Thursday, March 17, 2011

How does this fit with the Medical Home and ACOs?

Healthcare Reform has already made so many changes in running a medical practice. Many of these changes may not have been pleasant or easy to accomplish. Within the next few weeks the HHS is expected to release their guidelines on Accountable Care Organizations (ACOs). They have pushed back the release date several times already and it is possible that they will again. Why? These guidelines could after many existing anti-trust laws and state regulations.
Many feel that “this to shall pass,” and go the way of so many other changes in healthcare (many remember the 1990s and healthcare reform then). Whether or not you are consider joining an ACO or other practice affiliation, creating an overall quality improvement process is a good idea. If you do not wish to sell to an ACO, it allows you to improve your overall success and profitability. If you are consider joining an ACO, it allows you to measure where you are at and improve to develop a better bargaining chip when you are negotiating your contract. One of the biggest problems is choosing which program or process to use for the change management in your organization. This has been compounded by the fact that many wish to become Patient Centered Medical Homes (PCMH) and there are choices on which program to use to become one. To assist you, we are now offering a new book on change management that takes into consideration the PCMH and ACOs.

Excerpt from PMSA's new book:

How does this fit with the Medical Home and ACOs?
Two of the hottest topics in healthcare currently are the medical home and Accountable Care Organizations (ACOs) and how they can be created. This program, while not focusing on the medical home or an ACO, can be used in the development of one. In the inner parts of the diagram are nine separate sections. The most common standard currently for certification of a Patient Centered Medical Home is offered by the National Committee for Quality Assurance (NCQA). However, the standards used by all of the certification processes are similar and these have been identified in the inner parts on the Medenneagram.

An Accountable Care Organization (ACO) is typically considered to be a hospital or other organizational based provider system with employed physicians. A Practice Affiliation may be an ACO and is a group of providers that shares responsibility for providing care to a defined population of patients that together have a goal of improving patient health, satisfaction and efficiency. The Patient-Centered Medical Home (“Medical Home”) empowers primary care to coordinate care for patients across the continuum of care and it can become the core of an ACO but lacks the financial incentives, like shared savings, to encourage providers to deliver the highest quality at the lowest cost. However, by becoming a Medical Home it aligns the practice to become a practice affiliation or and ACO and allows the practice to began to measure and increase performance. To become an ACO it is necessary to incorporate a change process in the practice. Experts agree that incorporating parts of the Medical Home into the organization aligns with becoming an ACO.

This program allows the organization to include the principles in the Medical Home and those needed for an ACO. The principles of these change processes have been identified as how they fit or tie into the Medenneagram. Even if the practice does not want to become an ACO or obtain Medical Home certification, it may simply skip these sections and still be able to fully utilize the rest of the material in creating a better practice.

How is this broken up into sections and how do they work (personalize the program for your setting)
As mentioned this program is broken into section and it is possible to focus on the sections that are needed in your practice. The program is designed to be personalized and the intent is for a program that can work for you. This program has at its heart the concept of doing what is right and this will need to be identified by you.

We often hearing of failing business in the news due to scandal and corruption. Why has the subject of ethics become so important to the field of business in the last 40 years? In the past people had a different view of what was right and wrong. If you asked someone if stealing pens from work was wrong forty years ago they would have probably said yes. Now many employees feel that it is their “right” to take office supplies and are surprised when you actually confront them with the theft. They justify the theft by saying that the company is rich and powerful and that this is actually “owed” it to them. In healthcare we are experiencing a wave of patients and employees looking for drugs that can be sold on the streets.

As we have seen powerful people that were once held in respect and admired fall, we tend to be complacent about our own ethics. If they did it, why shouldn’t we? Many people have the mindset that they won’t get caught, it happens to other people, but not to me. Since it is easy to develop this mindset, it is important for everyone to be ethical and this is especially true for employers and business people. They are the example setters and can often be the “moral compass” for the rest of the staff. People that feel their employers are ethical according to Ferrell, Fraedrich, and Ferrell in “Business Ethics-Ethical Decision Making and Cases,” employees that feel their employer is ethical are more likely to remain loyal to their employer. Medenneagram addresses this problem by putting moral and ethical behavior at the center. While there are many books on servant leadership, there is a big gap in how all the other aspects of the business should be ethical. By having ethics at the core and having all the other aspects of the business around the core, it allows the reader to use that part and still find ways to “do the right thing”. While this is not a religious book or faith book, it encourages the reader to run a business in a profitable and ethical manner for long-term growth and sustainability.

In the center is Ethical Behavior that ties everything together

I. Ethics in the Practice
II. What is needed from leadership?
III. Management Fundamentals
IV. Patient/Customer Issues
V. Employee Development (professional and personal)
VI. Financial Accounting
VII. Clinical and Business Systems
VIII. Team Development
IX. Legal and Regulatory Aspects
X. Change and Strategic Decision Process
Each of the different aspects is as important as the others. If you do not have a strong leadership, then how can the employers follow? Without good customer service, why would your patients keep coming back? Without financial growth, how can the practice thrive? That is why each of the different aspects is as important as the others and they are all connected. As you will see in the final chapters, not only do they form a star, but they are all inter-related. By making each part of the diagram strong, you are building a star practice. The program is divided into sections with the understanding that your practice may be stronger in one area than another one. It is possible to review all the different areas and then go back and work on the areas that need improvement. In some cases, you may wish to just go through the entire program and focus on each section as you work through the process.

To assist you in the process, in the addendum is a test. Please take the test and then save the results. Later after you complete the program, go back in a few months and retake the test to see how you have improved. Maybe after the second test it will reveal a different area that needs to be focused on for success. The test can be taken as many times as you wish.

If you wish to receive additional information on this new book, please contact

Friday, March 12, 2010

Customer Service

A new business was opening and one of the owner's friends wanted to send flowers for the occasion.
They arrived at the new business site and the owner read the card.
It said "Rest in Peace".
The owner was angry and called the florist to complain. After he had told the florist of the obvious mistake and how angry he was,
The florist said:
"Sir, I'm really sorry for the mistake, but rather than getting angry you should imagine this: somewhere there is a funeral taking place today, and they have flowers with a note saying 'Congratulations on your new location'."

While funny, it does bring to light the issue of good customer service and what affects mistakes can have on your customers/patients and the need to diffuse a situation. Staff often has a hard time understanding how customer service is applied to the medical practice. It is a manager’s job to help them understand that they are representing the practice. To the patient-they are the practice.

Often we forget that the patient or customer has a choice, they can go elsewhere. In the medical practice that is still true and you may say that you are the only practice in your community town-that just means they will drive a long ways to go to a doctor or not go to anyone. That is not helping the patients or the practice. Customer service or patient service is a key component to the medical patient and is everyone’s responsibility. However, it falls heavily on the front desk staff. They often the have contact with the patient or have an opportunity to make a lasting impression. They are the first and the last person that the patient sees during a visit and can be the only contact on the phone or via e-mail. Remind them that how they treat the patient and their family will go a long way in helping the patient being satisfied with their visit and want to keep using the practice. By keeping satisfied returning patients this in turns help to assure that the practice will need staff and their job. If there are no patients coming in, why does the practice need a front desk person or any staff?

Take the time to assess your practice’s customer service and see if improvements can be made. Consider taking customer service training. There are countless books, DVDs, videos, conference, etc on customer service and many are either developed for the medical practice or might work. A free one can be found at

Friday, January 29, 2010

Fortune Cookie

Today I had a fortune cookie had the following: “If winter comes, can spring be far behind?” At first I dismissed the cookie without any further thought on it and later in the day I started thinking about the economy and healthcare in this country. Winter is often thought of as the dead or dominate season, when nothing is blooming. For many it can be a depressive and gloomy time. I would say that we are currently in the winter phase here in this country.

To everything there is a season and I believe that eventually things will turn around. Will all of the political leaders ever agree upon anything, probably not. I have known many hospital staff members say that if you gave 5 cardiologists the same rhythm strip, that you would get 5 very different diagnoses. This seems to be true in healthcare reform as well. Everyone has a different idea on how to correct our problems. It is often hard to say that any one plan is better than the other (they all have some good and some bad). However, most of us got in healthcare to help people and not because we thought we would get rich, but making a decent living would be nice!

I have had the opportunity to listen to several physicians that have been in Haiti helping the victims. They have all discussed how thankful these people have been to them and how much they appreciate even the simplest care. Often here in America we forget how good we really do have it. While I would like to see things be better than they are, we still have people that are willing to give their best and care for our sick. We usually have access to some form of treatment. It may not always be all that we need, but they are clinics and services available, while in other countries there are few services. Could there be more and could be make care more accessible here? Of course and we should have it more accessible and affordable. But the point is that we do have healthcare and I believe that eventually the spring will come and things will get better in this country. I plan to keep looking for the first shoots of spring.

Thursday, January 21, 2010

Do you resent your employees?

Recently, I overheard a couple of physicians discussing their managers and staff. One of the physicians complained that his manager after 15 years of making a “really good wage) of $35,000 was thinking of leaving. He couldn’t believe that she thought she might do better elsewhere. The other physician pointed out that the national average is around $50,000 and that his manager not only works as a manager, but is a certified medical assistant and does the billing. The first physician could not get over the resentment that his manager would consider leaving, but this made me wonder of there is not an even bigger problem lurking in this practice.

It is not uncommon to hear physicians and managers complain about their staff and how many view it as a “job and not a career.” Many are resentful of staff that leaves to find better wages. While some staff do consider it a job and in many cases it is because they are not encouraged to do anything more, other do consider it a career. Staff that is shown appreciation will feel that they are valued and this can translate into the felling of their work as a career. How do you show your staff that you appreciate them? Maybe you don’t actually resent them, but do they know that you do appreciate them? Do you show them? Do you encourage them to take their job seriously and that they are valued? How can they think of it as more than just a job, if their work isn’t valued? What difference does it make to you or the practice if they don’t do a good job as long as they do something and just make an effort?

Times are tough and many staff may need higher wages. Daycare costs can take a large percentage of their pay. Rent and daily living costs are also rising. Could you live on what you pay your staff? That doesn’t mean they should earn as much as you do, but that you should take into consideration that not only are times tough for you, but for your staff as well. They do not have the education or skills that you do and the providers are the ones that brings the most (if not all in many cases) revenue to the practice for that reason alone, you should be making a lot more. Your staff might be resenting what you make as well. Staff usually does not know or understand all of the overhead costs that you have and what it is you actually take home. They only see that you drive a better car than they do and live in a different neighborhood. They have no idea what you have had to sacrifice to get where you are and how hard it is to remain there.

You can’t always pay staff more, but you can show that that you do appreciate them. Think about what they do for you. Could you do all of the billing, handling patient’s problems such as refills, prior authorizations, and all of the many other tasks in a day? Could you do all of what they do and still see your current patient load? Only if you have a low patient load. Be honest with staff that due to tough times you may not be able to increase their salaries, but find other ways to show you appreciate them. Try thanking them for their work. Maybe you could pay for lunch, buy movie cards for extra work done, or treat then to a massage. There are many ways to say thank you and often that is what they really are looking for from you. Of course they could use more money, couldn’t we all? But most of the time they just want to be appreciated.

Monday, January 4, 2010


With a new year ahead of us, it always makes me wonder what the year will bring. This time last year, could we have guessed that legislation affecting medical practices would go the route that they have recently? It really makes you wonder what changes this year will bring and how we will have to adapt to meet these new challenges.

Facing the unknown and adapting to the challenges in healthcare requires a strong leadership basis to be successful. How are your leadership skills? Maybe this is the year to consider taking new courses and broaden your knowledge base, or maybe it is time to obtain additional certification/education. Whatever path you decide this would be a good time to plan out how you can develop new leadership skills and enhance your leadership style. There are many free courses, articles, and other resources as well as many cost-effective ones. Whatever you choose, why not make leadership enhance as part of your new year’s plan of action?

Tuesday, December 22, 2009

Holiday fun

This year has had its ups and downs. Take a few minutes out of your day to enjoy some of the beauty of the planet and a little holiday humor.
Places to visit in the US

Winter wonderlands
Already tired of the snow-maybe looking at it a different way might help
Or maybe some snow humor will help

Preparing for the holidays at home

Preparing for the holidays at work\


Holiday song playlist

And last but not least-we have nothing to give you

Enjoy and have a safe and happy holiday season!

Friday, December 11, 2009

Oops, where are my manners?

Around the holiday season the stress starts to build. Ever feel overworked due to the end of the year crunch and dealing with the holidays both personally and professionally? Does your office seem to lose their manners? Does the team seem to fall apart during this time of the year? You are not alone. Many people start feeling stressed and depressed during this season. How can you cope then? According to the Mayo there are some common triggers include relationships, finances, and physical demands. They offer 10 tips for handling the triggers:
1. Acknowledge your feelings
2. Reach out to others
3. Be realistic
4. Set aside differences
5. Stick to a budget
6. Plan ahead
7. Learn to say no
8. Don’t abandon healthy habits
9. Take a breather
10. Seek professional help if you need it

The Mayo’s advice can also apply to the medical practice. Have the staff sit down and acknowledge the problems, set aside the differences to work out realistic, workable solutions. Review the practice fiances by conducting periodic audits throughout the year. Plan for the future and how the team can become stronger. Sometimes it is necessary to minimize the work and just say no to some projects. Consider hosting a company’s wide wellness program to encourage a health lifestyle. This time of year, many of the staff will develop a New Year’s resolution to become healthy-help, so why not help them? If they become healthier than the cots can decrease.

Why not take a breather? Have a fun, but low-key holiday party with the staff. You probably already have a party, but why not have a fun day? Plan a pot-luck or potato/salad/taco bar, the list of possibilities is endless. Throughout the day have fun games or activities that staff can do in-between the work. Have word games that they can play or trivia games on manners, healthcare or even the season. Then close a little early and announce the winners. By eating and having fun together it makes the team stronger and helps to reduce the stress. If these ideas do not work and there is still an issue with manners, consider bringing in a consultant to help with the team. There are many ways to approach the problem, but the key is to reduce the stress and start enjoying the team. By reducing the stress and making it an enjoyable place to work, you can often instantly turn around the mood and improve the manners. Have a great holiday season ad don’t forget your manners.