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
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.
The iPhone, Android or other cell phone you depend on for everything – besides texts and calls your phone is likely keeping you busy with games; productive with email, to-do lists and calendars; in touch with Facebook, LinkedIn and Twitter; and convenienced with applications as straightforward as a simple flashlight. But how much do you really know about this rapidly growing library of applications? How well do you read the obligatory user-agreement before you install the application? Well, of those “free applications” that most of us have installed more than a few represent some potentially serious risks, especially if you have HIPAA data on your phone. Most free applications can access your contacts, calendar and other data on your phone – and for purposes of convenience, there are perfectly legitimate reasons for this, but can you be sure the publisher will only use this data for legitimate reasons? One shocking example came from a flashlight application for Android that, once installed, had access to nearly all the data on the phone. The potential threat from applications, malware and viruses is very complex within a BYOD environment – even the basics of keeping device system software current can be a nightmare when one is facing a multitude of different hardware and operating system platforms. Naturally, risks of this sort should be thoroughly defined in your HIPAA risk assessment that is a requirement of meaningful use. Regularly updating and refining your risk assessment alone could become overly burdensome very quickly. Accordingly, it's worthwhile, given the complexity and ever-changing nature of technologies, to consider a very conservative approach – we recommend practices own and manage all devices accessing patient and other critical data.
Physicians and practice managers love using online tools to help run their practices. Whether you’re submitting payroll, doing some online banking, reconciling a credit card statement or confirming patient eligibility you’re using a connected network of devices, any of which could pose a serious threat to the well-being of your practice. While I’ve blogged here on the importance of strong and regularly changed passwords, it’s every bit as critical to be disciplined and conservative with respect to connecting to Wi-Fi networks. Every time you venture out to a hotel, conference or café you’re likely seeing a variety of Wi-Fi networks with nothing to identify them other than a short name. Should you connect to “Starbucks-FREE” Wi-Fi? The following link describes just how simple it is for a hacker to set up a simple network with the goal of stealing the passwords and data of people just like me and you. The straightforward best policy is to never connect to an unknown network (and it’s hard to “know” a network if you’re away from home and work!). For this reason, I strongly recommend using the “share internet” feature of many smartphones – typically there is a monthly cost, perhaps $15 for access, and data usage counts against your monthly phone allowance. Click here to learn just how one hacker gains control over computers like yours.
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
Do you accept cash payments at your practice? The start of a new year is a great time to review how your practice handles cash -- to determine if your internal controls could use some tightening up. With cash, the biggest temptation is to handle these "small" amounts more casually than other payments. When cash payments are rare -- a $30 co-pay here, a $25 co-pay there -- it can seem that they're less important to the bottom line. But, over the course of a year, even a single $30 cash payment per day amounts to close to $8,000! Keeping tabs on those "unimportant" cash payments is actually very important, indeed. The biggest pitfall: mixing cash receipts with petty cash. This all but ensures these amounts won't be deposited and may not be properly tracked. Petty cash should never be more than about $50 or so -- just enough to handle small payment amounts for the office that cannot be handled by credit card or check. Allowing petty cash to grow creates a temptation for misuse -- or worse, theft. Cash should be deposited regularly -- ideally, every day -- for security and for effective tracking for practice evaluation and tax reporting. Receipt stock should be monitored, and the cash received should be reconciled against the day's postings by some at the practice who doesn't collect it and post it to the billing system (in smaller practices, this might need to be the physician/owner).
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
Too often, patients and practices alike are caught off guard by the resetting of deductibles on January 1. When patients forget they'll be responsible for a larger portion (or all) of the cost of their services, it can be difficult for front desk staff to handle the situation if they're not prepared -- and even physicians and managers find it hard to refuse a request to "please just bill me." The best solution to the problem is to prevent it. Make sure everyone in the practice knows that more patients will be responsible for payment until their new deductibles are met -- and that patients need to be informed and reminded before their visit. That means mentioning that deductibles have re-set when they set appointments, and checking patient responsibility amounts and outstanding balances before reminder calls -- and alerting patients to what they'll be expected to pay at visit time. Knowing that patients have been informed about their responsibility should make it easier for the front desk to collect in a matter-of-fact way. ("How will you be paying today, Ms. Jones?")
All of us at Capko & Company want you to start 2013 off right! We're rolling out a series of quick tips -- short bites that will take just a minute to read -- to help you make the most of all the opportunities of a brand new year. First up: don't let the deductible re-set short-change your first quarter revenue.