Helping Patients Without Hurting Yourself Financially

by Jennifer Zarate

We are all aware that we should help others, but not become part of the problem ourselves. That may be easier said than done in these tough economic times. After years of decreasing payment and increasing overhead costs, physician practices may now face even more dilemmas as patients increasingly feel the economic squeeze.

How do you handle the patient that has been with you and faithfully paid for the last twenty years, but lost her job last year and in ready for her account to be in collections? You hate to lose her and now many of your patients in the community are without jobs-what is a physician to do?

Most practices already have some type of plan for indigent care. These can include payment plans, assistance in obtaining loans for the balance or lines of credit, and writing off balances based upon strict criteria. Many practices require that the patient show proof that they have attempted or are in the process of obtaining governmental or community assistance, prior to consideration of write-offs. However the recently laid off patient may not be eligible for the traditional financial aid and is likely less knowledgeable about obtaining assistance.

Patients who are behind on their bills to you are probably having problems with other creditors as well. Patients most affected may be those with high-deductible health plans or whose COBRA premiums are unaffordable. To assist these patients, you may want to ask your staff to look into what resources are available in your community. In addition to the standard governmental resources, there may be community and faith-based charities as well. Your local hospital will probably be able to provide you with a listing. For patients who cannot afford their medications or whose health care needs would be better met through a free clinic, resources can be found through the Partnership for Prescription Assistance web site https://www.pparx.org/Intro.php. This web site provides information and applications for prescription assistance by state and medication as well as a listing of free clinics by zip code (see the Resources page). If a patient does need to seek care elsewhere, it is important to actively coordinate the transfer of care and ensure that all acute conditions are adequately managed prior to release from your care.

It is also important to select staff that is assertive, but respectful to counsel patients regarding their financial responsibilities. Patients should not be made to feel ashamed of their inability to pay but also should recognize that the physician practice is a business with expenses and obligations that also must be met.

Maintaining Practice Viability

This is a good time to review your patient payment policy and procedures. Talk to your billing manager/staff and review financial reports to find out where you are at financially in comparison to last year, take a pulse of the practice and evaluate the revenue-cycle process. Consider providing staff additional training to ensure that proper billing protocols are in place. Tips to enhance practice revenue include:

• Patient information is being entered correctly the first time by staff including patient demographics and codes, and modifiers.
• Complete documentation and submit charges as promptly as possible.
• Monitor whether insurance payments are received in timely fashion and amounts allowed are based upon existing contracts.
• Establish processes for review of denied charges to correct and resubmit claims, identify patterns of denials, and address any ongoing payment issues. Discovering a small problem now keep it from costing you more in the long run.
• Collect co-pays and deductibles or any portion the patient can offer at the time of service. Accept credit and debit card payments.Take advantage of real-time claims adjudication systems if available.

Other Options to Consider

If you do not already have a prompt payment discount for patients who are paying at the time of service, this may be something that you want to consider. Payers require that you provide discounts to their insured while withholding most of the payment until a “clean claim” has been submitted and processed. It saves your practice time and money to collect payment in full at the time of service so it may make sense to pass a portion of those savings on to the cash-patient. (Be sure that receipts are given for all point of service payments with duplicates kept in your records and frequently monitor these receipts against deposits.)

Some practices have gone to a bartering system. This can be regulated by the community and should be reviewed by your accountant and/or attorney before it is agreed upon. Valuing some services can be difficult. To help in this process there are now bartering services available on-line. For a membership fee, the service helps establish fair value and helps to process and track the services. This can be a great way to pay for work done to the building or services needed. How this will affect the practice and the revenue should be discussed with all partners in the practice. While the service is a great idea, you will need to maintain a balance between traditional payment and bartering. You will still need cash to pay for supplies, staff and other overhead charges.

Deciding how to care for the growing number of patients without insurance or the inability to pay for services is a difficult decision with no easy answer. What works for one practice may not work for another, but ask around and see how others in your area are handling the problem. You might find a solution that benefits both your patients and your practice.

Swine Flu and the Medical Practice

With a possible wide spread swine flu outbreak, what is a medical practice to do? Healthcare workers face special problems. In most cases we can ask sick people not to come to the office, unfortunately this is not the same for the medical practice. It is our job to help and see these sick patients. However, there are some things that can be done.

Consider some basic review:

• Review CDC recommendations http://www.cdc.gov/flu/workplace/
• Discuss staff sick leave policy and update if necessary
• Review signs and symptoms of flu with staff-has your patient been to Mexico or been around others that have recently?
• What is your emergency plan in a crisis?
• If you have a possible case of the swine flu:What is your protocol for notifying authorities? Review and update as needed.
• Sanitation methods in your practice to reduce spread of disease.

Discuss daily routine of cleaning rooms. Are the rooms being wiped down daily already? Some things to consider when cleaning include how often and how the rooms are being cleaned. Do you clean the door handles? Door handles are one of the worst surfaces, think about it. Your patient just sneezed and touched the handle and then you touched it when you left the room. What did you touch next?Do you clean the waiting room? How often? If you have a sick patient that is being seen with flu-like symptoms, do you have a separate place to put them that will reduce other patient’s exposure?


Does your staff practice good handwashing techniques? Do you encourage them to get immunized, eat right, get plenty of sleep and practice other prevention methods of getting sick? How will you handle it if several of your staff becomes sick with the flu? Do they come to work sick and expose more patients or do you encourage them to stay home when sick. How do you handle it if several become sick at the same time?


The American Academy of Family Physicians (AAFP) has some great information for both the practice and for the patient on their website at
http://www.aafp.org/online/en/home/clinical/disasterprep/pandemicflu.html
Swine flu: http://www.aafp.org/online/en/home/clinical/disasterprep/swine-flu.html
For the practice they even have business and clinical check-lists for preparing the practice.


For your patients, do you have handouts on the flu and are they current? Many patients may turn to you for additional information. If you do not have current information to offer, consider the CDC information, the AAFP handouts or your own speciality.

There are many other available resources.These are just a few of the possible questions to ask yourself. How and what you will do depends upon your practice, but with the new outbreak take this time to re-evaluate how you could handle the flu in your practice.

How to keep your office upbeat in a beaten up Economy

We all have heard about the bad economy. Something that is effecting everyone in one way or another: Budget cuts, layoffs, bankruptcies and businesses going belly up. Is this causing your employees moral to sink? Is fear in the air at your work place? Fear is not going to stop things from happening in a positive manner but make them worse. So what can you do or say as a leader in the office?

•Don’t keep talking about the bad economy. What people focus on becomes their reality.
•Create a new focus for your team, or your organization. Start a big initiative. Put your energy in productive work. Engage employees in an organization –wide, or a department-wide, service enhancement or process improvement effort.
•Get out of the “limited pie” mentality, where people fight for pieces of a shrinking pie. Summon people’s creativity to create a totally new pie, or enlarge the existing one. Break up the walls between departments. Open up the organization for the winds of innovation and change.
•Don’t waste time waiting for the other door to open. Jump with both feet and get busy.
•Instead of reducing your efforts, consider doubling them. Resist becoming paralyzed, not taking action, or waiting for things to improve. The world will not stop because you don’t like the way it is going. Push forward and quit waiting for change. Be the change you want to see happen
•Communicate often, delivering a message of confidence and hope. It’s not the end of the world. It may be only the end of an old way of doing business. This could be your exciting opportunity to create a new way of thinking about business, and turning that thinking into reality. Positive word/works will be need to
•If your organization has gone through a budget cut or reduction in force, communicate the reasons for this action and then move quickly to communicate the expectations, vision, and plans for the future. You must model, in words and action, the message of hope you need to deliver.
Pamela Larberg- 2009

Red Flag Rule

Practices all over are struggling to get ready for the Red Flag Rule before the May 1st deadline. http://www.ftc.gov/bcp/edu/pubs/business/alerts/alt050.shtm
The basic premise of this rule is to be able to identify a red flag and show what are you going to do about it in your practice. There are many resources now available to help practices become complaint and many of these are free. We have listed just a few below. When looking at the resources, be sure that it will work in your practice.

http://www.ftc.gov/bcp/edu/pubs/business/idtheft/bus23.shtm
www.mgma.com/redflagsrule
http://www.aafp.org/online/en/home/practicemgt/regulatory-compliance/id-theft.html
http://www.aha.org/aha/advocacy/compliance/redflags.html

If you have any suggestions or other resources, please let us know. We look forward to hearing from you!

Change Management in the Practice

“If I were in charge here, I would change …” How many times have you thought this when you knew there was a better way to accomplish a task? The funny thing is that many of us are in a position to help facilitate change if not directly instigating the change. Yet, how many times do we find ourselves resisting change? It is ingrained into us to resist change.

There is a great story about Willie B. He was a gorilla that lived at the Atlanta Zoo in isolation for 27 years with a tire swing and television set to keep him company. Finally, some supporters were able to raise the funds to develop an outside natural style setting for him. When they opened the doors he could see the trees and grass for the first time, but was afraid to move. He was only willing to put his paw out in the sunshine and let the sun on his hand for the first time. He could see that it was better, but he was afraid of change. Finally Willie B. ran into the sunshine and never looked back. He was able to raise a family and lived to the age of 41. Willie B. initially resisted change even though he could see it was better than what he had, we as humans tend.

Humans try to reduce stress and uncertainty by establishing routines. Sometimes even when we know that a change is needed, we still work really hard to keep things the same way they have always been done. Right now, everyone is talking about how we must change healthcare. There are many ideas floating around on how to make this change. Some new ideas include the medical home or transforming practices. They all seem to follow the basic principal that a change is needed. In many cases a change is needed, but it is always good to remember not to throw the baby out with the bath water. There will always be some things that you will want to keep and others that may need to altered.

Some of the staff will immediately jump on board and others will be drugged through a change kicking and screaming the entire way if you are not careful. How can this be avoided? The best way is to gain their involvement. In order for a change to be successful and not a temporary band-aid, Everone needs to be a part of the change process.

If this is a small practice, then it is easy to allow everyone to get together and brainstorm. If it is a larger organization it may be necessary to have group representatives that can be counted on to go back and keep their group updated and involved in the process. By allowing the entire group to be a part of the process it reduces their resistance to change and allows them to feel a part of the process.

Together begin with the end in mind, that is figure out where you want to be. What goal is it that you need to achieve? Maybe you want to make sure that patients are being contacted properly regarding tests or maybe you want to reduce patient wait times. Figure out what the goal will be and then establish the parameters and measurements needed to achieve the goal. How long do you need to reach the goal realistically? How will you know when you have reached it? Make a plan of action and allow the group to brainstorm to determine steps and measurements for the goal.

Most humans tend to have problems with only long-term goals. If you have small goals within the large goal it often makes it easier to achieve the ultimate prize. Look at it this way, to win at the Olympics you have to win at national events. To win at national event you have to win at regional events. To win at regional, you had to win at local events. To win at each event, you had to practice until you were good enough to win. Your ultimate goal was to win at the Olympics, but you had a lot of small wins leading up to the final goal. You would have started by establishing your baseline and along the way you would have continually measured and checked your progress. To reach your goal in change management in the practice you will want to do the same thing.

Sometimes, we start out with one goal in mind and find along the way that it isn’t going to work. By measuring and evaluating along the process you will be able to see if something is working or needs to be dropped and a new goal put into place. Life is all about change and how we handle it. We can let change frighten us or bring us down or embrace it as Willie B. did and go out into the sunshine and live life to it's fullest.

References http://www.zooatlanta.org/animals_willieb.htm

Rules in the practice?

Everyone needs a few ground rules in life and in business. It gives us the boundaries we need to become successful. Think back on your childhood or your children’s, one of the ways they learn is to test the boundaries. How far can I go before Mom says no. If I push can I get my way? Think about it as adults don’t we do the same thing?

When you barter for something or try to negotiate for a lower price, say a car or piece of medical equipment aren’t you pushing to see how far you can go before no comes up? You push the boundaries as far as they will go to your benefit. Employees do this as well.

Think about your employee who comes in as close as possible to the time, or how about the employee who pushes the break-time or lunch rules. As managers we are told all the time to give positive reinforcement, but employees need boundaries and if they cross over them they need to know what to expect.

At the minimum your office should have an employee manual. All staff should be responsible for reading the manual and signing off that they have received a copy of the manual. You should also consider a policy manual or office procedure manual. This can include all of the other rules and what is expected of the staff. This should be kept where the staff can have access. If you have monthly meetings or regular meetings keep a copy of the agenda and have staff sign-in. Then consider keeping this record where staff can review occasionally.

I suggest having a set of disciplinary steps that staff are aware of and can review. The example could be followed with the guidelines that certain circumstances could call have more severe punishment. In other words if a patient or staff had been in danger or HIPAA incident called for immediate dismissal this could be done without following all of the steps. The company, employees, and patient’s safety should be put first.

An example would be:

First infraction: The first step is a verbal warning. A copy of this is signed by employee and kept in their file clearly stating this is a verbal warning.

Second Infraction: This would be a written warning. It would be signed by employee and kept in their file.

Third Infraction: Time off with out pay. Many offices can have up to a week off without pay, but usually only have three days off.

Fourth Infraction: This would be dismissal from employment.

In all cases state and local regulations should be followed on handling disciplinary actions. The point is that the staff should know what is expected and what will happen if they break the rules. People need positive and not so positive feedback to help them set up the boundaries of what is expected and what is allowed. It is your job to give them those boundaries.

Handling Holidays in the Practice

Whether it is Passover/Easter or Christmas/Hanukah/Kwanzaa there can always be a problem with different staff celebrations. Many staff at this time of the year wants to celebrate by brining in their special Easter dishes. The problem is that other staff might be offended or at least unable to participate due to religious or food restrictions. That Easter ham or Hot Cross buns might not be a hit to the Jewish employee. On the other hand, the Gefilte fish might offend the vegetarian in the practice. Why not use the holiday season to celebrate the differences and include everyone? This is a great chance to learn about others traditions.

Many practices celebrate a multitude of holidays and celebrations and even include bringing in treats to celebrate the different holidays, but respect others wishes and dietary restrictions. Try to come up with ideas to incorporate as many different holidays and celebrations as possible and learn about them as you do so. This can be an individual thing where you take it upon yourself to learn about others or can be a team effort across the practice. Try to learn something new about others everyday. By learning and having a better understanding of others you learn to respect their beliefs and ideas. You may not agree with them, but you can still respect them.


http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1249.htm

Creative employee incentive plans for your staff- by Jennifer Zarate

How can you reward your employees and is money the only thing that will work? Most people are surprised to learn that money is not the only way to effectively reward your employees. Talk with your employees and find new ways to set up an incentive plan. Learn what will work for them and help them to reach their goals. Together set reasonable goals and rewards. It can be as simple as increasing the number of patient accounts billed and rewarded by points to earn simple prizes such as movie passes. Look at regulations to determine restrictions on amounts and what can be given.

How does an employer reward an employee? How can you make the reward be appreciated? Does it always have to be money? All employers struggle with employee issues. Physician practices often face special challenges in this area. You want to find a competent staff that will make your practice run smoothly but often are forced to hire staff with less than stellar resumes. On the other hand, maybe the staff member looked great on paper but not so great when it came to actually doing the job. When you do find a staff member who meets, or possibly exceeds, expectations, how can you be sure that they will remain and be happy in their job? How can you keep them involved and wanting to come to work every day?

Most people believe that staff members are motivated by cold hard cash; this cannot be further from the truth. Each of the staff members have different motivators that make them excel. As an employer, it becomes a challenge to determine what each employee’s motivation is and how you can tap into what motivates him or her. In a small practice, this can often be done by simply asking each employee what type of reward incentive they would like besides money. For instance, if the staff made it possible to increase the number of patients without compromising the quality of care; one day you could have lunch catered in to celebrate their accomplishment. Another possibility is to host a root beer float or a popcorn break when the staff creates a better system of moving patients through the practice that increase your productivity. On the other hand, maybe the billing staff was able to work through the old accounts and decreased the payments for the month and you arrange for an ice cream social in the parking lot. There are also ways to reward the staff on an individual basis; if someone were to go above and beyond the normal call of duty to help a patient out with their medication problem you could offer a gift certificate to a local bath shop.

One easy and inexpensive way to encourage is by personal acknowledgement of their work. Every day the staff does little things; sometimes they just want someone to acknowledge those little things. Try to catch the staff doing something good every day and comment on it. If you can catch one person doing something good every day and rotate through the staff, in small practices you would have just commented on every person at least once a week.

Leaders should be willing to open the line of communications with their staff and get to know them and their needs. Sit down with the staff and ask what they would like to have as an incentive program; set the boundaries and create the goals. By allowing them to be part of the development process, it ensures their buy-in. Offer suggestions such as short and long-term goals and rewards for making their goals. On the long-term, consider having small prizes throughout the process. Maybe, the staff would like movie cards or gift certificates to nearby restaurants for reorganizing the supply closet. Another option could be a long-term goal of reorganizing all of the exam rooms. In the short-term, every time one of the exam rooms is completed have the staff draw a prize out of a grab bag. When all of the rooms are completed, you could consider a team-building afternoon of shoulder massages, maybe an afternoon off, or taking everyone out to lunch. Let the staff help identify the problem areas and then let them be a part of the process and have input into their rewards. This can help develop the team and make the place an enjoyable environment. Although, there may be some employees that are not as engaged in the process as you would like, try getting them involved by directly asking them their opinion. If they feel that their thoughts and ideas are important to you, they will be more likely to join in on the conversation and take part of the incentive program.

It is important to remember that rewards and incentive programs need to be well thought out in advance. It is also important to keep account of money spent, and it might be necessary to report as income if the dollar amount is very much. It would be necessary to check with local and national regulations for current restrictions on the amount allowed. Discussing it with the entire staff ensures that everyone understands the intention and use of the program. These types of programs strike an emotional chord with people and can become either a huge success or a nightmare. However, with careful planning and group involvement everyone understands what is expected and what can be achieved. It allows everyone to be involved and feel important. By feeling involved and appreciated, your staff is more likely to want to come to work every day and want to stay. Getting good staff involved and willing to stay is an incentive program for the employer. As a leader, why not make this a goal and part of a change process? As leaders in our field, we can make a difference with our staff and our work environment by the development of our staff and recognition of their hard work. After all, who would not want to be rewarded for their hard work? I know we do and part of our reward is working with happy, involved staffs. For us, that is incentive enough to develop a plan.