morgan|2022-01-01T22:51:45-08:00November 28th, 2018|

Cost-cutting: pick your battles wisely

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

By Morgan|2022-01-01T22:51:45-08:00October 15th, 2018|

You can’t cut your way to growth [practice management tip: financial management]

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

By Morgan|2022-01-01T22:51:46-08:00July 6th, 2018|

Does “personalizing” the patient experience sound impossible?

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

By Morgan|2022-01-01T22:51:47-08:00February 12th, 2018|

Need a summer read? We’ve got you covered — and we’ll even provide a beverage.

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

By Morgan|2022-01-01T22:51:48-08:00June 8th, 2017|

New ebook on the ROI of investing in the patient experience

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.

By Judy Capko|2017-03-27T08:19:14-08:00March 27th, 2017|

The power of managing details

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

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

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

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

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

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

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

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

The upside of staff downtime, the downside of multitasking

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

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

Obsessing about front office technology

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

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

The worst thing that can happen when patient deductibles aren’t well managed

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

By Morgan|2022-01-01T22:51:59-08:00June 14th, 2015|

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"]

By Morgan|2022-01-01T22:52:03-08:00October 27th, 2014|

Small practices: PCMH is not out of reach

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.

By Morgan|2022-01-01T22:52:08-08:00March 24th, 2014|

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 Judy Capko|2022-01-01T22:52:11-08:00December 23rd, 2013|

13 for 2013 Tip #10: Engage staff

Most practices have an underutilized resource - namely, their employees' ability to identify and solve problems. As practices deal with the day-to-day business, it's all too easy to fall into a routine-inspired complacency. To establish some positive momentum, make a point to ask each of your staff to identify problems and possible improvements - and give everyone an opportunity to contribute their ideas during your regularly scheduled staff meetings. We think you'll be surprised at the sources and quality of ideas that emerge. Be generous with your appreciation and praise and you'll see a staff that is happier and more motivated than ever.

By Joe Capko|2022-01-01T22:52:35-08:00February 4th, 2013|

Will 2013 be better than 2012? It’s up to you!

A new year has already begun! If you are hoping for significant year-over-year improvement you need to act – and sooner rather than later. Here’s how great practices help ensure that each year is better than the last. Examine past performance. Consider what data points are important to review. As a guide, great practices will compare their performance against at least these benchmarks every year: Total revenue per full time equivalent (FTE) physician Total operating expense as a percentage of total medical revenue Total visits/procedures per FTE physician Percentage of total A/R aged 120 days more Bad debt due to fee for service activity per FTE physician Determine what the numbers mean to you. Compare your performance between 2012 and 2011 to evaluate your year-over-year performance. Are you clearly performing better or worse? Then assess why there is a difference. If you did better was it because you were more assertive? Dit you have clearer established goals to guide you? Perhaps changes in performance can be traced to changes in staff or actions taken to improve contract reimbursement? Did you implement a marketing plan or are differences between years merely chance variation? If there was no change in 2012 or you did worse, you will want to take decisive action to make 2013 a better year. Plan for 2013. Of course, given the challenging business environment, leaders of improving practices make planning a priority. I recommend a strategic planning session be scheduled well in advance. Scheduling an off site meeting in early February can minimize interruptions. If you have a skilled communication facilitator on your staff, and your practice isn't facing especially serious challenges, your practice might conduct your meeting without an outside consultant. On the other hand, a consultant can increase the value of strategic planning sessions by facilitating communications on difficult topics, providing an objective overview of your practice’s performance, helping you understand your position in the marketplace, and assisting leadership in determining goals for the upcoming year. Practice leaders it is not too early to think about the steps you can take to protect and guide the practice’s

By Judy Capko|2022-01-01T22:52:36-08:00January 16th, 2013|

13 for 2013 Tip #2: Analyze your E&M code utilization

For most practices, E&M codes represent a significant portion of billings -- and, for some practice types like pediatrics and other primary care, E&M codes can approach 100% of billings. Physicians and non-physician providers are often so sensitive to the risk of down-coding, denial or audit that they develop a bad habit of 'defensive' E&M coding -- i.e., sticking to the lower range of the codes for virtually every patient. Far from being an effective defense, though, this type of habitual coding may actually create more audit risk, since it leads to a distribution of codes that is skewed rather than the expected bell-shaped curve. And, it does so while also leaving thousands of the practice's dollars on the table! The end of one year and the beginning of another is the perfect time to analyze your practices E&M coding patterns -- and set new habits for the new year. Run a report for each physician by code for the full year, and you can create a table like this that totals how many times each provider used each code: code 99201 code 99202 code 99203 code 99204 code 99205 Total Anderson 12 252 900 12 24 1200 Buford 0 132 996 348 0 1476 Cochrane 12 996 96 0 0 1104 Delaney 0 36 732 432 120 1320 Elliott 12 48 1092 156 24 1332 From this data, you can easily calculate percentage utilizations to get a clearer idea of distribution -- and from there create a chart to spotlight any skewed coding: E&M Distribution Chart E&M Distribution Chart Notice the skewed utilizations of Cochrane, Anderson and Elliott? It's unlikely these codes are accurate -- especially Cochrane, who appears to be habitually and defensively under-coding. (Note, also, the addition of the CMS averages to the chart -- available from the CMS website. This is a great double-check to see the typical coding mix based on all practices billing Medicare -- and to get a sense if your coding patterns will look odd (or audit-worthy) to the CMS.) Next step: identify the number of instances of

By Morgan|2022-01-01T22:52:37-08:00January 8th, 2013|

Beware of opportunity costs

Recently, we worked with an OB/GYN practice that had taken some big steps to reduce staff costs. In particular, the practice was concerned about their long-standing process of providing new maternity cases a lengthy consultation with an RN -- covering all the information a newly pregnant woman would need, and offering her a relaxed opportunity to ask questions. Because the RNs were paid at $22-$25/hour, the practice manager and managing physician partner felt that these consults were an extremely wasteful expense. They reasoned that the consults could be easily incorporated into the initial physician visit -- adding 15 or 20 minutes to the visit, instead of paying for 30-45 minutes of RN time for the consult. The maternity visit with an OB would be included in the patient's global payment -- no additional revenue would be generated by adding 15-20 minutes of physician time to the visit. But, the practice reasoned, they would no longer be incurring the RN costs of $15-20 per consult -- and, since the revenue was the same either way, the impact would be bottom-line positive, right? Wrong. What the practice failed to consider was the opportunity cost of tacking 15-20 uncompensated minutes onto the physician visit. While the practice no longer had to pay an RN $15 to discuss pre-natal vitamins and exercise with maternity patients, the practice was giving up 15-20 minutes of provider appointment time -- time which could potentially be billed out at much more than $15 if it were used for an additional patient visit. Provider time is a practice's most precious resource -- it's the only means the practice has to generate revenue. Using providers to do tasks that can be done by an RN or MA almost never makes economic sense for a practice. Plus, taking higher level tasks away from your RNs and MAs deprives them of the satisfaction they get from those activities. Keep everyone -- especially your providers -- utilized at their highest potential, and you'll keep everyone more satisfied with their roles and your practice more profitable.

By Morgan|2022-01-01T22:52:38-08:00November 13th, 2012|

Doing things the MBA way

My partner Joe Capko and I just had a new article published in Practice Link, a magazine for job-hunting physicians. Our assignment was to explore the idea of a "15 minute MBA for doctors." In other words, are there guideposts that we can draw from business school training that might help physicians know what they need to learn, and how to develop the business skills they'll need to thrive in the future -- whether they run their own practices or work for a larger system? We're delighted with the input we had from the physicians we interviewed -- wonderful advice for newly minted doctors. We spoke with a wide range of physicians -- including anesthesia, OB/GYN, pediatrics, family practice and academia -- as well as a number of practice management experts to get a diversity of viewpoints. Check it out here - we'd welcome any feedback.

By Morgan|2012-01-22T18:50:57-08:00January 22nd, 2012|

Inspiration from small businesses

I recently completed a series of articles for Kareo's Getting Paid blog about how small business management issues relate to practice management. While medical practices have an important mission that reaches beyond business, they can't achieve that mission without succeeding on business terms. And, in many fundamental ways, medical practices are not so different from other kinds of small businesses. There's a lot to be learned from examining the success factors that apply to seemingly-unrelated businesses. Plus, it's kind of interesting and fun to think about other businesses in the 'real world' and how they deal with their challenges -- almost like looking at your own organization through a different lens. If you're interested in checking out the Small Business Lessons for Physician Practices series, here are the links: Small Business Lessons for Practices: Human Resources Getting Started with Marketing Financial Basics Operations Management for Physician Practices

By Morgan|2022-01-01T22:52:40-08:00January 9th, 2012|

Tackling a long list of resolutions for your practice? Here’s how to start.

It's that time of year again ... when every goal you've imagined for your practice seems possible, and every problem seems fixable. So you make that long list of resolutions, but, by week two, you're already overwhelmed and discouraged. After all, there was a reason you didn't fix all those problems or implement all those big ideas last year: it was too much to do all at once. Before you get discouraged, start again. And this time, pick just ONE thing. Focus on that, and you can tackle it. And once that one item is conquered, you can then move onto the next. For more on this approach, visit this article from Harvard Business Review. Need help setting your priorities for success in 2012? We can help. Contact us for more information about our practice assessment services and practice management consulting. Let's make 2012 your best year ever!

By Morgan|2012-01-02T10:38:30-08:00January 4th, 2012|

How to be a better-performing practice

We hear a lot these days about best-practices, benchmarks and key performance indicators, but what does it really take to be a better-performing practice?It starts with developing your own report card. Determine what key performance indicators you want to follow. Here are some standard industry measures: Total accounts receivable (A/R) and days in A/R (DAR)Percentage of A/R over 120 daysPercentage of insurance contract adjustmentsCollection ratio as a percentage of charges minus contract adjustmentsIncome and expense as a percentage of revenueStaffing costs as a percentage of revenueNumber of full-time equivalent employees (FTEs) based on 40 hour work weekNumber of new patient visits and established patient visitsNext, Review your data and past performance history. Prepare your calculations based on per FTE provider number. Compare this year's practice performance to the same time last year. Also compare your figures to national data from MGMA's Cost Survey, http://www.mgma.com/ and NSCHBC's statistical report, http://www.nschbc.com/ for your specialty. Some of the national data represents the average among all the sampling practices - that is the 50% mark, so this should only be a base. Shoot be in the top 10% to be a best-practice. Now set improvement goals where you are not in top 10%, increasing your goal each year until you reach the mark.If your performance with these key indicators is already at the best-practice level, expand the tracking to include other indicators that compare your performance in these suggested areas:Indicator: GoalLow turnover: Rolling three year average under 15%Staff over-time pay: Less than 3 hours per provider each weekPatient wait time: Less than 15 minutesClaims error rate: Less than 3%Collection at time of service: 90%Missed appointments: Less than 5%Now you'll have some real tools to work with - so start tracking! If you need help, call on a consultant in your area.Judy Capko is one of America's leading practice management and marketing consultants, and author of the runaway top-selling book: Secrets of the Best-Run Practices. https://capko.com/

By Judy Capko|2022-01-01T22:52:57-08:00August 7th, 2010|