Practice Tips

How does this fit with the Medical Home and ACOs?

2011-03-17T08:38:00.000-07:00

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

Excerpt from PMSA's new book:

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

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

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

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

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

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

In the center is Ethical Behavior that ties everything together

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

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

If you wish to receive additional information on this new book, please contact jenniferzarate37@yahoo.com

Customer Service

2010-03-12T12:14:00.000-08:00

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

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

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

Take the time to assess your practice’s customer service and see if improvements can be made. Consider taking customer service training. There are countless books, DVDs, videos, conference, etc on customer service and many are either developed for the medical practice or might work. A free one can be found at http://tinyurl.com/m37evp

Fortune Cookie

2010-01-29T13:29:00.001-08:00

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

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

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

Do you resent your employees?

2010-01-21T07:43:00.000-08:00

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

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

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

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

2010

2010-01-04T07:48:00.001-08:00

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

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

Holiday fun

2009-12-22T07:48:00.000-08:00

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?

2009-12-11T09:08:00.000-08:00

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?

2009-11-11T06:24:00.000-08:00

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?

2009-11-05T13:02:00.000-08:00

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!

2009-11-03T09:22:00.000-08:00

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

2009-10-26T06:18:00.000-07:00

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

2009-10-21T07:42:00.000-07:00

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

2009-10-16T10:45:00.000-07:00

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

2009-10-08T14:12:00.000-07:00

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

2009-10-02T03:39:00.000-07:00

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

2009-09-11T14:12:00.000-07:00

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

2009-09-11T06:55:00.000-07:00

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

2009-09-10T07:03:00.000-07:00

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!

2009-09-05T06:57:00.000-07:00

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?

2009-09-04T05:54:00.000-07:00

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

2009-09-01T13:56:00.000-07:00

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

2009-08-26T13:14:00.000-07:00

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!

2009-08-20T12:41:00.000-07:00

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

2009-08-17T07:31:00.000-07:00

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

2009-08-11T10:44:00.000-07:00

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!

2009-07-29T07:21:00.000-07:00

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

2009-07-17T07:33:00.000-07:00

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?

2009-07-13T11:40:00.000-07:00

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

2009-07-13T07:55:00.000-07:00

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?

2009-07-06T09:10:00.000-07:00

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 ($)

2009-07-02T06:32:00.000-07:00

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

2009-07-01T13:52:00.000-07:00

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

2009-06-23T06:25:00.000-07:00

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 ?

2009-06-21T07:38:00.000-07:00

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

2009-06-09T07:53:00.000-07:00

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

2009-06-05T09:35:00.000-07:00

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

2009-06-04T14:14:00.000-07:00

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

2009-05-28T06:47:00.000-07:00

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

2009-05-18T06:33:00.000-07:00

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

Importance of telephone communications

2009-05-15T06:18:00.000-07:00

When someone calls the practice, who is often the first person that they make contact with? Is it the front desk? The front desk has the opportunity to be the major customer service representative of the practice. How they handle callers and patients in person affects the tone of the contact with the practice. If the caller is treated rudely then this leaves a bad impression on the caller. Think of it like this, when you go out to eat and the restaurant’s host or hostess doesn’t not provide you with a friendly greeting and information on when you can expect to be seated, what impression does that make? What does that make you think about the food? Most people will answer that the food is of poor quality or that this is a bad place. That may or may not be true, but it is the perception that the customer takes away. Your callers are customers, what are they taking away from your contact with them? Would they give the practice a good rating or not? Ask yourself what was the best service that you ever had as a patient or customer, are you matching that type of service? Why or why not? What can you do to improve it?

A major part of phone etiquette is actually listening to the caller. Learning to listen is an art that most people never really learn. It is something that we do everyday and yet we take it for granted, but how much are we really listening. True listening is an activity that takes skills and effort. Just because you can hear what someone is saying doesn’t mean that you really hear them. When you hear without listening you are no longer thinking about what is being said to you. You can learn more by learning to listen. A few keys are listed for in person and phone calls, but there are many good books on the subject that are available.
1. Focus your attention on the speaker and try not to interrupt or assume information before it is said..
2. Stop doing anything that does not directly relate to the subject.
3. Think about what you know about the subject being discussed.
4. Avoid listening to other issues or thinking about them.
5. Look at the speaker-try to maintain good eye contact
6. Mirror their mannerisms, but don’t go crazy. If they lean forward you should lean forward.
7. Set aside your feelings for the time being-this is a business. Later you can examine your emotions and see how you feel.
8. Plan to learn from the speaker, you may not always agree but you can learn from everyone.
9. Be aware of your non-verbal communications. Sighing and rolling the eyes is never a good one.
10. Lean forward and act interested in the speaker.

These are just a few hints on how to act interested and becoming a good listener.

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. Next week we will give some additional tips on the phone.

Source: PMSA Front Desk Training Module One

Don’t believe everything you hear

2009-05-07T11:38:00.000-07:00

Can you believe it; people don’t always tell the truth! Hard to believe isn’t it, but it is possible that employee, patients, vendors, and anyone that you deal with might not always be telling the whole truth to you.

For that reason it is important to not always believe the first thing you hear. Often the staff member that complains the most or is the most vocal are that way because they have something to hide.

When you are new, especially if you are new to the office keep in mind that everyone only wants you to see their side of the story, after all that is what is important to them. As a manager it is your job to remain impartial and be fair to all. At first it is important to step back and make no opinions about anyone. After being around the employees you can get a feel of what is the truth and what you need to do in any given situation.

One of the biggest mistakes a new manager can do is to jump in without the facts. You feel you have to do something, but if you go in with both barrels blazing you can do more harm than good. It is much harder to try to undo something you did or to fix a problem then getting it right the first time.

Before you take sides or do something you could later regret-take a deep breathe and think about it. If possible get away from the issue; if possible let it sit until the next morning. That is not always possible, but at least take a minute to think about it before you decide.

From PMSA New Manager's Starting Out 2007

New Managers Tips

2009-05-05T01:07:00.000-07:00

Being a new manager can be a daunting task but there is help out there. The government has many free web sites that offer a variety of resources, especially for human resources and complaince issues. Consider taking some classes, often community colleges and other free or low cost classes are available. You can also find help with your peers and this group. We are here to make sure you are a success.

Here are a few key areas that will help you to be successful in your new career as a manager.

Be precise with all paperwork. Nothing is more frustrating than sending an application in for privileges or other important document than to find out later you missed something. Be sure to double-check all of your work.
Keep on top of the paperwork, especially if it involves the payroll. Both the owners and the employees will be the most upset about that one area. There are many ways to handle payroll. One consideration is to out-source it that way all of the regulations should be covered. An added benefit is for a small practice it might be possible to lease the employees and that way their benefits would come through the leasing agency.
Create an employee handbook. An employee handbook should be available for all employees upon hire. They should sign a release of receipt of the handbook that is kept in your records.
Stay informed of new regulations and updates. The legal requirements in a medical practice change on an ongoing basis. It is important that you stay current. Be sure when checking to make sure of state and local regulations as well.
Have a standard policy on how you recruit, what questions you ask, how the entire hiring process is done. Keep records to ensure that you are compliant and being fair to all recruits.
Have a standard policy on disciplinary actions and termination
Keep staff trained and maintain accurate records on their training

This is just a small sampling of what you can expect in managing a practice, but your focus should be staying current in legal requirements and remaining fair to all (and being able to prove it).

Source:

PMSA’s New Managers Starting 2007

Staff Training

2009-05-04T06:51:00.000-07:00

Staff training is often one of the most overlooked areas in a medical practice. However, well-trained staff members are the key to providing quality care. Training can help staff members improve their skills and learn how to manage their job effectively. Good training programs offer fresh and interesting ideas for activities. Training is an important part of keeping a practice alive and healthy. They also help staff members grow as professionalsCost can be one of the biggest obstacles in training, however due to the internet and new resources often it can be done inexpensively and be creative at the same time. It helps to have a schedule and some training throughout the year. Often many practices will attempt to “cram” all of their training into a short time period before it expires. This can be especially true when it comes to required training to remain compliant, but in massive cram sessions how much will they retain and learn is questionable.

Some key areas to consider in developing a training program include:

What training are you required by law to have in your practice setting? This can vary by the type of service that you provide, but all practices should have HIPAA, OSHA, and HR as a starting place.
Assess the needs of the practice and staff. Talk to the staff to see what training they need and want. From the list you develop you can then go through and see what common factors develop. Make these your target areas to begin start on.
Then look at what is available. Do you have staff that can teach some of the classes, for example is one of the staff a BLS Instructor? Would they be willing to train the staff and what equipment and resources would they require to accomplish the task? Could you pool your resources with another physician’s office? Maybe you can do the training together to save money. Does the hospital or community offer any courses?

Once you have your list of what is needed then you can start to work on a budget for the classes and start planning on the when and where aspects. In your plan be sure to include a way to evaluate and monitor the success of the training program. Good luck you are on your way to having staff that is trained and knows what they are doing!

From PMSA’s New Managers Starting 2007

Red Flag Rule Delayed

2009-05-01T11:44:00.000-07:00

The FTC has announced that the Red Flag Rule that was to go into effect today has been delayed until August 1, 2009.

Originally the ruling was to begin November 1, 2008, but due to the objections of many medical associations and other organizations; the FTC had agreed to delay until May 1st. Then earlier today, the FTC announced this new delay with the statement “to give creditors and financial institutions more time to develop and implement written identity theft prevention programs.” The FTC has further agreed to provide a template to assist entities with a low risk of identity theft comply with the law.

More on the rules can be found at http://www.ftc.gov/bcp/edu/pubs/business/alerts/alt050.shtm
http://www.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtml

What It Means To Be a Professional

2009-05-01T09:53:00.000-07:00

Having problems with your medical staff acting in a professional manner? Working with medical practices, PMSA has developed training resources for the staff. These are excerpts from PMSA’s Front Desk Training Manual #1.

What It Means To Be a Professional

Many people work in the medical field and are true professionals, but unfortunately there are many that consider this just a job until they can get something better, hit the lottery, or retire. A true professional is the person that exhibits certain traits and skills in their profession and has a continued sense of learning. They are considered to be an expert in their field. Often this comes with education, but not always formal education. It can come from personal experiences, continued education by seminars, classes, networking, and studying books and other material on the topics related to their work.

People judge the office by the way the staff presents themselves. If they appear knowledgeable and look neat, the patient will feel better about the entire office. If the staff comes across rude, uncaring, or messy, the patient will have a lower opinion of the office and these patients are usually the ones that report malpractice issues. Even when the care goes wrong, patients who have been treated well are less likely to seek legal action and are more likely to become regular customers and refer their friends. How you treat the patient and the way that you dress can have a financial impact on you and the office.

Staff that comes to work in dirty or wrinkled clothes is less likely to get a promotion or raise then neatly dressed “professional” staff. Personal appearance can detract from your professional accomplishments and cause others to not recognize your value to the team. It pays to in the long run to be a professional-it can be monetary or just the feeling that you get when you know you look good and are presenting your “professional image.”

The attitude that you give off gives a person an impression of you. It is said that you have less than 6 seconds to make an impression on a person. The impression that you make can have lasting consequences, often financial consequences. Well liked and well thought of employees are more likely to get noticed and possibly even receive pay increases. The bottom line is that your attitude could affect your bottom-line. A bad attitude can send you out the door for good.

Sometimes the image that we think we are presenting is not the image the world is seeing. Perception is everything. For that reason it is important to project a professional image. It is important to have a positive outlook this will allow you to have the ability to let many problems roll off without bothering you. Nothing improves relationships with others more than a consistently positive attitude on your part. As the frontline of communications for the practice, your attitude often sets the pace and the tone for the patient’s care and visit. A pleasant verbal exchange during or after a long wait in the waiting room can often turn an unhappy patient around. While it can be difficult to listen to complaints about issues you did not cause, your words of understanding and assurance that staff will address an issue as soon as possible can turn complaints into praise.

If show up to the office in wrinkled clothes or are always late it sends out the message to your employer’s that you do not care about the job. Whether you do or not, keep in mind that things can come back to haunt you. The medical community can be a small one. Many employees have thought that the job they were doing for one place wouldn’t really matter. Then they apply at another office for a job opening, but do not realize that the manager there is familiar with the type of care that they had given at the other office and has seen the way that they dressed. Put yourself in the manager’s position and ask yourself what would you do if the person comes to work in messy clothes or all of the paperwork that they sent my office is incorrect, why should I hire you? What keeps me from thinking you will do the same at my office?

Your attitude can directly affect your own productivity. When you are happy or upbeat, it can help to make the hours go faster. When you act positive, others will respond positively to you. The phrase “do unto others as you would have done unto you,” can work to your advantage. When you are cross or unhappy, it rolls down hill and out to the patient waiting room. You can change your mood to a more pleasant one by smiling and thinking pleasant thoughts. Studies have proven that if you pray or mediate you can relax and improve your attitude-try it yourself! Make sure that on a daily basis the office sees you smiling and being pleasant to others. You need to project a professional image that the other staff can follow, be a positive trend-setter. Being pleasant and polite is a great way to start.

We have all heard the saying “If you can’t say something nice, then don’t say anything at all.” In business this applies when the other employees and patients are listening. Don’t let them catch you saying something bad about your boss, a co-worker, or worse a patient. Most people have made that mistake at some point and it often comes back at a price to the person. Many offices and employees have found themselves in court defending an idle comment that had little meaning to them at the time, it was a carelesss comment made without thinking. The littlest comments can often be the biggest problem! Always watch what you say and do! Think positive and if you need to get it off your chest talk to your manager in private.

You express your attitude before you ever say a word by how you look, stand, walks, and talk. If you look groomed, stand tall, walk confidently, and are cheerful and upbeat, your attitude acts like a magnet. You not only attract others, but they are friendlier towards you because they sense in advance that you already like them. People appreciate a positive attitude for several reasons. Most people would rather be doing something other than work or seeing their doctor. Being with fun positive people makes the time go by faster. Many people have difficult home lives and in some cases going to work or to the doctor’s visit is the highlight of their day. Both positive and negative attitudes travel fast. Everyone wants to be around positive people, being around unhappy individuals can make the day very long and make it difficult to go in day after day.

Having a positive attitude can increase the work being done and decrease the number of errors. When there is a problem, patients are less likely to become upset if they see an office with a positive attitude. How you treat the other staff and your patients will come back to you. Remind yourself to smile and have a good time.

Additional Resources:

http://www.careerbuilder.com/Article/CB-956-The-Workplace-Has-Your-Office-Become-Too-Casual/
http://www.careerbuilder.com/Article/CB-913-The-Workplace-10-Tips-for-Proper-Etiquette/
http://www.careerbuilder.com/Article/CB-964-The-Workplace-Social-Networking-Dos-and-Donts/http://www.careerbuilder.com/Article/CB-891-The-Workplace-7-Signs-of-Poor-Productivity/

Helping Patients Without Hurting Yourself Financially

2009-04-29T11:35:00.000-07:00

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

2009-04-27T11:32:00.000-07:00

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

2009-04-23T16:24:00.000-07:00

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

2009-04-21T15:12:00.000-07:00

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

2009-04-15T19:56:00.000-07:00

“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?

2009-04-13T11:48:00.000-07:00

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

2009-04-06T16:55:00.000-07:00

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

2009-04-02T18:18:00.000-07:00

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.