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.

http://www.fourwinds10.com/siterun_data/spiritual/pictures/news.php?q=1245101530
Places to visit in the US
http://traveler.nationalgeographic.com/drives/photography

Winter wonderlands
http://photography.nationalgeographic.com/photography/photos/patterns-snow-ice.html
Already tired of the snow-maybe looking at it a different way might help
http://photography.nationalgeographic.com/photography/photos/patterns-snowflakes.html
Or maybe some snow humor will help
http://mymerrychristmas.com/2005/shoveler.shtml

Preparing for the holidays at home
http://mymerrychristmas.com/2005/parentsnite.shtml
http://mymerrychristmas.com/2005/momsletter.shtml
http://www.humormatters.com/holidays/Christmas/santas%20day.htm

Preparing for the holidays at work
http://mymerrychristmas.com/2005/lawyer.shtml\
http://www.humormatters.com/holidays/Christmas/Twas/twascomputer.htm

http://www.humormatters.com/holidays/Christmas/Twas/twaslawstyle.htm
http://www.humormatters.com/holidays/Hanukkah/twashanu.htm

Games
http://www.humormatters.com/holidays/Christmas/xmassongs.htm
http://holidays.kaboose.com/games-xmas.html

Holiday song playlist
http://www.sciencebasedmedicine.org/?p=3167&utm_source=twitterfeed&utm_medium=twitter
http://www.guy-sports.com/humor/christmas/christmas_carols.htm

And last but not least-we have nothing to give you
http://mymerrychristmas.com/2005/nothing.shtml

Enjoy and have a safe and happy holiday season!

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.


Source: http://www.mayoclinic.com/health/stress/MH00030

Want to Help the Healthcare Crisis?

Want to give back to the community? Want to help with the healthcare crisis? Consider donating your time and resources to a free healthcare clinic http://freeclinics.us/ These events are in need of volunteers, of course they always need healthcare workers to make it happen, but also need others to make the event function smoothly. If you can’t donate your time, how about money to help serve those that can’t afford healthcare?

For those that live in the Kansas City area:
The National Association of Free Clinics has been very busy this fall as a result of the CARE Clinic in Houston sponsored by Dr. Oz where we saw almost 1800 people on a Saturday in September and then the phenomenal response from across the nation as a result of a call to action by Keith Olbermann on Countdown that raised money to support additional clinics.

We are pleased that on December 9th and 10th the National Association of Free Clinics (NAFC) will be sponsoring a two-day clinic in Kansas City at Bartle Hall and the health care community here is responding to make it happen.

We are recruiting volunteers—professional and lay people—and are just beginning the planning. I hope you will send this on to those in your contact list that might be interested in working with us. And, if you would like to help in the planning, let me know.

The website for volunteer to sign up to work at the Clinic itself should be up over the weekend.

This is an exciting opportunity to show the nation the wonderful way that Kansas City comes together to serve the uninsured!

Sheridan Y. Wood
Executive Director
Kansas City Free Health Clinic
3515 Broadway
Kansas City, MO 64111
DD: 816.777.2763
Other: 816.753.5144 Ext. 263
Fax: 816.777.2796
http://www.kcfree.org/

Should we wait to fix a mistake?

Sometimes mistakes happen in business. It can be as simple as staff error or equipment failure. In medicine this can have an adverse affect on the patient. In business it can mean bad publicity, for example recently a man was at a famous casino and the machine indicated that he had won $166 million. However the machine’s top prize was only $2,500. Initially they told him that it was a mistake and that he would take away nothing even though the machine clearly showed that he had won something. They pointed out the disclaimer on the machine and told him that it was an electronic error and therefore no prize would be awarded. Needless to say, he had the news on this one and it hit the wire service and was picked up and broadcasted around the country. The big question will be how much is this going to cost the business in the long run? Maybe they shouldn’t pay the entire amount that the man thought he won, but why not pay the machine’s maximum limit since it did show that he had won something? How many people have heard about this and how much is it going to affect the business image? Would it not have been worth it to offer something to the man on the spot? Later on after the story initially ran and they received so much negative publicity, they did offer an undisclosed settlement, but the damage had already been done to their reputation.

Every day in practices across the country, mistakes can happen. There has always been concern about admitting mistakes in healthcare, but sometimes it is a good idea and as soon as possible. Maybe just a simply apology from the staff member that made the mistake may be enough to satisfy the person before the problem spreads. How many people will the unhappy patient tell the longer the problem exists? What damage will it do and with on-line comments can it even be measured any more? The question becomes how much is our image worth to us? Everyone makes mistakes, but waiting to fix them can hurt.

Red Flag Delayed Again!

This may seem like a broken record, but yes the Red Flag Rules have been delayed.
"At the request of Members of Congress, the Federal Trade Commission is delaying enforcement of the “Red Flags” Rule until June 1, 2010, for financial institutions and creditors subject to enforcement by the FTC." For more details http://www2.ftc.gov/opa/2009/10/redflags.shtm

Changing from Being a Worker to a Leader

Congratulations, you were recently promoted, now what? Changing from a worker to a leader can be exciting, but also daunting. You feel the pressure of performance, not only of yourself but of the others as well. You are now expected to do your work and monitor the others as well. That can be scary, understanding that you are now responsible for what other people do. If they do well, then it reflects well on you. When they mess up, you are expected to fix the problem and deal with the consequences. That can be a problem; you will wonder how you are supposed to get everything done in the day? You could give up eating and sleeping-or you could learn another part of your new job-delegation.

Delegation can be an especially difficult thing for most managers to do. You feel that the staff cannot handle something or feel you are responsible. Ask yourself, why can’t they handle it? If it is something confidential or due to regulations they cannot handle it, but otherwise you would be surprised what they can handle.

One new manager was so afraid to let go of things that she would work 70+ hours per week! She had no personal life at all. Her kids were in trouble with the law and struggling in school. She was depressed and anxious all of the time. After we discussed this issue many times she was finally able to let go of a few things. It was very difficult for her to do that and she struggled with it for a long time. She was so obsessed with how she wanted everything done that she would even tell someone how to put the statements in the envelope, speaking to them as if they were a small child. This was a true problem, all of her staff felt that she didn’t trust them at all, which she probably didn’t. This affected staff moral and their dedication to the company. It is not uncommon that when one person is moved from a worker to a manager position that there are problems, but when all of the staff leaves in just a few months it is a sign that maybe we need to work on the manager.

Some people make the transition to manager smoothly never missing a beat; however most of us need a little help to get on the right track. One of the first things you can do is to find someone that you respect and emulate their behavior. For some reason you respected that person. Why, what do they do that is so special? Make a list of traits that you like about them and then starting thinking about how you can do what they do. This can help give you an idea of what you should probably be doing. That and studying different views on the subject can give you ideas of what type of leader that you want to be and what you need to become to do the job. I suggest studying many different books and take as many classes on the subject that you can. You will find many variations on the theme, find what works for you.

Taken in part from PMSA’s New Manager

Leadership and Teamwork

Sometimes we can learn so much about leadership and teamwork from the way we play a game. Often in our society we focus so much on winning and getting ahead that we lose sight of what is really important in life-each other. In healthcare we often talk about team approaches and working together, but in reality that real team is often what is missing in a practice. Though we do have to think about the bottom-line, healthcare regulations, staffing issues and the list is endless; ask yourself at the end of the day, did we make a difference? Did we really help someone and make their life a little easier?

Over the many years of being in healthcare, we can easily lose focus of why we entered the field to begin with-helping others. In healthcare we really are our brother’s (or sister’s) keeper. While working towards building your team, remind everyone to keep sight of what is really important and what is probably part of your mission or vision statement-serving others.

As a leader in your organization you often set the tone on the team, what type of tone are you setting? Do you set one of focusing on the concept of serving others as a team? What is your focus? Is it of improving the balance sheet or of overall improvement? Sometimes we can learn from a game on what is really important.
http://www.youtube.com/watch?v=wKUaLlK776s.

Influenza Phone Triage

I know that you have probably been overwhelmed with influenza tips and suggestions, but someone sent us a link to a telephone triage that we thought we would share. The triage is through the American Academy of Family Physicians and many of our members have found it helpful. We have also attached a few others that members have recommended recently.
http://www.aafp.org/online/en/home/publications/journals/afp/preprint/influenza-telephone-triage.html
The CDC’s triage can be located at http://www.cdc.gov/h1n1flu/clinicians/pdf/adultalgorithm.pdf
Suggested example for employers
http://www.ucdmc.ucdavis.edu/hr/hrdepts/ehs/Forms/employees_influ_tri_final.doc
Self triage from Carleton College
http://apps.carleton.edu/campus/flu/flu_reports/student_report/self_triage/
Self triage from Monterey County Health Department
http://www.co.monterey.ca.us/inc/pr/20090827/Self_Triage_influzena.pdf

Passion for what you do

Everyone at some time or other has had a job that they hated. Many of us are lucky enough to have a position sometime that we love. Whether you hate your job or love it, right now you probably need it and in every job there is something that you probably enjoy. Maybe you hate the drudgery of cleaning exam tables/equipment or doing the paperwork. Yet each of these tasks is very important to the overall job and service that you and your company provide. Right now there has been a lot of focus on the importance of cleaning equipment/doors/chairs or whatever due to the flu. Everyone understands how important that is to all of us.

How important is the paperwork? Very important for many reasons including patient safety and billing. If the paperwork is done incorrectly it could mean that the patient receives improper care and could even put them at risk. Paperwork can also affect the billing and with delayed payments or missed payments this can affect the practice’s revenue. If the revenue is decreased can the practice continue to support everyone? This can and will eventually affect all of the practice staff including providers, clinical and administrative staff.

The key is that every job has aspects of it that are important and can be enjoyable and “make a difference”. Finding these parts of a job can make all the difference. When you find something that makes you passionate about your job and focus on it. It will make your day go by faster and others see the passion in your work. When you are passionate about something appear more focused and it usually appears that you are knowledgeable and a professional and in a tough job market that has to help!

Differences in Medical Assistants

In the past we have discussed how staff should be cross-trained and encourage to do more and continue to grow. We have also mentioned that what a staff member is allowed to do varies from state to state and you should always check with your medical association/Board to determine what can be done in your area. Recently, this table was shared with us on the breakdown of what Medical Assistants can do in each state. We have not verified the information and suggest that it be used for information only and as a starting place for gathering your own information. It does however, illustrate the vast differences in what staff is able to do in different states (please check your state’s requirements by contacting your Boards/Medical Association before using as a guide in the practice for hiring or staff duties). During the discussion of healthcare reforms, many have suggested that just there is a need to have a set of formal requirements (certifications) in place for all practice staff. Others argue that this would limit who the practice could hire and in many cases would require the practice to hire staff that would affect their bottom-line. While we do not suggest one idea is better than another, we do believe it is helpful to have as much information as possible while engaging in reform discussions. Both arguments have merit and in some cases the absence or presence of a certification does not guarantee professionalism or competence. That is one of the reasons PMSA was developed to address staff weaknesses and help fill in the gaps of knowledge or training. In healthcare reform there are no easy answers and unfortunately the reform process will be a long one. Healthcare reform can happen on many levels including at the practice level and national level. By maximizing your staff’s potential this will allow maximizing the practice. The staff and the practice should be evaluated to determine what is right for your situation based upon regulations and capabilities. Scope of practice for Medical Assistants table can be found at http://www.docstoc.com/docs/12388436/Medical-Assistants-Scope-of-Practice

9/11/09

Today on my way to work, I saw an accident. As I sat there in a long line of traffic, I thought about how fortunate we are to have individuals that come to help us in our time of need. Often they are putting their own lives at risk and yet do it anyway. In healthcare we have many people that put other’s needs before their own. In this time of so many shouting that we have a broken system and nothing works, sometimes it does. I know that if I had been in that accident I would have been thankful that the paramedics, firefighters and police officers had been there. Once they took my injured body to the nearest hospital, I would have been thankful that the ER cared for me and if I needed immediate surgery that they would have been there for me.
Today on this day when we remember the fallen; I am personal thankful for all of those that are there caring for the sick and injured.

Thank you to all in the medical and emergency services for the job that you do everyday!

New Year Resolutions in September

The Jewish New Year is fast approaching and to all of our Jewish friends, we wish you shana tova umetukah for "a good and sweet year." The upcoming holiday for some, got us to thinking about traditional New Year Resolutions. Most Americans will reflect upon the past year and makes New Year Resolutions in December. This has been and continues to be a year of change. In light of all of the discussion of reform, why not consider reflecting and making resolutions now instead of waiting until December? Now is a good time for all of us to reflect upon what has happened and what is happening in healthcare and in our practices.

Just as you normally do in December, ask yourself a few questions. For example, what have you done what have you done to others, what can you do better? By taking the time now, you can develop a baseline for change of where you are and where you want to be. What can you accomplish by December? What will take the next year to accomplish and how can you build steps or little goals to reach the big goal?

Then in December, use this guide as a measurement of how you are doing and look at your goals. In change management, it helps to begin with the end in mind.

Consider the following:
What are your goals?
Then where are you at now?
What steps will you need to take to reach your goal?

By starting now, you will be well on your way to your goals by the time you sit down to do your New Year Resolution’s in December!

Funny Swine Flu Videos

Due to all of the discussion on how to avoid the swine flu, we decided to look at the more humorous approaches some have taken. Last week we covered a list of videos featuring how to wash your hands. This week we cover a more global approach, by hitting sneezing, coughing and the swine flu in general. These are just a few of the videos out there, but it gives you an idea of what you can find on the topic.

Cover your sneeze game
http://www.routesgame.com/games/?challengeId=2
Cute sneeze
http://www.youtube.com/watch?v=FzRH3iTQPrk
Slow motion sneeze
http://www.i-am-bored.com/bored_link.cfm?link_id=43224
Cover your cough
http://www.sfcdcp.org/sneeze.html
Swine Flu Fighters
http://www.youtube.com/watch?v=wQcMB--VWSI
Cover Your Mouth
http://www.evtv1.com/player.aspx?itemnum=2013
Musical Swine Flu video
http://www.youtube.com/watch?v=EiXmw5a9kiM
http://www.youtube.com/watch?v=7iIwNX792dE
http://www.youtube.com/watch?v=tbt_PuVAVTU&feature=related
Training video for staff and patients
http://dennysblogfeeds.blogspot.com/2009/09/funny-video-rapping-swine-flu-doc.html
http://www.coughsafe.com/media.html
More videos
http://hubpages.com/hub/10-Amusing-Videos-About-Swine-Flu

Mentioned last week, but still our favorite:
Cough into Your Sleeve - The Somali Parrots
http://www.youtube.com/watch?v=MfNGq96-ruE

Disclaimer: PMSA does not have financial interest in any of the videos and does not support or endorse in any fashion. The list was compiled by members and suggestions sent to PMSA. All rights and property of the videos belong to the owners. PMSA only lists the videos as a service.

Wash Your Hands!

These days it seems that everyone is getting into the act of creating videos on hand washing. From our President to our cartoon characters we are being told to wash our hands and tips on swine flu prevention. While we do take hand washing and swine flu prevent seriously, we can still have fun!

PMSA has always worked to bring practices information and we have collected some of the resources that we have found or others have shared with us. Some of the clips we have seen have been great and this week we are highlighting a few of the many hand washing clips (Some may not be on swine flu prevention, but great hand washing videos) and next week we will share “cover your mouth” clips. If you would like us to list a video to share with others, let us know by contacting jz@thepmsa.org

Elmo and his “Wash Your Hands” Video
http://www.youtube.com/watch?v=a7u4zUQh1GE
The Wiggles
http://www.youtube.com/watch?v=iDe3wmOLvk0
Wash Your Hands Too Mr BrownShow
http://www.youtube.com/watch?v=lViRlo1_b1o
and a different version
http://www.youtube.com/watch?v=CUu-UuNcU-k
Food Parody
http://www.youtube.com/watch?v=AtlcS77LaB0
Sesame Street - Wash Your Hands Before You Eat
http://www.youtube.com/watch?v=XCO5RpTIU1Y&feature=PlayList&p=DD1C802E005EDF6C&playnext=1&playnext_from=PL&index=14
Bill Nye the Science Guy - "Just Wash Your Hands"
http://www.youtube.com/watch?v=3ELm7VjrFg4&feature=PlayList&p=DD1C802E005EDF6C&playnext=1&playnext_from=PL&index=15
Wash Your Hands
http://www.youtube.com/watch?v=vDvOszLSYzg&translated=1
Wash Your Hands (Jasongs)
http://www.youtube.com/watch?v=zjenyvKsnvk
Soap In the City
http://www.coughsafe.com/soapincity/quick.html
Wash your hands!
http://www.youtube.com/watch?v=bM-iGBM3OfA&feature=related
Hand Washing with Soapy
http://www.youtube.com/watch?v=eNhS2uyC6xI&feature=related
Hand Washing for Kids - Crawford the Cat – Educational
http://www.youtube.com/watch?v=s_yR-oGNMaA&feature=related
SafetyTV: Scrowford Washes Hands -Cartoon
http://www.youtube.com/watch?v=tjlCoY7B9WM&feature=related
Kandoo Wash hands
http://www.youtube.com/watch?v=WJrtiJEZIPI&feature=related

For staff training:
Clean Hands Help Prevent the Flu
http://www.youtube.com/watch?v=XHISh559oho
Prevent flu, wash your hands!
http://www.youtube.com/watch?v=Jdw-W2MF6ow
Washing Hands - Six Steps
http://www.youtube.com/watch?v=rrNJt73BG_8&feature=related
Washing Your Hands the Right Way
http://www.youtube.com/watch?v=brrf2inGs7E&feature=related
CNA Skill Hand Washing
http://www.youtube.com/watch?v=oVUsUIVgmcQ
The Importance of Hand Washing
http://www.youtube.com/watch?v=HE_y-UHmlWI

Preview of next week’s list
Cough into Your Sleeve - The Somali Parrots
http://www.youtube.com/watch?v=MfNGq96-ruE

Disclaimer: PMSA does not have financial interest in any of the videos and does not support or endorse in any fashion. The list was compiled by members and suggestions sent to PMSA. All rights and property of the videos belong to the owners. PMSA only lists the videos as a service.

Are You Looking For Methods To Cut Costs and Receive Free Products and Services?

A large part of what makes a practice successful is the products and services used. Making wise and educated investments now, is vital in strategically aligning the practice for future success and minimizing risk. Times of economic uncertainties are forcing consumers to be more reluctant or reserved when making purchases and they demand quality, flexibility, and affordabilty. Here at PMSA we understand the struggle of practices trying to fit vendors into an already overstressed appointment log. Often managers feel bombarded with resources and have difficulty making sound business decisions on products and services. Medical staff is often the gatekeeper and deal with both the patient and the vendors on a regular basis. They depend on vendors to provide a reliable and trusted product, at a competitive rate that will bring maximum results. With so many choices, it is easy to become overwhelmed and lost in the masses of meaningless advertisements.

At PMSA, as a free value added service, we serve as a liaison between the medical practice and vendors, bridging the gap. We believe that a strong relationship between the vendor and medical practice will translate into a win-win solution for everyone involved, including the patient. By acting as a liaison, we save the practice valuable time and money in their search, provide fact-based options that are relevant to their individual practice needs. Although we do not endorse products, companies, or services, we do understand and value the importance and benefits of establishing a cooperative client-vendor relationship, built on mutual trust and respect. Quality care begins with quality products and services! For more information go to http://www.thepmsa.org/becomeatestsite.html to find the resources you need.

Dealing with Petty Cash

Many front desk individuals are responsible for handling the petty cash and handling payments from the patients. This is something that you will have to discuss with the manager on the policy. It should be checked out in the morning and returned at the end of the day. If possible at least two people should verify the amount each time. Many offices will have a logbook for everyone that counts or handles the cash to initial and put the amount in the log. Anytime that you are handling money, it is a good idea to share the responsibility, in other words have one or two people that count the money and another person that verifies (usually a manager) and puts the money away. At the beginning of a shift, the manager would check the money and then those taking the money would verify the amount. A good example of a petty cash policy and how the cash is handled can be found at http://www.toolkit.com/small_business_guide/sbg.aspx?nid=P06_1428

Being responsible for someone else’s money is a huge responsibility. Many employees are tempted by handling cash and often do not see a problem in taking small amounts or “borrowing” the money until payday. The problem is that once you are tempted and give in to the temptation it is always easy to justify doing it repeatedly until you are caught or it has become a large amount that you could never pay back.

Why have morals, everybody cheats, tells a white lie or take a little something, right? Well maybe everyone is doing something dishonest in your practice, but that doesn’t mean you should. Not being moral can wear on you and affect other areas of your life. Most criminals did not start out thinking about the “big job”; they usually started out small and the moved on to bigger crimes. Even a little theft or a small white lie can have consequences. Small lies can lead to another lie, and another one, etc. Sometimes it is harder to tell you the truth, but being a person always has its rewards, even if it is just the satisfaction of knowing you did the right thing.

It may seem like taking a few items from work will not matter and they sure can afford it more than you can, but does that make it right? Theft adds up, a few items from everyone can reduce how much the company makes and eventually can lead to bigger problems. Why should you care, after all they make lots of money? You should care because if the company has a reduction in profits and an increase in loss, bonuses, pay raises, and even the company itself can be at risk. It may seem like something small, but what if it was yours? Would you like it? Treat others (including the company), as you would want them to treat you.

What if you know that the company is billing incorrectly or engaging in illegal activity? You should try approaching your supervisor with this issue. This can become very difficult if they are part of the problem. If you have a hotline for compliance issues, you should consider using it. You can refuse to engage in illegal activities and be a person of integrity or become part of the problem. If things are bad enough, you may have to consider changing practices. If you do, be sure to leave on good terms and give a notice. When you apply elsewhere, do not say it was due to illegal activities (unless it receives wide media coverage and is well known) since it could backfire on you. Who wants to hire someone who works at a place that had illegal activity? As a manager I would always wonder what bad habits you had picked up. Use your discretion in these circumstances.

Borrowing something, especially on a permanent basis, is never good. We have all learned from childhood not to take things that do not belong to us, yet it happens everyday in business. It is bad enough when employees steal from their own employer, but is unthinkable when they steal from their coworkers or boss.

Own up to your mistakes, we all make them. When dealing with cash or numbers, it mistakes can happen. Admit what happened as soon as possible and handle the problem. Hiding it will only make it worse and be harder to fix later on. The longer you wait to be truthful or be honest about something the bigger the problem it will become ( a molehill can turn into a mountain if not watched) it will become down the road, in addition you begin to lose track of what you’ve told certain people and what you haven’t, thus losing your credibility

Now maybe you personally have not taking anything, but have witnessed a friend or coworker in the act or you suspect they did. If you knew about it and did nothing, you are just as responsible as they are. If you or your friend just “borrowed” the item without asking, this should be considered stealing as well. Never take anything unless you have previously asked permission and that includes money!

HHS Releases HITECH Act Breach Notification Rule

HHS issued regulations requiring health care providers, health plans, and other entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify individuals when their health information is breached. On Wednesday August 19, the Office for Civil Rights of the Department of Health and Human Services (the "OCR") posted a copy of its Interim Final Rule for Breach Notification for Unsecured Protected Health Information (the "Interim Rule"), implementing Section 13402 of the HITECH Act (the "Act"). As an Interim Final Rule, there is a sixty day comment period after publication in the Federal Register. Comments may result in further changes or clarifications. This new Alert covers the highlights of the Interim Rule and is focused on the comments and analysis of the OCR that accompanied the Interim Rule.
These “breach notification” regulations implement provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of American Recovery and Reinvestment Act of 2009 (ARRA).
The regulations, developed by OCR, require health care providers and other HIPAA covered entities to promptly notify affected individuals of a breach, as well as the HHS Secretary and the media in cases where a breach affects more than 500 individuals. Breaches affecting fewer than 500 individuals will be reported to the HHS Secretary on an annual basis. The regulations also require business associates of covered entities to notify the covered entity of breaches at or by the business associate.
“This new federal law ensures that covered entities and business associates are accountable to the Department and to individuals for proper safeguarding of the private information entrusted to their care. These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information,” said Robinsue Frohboese, Acting Director and Principal Deputy Director of OCR.
The regulations were developed after considering public comment received in response to an April 2009 request for information and after close consultation with the Federal Trade Commission (FTC), which has issued companion breach notification regulations that apply to vendors of personal health records and certain others not covered by HIPAA.
To determine when information is “unsecured” and notification is required by the HHS and FTC rules, HHS is also issuing in the same document as the regulations an update to its guidance specifying encryption and destruction as the technologies and methodologies that render protected health information unusable, unreadable, or indecipherable to unauthorized individuals. Entities subject to the HHS and FTC regulations that secure health information as specified by the guidance through encryption or destruction are relieved from having to notify in the event of a breach of such information. This guidance will be updated annually.http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/breachnotificationifr.html

NOW WE ARE FREE!

PMSA is now offering free memberships to our online community for all levels of medical staff!

Due to economic stresses, the PMSA has changed the structure of memberships and are now offering free access to medical staff members. There are absolutely no hidden surprises and all of the following are included in the membership:

Some of our FREE MEMBERSHIP benefits for medical staff include:

· Free membership access to our exclusive online community
· Free downloadable forms
· Free downloadable and customizable e-books
· Access to in-practice vendor evaluations and ratings (see what test sites had to say about their products).
· "Product of the Month" highlights
· Submit questions to be posted to the FAQ's and read what others are asking
· Trivia Management of compelling content that allows you to interact with others
· Fun incentivizing activities, online education and testing with a points system allowing store discounts and free products for answering correctly.
· Points system that can be redeemed in our store, gift certificates, or redeem to enter a contest for free products!
· Monthly e-letter highlighting current trends in healthcare
· Access to post to or view Job Board
· Vendor interaction- a forum to ask questions without the pressure
· Forums – for exchanging ideas and discussing a wide range of technical subjects
· Form resources for creating and maintaining reference content
· Blogs – online journals for communities and individuals to publish opinions and ideas
· Resource Galleries – for sharing images and files with community members.
· More freebies coming soon!

Check out our newly updated website at www.thepmsa.org. We are continually in the process of updating our services, based on suggestions made by our audience. Keep ‘em coming, we love hearing from you and how we can better provide the tools and resources you need.

Office Gossip

Everybody does it, don’t they? The better questions should be, should everyone be gossiping? When you were young you were probably taught that talking about others is bad and yet it is still done. Occasionally articles will surface that recommend some gossiping in an office. The problem that is in general gossip can be hurtful and the affects are long lasting. The bigger problem is often that people do not realize that they are gossiping.

Think about the last time you and your co-workers were discussing a patient. What were you discussing? Was it really relevant to her care that she was wearing something that you wouldn’t be caught dead in or that she is dating someone you know? Put yourself in her shoes, how would you feel if you had overhead the conversation? Even if the conversation was medical in nature, do you have a need-to-know and was it necessary? Could this be a HIPAA breech? Are you discussing confidential patient information? Could any patient or staff member that did not need to hear the information, possibly hear what was being said?

What to do if confronted with gossip-
Find out if your practice has a policy already in place and if so follow policy.
Tell the other person that you do not wish to be a part of the discussion and walk away or change the topic.
Just because you heard something, doesn’t mean you have to spread it. Let the gossip stop and die with you. Don’t be the one spreading a rumor.
If a person continues to gossip, confront them and ask them why they are discussing something that is not their business? Remind them that this is not the place for it and it is especially a bad idea to discuss patients.
If someone gossiped about you, confront them. This gives them a chance to clarify what was said or what they meant; it might be a simple misunderstanding. If they were gossiping, most will stop when confronted.
If problems continue discuss with supervisor.

There are times when gossip is a good thing. For example, if you overhear other staff plotting something that could hurt or harm others or the practice, then you should do something and report it. If you knew that two co-workers have been discussing how they took some cash from the co-pays, you should report it. If you don’t’ then you could be held responsible for withholding information. If they know that you overheard, it is even possible that they blame you for the theft to clear themselves. Always ask yourself, what is the right thing to do and then do it. If you think it is wrong, then guess what, it probably is wrong! Be sure of your facts before reporting something and be as clear as possible. You should present the facts and try to remain as professional as possible. This is someone else’s job and their life you are affecting. Therefore it is important to be discreet, but remain honest and true to yourself and to the practice.

Ask yourself when it comes to discussing others, how would you feel if the shoe was on the other foot and it was you in their place? Do to them, what you would want them to do to you (and possibly even better).

Stress management

The medical field can be a demanding one and medical professionals often find themselves stressed, tired, and overworked. This can increase the chance of mistakes and problems. Save and use time-off wisely. Just because you have earned a day off does not mean that you need to use it immediately. Save some up for personal emergencies, but make sure you do take some time off.

Work can either be enjoyable or the most miserable place on earth. There are many ways to have fun at work. One of the largest retailers has a daily “team huddle” that is fascinating to witness. At a local one, you could go early in the morning and watch as the manager demand that the employees jump up and down and yell that they were having a great time and that they loved their jobs. The looks on their faces, did not look like they were having a good time, in fact they might have been mentally going over their resumes at that moment. It can make you thankful that you are not having a “good time” and “team build” Team building and games are great, but only work if everyone “buys into them” and wants to be a part. There are many ways to build teams and many different ways to have fun at work.

You can have fun and still be a professional. The biggest part about bringing joy to the workplace is to let people know that you are happy that they are there. Greeting them with a smile and asking how they are, if their kid was sick yesterday, ask how the child is today. Let them know that you care. Once there is an atmosphere of caring, the fun will come. It cannot be forced, well you can make employees jump up and down, but they will not enjoy it if they are not happy to be there. Once people know that they are appreciated, they can relax and have fun. We all have the need to be liked by others-coworkers, bosses, anyone. Everyone in the practice should make it his or her own responsibility to “team build” and to make the place a fun or good place to come to everyday. You will be spending a lot of time there, do you really want to go to a place that you dread or hate?

You may love your job, but sometimes it can get to you. Often managers and staff say that they have to go into work early, do not have time for lunch and have to stay late. This may be true, but everyone needs a little time off to rejuvenate or their tank starts to run on empty. If you notice someone is overwork and you are done with your own, why not offer to help?

Look for ways to reduce your stress. What makes you stressed? Is there something you can do to reduce the stress or get rid of it? Stress can and will make you sick, in small doses some stress is healthy but overall it can hurt you. How can stress ever be healthy? Stress will make you find a new way of doing something or let you know something is wrong. It is often a warning sign to your body. If you treat it as a warning sign, than it can be healthful.

There are many ways to manage stress, discuss with your boss ways that can help you to relieve stress. Some of the best ways are making sure that you have a good diet and exercise. Exercising can work out some of the tension. When we are stressed, we tend to overeat or eat poorly. Then we stress about that and we eat more junk food. It becomes a vicious cycle. Breaking the cycle can be difficult, but will help you to feel better. Another important area is to make sure you are getting enough sleep. This can also be difficult when stressed. Maybe you should consider a warm bath or listening to music before going to bed. You might also want to consider taking up a hobby, many find working on something they enjoy relaxes them. Playing with kids or pets can also be a great way to relieve stress.

The most important thing is to recognize when you are stressed and do something about it. Use stress as an indicator that something needs to be changed and work on techniques to help relax you. A more relaxed and unstressed staff member will be more efficient and have fewer errors. Just by being relaxed, you can make your own job easier and be fun to be around!

Red Flag Delayed Again!

FTC Announces Expanded Business Education Campaign on 'Red Flags' Rule
“To assist small businesses and other entities, the Federal Trade Commission staff will redouble its efforts to educate them about compliance with the "Red Flags" Rule and ease compliance by providing additional resources and guidance to clarify whether businesses are covered by the Rule and what they must do to comply. To give creditors and financial institutions more time to review this guidance and develop and implement written Identity Theft Prevention Programs, the FTC will further delay enforcement of the Rule until November 1, 2009.”
For more details: http://www.ftc.gov/opa/2009/07/redflag.shtm

Strategic and Critical Thinking- Being Proactive Instead of Reactive

In the medical field, we are all used to the fight or flight response to problems. Often we have seen people that rush to get something done without thinking it through or only deal with problems when they absolutely have to for example instead of equipment maintenance they wait until it is broke before they do anything for it. This would be like the person who never checks the oil in the car or changes it until it completely runs out and burns out the engine, Instead of burning your engine how about handling things before they become critical.

There are many definitions and ways to define strategic planning. One of the best ways to define it is as the person that looks at the entire problem and then based upon all angles comes up with a plan. Much like a chess player who knows what moves he or she will make several moves ahead in the game, we must plan ahead. To do strategic planning first look at the problem, ask what is the problem, what can be done, what will it take to accomplish the goals, what are the resources such as time and money? Is this really needed? What impact is this going to make on the practice or patients?

Try beginning with the end in mind. That is determining what the final outcome should be and then identify the steps that are needed to get there. This will help as you systematically work through the problems and reach the solution.

Keeping a positive outlook will help as you define the answers to your problems. Things can always be worse and occasionally are, but things only last for a time. There is a time to everything and things change. There is an ancient analogy of how oaks are strong but break in the wind, a willow if bendable and adapts to the environment when the wind blows. Look for ways to adapt and change. Healthcare is always changing, but many things stay the same. You still have providers and patients with needs. Adapt, but keep your professional roots firmly in the ground.

Got a practice question?

For the past few months we have been posting on topics that we feel are important or ideas that might be helpful to a medical practice. We would love to hear your ideas for a post. Let us know your questions regarding practice management, staff training, team building or whatever. If we cannot answer the question, we will try to find someone that can. Just twitter us, send a comment on this blog, or e-mail jz@thepmsa.org
We would love to hear from you!

Dealing with Argumentative Patients

Sooner or later in every medical practice you will have an unruly patient. Most of the time it is verbal abuse, but can escalate into physical. It is best to defuse a situation before it gets to the point of physical violence. These can often be done by actively listening and repeating back to the patient what they feel is the problem. For example you notice that your normally calm receptionist and patient’s voices keep getting louder and louder. It is time to step in and ask the patient what the problems is, your staff and you do not deserve to be yelled at or verbally abused.

When the patient tells you why they are shouting, paraphrase it back to them for example “Let me see if I understand you Mr. Smith, you feel that you should not pay a co-pay because the physician only saw you for ten minutes and you waited an hour to be seen. You feel that we should have paid you for your wasted time in our waiting room, is that correct?” This gives the patient a chance to see that you are listening and correct you if there is a misunderstanding of his or her need. Then explain to the patient what your policy is regarding the issue. They still may be angry, but they feel that someone is listening to what they have to say. Let them know that if someone is to blame that you will look into the issue and take the appropriate action. The biggest thing is to let them know you care and that you are listening to them. You may not be able to change the problem, but they need to know that you would be willing to try if possible. By listening and empathizing with the patient this allows them to let go of their anger.

It is important to make the staff understand that the patient and their family are the customers. This is a service industry and without patients we would not be in business and I am betting your staff likes getting a paycheck. The staff needs to also understand that often the reason the patient is in the office is they are sick, in pain, and often scared of what is wrong.

Patients that have their problems and concerns are less likely to seek legal action against someone. It is hard to sue someone when they have been trying and were nice to you. Studies have shown that a good bedside manner in a totally incompetent physician is less likely to bring legal action than a rude vastly talented one.

Some patients that are vocal and pushy often are trying to get their financial obligations reduced or are looking for pharmaceutical relief from their problems. Now there will always be a very small percentage that no matter what you do still become threatening. Train your staff to have a plan of action in the event of a violent patient. Have a plan of whom and how they will contact management and the authorities. For example if a patient starts to become unruly, they immediately contact the manager. The manager can then designate a person to contact the authorities if need be. Plan and rehearse this just as you would a fire or tornado drill.

What happens when the Dr. is left waiting?

Is your provider often waiting on others? Do they have a lot of down time between patients? This is often lost revenue when the physician is waiting on staff or patients. What can be done? Training staff to do as much as possible before the visit is one of the best ways to avoid this problem. Staff should make all of their follow-up calls and do paperwork when the physicians are not in the office or at a scheduled time. This will reduce the chance that staff is caught up handling a problem for one patient while an entire waiting room sits. It is also good to have staff cross-trained to help out when one is busy and another has time on his or her hands. After a bad day, sit down with the staff and discuss what happened, ask what they think could be done different. Don’t be surprised if they have some suggestions for you as well. Consider having the staff keep track of how long it takes them do each task, then review the data and see how duties can be shifted. If might be necessary to move a job from one person to another one, move it to a different time, or stop the activity all together.

If the physician is scheduled to come from the hospital to the office, let staff know of when arriving and of any delays. Staff should relay this information to the patients. Nothing is more frustrating to a patient that has been waiting for a long time, only to learn that the doctor is not even in yet. If there is going to be a long delay allow the patient the option of leaving and coming back or rescheduling to a different day. Make sure staff asks the patient if they feel it is alright to wait. Patients will usually let you know if they need the concern addressed right away or if they want to wait, but let them help to make that decision.

Another problem can be patients being a no-show or late, this can often be avoided by having staff call and remind patients of their appointments the day before. When staff calls they can also remind patients to bring list of medications, insurance cards, co-pays, and any other information that might be needed.

Take a look at the patient schedule, maybe it needs to be adjusted. Most physicians’ average around four visits per hour, look if there are in any gaps in the schedule. If a gap does occur could dictation or something else that needs the physician attention be done? To save time dictation can often be done while with the patient, there are of course exceptions to this.

When it comes to patient education, delegate as much of this to staff as possible. Be sure that the handouts are up to date and accurate. Years ago when I surveyed patients I discovered that much of the information that they received about their condition came from the handouts in the waiting room. Many patients do not feel comfortable asking a lot of questions and feel that if the information was obtained at the physician office, it must be accurate. For that reason it is important to check the material on a regular basis and remove old data. I would also recommend a disclaimer on the rack that just because some information provided is from a pharmaceutical company does not mean that that medication is right for every person with that condition and that the physician will determine what drug is right for you.

As a manager trying to keep all of the physicians on schedule nothing is probably more frustrating than overhearing a patient ask the physician to see a family member while they are there or bring in a really long list of many problems. Over the years I have seen many different ways of handling this problem. One of the best is to have a sign out front letting the patients know that only 1 person will be seen at a time. Let the patients know that you can only see those patients that are scheduled-not the entire family. Be firm and let them know, this will avoid problems in the future, often these people are repeat offenders.

The other issue is multiple problems that they want addressed. Remind the patient that you are on a time restriction and if needed, they can be scheduled for a longer time period. Ask if there is something that they feel must be addressed right now or is it an ongoing (chronic) problem. Most of the add-on problems can be avoided by having staff going over all of the concerns and doing a preliminary evaluation prior to the physician coming into the exam room. By training the staff to do this and write it out in short notes all of the patient’s concerns can be gone over in a shorter amount of time. Have your staff fill out a worksheet and if needed they can add the additional concerns. When the patient sees you going over the list they feel that you and the office cares and is addressing their problems. By the staff writing it out you can look it over before going into the room and can get an idea of what you will need to do while with the patient and will help to know what to ask about. Another method is to have staff make a copy of the patient’s list and have the staff go over it, making notes on the copy for you to review.

The biggest thing for everyone to remember is that it can be lost revenue when the physician is left waiting. By everyone working together this wasted time can be reduced and increase productivity which can increase profits.

Hemorrhaging ($)

One of the most common problems in a practice is hemorrhaging profits. At this point a small band-aid may not do the trick. First we will try direct pressure, pressure points, and if all else fails we may consider a tourniquet or possible amputation. It’s easy to fix a bleed if it’s small a little band-aid and pressure and it goes along ways, but little bleeds can develop into big gushers if they are not stopped. It can happen that we don’t recognize the signs and symptoms of hemorrhagenic shock (bleeding out) until it’s too late to save the patient.

There is an old saying in EMS “all bleeding eventually stops.” However the idea is to stop it before the patient dies or in this case the business dies. Finding out that one employee has been making small errors on the charge sheet, may not seem like that much, but over time it can really add up and before you know it the employees “mistakes” have enabled her/him to take a really nice vacation at your expense. Now most mistakes are truly that, just mistakes but not always. A small clerical error can be a cover-up.

One office had this problem. Unknown to management, the two receptionists had obtained two different receipt books. If the person paid by check or a small amount of the cash this was put on the receipt book that management was aware of, but the patients that were not going have their insurance billed (paid for the test or office visit in whole, by cash) these people went into another book and were given a receipt so that it appeared upfront to the patients. This had gone on for a long time, until they slipped up and a patient was billed. The patent called the billing department and complained and sent in a copy of the receipt. It was later discovered that this had happened to an unknown number of people, and in one case a test that cost over $2500 was paid for and not accounted for on the books. As soon as questions started to come up about possibly missing cash, the two employees immediately quit, so it wasn’t until much later after they had been gone awhile that anyone became aware of the extent of the fraud. Legal action was considered, but due to several other circumstances was dropped. To prevent this from reoccurring, a policy was instituted that all of the receipt books were numbered and checked in and out by management. However, from time to time there was still a few missing payments. The next year and subsequent years the profits increased greatly with just this one fix, but there were other problems such as incorrect billing. However the two new receptionists made a vast difference in the overall profit of the practice.

Often around the beginning of the school year, many staff members think it is appropriate to do their school shopping in your supply closet. It amazes me how many pencils, pens, and other office supplies a practice can go through in the fall. In one practice, when a staff member put crayons on their supply list, I knew I had to put a stop to the shopping spree. I never did figure out why she thought I might fall for buying crayons in an office where we only saw patients over the age of 18. Then again maybe I should have supplied them for the patients as they waited for 2 hours to see the physician. Better yet the providers would have enjoyed them and judging by one of their handwriting samples the crayons might have been a good idea-only kidding!

A simple inventory list on the door of each supply closet and inside of the doors of the exam room will help keep track of supplies. It is simple but effective way to monitor the dwindling supplies. I do not recommend ever putting labels on the outside of the cabinets, unless you just wanted to make it easier for patients to clean the shelves for you. Having worked in some not so nice neighborhoods and some expensive ones, you would be surprised which offices had patients leaving with supplies stuffed in their purses or coat pockets. Why a patient would take a vaginal speculum has always puzzled me and I probably really do not want to know what happened to it once it left the office.

It is great for the physician to be able to give your elderly patient, who is on a fixed income, some dressing changes; however when the waiting room sees that she got free stuff and they did not, it always spells trouble. It is a good idea to put any samples or supplies in a brown lunch bag, they are inexpensive and no one knows what is in them. It is hard to get them to do, but having the physician or the assistant mark in the chart, billing sheet, and supply list was used helps give good patient care and will track supply charges as well as reduce inventory time later on.

The drug closet and crash cart should be run the same way with a continuing inventory list. It is especially important in these areas to check expiration dates and rotate your stock. Syringes and needles have expiration dates, but are often overlooked. No one wants to use a needle that has been sitting in a dusty drawer for the last 20 years or use old nitro that was opened months ago and is ineffective (once opened it is good for only 30 days, for that reason I always liked the nitro spray). It may seem as if you are a nag and the bad guy to the staff when you start implementing new policies controlling loss, however when they see the new system working and their bonuses go up they learn to like it or just not complain so much to your face. Either way it is quieter.

Accounts Payable Success

In a world full of uncertainties how do you keep your staff onboard with the vision and goals of the company? So many times, companies forget who they’re really servicing, who is really important. It’s not only your clients but it’s your staff as well. Now don’t get me wrong, we wouldn’t be here if it weren’t for the client, but let’s face it, if your staff is unhappy and disgruntled so will be your clients. Even if you’ve got one “bad apple” if you allow that “bad apple” to fester in the bushel, you’re going to eventually end up with a rotten bushel of apples. How can one bad apple spoil all the good ones you ask? As I’ve consulted in many different companies both in healthcare and elsewhere, over the years I’ve come across many “bad attitudes” and I’ve seen how the infection can spread, if not dealt with promptly. It can be anywhere from someone not being promoted when they thought they should have been or having someone in the wrong capacity, meaning they hate what they’re doing. Remember the old adage, “misery loves company”. Human beings want to know they’re appreciated and valued and when they’re not, they tend to let the world know it, whether it be intentionally or not.

On my last consulting project, I came onboard a major corporation, who we’ll call XYZ, who was working on outsourcing their accounting department, which none of the staff was aware of. The goal was to get all of the accounts current, then slowly work on the outsourcing, thus eliminating the majority of the staff. Eight of the eleven employees were temporary, hoping to gain a permanent position within the company. When I was first brought on, one of my objectives was to do a major vendor cleanup, bringing over 3,000 accounts current within only two months. For years, staff had gone untrained and unsupervised, causing an accountants worse nightmare. The department had a horrible reputation and became known as the “revolving door”, the supervisor didn’t care, so why should the staff, and it showed in every way imaginable. Vendors either weren’t being paid at all or were paid thousands more than they should have been because invoices were being keyed to their account in error. When you’re vendors aren’t happy the whole company hears about it. The XYZ would call a vendor to schedule services only to hear an earful about how they had many past due invoices and refused services until they were paid. Now I won’t say that this one department brought down the moral of the whole company, but it sure did make a negative impact. Not only was the vendor unhappy but now the employee trying to schedule services is upset because they just got an earful for something that was out of their control. It’s a trickle effect and if left untreated, can cause a company of low morale.

After getting in and analyzing the situation, I quickly realized the near impossible task that was set before me. Not only did I have to figure a way to get these accounts current in two months (which took years of tangling), but I had to find a way to motivate the team, that simply didn’t care anymore, to do so. The first thing I did was I spent a whole week meeting with the team, asking questions, setting expectations of what I was going to be asking of them, and getting an overall perspective of their view of the company. The one-on-one wasn’t just to get to know the individual, but it was also to get a feel for their strengths and weaknesses. I wanted to know if their current roles were in theirs and the company’s best interest. It’s amazing how people will open up when they feel like someone in authority actually cares and is there to help and I was shocked at what I learned, if not horrified. The supervisor, who was still there but had been demoted, had run the department into the ground. The department had such a bad reputation and a horrible morale, I wondered if I had bitten off more than I could chew. Not only did the staff lack proper training, but there was gossiping, cheating, favoritism, tattle telling, and so on and so forth, you get the picture. I thought I had heard it all, until I spoke with a lady who we’ll call Emily. Emily was a permanent employee who had been there for five years, but had recently fallen ill to Multiple Sclerosis. She had been struggling with this illness for several years that finally landed her in a wheelchair. Emily, being a single mother, was eventually forced to work part-time. After only being on this consulting job for a few days, I quickly realized she wasn’t well liked within the department and I wondered why. When she and I had our one-on-one meeting I saw a person with a great deal of knowledge and experience, not to mention a great outlook on life, so why did she not have the best image within the department. Turns out that the supervisor didn’t like her and was trying to get her fired. Before Emily’s illness had been diagnosed, the supervisor told her it was all in her mind and she was a hypocondriac and would talk about her to the other employees. She would overload as much work on Emily as possible and then ignore her requests for help, watching and waiting for Emily to slowing sink into failure. Emily had far more experience than anyone there, including the supervisor, yet nobody was allowed to ask her any questions. In short, the supervisor ostracized Emily from the team. The team, most of them being new, began to have a negative impression of Emily without really having a valid reason. Turns out that Emily wasn’t the only person feeling this way. The supervisor had one favorite person and this individual could do no wrong, even though she had been caught in numerous lies and had basically been allowed to do as she pleased. Everyone sat there watching as this “favored” employee did as she pleased and got away with it, what kind of environment do you think this caused?

After getting a clear picture of what and who I had to work with, I started formulating a “plan of action”. The first task on the agenda was to institute proper training. This company had three different systems that the staff had to work with, two for accounting, and one for operations. Nobody had been properly trained on these systems, nor was there a training manual in place. Now I know what you’re thinking, why would you worry about implementing a training manual when they were going to outsource and in most scenarios I might agree, but we had years of cleanup to do within a very short amount of time and the cleanup had to be done right this time. The manual wasn’t fancy nor did it cover every intricate detail of “what ifs or what to do’s” but it served as a central focus point of reference for the team to fall back on. In this manual, I included a list of “who does what” and sent it out to every department within the company. A common problem was that nobody knew who to go to and vendors or internal customers would be passed around like a hot potato; nobody wanted to deal with the irate vendor but didn’t know where to send them. I also facilitated some one hour sessions of system training. Remember Emily who had been ostracized, turns out she was a wiz with the systems and knew all kinds of shortcut keys. One key ingredient to making a strong team is recognizing each individual’s talents and strengths, then allowing them to shine in that capacity. Watching Emily glow as she was once again able to contribute to the team was a gift in itself. Not only did the whole team benefit from her knowledge, but for the first time she felt appreciated and part of the team.

After I felt comfortable that the team had been properly trained and had all of the necessary tools to succeed, I implemented metrics and measurements. Imagine being told “just get it done” but not being told how much and how often it needed to be done, thus having nothing to measure against. People want to have clear expectations and to be measured on their accomplishments; a little friendly competition can do wonders for an under motivated department, as long as you keep it fun! With the metrics, we started tracking the number of active accounts we had, the number of past due invoices, and the number of invoices currently coming in. Not only did this set a clear understanding of how bad things were, but it gave us a way to track how much better things were getting. To stirrup bit of that “friendly competition” I started having weekly goals and small incentives. For example, the person with the least amount of unprocessed invoices got to leave an hour early one day. Now with this huge cleanup effort in place, the first thing to do was to evaluate what was on everyone’s desk (and hiding inside!) in order to determine if the workload was spread out evenly. Of course you will always have some employees that are stronger and faster than others, but you want to be careful not to set them up to fail by expecting too much. It’s natural that you would start leaning on an individual who always proved to be reliable, but you must be careful not to over do it burning them out, or that it comes off as having a favorite. Let them know that you want them to be challenged and to go above and beyond, but let them tell you what they can and can’t do. If you feel as though they are setting their goal too low, try some positive encouragement. Most of the time, if you let someone know you expect more out of them, they won’t want to disappoint. The key is building up their self esteem of themselves and letting them know you believe in them.

After outlining the enormous workload we were up against, I decided to lay it all out on the table for the team to see. We started having weekly team meetings and in the meeting we would discuss the metrics and where we were at with the cleanup effort, in addition to recognizing those who had gone above and beyond. Don’t forget, recognition can go a long way in boosting moral, but you’ll want to be careful since some people don’t like being the center of attention. In these cases you can find more discrete ways of recognizing someone for their efforts, but it’s still important to do so even if it’s a pat on the back. It was enlightening to watch everyone come together as a team and volunteer to help one another. A problem would be presented and the team, as a whole, would discuss how they would conquer. More times than not, a supervisor will go it alone in trying to determine a solution to a problem, but in my experiences I’ve found that if you allow the team to be part of the decision making process, they will feel as though they are partially responsible for seeing the solution come to fruition and everyone comes out on top. This approach teaches teamwork, but it also gives them the sense of feeling important and needed. Not only was the main objective met, of getting the word done, they all felt as though if one was going to fall they would all fall together.

Along the path to getting the accounts clean, the difficult task of keeping the staff on board was an ongoing issue. Remember, the majority of the team was temporary and had no idea if they would ever be hired on. Understanding so, they would frequently ask when they would be hired. For me this was an extremely difficult situation because I had an obligation to the organization to keep things confidential, which I would never have compromised, but on the other hand I am a person of integrity and didn’t want to lie to anyone. I couldn’t look them in the face and tell them they would be hired someday, knowing full well that most their positions would soon be eliminated, but I needed to find a way of keeping them onboard for as long as possible. Now if you’ve ever been in a situation like this or something similar then you know my pain. Much of my team was made up of single mothers, struggling to make ends meet, but who deserved advancement, if only someone would give them a fair shot. How was I going to build them up to succeed only to watch them fall when the outsourcing took affect? How was I going to motivate them to work on the cleanup, without compromising my integrity and making empty promises? One thing I’ve learned over the years is no matter where you’re at or what you’re doing, you should take advantage of the experience you’re obtaining; you never know when you’ll need it. I have worked at many companies and I have to say, I’ve learned something with every place I’ve been and it has made me who I am today. Even if the employees couldn’t stay in that department, that didn’t mean they couldn’t advance within the company. See, by now the team had done a complete 360 and had regained its reputation. They were now known as a team who was there to help, not only the vendors (the external customer) but also other departments (the internal customers). For once they were actually proud of working in the accounts payable department and had a sense of achievement, which they could take with them. My goal was not only to get the accounts cleaned up, but to build a strong team atmosphere. If I could ever give one piece of advice to supervisors or managers, it’s not always what you’re doing, but it’s more who you’re doing it with. Here was a team that, for the most part had always worked in accounts payable. At some point they hated their job, but it wasn’t the job itself, it was the environment. Once they came together as a team, they started learning how to work together in unison and built a strong bond amongst each other. Sure there were still differences of personalities, and an occasional disagreement, but over all they were happy and proud to work together. When I first started, I would go into an office that was dull and dreary, but overtime I would come into an office where people were smiling and laughing. What was even better was when I noticed the accounts payable team interacting with other departments, working together for improvements across the board.

What you say and do is an example to others

Often what we say and what we do has an impact on others, without our ever realizing that we have made a difference in someone else’s life. For that reason, we always have to be aware of what we are doing. Most people can name a schoolteacher or other important figure in their formative years. That person probably does not know what an impact they made upon you. One of the biggest on my own life is a person that I never even knew their name. Something that they did change the course of my life and made me becomes the person that I wanted to become. I never had the chance to tell them the impact that they made. At the same time, I have had people that I could barely remember their name, tell me what a difference I had made in their life by just doing what I felt was part of my job. You are doing that to people around you all of the time and you never know it.

Often patients will remember the little things that you did for them. It may have made been the day that you got up and walked around the counter just to open the door for them. Maybe you went out of your way to find cheaper medication for them or helped in some other way. You leave an impression without ever knowing it. This can affect you in many ways.

You have satisfaction of knowing you did a job well and sometimes you are even recognized for that. However, do not expect to be recognized for a job well done, often you do not hear what people think of your work. If you do something poorly, it can come back to haunt you and can hurt you in ways you never know. For example, if you were rude to a patient and they tell a family member or friend it can keep that person form coming to the office and hurt business or it is possible that you want to apply for a job. One time I did not get along well with a co-worker due to several issues. Later on, I applied for a job with another company. It turned out that the former co-worker was related to the interviewer. I had done very well until they asked the former co-worker their opinion of me. Several other people later told me that was the reason I did not get the job. Healthcare is a small field in many ways. Keep that in mind and do not make the mistake of burning bridges. Once lost a reputation is hard to rebuild.

Always be an example of what you would want to follow. You may not be in a current leadership position, but that does not mean that you cannot set an example.

Who are Leaders in Healthcare ?

On Father’s Day as we thank our fathers for being leaders in our lives, we can ask, “Who are leaders in healthcare?” There are many types of leaders, some good and some bad. Everyone has since the effects that a charismatic leader can have and often the devastating consequences that these personalities can have on their followers. Leadership has been thought of in many terms over the years. At one point, the common belief was that great leaders were born and not made. During that same time period, most people followed in their parent’s footsteps and maintained the same job for most of their lives.

Times have changed and people’s views changed. Most people would agree that good leaders and either made or a combination of environment, born with natural talent, or learn to be a leader.

One of the best keys to being a leader was given by a firefighter, “You can’t be a leader if no one is following you.” To him it is important as a leader to know where you are going and to have followers. Some people are followers and some are leaders. It takes both and both should be good at what they do.
Some keys to being a leader include:

• Being a role model, don’t be afraid to get down and do the dirty work. We all have to pay our dues sometime.
• Know where you are going and let others know where you are going. Share your ideas and vision with them. They may have some good ideas on how to get there.
• Challenge the old beliefs. Don’t do something just because that is the way it has always been done in the past.
• Help and encourage others to act. Be supportive and help them to grow.
• Follow your instincts. If you believe in the cause or idea, then make the decision and stick with it.

Many of the problems with leaders is our inability to trust them. When you are a leader, you need to move to the position that what you say is what you do. If someone can’t respect you and doesn’t trust you, why should they follow you? Your followers are important. Think about a flock of geese. They take turns being the leader, but while they are the leader, they can hear the other geese honking them on. The other geese are offering praise, support, and criticism. You will find that the critics can be the most vocal, but even they can urge you on, by keeping you moving forward.

You make yourself either a good leader or a bad one. If you are going to be involved, then get involved have the commitment and follow through. Be the best you can be at what ever you choose. Lead by example; be willing to do the necessary dirty work. Begin with the end in mind, that is know where you want your followers to end up before you start out. Help them to be come competent. People respect others that are competent and the competency has been proven. Inspire others to be competent and encourage them to have compassion and follow their heart as well as being confident in what they do.

Leaders are made by applying formal or non-formal education and experience. They often come out of adversity or need, they are the ones that rise to the situation to be the voice of reason and lead others. In many cases they may have not shown leadership tendencies until they were called upon, there is an ability to get along well and work with others but the leadership aspect at a high level can be achieved by training.

One of my favorite leaders is Joshua Lawrence Chamberlain. I first became familiar with his story several years ago in my readings and watching the movie Gettysburg. It was a difficult time to live and lead others during the Civil War and Colonel Chamberlain rose to the challenge. He had been a scholar and seemed an unlikely leader, but when the time came he was able to lead his men and help the cause. If he had not held Little Round Top during the battle of Gettysburg, the outcome of the entire battle might have been different. It was especially interesting how he fell back on his studies and faith; he used the experience of others to guide him in his direction. It was a good lesson in how we can learn so much from the mistakes and achievements of others. We would save ourselves a lot of problems if we could learn from the past and not be destined to make the same mistakes as our ancestors. Unfortunately, we do not always do that and will need leaders with Colonel Chamberlain’s the ability to learn from other people’s triumphs and failures so that we do not repeat the mistakes of the past.

The speech that Colonel Chamberlain used to motivate the men reminded me of the one in William Shakespeare King Henry V. On Saint Crispin’s Day, King Henry in the play rallied the troops, by saying “We few, We happy few” and “We who are about to die gallantly” in his speech. This speech moved the troops to willingly sacrifice themselves for their leader. Both King Henry and Colonel Chamberlain were able to move their men from despair to be willing to lay their life down for their cause. They did this by emotionally enlisting the people. The listeners were told that the cause was just, personal calling was noble, challenge was critical, and the leader valued their support. There are many men and women that have been able to move people, but few have achieved that level of success.

Some time ago, Louis Gerstner as IBM chief executive had to motive his “troops” at the newly acquired Lotus Development Corporation to support him and IBM. He used similar tactics and was able to motive the newly acquired employees. Leadership is a learned trait; it does help to have certain personal characteristics, but can be learned. This can be done through observation, reading, and a willingness to learn from the past. Several of the leaders that we studied did not appear to have strong leadership skills before they were called upon, but were able to draw on their knowledge, beliefs, integrity, and had a willingness to act. People look for honesty, forward-looking, competency, and inspiration from their leaders. Many of us were fortunate to find this type of leadership from our fathers. Some of us were not this fortunate, can find examples of fathers or leaders that have provided this type of leadership. By following the principles that we learned from great leaders we can apply the knowledge to enable each of us to have strong leadership skills.
Have a great Father’s Day and remember to thank your Dad and the others that inspired you for providing leadership in your life

LAST CHANCE

There are only 6 more days for the Early-bird discount!!!!


The Professional Medical Staff Association (PMSA) is pleased to invite you and your colleagues to attend the 2009 “Changing the Future of Healthcare, One Team at a Time” Conference at the Doubletree in Overland Park, Kansas. During tough times it is vitally important for the team to work together to reduce costs and increase efficiency.

Having a dysfunctional team increases errors, decreases moral and can led to high staff turnover. By learning to work as a team, this can help the practice to improve and reverse many problems. This one-day conference allows the team to come together for group lectures and a break-off session to network with others that are doing the same job.

Highlights include lectures on the following: - Team Building - Team Effort: The Key to Getting Paid - Getting Better Results - Becoming a Better Employee
We are fortunate to have two speakers from the American Academy of Family Physicians this year. Gail Jones on practice management and teambuilding and Cindy Hughes on billing and coding. Join us July 17, 2009 at the Doubletree in Overland Park, Kansas. There is no better opportunity to meet and network with others that are facing the same obstacles as you. Register now and together we can learn how to change the future of healthcare, by developing your team! Best regards, Ms. Jennifer ZarateExecutive Director/CEO
For further information about PMSA, please visit www.thepmsa.org


Early Bird Discount if Registered before June 1st $150
Become a member of PMSA and attend the Conference before June 15th for only $225
Conference only, after June 15th $250
Become a Member & attend the Conference after June 15th $325

Patient's referring others

In a previous post I recently discussed my own provider’s practice and the service that I received as a patient.

Per a recent study* “When selecting new primary care physicians, half of all consumers relied on word-of-mouth recommendations from friends and relatives, but many also used doctor recommendations (38%) and health plan information (35%), and nearly two in five used multiple information sources when choosing a primary care physician.”

This highlights the importance of how staff treats every patient. While I would not share the name of my provider, how many of your patients would share with others how they were treated and your practice name? As a patient, in the past I have been treated rudely and even heard staff gossip about me (it was a former employee of mine gossiping with my new provider outside the exam room as I waited to be seen). What message does this send across to our patients? How can we be sure that our patients are signing our praises and not spreading bad news about us?

Staff education on customer service and patient etiquette should be a high priority. If we rely on our patients to refer us to their friends and families, what message will they give? Be sure that staff is aware that what they do can affect the practice and in turn affect the need for their continued employment with the practice.

Conduct regular training sessions with your staff and consider conferences and workshops to help with the training. Conduct an audit of the practice and see how things are really going. If you do not already do patient satisfaction surveys consider starting one.

For additional resources and information www.thepmsa.org
*Tu HT, Lauer J. Word of mouth and physician referrals still drive healthcare provider choice. Center for Studying Health System Change, Research Brief No. 9, December 2008, Accessed from http://www.hschange.com/CONTENT/1028/ on June 1, 2009

Appointment Scheduling Doing It Right Every Time

One of the most frustrating aspects of a day for a provider is having a bad or inaccurate schedule. It makes it difficult for everyone to do their job when this happens. Occasionally mistakes can and do happen, but they should be kept to minimum. In a previous module we discussed the importance of repeating the information back, but still ensuring that you are not violating HIPAA and that others cannot overhear personal information.

It is easy when you get in a hurry to make mistakes, the importance of ensuring that the information is correct and that it is saved to the system. If you have all of the information entered, but do not save or submit the appointment, what good does it do? You have done all the work, but have still created a problem.

What should you do if you do make a mistake? It is important that if you think you forgot to save something or could have incorrectly entered something to do something about it right away. Even if you cannot do something about it (e.g. the new patient’s information was lost and you have no number or contact information), by saying something right away there may be something you or someone can do about it. Maybe the patient had been referred by another practice. Can you call the practice to see if they know who it might have been or maybe the patient had just been seen in the ER the night before? It is possible that you might be able to find out something or track it down. If nothing else, you can at least save the appointment slot and ensure that it is not double-booked.

What if you did not know that a mistake was made and a patient showed up that you were not expecting? Make sure that the patient has the correct day and time. Then tell management as soon as possible. If you do not have any open slots or are not a type of open access, the provider will need to be consulted to see if the patient can be worked in. In any case it is important to let others know of the mistake and correct as soon as possible.

Source: PMSA Front Desk Training Module Four

Front Desk Issues

This article was written by one of our members.

Front Desk Impressions
By a patient and staff trainer.

Here at PMSA, we often discuss training and how important everyone in the practice is in the impression that your practice gives your patients. This week for me, this really became apparent. I have a chronic condition that has required that I go to a specialist on a regular basis. The specialist that I have chosen is in a new high rent area that is known for the upscale care that the providers in the area provide for their patients. In this particular practice, the physicians only hire RNs or higher to work in the back office. They do not hire medical assistants and focus in advanced education for all clinical staff. The back office is a warm caring, highly trained area. My only complaints have ever been the tendency to call me “hon” or “sweetie” by the staff and the name tags.

All of the clinical staff has “P.A.” after the staff member’s name. I asked what this stood for since two of the girls had already mentioned that they were RNs. I wondered if they actually did have PAs on staff and was told no, but there are ARNPs. I then asked what it stood for and the staff was not able to tell me. Having P.A. on the name tags is confusing and goes back to our argument here at PMSA of staff misleading patients of their training. There have been several cases of lawsuits of medical assistants or front desk staff referring to themselves as “nurses”. I am sure this was not intended at my providers, but it is confusing and especially troubling when the staff cannot explain the meaning.

As mentioned the clinical staff is highly trained, unfortunately this does not seem to follow through with the front desk. I was early for my appointment when the office opened in the morning and actually got there before a couple with a child. The couple was waited on first and when the receptionist was done with the family, I tried to check in and had my head bitten off. “I will get your chart when I get a chance, just sit down.” I was amazed, I had waited patiently and she was actually done with the family that arrived after me when I tried to sign-in. Having worked a front desk for many years, I try to be understanding on how you can get busy, but she did not even try to acknowledge me or speak to me again. I found out later she even had my date of birth wrong in the chart and if she had actually checked me in, she might have discovered the mistake. The nurse had to write the correct date in the chart. I have had many problems with the front desk, including being given the wrong information for a procedure. Over several visits, I have watched as they discussed patient information at the front desk, took personal calls and basically do most of the things that we tell staff not to do, but find that they often do anyway.

The providers have gone to a lot of trouble to make sure the clinical staff is professional and providing the best care possible (except for the “sweetie” problem). I think they would be amazed at the behavior of their front desk. Over the course of my visits, I have had the chance to hear other patients discuss how rude the front desk is and how they hate to deal with some of the front desk.

This is something that happens all of the time in practices. Working as a manager, I have been guilty of focusing attention on the clinical staff, but the front desk is the first and the last contact patients have with your patients. Often patients do not say anything, but switch providers or tell others about the way they were treated in your practice. I really like my provider and have improved while under his care. I am planning on letting the practice know about the type of service that patients receive and see what happens. I am hoping that they will extend the same high level of care and training that they expect from the clinical staff and start expecting it from the front as well.


To help practices with staff training, PMSA offers training modules, membership, webinars and an upcoming conference. Visit our website at www.thepmsa.org to learn more.

Phone tips

One of the greatest skills you can have is good phone etiquette. Much of your day will be spent on the phone and how you handle the phone can really step you apart.
Create a good impression:
· Answer promptly; most offices require that the phones be answered by the third or fourth ring.
· Always answer with a friendly greeting. Most companies have a format to use. Try smiling when you speak on the phone, the listener can hear the smile.
· Do not chew food, gum or drink something while on the phone.
· Do not use your keyboard if possible-the caller can hear the clicking.
· Speak clearly and slowly and modulate your voice. Either raise your voice if they are hard of hearing or lower it, if you have a normally loud voice.
· Move the receiver two-finger widths away from your mouth to provide a cleaner sound.
· Keep in mind who can hear your conversation. Be careful giving out personally identifiable information over the phone when other patients can hear you. Due to HIPAA, ask the caller to identify themselves and give a piece of personal information to identify them before discussing any information related to medical care, appointments, or billing. If the caller is not the patient then check the chart to ensure that you are able to speak to the person

Putting Callers on Hold
· Before you place the person on-hold, ask permission. If they ask why, provide an answer.
· When taking a caller off of hold, always thank them for holding.

Transferring a call
· If the caller needs to speak to another person or department, please transfer the caller directly to the desired person's extension, not to the operator. This will save the caller having to explain his/her requests another time, and it will cut the number of times the caller needs to be transferred.
· When transferring a caller, tell them who you are transferring them to and how they can reach that person directly in the future, and announce the caller to the person you are transferring them to.

Taking Phone Messages
When taking messages include the following details:
Callers name and company (if applicable)
Time and date of call
If a return call is required
When and where they would like called as well as a possible alternate number
What the call is regards to

Ending
Always thank them for calling and let them hang up first. This allows think to feel that their call was important and you were not rushing to get rid of them.

Phone skills are an important part of doing business and a true professional works consistently on improving their phone skills. You should always use professional manners, you never know who is really on the line. Due to HIPAA and common courtesy, we should be very cautious about what information is given over the phone. I can say that I am anyone, but how can I prove it? Name and date of birth are easy to obtain. I often ask the patient to identify something on the chart, such as who they have as their contact. If permission was given to another person to give information to, they should be able to give information about the patient, such as date of birth or Social Security number. Have a plan that follows office and HIPAA guidelines on what information is to be given and how to give it.

Things to consider when on the phone:
Can anyone overhear this conversation? If you are calling patients and other patients might overhear personal information about your patient, you might need to consider moving when making calls.

Are you sure that the person on the phone is entitled to the information? Is it the patient on the phone or a family member? Do you have permission from the patient to speak to this person?

Is this highly personal material? Is this PHI (Personal Health Information) something of a confidential nature, such as communicable disease, mental illness, disability, related to abuse or addiction of any kind? If so, take extra precautions when discussing information.

A few guidelines that should be considered when phoning patients include:
· Did you check the patient’s chart to make sure they have not given a preferred method of communication or have limited what can be given?
· Did the patient give permission for another person to have access to any information?
· Is it alright to leave a message? It is hard to tell if it is a secured answering machine or if others have access to it, when leaving messages it is best to give to leave your company’s name or abbreviations if applicable, and number to call back. For appointment reminders leave the date of appointment and a call back number. Many times I have heard staff leave the reason for the appointment, such as mammogram, x-ray, labs, etc. Don’t do that, what if the person listening did not know that your patient was scheduled for labs for STD, they may not want them to know. Use common sense when leaving messages. If there are instructions or results, have them call you back.
· If you have to transfer the call, put them on hold, or call them back once you have the answers, let them know. Know one expects you to know everything; people will appreciate if you tell them that you want to verify something before you answer their question.
· If the person on the phone is rude to you, try to stay clam. Try to remain diplomatic and polite. Getting angry will only make them angrier. Always show willingness to resolve the problem or conflict. Try to think like the caller. Remember, their problems and concerns are important. Patients are often sick, in pain, or scared; keep in mind that this may be a bad time for them. Offer to have your supervisor talk to the caller or call him/her back if the caller persists. Speak slowly and calmly. Be firm with your answers, but understanding.
Your telephone policies can set you apart from others, in a good way or a bad way depending on how you handle them. Evaluate how yourself and see how you are doing. Then see what can be done differently to improve the phone conversations.

By having a polite consistent phone manner, you can set yourself apart from others. You can be a leader and professional in part by the image that you project.

Source: PMSA Front Desk Training Module One