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.