Sometimes when I feel like challenging myself I’ll try to make a checklist in the form of the ABCs. It’s a great brainstorming technique and you can take a little poetic license just for fun. Here’s a list for new practice start-ups or practices being acquired by larger practices or hospitals.
Appointment schedules, (are wRVUs or appointment hours required for base salary or break even?), Answering service, Answering machine
Business cards, announcements, advertisements, letterhead, logo
Credentialing, vendor notification, payer notification
Descriptions, positions (administrative & clinical support), medical director, physician leader
Evaluations (performance) for staff, mid-level providers, physicians, managers
Financial reports and practice benchmarking, budget, financial and payment policies
Group purchasing with hospital discounts or association discounts
Housing – offices, staff, lab, procedures, breakroom, supplies, storage
Information Systems - telephones, email, smartphones, pagers, laptops, PM, EMR, PACS, training and sign-off
Joint Commission or AAAHC requirements accreditation
K(401) and other retirement programs (403B, 457, non-qualified)
Liability insurance, professional and other
Medical associations and other dues and licenses, Music or messages on hold
New employee practice or hospital orientation, National Patient Safety Guidelines
Operations management – chain of command, organizational chart
Payroll setup and payables protocols
Questions about benefits, same as hospital, new practice or different?
Rx pads and electronic prescribing
Sample meds & pharma visit policy to conform to hospital or practice policy, Staff competency checklists
Trips - professional development, continuing education allowances and protocols
Undercoding and overcoding chart audits, charge reporting mechanism
Vetting who will take call & when
Website update, overhaul or brand-new
Xactly to whom do the physicians report?
Yes or no to PQRI?
Z-z-z- time away from the practice/PTO
A reader recently posed the question “Should a medical office manager eat lunch with the staff?” This question is more complex than one might originally think, and a lot of psychology actually plays into the answer. Here are some guidelines to help managers find the right times to eat lunch with the staff.
A manager should follow the rules set for the staff. If the rules say that lunch is to be eaten in the break room and not at desks, then the office manager should not hold her/himself above the rules and eat lunch at her/his desk because it is more convenient or relaxing.
The manager should appear in the lunchroom periodically to eat lunch as the staff likes to see the manager casually once in awhile and it’s a good chance to catch up with what everyone is talking about. It’s not good to eat with the staff in the break room too often, as sometimes they can’t relax or be natural or enjoy their lunch if they feel you are there watching them or listening to their conversation.
As to eating lunch outside the practice with the staff, choose your occasions wisely. I think it is acceptable to take the staff to lunch one-on-one for their birthday or anniversary as long as you take EVERYONE throughout the year, but typically it would only be appropriate to go out with all the staff for a practice occasion. You can take a team of managers or supervisors that report to you out for a lunch meeting or a special occasion.
If you go to lunch with one employee regularly, you can be sure the rest of the staff is thinking that your lunch buddy has special information that they don’t. Employees will worry about your ability to keep information confidential if you seem to be more friendly with some employees than you are with others. Some employees will even intimate that they have a closer relationship with you than they actually do.
If you’re tired of eating alone, connect with other practice managers in the area and use the time to compare notes on issues without divulging any proprietary practice information, or just to connect on a personal level.
Managers of smaller practices might not have these kinds of decisions to make as their staff lunch breaks are separated, or the culture is such that everyone always eats together. I once worked with a practice many years ago where the staff cooked lunch most days for the physicians (2) and the staff (3) – it was both surprising and charming!
If you have any management questions you’d like me to answere, send an email with your question to email@example.com. Your name will not appear in the article.
Bill Moyers spoke with ex-insurance executive Wendell Potter recently, exploring why Potter left CIGNA and is now revealing insider information on how insurance companies maximize profits and influence lawmakers. Potter testified before Congress in June and writes and speaks on his now/new understanding of why insurance companies are lobbying ferociously against a single-payer system. He is now the Senior Fellow on Health Care with the Center for Media and Democracy, of which he says,
“One of the reasons I chose to become affiliated with the Center for Media and Democracy is because of the important work the organization does to expose often devious, dishonest and unethical PR practices that further the self interests of big corporations and special interest groups at the expense of the American people and the democratic principles this country was founded on.”
What I found most interesting is Potter’s discussion on how insurance companies dump businesses by raising premiums absurdly high for those companies whom they determine to have overly-expensive claims. Through the years I have had many meetings with physicians and staff discussing what increased premiums would mean for the practice.
In my earliest days, medical practices typically paid 100% of the employee (and sometimes the dependent) premium for very rich plans. As time went on, practices stopped paying for dependent coverage, started offering tiered plans (paying in full for the lowest tier), then increased co-pays and deductibles, then introduced cost-sharing, and now are offering high-deductible plans and health savings accounts. If I believe Wendell Potter, and I think I do, practice premiums have been raised year after year after year, not because the claims experience of the group was particularly high or off-ratio, but because there were other small businesses whose claim experience was lower, thereby affording the retention of more of the premium dollar by the insurance company.
It’s almost humorous to think of the time I’ve spent evaluating the administrative and customer service received from each insurance company, balancing the out-of-pocket dollars for the employees with the out-of-practice dollars paid by the physicians, trying to make each new yearly plan as palatable to everyone as possible, when offerings were priced in double digits to DISCOURAGE our business!
Possibly the most humorous (or depressing) of all situations is when I am simultaneously negotiating with an insurance company for health insurance for my staff, and negotiating with them for professional fees to provide care to their subscribers. Let us pray that insurance companies don’t decide to get into the food or sunshine business…
Bill Moyers’ Interview with Wendell Potter here.
Wendell Potter’s testimony to Congress here.
VistA, (Veterans Health Information Systems and Technology Architecture) which was originally developed in the 1970′s by the Veterans Administration, is an open-source (meaning that the code is available for others to collaborate upon and improve) clinical documentation system that is used by all the 160-plus VA hospitals in the United States, plus all of their outpatient ambulatory clinics. Providing care to over 4 million veterans, employing 180,000 medical personnel and operating 163 hospitals, over 800 clinics and 135 nursing homes , about a quarter of the nation’s population is potentially eligible for VA benefits and services because they are veterans, family members or survivors of veterans. The VistA system has been in use by the Veterans Administration for more than 20 years, and as such is one of the most mature electronic medical records in existence.
As the Veterans Administration does not bill third-party payers, VistA is not a billing system. VistA was released to the public through the Freedom of Information Act by the Veterans Administration and today is publicly available on CDs for a nominal fee. Althought the software is free, there is a cost to install, implement and maintain it.
WorldVistA was formed to extend and collaboratively improve the VistA electronic health record and health information system for use outside of its original setting. The system was originally developed by the U.S. Department of Veterans Affairs (VA) for use in its veterans hospitals, outpatient clinics, and nursing homes. WorldVistA has a number of development efforts aimed at adding new software modules such as pediatrics, obstetrics, and other functions not used in the veterans’ healthcare setting.
WorldVistA seeks to help those who choose to adopt the VistA system to successfully master, install, and maintain the software for their own use. WorldVistA will strive to guide VistA adopters and programmers towards developing a community based on principles of open, collaborative, peer review software development and dissemination.
For more information on VistA, click here for the Wikipedia entry.
I don’t often find articles that reflect my own views as closely as the article “10 Ways to Keep Employees Happy” from HowStuffWorks by Cristen Conger does. Not only does Ms. Conger hit the list with 10 strong concepts, but she also gives great sources to back up her points. Here are her 10 points – click each one to go to the page for more information.
10. Offer Flexible Work Options Some jobs in medical practices are ideal for flexible work options, but most are not. Any position that requires face-time with the patient will likely need to adhere to appointment hours. My question: is it “fair” to allow some positions to have flex-time and others not? If you have a group of people all doing the same general job, letting some people have flex-time and others not may lead to a mutiny. Consider carefully the precedent you are setting when allowing flex-time, and make sure employees understand that as the needs of the organization change, work arrangements may need to change.
9. Practice Open Communication I couldn’t agree with this one more. Communicate, communicate, communicate. One-on-one, in departments, in all-staff meetings, in all-organization meetings. I typically send out an electronic newsletter every Friday (an idea from my mentor, Tom Girton) that announces/reminds people of events, clarifies policies and acknowledges achievements. Oh, and don’t forget to make sure that people are understanding what you’re trying to communicate. Touch base every once in awhile to make sure the message you’re sending is the one they’re receiving.
8. Pencil In Face Time When beginning a new job I often meet with every employee who reports to me (and sometimes meet with everyone in the organization in a smaller practice) for at least an hour to learn a bit about them and hear what they think the practice is doing well, and what the practice could be doing better. Yes, it takes a lot of time, but it starts to form a bond with individuals and it gives me more information that anything else I could do to start to learn about my new group. People are fascinating and I really enjoy an uninterrupted hour with someone – it’s almost a luxury in this day and age. Once you’ve established that bond, make sure to nourish it by connecting with individuals on a regular basis. Letting people know you truly care about them as individuals is how dynamite teams are created. And the karma ain’t bad either.
7. Recognize Success and don’t save it all up! Recognizing efforts, going the extra mile, dealing with a difficult patient, all deserve a pat on the back in front of other employees. Remember to always praise in public and counsel in private. Share the joy of something well done, and let the employee have the privacy of a critique.
6. Set Goals I like to establish individual goals every six months during the annual performance review and six months later during a less-formal touch base. 12 months is a long time to keep a goal in mind, so I prefer to deal with 6-month goals. Performance evaluations should not be a rehash of what was done right and wrong over the year, but rather should be a time to review the goals from the last six months and see what wasn’t accomplished and why, as well as celebrating the goals that were accomplished. See my simple evaluation for more information.
5. Explain the Big Picture I’m often surprised how many medical practice employees don’t understand how their job (especially done well) contributes to the big picture. Check-in staff might not understand how their job impacts billing. Scheduling might not understand how their job impacts the nurses. Nurses might not understand how their job impacts the check-out. No one may understand what their efforts mean to the financial viability of the practice. If all the staff know that they haven’t had raises for two years yet new medical equipment is being purchased for a new service line, they need to have some insight into why a decision was made and what potential it may have for keeping the practice viable.
4. Provide Career Growth Opportunities This fits in well with the 6-month performance evaluation when you set goals with your employees. Goals may include projects, new skills, improved skills, shadowing other jobs, cross-training on other jobs, conferences and workshops, and online or classroom training. Never think that someone can’t do something as predicting success is one of the hardest things in the world. Encourage everyone!
3. Give Employees Respect Give everyone respect. Know that every single person is much deeper than you will ever know and more fragile that you would ever expect. Never forget that you can make someone’s day and break someone’s day. Being a manager is making a choice to care for and respect the people who have chosen to work with you. In many ways, management is the most powerless job (next to parenting) there is.
2. Provide Consistent Feedback For you to effectively provide feedback, positive or negative, the employee must have been trained, must have resources to help them do their job and must understand the expectations of the job. Do not take for granted that your front desk person knows instinctively that your expectation is to have the day’s charges posted and reconciled before the end of the day. Have written performance expectations for each person, then explore the reasons why those expectations are not being met (communication, misunderstanding, workload, etc.)
1. Build Trust I’m so glad Ms. Conger put this as #1 -I agree! Here’s how I build trust: Keep confidences. Follow the same rules I set for the staff (if they can’t eat at their desks, neither can I.) Make promises sparingly and fulfill all promises. Don’t mess up peoples’ payroll or their time off. Understand the details of their job. Don’t allow the doctors or the patients to abuse them.
What’s not on this list that you would add?