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

Reducing the cost of no-shows at your medical practice

(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

By |2022-01-01T22:51:46-08:00June 11th, 2018|

Technology’s magic trick: making duplicate effort disappear

Technology for the medical practice front office has many benefits. It can speed up processes, keep critical data safe from fire and flood, allow practice staff to tap resources from other organizations via the Internet, and so on. The list is long and growing. But my favorite front office technology benefit by far is the ability to eliminate duplicate effort, especially duplicate data entry. The reason is simple: eliminating duplicate effort is like money in the bank! When you cut down on duplicate data entry, you don't just eliminate the cost of repeating steps; you also reduce errors, which can be even more costly to find and fix. Some errors -- like mistakes in patient demographics or coding -- cause a direct hit to the bottom line, since they affect billing and reimbursement. Get those demographics right the first time, and your likelihood of getting paid promptly just went up -- and the effort required to make it happen just went down. There are many technology tools that medical front offices can use to reduce duplicate effort. Here are just a few that most practices should explore, if you're not taking advantage of them already. EHR/PMS integration. When a practice moves from separate billing and EHR systems, or from paper charts to an EHR that integrates with the billing/practice management system, the gain in billing efficiency is profound. An integrated EHR/PMS set-up allows physicians and other clinicians to transmit superbills electronically from the EHR into the PMS. This means no data entry of CPT and diagnosis codes from paper tickets -- a huge time savings. But even more important, the data that's transferred over to the billing system is exactly what the physician or non-physician provider intended -- not what the biller guessed at based on a handwritten superbill. And if there are any doubts about the services provided or diagnosis codes, the chart note is right there in the system to provide clarification. EHR/PMS integration means faster, more accurate billing -- for faster, more reliable reimbursement. Fewer delays to clarify what's supposed to be billed, and no risk that

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

Deductible reset: you have choices

Q4 is here! For many practices, it's the busiest time of the year, as patients who've been timing their care to maximize the value of their insurance coverage or their tax deductions are now ready to schedule. During this period, a greater proportion of reimbursement will usually be collected from health plans, rather than patients. That means it's a good time to maximize productivity and generate revenue that can be collected more easily -- both to close the year out on a high note, and to prepare for Q1, when the pattern reverses. In January, patients are more likely to put off services if they feel they can, thanks to the double whammy of the deductible reset and holiday bills coming due. Looking out over the coming five-six months, it may seem like much is out of your control. And it's true that the hard deadline of December 31 isn't something you can change. But you do have choices to make. When you consider how you'll prepare for the deductible reset, will you fight the slowdown with marketing? Or will you plan to use the downtime in other ways? If you decide to go to combat the deductible reset slowdown with marketing, much depends on your specialty and your local market. And if you decide instead to go with the flow, you'll still need to start planning now, to be sure your opportunity isn't wasted. Either way, your first step should be a thorough analysis of how the deductible reset has affected your practice's workload in the past, and a projection for the impact in Q1 2017. Then if you're planning to try to boost volume, you'll need to consider your strategy (preventive care? elective services?). And if you want to take advantage of an anticipated slowdown, be strategic about it and plan for scheduling adjustments now. In my upcoming webinar (October 20, 10:00 Pacific), I'll delve into some of these ideas and possibilities. It's free, thanks to my generous host and sponsor, Kareo.  Click this link to sign up.  Look forward to your participation and questions!

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

The power of managing details

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

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

Toast, workflow, and the quest for practice productivity

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

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

Persuading providers to be more productive

When we analyze practices that are not as profitable as they'd like to be, the physicians that hire us usually expect us to focus on expense cuts. But while we sometimes find over-staffing, outdated service contracts or other expenses that can be shaved, more often than not, the critical issue is on the revenue side: productivity and visit volume. Providers don't usually like hearing that they need to be more productive.  They may be nervous that they'll end up on a treadmill, running from patient to patient.  Or they may feel sure that they're already seeing as many patients as they can -- and even more than their peers.  If they're aware of workflow problems in the practice, they will also be concerned that the number of patients they can safely and efficiently see in a day is limited by the strain on their processes -- not by their own efforts. Changing providers' minds about productivity and workflow isn't always easy (and you can see why they'd be nervous).  But there are a few tools we rely on that physician partners and practice managers can use, too, if you find you need to book your providers more fully, including: Workflow analysis.  This is perhaps most important. A thorough analysis of your workflow can spotlight problems that are beyond providers' control but that impact their ability to see more patients in a day.  Are there bottlenecks that cause providers to wait as patients wend their way through the practice to the exam room?  Are providers wasting time looking for supplies and tracking down MAs?  Get a handle on these issues before asking providers to be busier -- and be sure to explain the issues you've identified, ask providers to share any issues they see, and implement solutions before hitting the gas on booking patients more aggressively. Productivity benchmarks.  Today there is great data available to help you understand how your providers' productivity compares against comparable practices -- and to illustrate to your providers where they rank.  For a quick review of productivity based on weekly visits, the Medscape survey can't be

By |2022-01-01T22:52:01-08:00March 1st, 2015|

Increasing productivity targets for your providers? Make sure they’re achievable

If you've found that your practice can't sustain profitability at your providers' current level of productivity, you may be thinking that it's time to ask your physicians and mid-levels to start seeing more patients per day.  But have you evaluated whether your patient workflow actually has extra capacity?  Sometimes, your providers may have already maxed out their capacity, given your current set-up. Before embarking on outreach to patients to fill up the calendar or starting a more aggressive marketing program, be sure to look at the following parts of your practice's patient flow, to be sure you're ready and able for more volume: MA/nursing support If more patients are booked, your providers will need more support to move them through the practice -- checking vitals, rooming/cleaning rooms, drawing blood, collecting data, etc.  Are you confident your current team of MAs/nurses has unused capacity?  (If you're not sure, benchmarks from resources like MGMA can help you decide.) Scheduling If you want your physicians to see more patients, you'll need to be sure there's room in the schedule for more appointments.  If you're finding that your providers aren't bringing in enough charges, check the appointment schedule: are you offering the right type of slots?  (If every appointment is set for 30 minutes, you won't get more than 16 in an eight hour day.  And, if many of those slots are used by short follow-up visits or injections, the schedule's depriving your providers of the opportunity to see more patients and deliver more revenue.) Exam rooms You may want your physicians to move more quickly through the day -- and they may want to, too.  But if exam space is short, booking more patients will just lead to bottlenecks, stress, long wait times in reception, and irritated patients, staff and providers. Do you have enough exam space?  One big hint that your exam room capacity is your bottleneck is if physicians and mid-levels are waiting for rooms.  This can be a very difficult problem to solve.  If your practice expands its office suite or moves to a new location, make ensuring adequate office

By |2022-01-01T22:52:02-08:00December 15th, 2014|

Increase productivity and enjoyment with a larger monitor

It’s commonplace to see staff and physicians hunched over their computer monitors squinting as they work.  When you consider the amount of time each day that people are working on their computers, the benefit of alleviating eyestrain with larger monitors is clear.  While many off-the-shelf computer bundles (CPU and monitor) purchased a few years ago came with relatively small monitors, perhaps 15 to 17 inches, much larger monitors can be purchased for very little – high quality 27-inch monitors currently run under $300! While we highly recommend at least 24-inch models wherever space allows, there are a couple of considerations to keep in mind.  First and foremost, while nearly all monitors are plug-and-play making basic set-up a snap, it is still crucial to fine tune your graphics settings to optimize both the resolution and the type size – even though the maximum resolution (number of pixels, sharpness) of new monitors is high and the screens large, you may find that they type size is too small. Do not reduce the screen resolution to increase text size.  It’s far preferable within Windows-based systems, to adjust through the control panel/display and adjust text size without sacrificing clarity and resolution. If your routinely use multiple pieces of software concurrently, it may well be worth exploring two-monitor configurations so that they can display more than one system at a time. Setting up a these systems, may require special hardware such as an additional video card, while it isn’t tremendously difficult, it is a task best left to professional. Monitor upgrades are a frequent recommendation in our practice assessments and I've never seen a single person that wasn't delighted to have more screen space. I trust that you’ll see the same gains in productivity that we've seen.

By |2022-01-01T22:52:06-08:00June 30th, 2014|

Using benchmarks wisely: staff, staff expense per provider

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

By |2022-01-01T22:52:09-08:00March 3rd, 2014|

Trade shows – there’s so much to gain

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

By |2022-01-01T22:52:10-08:00January 21st, 2014|

Will 2014 be a better year for your medical practice?

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

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

Conference attendance is so important for practice managers

Just back from speaking at the wonderful Association of Otolaryngology Administrators (AOA) annual conference -- what a valuable event. It's such a great experience as a speaker to participate in such a well-attended, well-run event. In both of my sessions, attendees  were so attentive, taking notes, asking great questions, and making great comments and sharing anecdotes about their own practices.  The attendees were helping each other as well as benefiting from content from all of us speakers. I have no doubt all attendees will go home with dozens of ideas to improve their practices' profitability. I was just one of dozens of qualified presenters -- what a download of information for the attendees.  And they were clearly so motivated to soak up as much information as possible.  (For example, I tried to sneak into the talk before mine -- which started at 7:30 AM! -- on the Affordable Care Act.  Standing room only, despite the early hour.) Physicians may sometimes doubt the value of sending a manager off to a conference like this.  The cost may be in the neighborhood of $2,000 when travel and downtime are figured in, so it's not a trivial expense.  But just one coding tip that brings more revenue or marketing tip that brings more patients -- or compliance tip that avoids an audit -- would pay for that expense many times over.  And the network that attendees can form is absolutely priceless.  This is especially true when your specialty has a dedicated practice administrators association like the AOA -- but, even at the larger/general practice management events like MGMA, medical office managers will meet like-minded professionals they can bounce ideas off of and gain advice from in the future. In tight times, cutting out conference attendance may seem like an easy choice. However, you may be unknowingly hurting your practice's chances to grow new revenues, stay ahead of regulatory issues, or nip costly problems in the bud.  It's useful to be picky about attending events -- make sure they'll have a variety of relevant subject matter that is important to your practice.  But don't

By |2022-01-01T22:52:13-08:00October 26th, 2013|

Teaching your medical practice employees vs. coaching them

Today's Harvard Business Review  features a wonderful tip for medical office managers: Know when to coach versus when to teach. Teaching -- i.e., demonstrating or instructing an employee on exactly what to do -- is key for bringing new employees up to speed (aka, training).  It can also be useful when corrective action is needed -- e.g., "Emily, please be mindful of HIPAA when speaking with patients about private information -- ask them to step out of the reception area, like so." Teaching can backfire, though, with competent and motivated employees who just need a little help with problem-solving. Coaching -- supporting and gently helping staff find the right solution -- is the right approach in that case. For example, let's say one of your receptionists is having trouble collecting co-pays -- but, she's a quick learner who's eager to try new things. Giving her ideas and asking questions about what she's already tried could help her develop an effective style she's comfortable with -- and that she'll be able to use routinely. By coaching employees with ideas and, most important, asking questions, you help your employees feel competent and trusted. What's more, even though it might take a little longer to solve today's problem, your coaching might lead to your employee finding a better solution that will pay off over the long run.  For example, if your instinct would have been to pick up the phone to get urgent payer feedback, but your encouragement leads a biller to find an important source of information via the payer's portal, that could save a lot of time for you and your biller down the road.

By |2022-01-01T22:52:15-08:00October 8th, 2013|

Wharton School online MBA-level courses: free!

I've previously recommended Dr. Christian Terwiesch's introductory MBA-level operations management course on Coursera -- and, great news, it's being offered again this fall. UPenn/Wharton have expanded their selection on Coursera to include four "MBA foundation" courses in operations, marketing, finance and accounting -- an incredible opportunity for physicians and practice managers alike to explore these first-year courses (and maybe learn if further MBA training is right for them). I can vouch for Dr. Terwiesch's operations management course -- I took it to get a refresher on my own MBA training in operations, and was delighted to find that many of his excellent examples were actually drawn from healthcare. The course will provide you with some new insights for evaluating your own practice workflow.  Best of all, it's presented in digestible online sessions of 15-20 minutes -- perfect for busy professionals. To learn more about the ops course and the entire MBA Foundation Series, visit this link -- or to see more about Penn's other offerings on Coursera, or the program in general, visit coursera.org.

By |2013-09-25T11:48:31-08:00September 25th, 2013|

The busy-work trap

Many practice managers do anything to keep staff busy -- lest doctors see them "doing nothing" and start to believe they're overstaffed. It's admirable to want to get the most from the team, but obsessing about staff utilization to the point of burdening them with unnecessary tasks is a pitfall.  Here's an example: recently we worked with a practice that had very busy phones -- it was a psychiatric practice, and more than 80% of the calls were about prescriptions, and needed to be handled by the prescriptions nurse.  The practice had experimented with a phone tree that allowed these patients to connect directly to the prescription nurse -- cutting down patient wait times substantially.  But, once they did this, the front desk was somewhat less busy since they no longer needed to answer these calls and put them on hold while hunting down the prescriptions nurse (or taking a message for her). The doctors at the practice were concerned about the perceived 'down time' -- even though patients were being processed more attentively at the front desk, and with less waiting.  So, they rationalized that the phone tree should be disabled, and that the front desk should answer all calls first, then forward them as needed.  Once the receptionists began answering every phone call -- often putting them on hold while dealing with the patient in front of them -- they certainly seemed less 'idle.'  But, patients in the office waited longer to be checked in, patients on the phone had to wait to be connected to the prescription nurse (or her voicemail), and the front desk environment was much more stressful. Worst of all, this artificial burdening of front desk staff meant that all staff were now perceived to be fully "utilized" -- i.e., no one was available for additional projects or important additions to their job content.  On our visit to the practice, one of the first things we noticed was that the front desk was doing a poor job of collecting co-pays (routinely billing them instead of collecting them at check-in).  Naturally, we urged the practice

By |2016-03-04T12:01:50-08:00August 15th, 2013|

Lessons and reminders from the Yahoo! work-at-home flap

Practice managers and physician owners might look at the media attention focused on Yahoo! CEO Marissa Mayer's decision to end work-from-home at her company and think, well, that doesn't apply to me.  And it's true, with only a few exceptions (say, billing), medical practice staff members are unlikely to be able to do their work from home -- not just because they need to be where the patients are, but also because of the privacy risks of bringing documents out of the office. That doesn't mean, though, that the controversy and discussion that Mayer's decision engendered (and now Best Buy CEO Hubert Joly's as well)  are completely irrelevant to physician practices.  Because even though working at home is an option that won't often make sense for medical office staff, the media frenzy about one company's HR decision does illustrate how challenging it can be to make management changes without unintended consequences, even when the need for the change seems obvious. Change sparks fear One of the theories that immediately emerged about the Yahoo! telecommuting ban was that Mayer was simply implementing "backdoor layoffs" -- i.e., that she'd determined that forcing everyone into the office would be an easy way to encourage telecommuters to quit to achieve needed cost reductions.  Naturally, this theory provokes fear in all staff -- what if there aren't enough quitters to bring costs down, and my job ends up on the chopping block? There are mixed reports of how the end of telecommuting is actually playing with Yahoo! employees -- despite the ongoing outrage of bloggers, there are also reports that many current Yahoos understand the need for and actually support the change.  But, certainly the situation is a good reminder about how important it is to communicate effectively with employees, to help prevent unnecessary fears from taking hold -- otherwise, you risk losing  your most valued employees, who will begin job hunting in earnest when they sense trouble.  (I have seen changes as small as eliminating free coffee to save a few bucks lead to swirling rumors that bankruptcy is imminent!  When communication is missing,

By |2022-01-01T22:52:33-08:00March 9th, 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 |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 |2022-01-01T22:52:36-08:00January 16th, 2013|

Faux busyness

It might be the toughest message a practice management consultant has to deliver to a physician client: you're just not working hard enough.  When doctors bring us in to analyze their practices' profitability problems, they usually expect us to find they're over-staffed, or that their building expenses are too high, or that their billing service is inadequate.  And, to be sure, we do often find those problems. But, it's just as often the case that we find that the physicians are seeing many fewer patients than they thought.  And, when we show the doctors data comparing their visit volume against other practices in their specialty, we'll hear, "but we're so busy!"  How is it possible that we can walk into a practice and see underutilized exam space and know immediately that visit volume is an issue, while the physicians simultaneously feel -- truly believe -- that they're operating at capacity? This is the phenomenon I like to call 'faux busyness.'  The physicians feel busy -- fully occupied -- but the real number of patients they're seeing tells a different story.  The sad thing about faux busyness is that it's just as tiring as the real thing, but a lot less profitable. What are some of the causes of faux busyness?  Here are a few: Provider calendars with gaping holes -- so that the physician is in the office all day, but not seeing patients much of the time Providers scheduled in multiple places for partial days -- adding transit time and scheduling hassles to every day Layout issues, inconsistently prepped exam rooms, and other issues that require physicians to be moving around the office too much -- cutting into possible visit time Is faux busyness cutting into your practice's profitability?  There's only one way to find out: start digging into data.  Analyze your scheduling processes to determine if they include unnecessary complexity.  Make sure your staff understand the importance of booking next-available appointments.  And look to benchmarks to reality test your patient volume against comparable practices.

By |2022-01-01T22:52:38-08:00October 30th, 2012|

OB/GYNs are hard-working … this one may be the hardest-working!

We've been working on several projects with OB/GYNs of late, so stories related to obstetrics are catching my attention more than usual.  This one is really inspiring: a 101-year-old OB who has personally delivered more than 15,000 babies!  I heard about him on NPR -- read or listen to the story here: At 101, and 15,000 babies, an OB/GYN works on  

By |2022-01-01T22:52:40-08:00April 12th, 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 |2022-01-01T22:52:40-08:00January 9th, 2012|

Leadership: It’s about treating people well

Joe Capko did a webinar with Medical Practice Management Web Advisor earlier this week on how effective leadership translates to more productivity from your staff -- and vice versa.  One of his themes was establishing trust by listening and treating people fairly, and letting them know they are valued.  People give more to their jobs when they know you care! Aptly, today's email tip from Harvard Business Review was called "Engage Your People," and featured some of the same ideas Joe offered.  Basically, less top down, more listening, more working together. To read the HBR tip, click here.  

By |2022-01-01T22:52:41-08:00October 27th, 2011|

Solving work flow problems

Balancing work flow and eliminating troublesome bottlenecks in a busy medical practice are chronic problems, but if ignored they become a financial drain and compromise patient service. In fact, a decline in profits and patient gripes are often the things that alert the physician or manager that workflow problems have gotten out of hand. But what's the best approach to getting to the root of your problems and finding the best solution? Start with communication. Meet with staff and enlist their support in clearly identifying where the bottlenecks are, what is causing them and what are the most reasonable solutions to pursue. It is leaderships job to be sure staff feels important and comfortable enough to come to you when they have a problem and believe they will get your support. Analyze the processes. Look for where the errors occur and where there are unnecessary steps or duplication of tasks. Even better, are there steps that can be eliminated through technology that save time, reduce errors and improve outcome? Invest in staff. Errors often occur and go undetected when new staff is not properly trained and when existing staff does not get on-going training to stay at the top of their game. This can result in frustration, poor morale and compromised outcomes, as well as causing division among the troops. Everyone needs the support of management; beginning with training and ending with performance evaluation and getting the tools to enhance performance.

By |2022-01-01T22:52:41-08:00October 10th, 2011|

Stop Wasting Energy & Money

Medical practice revenue is tighter than ever. It's time for you to take critical steps to keep costs under control and improve profits. The first step to fixing the bottom line is to look for the waste. Wasted energy results in a loss of potential revenue and lots of frustration.  There is waste throughout the typical practice, but most of it is silent and doesn't get the attention it should.  Here's some common threads we see in your world: A lack of clearly defined job responsibilities that result in duplication of effort. Accepting poor performance and inferior outcomes Mistakes that one person makes and another one corrects because it seems faster or easier. The good news is all these things are fixable.   Make the commitment.   Look at the action that needs attention. Is it the scheduling, patient visit or billing and collections, or something else? Then  flow chart the processes involved and identify the cause for errors and inefficiency, discuss the possible solutions and pick the one that makes the most sense.  Then  [and this is important]  assign someone the responsibility to see it through, set a reasonable time-line to get each change completed and  schedule meetings to review progress along the way.  You may need to hire a consultant to get the ball rolling and develop a process improvement plan, but it will be worth the effort.  Start thinking lean and reduce the waste! Once you see improvement it's time to celebrate.  Your bottom-line will improve, staff will enjoy their work more and patients will be happier.  Sounds like a win-win-win.   So just  do it! Capko & Company, experts in practice management and markeeting - We are here to help make your practice shine. s

By |2022-01-01T22:52:56-08:00April 5th, 2011|

Marketing Your Practice with a Code Update Event

By Joe Capko, Capko & Company Every year, changes to the CPT codes take medical practices by surprise -- even though everyone knows the updates are coming.  Whether it's because doctors and administrators assume that coding changes won't likely apply to their specialty, because it's hard to find time to go through the materials, or just due to old-fashioned procrastination, most of the practices we work with wind up ignoring the new codes until they start finding out the hard way that the codes they've been using are no longer valid -- i.e., once claims start to be rejected. Naturally, this is a costly problem for all practices, as these rejected codes can mean payment delays of six months or more. Here's the good news.  Since most (if not all) of the other practices you work with as referring partners are facing the same pain-in-the-neck, why not turn this hassle into a marketing opportunity?  You can do it by hosting a Code Update Seminar -- call it a "code party" if you want to be less formal about it -- and invite the practice managers and administrators from the other practices you work with to learn about the changes.  You arrange for a coding consultant to present an overview of the changes, along with a meal or some snacks -- depending on the size of the group you're inviting, you may need to rent out a large conference or event space at a nearby hotel or business center.  Depending on your preferences (and those of your colleagues), you could schedule an early morning breakfast event, a lunch event, or an evening or weekend seminar. If this seems like too much effort or expense, you can try the "lite" version: a smaller, more intimate, group hosted in the office reception area during non-clinic hours. Helping to solve a problem that your colleagues all share while also giving your administrative staff the chance to network with their counterparts at your key referring partners is a wonderful way to promote your own practice without "selling."  Be sure to have some tchotckes (pens, post-it

By |2011-01-17T19:03:22-08:00January 17th, 2011|

Monkey Business

Did you know that  American workers spend nearly 20% of their time goofing off on the job?  That's what a 2006 survey conducted by Salary.com and AOL revealed.  I doubt that medical practices are excluded from this phenomenon. Here's what these employees are doing the most when they should be busy at work: Surfing the net; Socializing; Errands;  and Spacing out. Why is this happening and what can you do about it?  I believe the primary reasons for monkey business happening on your time are boredom, a lack of direction or people not really liking their jobs very much.     Stand up and take notice.  Make sure you are clear on your expectations and provide a work environment that makes people feel important and helps them succeed.  Employees can make a break your future - you need everyone on the team contributing and feeling valued. Capko & Company experts in healthcare business management and marketing.  Call on the Capko consulting team: www.capko.com  

By |2011-01-11T17:46:09-08:00January 5th, 2011|

Dream Teams

Here's seven key points that exist within a Dream Team. Players are motivated toward the same goal. There are effective communication channels between each team member. Criticisim is respectful, honest and constructive. No idea is considered stupid. The culture is deep-seated in team unity. Team is willing to compromise to achieve goal in real time. Ability of team members to face obstacles objectively. With a strong leader you can inspire your staff and work toward creating the Dream Team. It's worth the effort!   Capko & Company is one of America's leading healthcare practice management and marketing consulting  firms.

By |2010-12-14T17:42:34-08:00December 14th, 2010|

Getting Bugged?

Patients first.Patients are a priority in every practice, in fact, they are the purpose. So why don't doctors pay closer attention to patient complaints? The top three complaints all have to do with time and these issues can be solved.What bugs patients??1. Waiting more than 1/2 hour in the office2. Waiting too long for an appointment (access)3. Doctor spent too little time with meThese problems can be resolved by setting up realistic scheduling parameters based on the actual time a physician needs with the patient and then starting on time. This will require staff taking the right initiative to have patients and charts properly prepared for the visit. I'm sure you are up for the challenge. After all, you will gain a lot: higher productivity, happier patients, and a better bottom line!Now its your turn.Tell me doctor, what bugs you? I really want to hear from you and will report the results in a future blog. In fact, answer this blog and share your opinion with your peers.Contact Judy Capko, one of America's leading practice management and marketing consultants. e-mail judy@capko.com

By |2022-01-01T22:52:59-08:00March 23rd, 2009|

Marketing on a dime in a turbulent economy

Medical practices are feeling the impact of the looming recession, as patients become more concerned about personal finances. They thiink twice before scheduling an appointment and put off treatment that doesn't seem urgent. Yep, with gaps in the schedule, revenue starts to slide and practice economics become uncertain. So how can you fill those gaps and pump iron into practice revenue without spending big bucks on marketing? Read on...1) Mine your data base. Find those patients that are overdue for an annual visit, follow-up care or screening tests the practice offers. E-mail or give these patients a jingle. Don't just remind patients to schedule appointments, offer each one a specific time slot to increase your odds for filling the schedule. Be sure to confirm appointments 48 hours in advance with verbiage that accentuates the importance of keeping appointments.2) Be visible. Participate in community social and fund-raising activities. The more you (and your staff) are in front of people, the more you remind them of who you are and what you do.3) Be a media darling. Get to know the writers focused on healthcare for local newspapers and regional magazines. Become the "go to" person when they are seeking physicians to quote. It's easier to do than you might think. Go on line to their websites and e-mail the writers that cover features on healthcare business and clinical issues. Invite each one to contact you when they need a source, and direct them to your website so they can check you out. When a medical topic becomes of interest to the community and you can offer solid advice, e-mail your media contacts. 4) Be active with the hospital and local medical association. Communicate your interest in being their media source for information and interviews.5) Be responsive. When someone needs something from you or makes a query, respond without delay, whether its the media, another medical practice or your patients. Be timely and dependable. Now watch your practice thrive!Contact Judy Capko, one of America's best known practice management and marketing consultants: www.capko.com

By |2022-01-01T22:52:59-08:00February 24th, 2009|
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