Manage My Practice

Why are staff meetings important?

They are important because face-to-face communication is important to people and bi-directional communication is important to people.  In other words, they want to see your face and they want to have a dialogue with you.  They want to hear what you’re thinking and they want to voice their opinions.

Teams that don’t have staff meetings where they can be face-to-face and dialogue usually get frustrated.  Conscientious staff care about the practice, and want to know what’s being done to fix problems.  Without regular communication, staff will make assumptions and speculate on things you probably don’t want them to speculate on.  Remember this: when you don’t inform employees, they will make something up.  Believe it.

Team Building During Staff Meetings

Staff meetings are also a great time to do team building.  Whether you give an update on universal precautions then split into teams to play Universal Precautions Jeopardy, or do a brainstorming session on what should be included in your new patient brochure, you are giving staff a voice, letting them be themselves, and helping them get to know employees they might not work beside on a daily basis.  You are a building a team.

I like to have two staff meetings a month, even if they are only 20 or 30 minutes long – I find the ideal length to be about 45 minutes long.  I have the meetings on a standing date (2nd and 4th Thursday of every month, for instance, and make sure everyone is perfectly clear when the meeting will take place.  The first meeting of the month is typically a department meeting, so that clinical staff and clerical staff can each meet to discuss issue specific to them.  In a larger office, you may have more than two departments that will need to meet.  The second meeting of the month is an all-staff meeting and at certain times of the year, the meeting may actually be a “meeting for eating” and this time can be used for a holiday breakfast or luncheon.  It is easy to cancel a meeting when there is nothing on the agenda, but it’s hard to get one scheduled on short notice without messing up everyone’s schedule.

The Oreo Cookie Method of Agenda-Setting

Prepare an agenda and invite everyone to add topics that they would like to have addressed.  Make sure you understand their items and can address them, as some staff will not want to be identified as being the ones who asked to have “the policy on making personal calls at work” reiterated.  Use the Oreo cookie method of setting an agenda – start with something pleasant (welcome new staff members, congratulate the staff on specific accomplishments),  then put in any very serious or uncomfortable topics next (raises are frozen, overtime is not allowed or mandatory overtime is in effect), then finish with something pleasant (the quarterly employee event is upcoming, we will sing Happy Birthday and have a cake after the meeting for Susie.)  Some staff do well with a roundtable to finish the meeting, others will not say a word when asked if they have anything to bring to the group – this is entirely dependent on what kind of office you have.  Every office has its own culture and that culture will show itself in staff meetings!

Here are some ideas for your staff meetings:

Annual Training:

• OSHA, Infection Control, HIPAA, Fire Safety, Disaster Communication
• Computer – Practice Management, EMR, Office, Outlook, Lab
• Diversity Training
• Benefits Enrollment & Ask the Expert
• Retirement Plan Enrollment & Ask the Expert
• Customer Service

Team Building:

• Brainstorming
• Who Am I? (find out interesting facts about each employee and have them ask each other questions to identify the person)
• Jeopardy, Pictionary, Family Feud about any office topic
• Breaking into cross-departments teams and choosing one problem to focus on solving over the next 3 or 6 months

In-services:

• Have your physicians give talks on illnesses or problems they address in their practice – most staff really like to learn more about the medical issues the patients face
• Invite physicians from other practices to speak with the office about their specialties
• Invite staff from practices you refer to, to speak about the tests or procedures they perform on your patients
• Stress Management
• Personal Safety
• Advance directives, living wills

Holidays:

• Decorate pumpkins, gourds, or papier mache eggs to look like the physicians and invite the patients to vote on the closest resemblance
• Give the staff a Halloween theme (scarecrows, witches, black cats) and award prizes (have the nearest office come over and judge) for decorating or costumes
• Invite someone from the community to come and talk about a holiday that no one on the staff celebrates
• Provide the goodies for valentines and have the staff send thanks and letters to hospitalized soldiers
• Sponsor a needy person or family  at the holidays and use staff meeting time to plan for purchase, wrapping and delivering gifts

Some specifics about staff meetings:

1. Announce the meeting date and time well in advance.  Place reminders on the doors that staff enter and exit the practice from, especially if the time is earlier than they usually arrive to work.
2. Post an agenda, or more informally, let staff know what some of the topics are that will be discussed.
3. Have everyone sign in, and place the sign-in sheets in a folder documenting that staff meeting were held.  This may be needed for annual evaluations, accreditation surveys, etc.)
4. Include enough time for Q & A, or roundtable.
5. If everyone seems stiff and uncomfortable, plan something fun early in the meeting, or bring something good to eat, or do something that relaxes everyone (put on marching music and have everyone march around the room to get some smiling going!)
6. Produce brief minutes from the meeting and include any new policies or guidelines that were introduced.  Place these minutes either in a binder centrally located or online so that anyone who missed the meeting can find out what happened.

Photo Credit: © Maigi | Dreamstime.com

I recently had the pleasure of speaking with Steve Malik, the CEO and Founder of Medfusion.  Medfusion offers an array of products to the healthcare industry including physician websites and patient/provider portals.  With a background in healthcare billing and eligibility, Steve has been in a unique position to guide his company to solutions that make good sense financially and efficiency-wise for physician practices.  Steve predicts that Medfusion will be serving more than 40,000 physicians by the end of 2009 and says that “patients are used to the world of self-service, and physician offices want to offer that option.”  He sees practices ultimately offering completely automated check-in (including collecting payments) prior to the office visit similar to airline kiosks.

Based in Cary, North Carolina, Medfusion enjoys the distinction of being named the leader in patient portals by KLAS, a company which independently monitors and ranks healthcare technology vendor performance.  The HIPAA-compliant patient portal developed by Medfusion allows patients and providers to communicate and share protected health information and private identifiers such as social security and credit card numbers via a secure portal.  Medfusion’s secure portal empowers patients and practices in a number of ways including:

• Secure online bill pay.
• Appointment reminders and lab results messages.
• Patient registration, demographic and health history completion online.
• Completion of a history of present illness prior to the visit.
• eVisits or Virtual Office Visits for established patients. Patients may pay out-of-pocket for the visit or pay a co-pay and the practice can file for the balance of the reimbursement (note: payers, most notably BC/BS, are starting to pay for virtual visits.)
• Shared patient communication between practices.  Practices that refer patients to a specialty practice can make that referral electronically and can follow-up on the patient’s progress via the portal.
• “Chat with a Biller” function.
• Appointment requests and requests for prescription refills.
• Credit card payments without the use of a credit card machine; online payment plans that automatically drafts the patient’s credit or debit card monthly.
• Patient refunds via the web portal.

Medfusion has strategic relationships with the American Academy of Family Physicians (AAFP) and the Medical Group Management Association (MGMA) to provide website services to their member practices.  Steve is an active speaker and presenter on technology in healthcare , and is widely quoted in industry publications. The company also has a relationship with Allscripts and Origin Healthcare Solutions and provides connectivity to those products to import information from the patient portal into the practice management system.

Recently Medfusion enhanced its existing Symptom Assessment and Virtual Office Visit solutions to include H1N1 Influenza (Swine Flu) screening.  Medfusion’s press release from May 2009 states:

Without having to come into the office, the patient can log into the practice’s secure HIPAA-compliant patient portal, select either Symptom Assessment or Virtual Office Visit, and type in Swine flu when they are prompted for a condition. The patient then responds to a series of interactive clinical questions relative to their symptoms so that the doctor can provide a secure online consultation, prescribe the appropriate anti-viral drug, if necessary, or determine if the patient needs an in-office visit.

Additionally, physician practices have been able to use Medfusion’s Secure Patient Messaging solution to mass broadcast the availability of H1N1 influenza online screening and to keep patients informed about the latest news regarding this outbreak or any other dire health issues. ‘We immediately launched Webinar training session’s specific to Swine flu patient messaging and Virtual Office Visits, and the response from the practices was overwhelming,’ said Crystal Upson, Vice President of Client Services. Medfusion continues to hold these training sessions regularly. Also, physician practices that have a website powered by Medfusion have complete control over their content management, which means they are able to post and change messaging at any given time about their services and the latest health issue developments.

After all the excitement of the products described above, it seems a little anti-climatic to discuss Medfusion’s website design and hosting offerings, but it is well-worth mentioning as the products above can be integrated into a custom-designed website by Medfusion, or an existing website.  Medfusion will take the look and feel of a practice’s current website and replicate it so the patient always feels that they are “inside” the practice’s site.

What doesn’t Medfusion do?  I recently saw the Medfusion product line again and was a tad disappointed that the referral portal does not have the ability to use custom forms.  It would be ideal to refer a patient to another practice or a test facility and be able to complete the order electronically including an electronic signature.  Referrals are one of the most time-consuming functions of a physician’s practice (primary care practices particularly) and can significantly impact patient care and reimbursement when done incorrectly.

What’s in Medfusion’s future? It was recently announced that Medfusion purchased Medem and their iHealth personal electronic record.  As personal health record capability  is included in definitions of “meaningful use” of an electronic health record eligible for the ARRA stimulus money, it looks like Medfusion will be well-positioned to help its strategic partners meet that definition.

By the way, I have used Medfusion at three different practices in the past and am evaluating it again for my current employer.  I’ve not received any consideration for this article.

Today I was fortunate enough to attend an outreach session designed to educate hospitals, physicians and other providers about Recovery Audit Contractors (RAC), specifically Connolly Consulting, the RAC for North Carolina.  Although I cannot vouch that the information I am sharing for Region C will be consistent for the other three RACs, the fact that there is a standard handout being used for all RAC outreach sessions makes me think there’s a very good chance that CMS is encouraging a high level of consistency.

If you read the recent Manage My Practice article here by Carla Hannibal, you already know that the RACs were established after CMS demonstration projects proved “to be successful in returning dollars to the Medicare Trust Funds and identifying monies that need to be returned to providers. It has provided CMS with a new mechanism for detecting improper payments made in the past, and has also given CMS a valuable new tool for preventing future payments.” (CMS website)

Each RAC bid for and won the jurisdiction as follows:

• Region A: CT, DE, DC, MD, ME, MA, NH, NJ, NY, PA, RI, VT Diversified Collection Services (DCS) -1-866-201-0580, website here
  

• Region B: MN, WI, IL, IN, OH, MI, KY CGI Technologies and Solutions -1-877-316-7222, website here

• Region C: AL, AR, CO, FL, GA, LA, MS, NC, NM, OK, SC, TN, TX, VA, WV and the territories of Puerto Rico and U.S. Virgin Islands. Connolly Consulting, Inc. -1-866-360-2507, website here

• Region D: WA, OR, ID, CA, NV, MT, WY, UT, AZ, ND, SD, NE, KS, IA, MO, AK, HI HealthDataInsights, Inc.-Part A: 866-590-5598, Part B: 866-376-2319, e-mail: website here

Each RAC is required to provide outreach education sessions in their region prior to sending out any letters.   Any hospital or physician who bills fee-for-service programs (Part A and/or Part B) for Medicare beneficiaries is eligible for a RAC audit.

These are the important points that I took away from attending this outreach program:

1. RACs may review claims as far back as October 1, 2007.
2. RACs review claims after they have been paid using the same Medicare policies used to pay the claim initially.
3. There are two types of reviews: Automated Reviews which do not request the medical record and Complex Reviews which will request the medical record.
4. Automated Reviews are “done deals” and the claim will be adjudicated and a letter sent detailing the dollars requested.
5. Providers may return the payment by writing a check, allowing a recoupment from future payments or may apply for an extended payment plan.
6. Complex Reviews entail a request for medical records.  Records can be mailed, faxed, or sent on a CD/DVD.  Mailed records must be sent in a tamper-proof package, and should be sent via trackable carriers (FedEx, UPS, Registered USPS.)  Multiple records may be sent in one package if each record set is in a separate envelope inside the package.
7. Note: if faxing, fax the records to yourself to check for readability before you fax to the RAC.
8. Email records are currently not acceptable due to HIPAA.
9. Providers have 45 days plus 10 mailing days for a total of 55 days to send the records, but extensions are available if this is not abused.  If you do not communicate with your RAC about any problems you are having sending the records (e.g. you can’t find the record!), you risk having the claim(s) automatically recouped.  The Connolly representative even mentioned something to the effect that she wasn’t above calling the practice/entity CEO to let them know that their contact person wasn’t playing by the rules.
10. Once a claim has been reviewed and a Complex Review is in play, the provider will receive a Demand Letter from the RAC and the provider will have a “discussion period” to contact the RAC and ask questions and/or provide additional information.  The RAC representative emphasized to communicate, communicate, communicate and to call the RAC and  speak to the reviewer of the claim.  Once you have spoken to the reviewer, if you still disagree with the decision, you should ask to speak to the supervisor, and if there still is no agreement, you need to file an appeal.
11. Appeals must be filed within 120 days of the receipt of the demand letter from the RAC.

Here is a suggested action plan for physician practices to prepare for the RAC process:

1. Visit the CMS website here and click on Demonstration Projects to see what improper payments were found by the RAC demonstration projects.
2. Visit the CMS and OIG websites to see what improper payments were found by reading the OIG (Office of Inspector General) reports here and CERT (Comprehensive Error Rate Testing) reports here.
3. Conduct an internal assessment to see if you are in compliance with Medicare rules, and if not, identify corrective actions needed to bring your group into compliance.  Corrective actions may include provider education and a periodic internal audit to rate the improvement.
4. Provide your RAC (they will tell you how to do this) with a contact person who will receive RAC letters and who will be the point person for providing the RAC with additional documentation.  The RAC will also ask for information about providers and their NPIs, including any providers who were with the group between October 1, 2007 and now, even if the provider is no longer with you.  Connolly suggests copying the list of providers you supply to the RAC and placing it in the personnel file of the contact person to be reminded of this important responsibility if this person leaves the organization.
5. Develop a basic tracking system for receipt of letters, and activity for each request.
6. VISIT YOUR RAC WEBSITE AT LEAST WEEKLY.

I have received lots of questions about what a RAC letter will look like, and the speaker today provided a sliver of information saying that the Region C letters will have the CMS logo at the top of the letter and Connolly’s logo at the bottom of the letter.  Because your practice/entity will be providing the RAC with a contact person’s name, unless things are in total chaos at your place of business, the letters will go to the person you’ve entrusted with this important responsibility.

Here are some other questions and answers from the program today:

Q: Does the RAC pay for the copying/mailing for records?

A: They will pay hospitals, but will not pay physicians for record expense.

Q: If  a claim is refunded to Medicare, must the patient be refunded their portion?

A: Yes.

Q:What determines which region the practice/entity belongs to for RAC?

A: The state that the practice/entity is located in.

Q: Are patients contacted if their claim is audited?

A: They receive a notice if the claim is adjusted in any way.

Q: I heard that there are consultants selling RAC insurance – is that a good idea?

A: There is no such thing as audit insurance, but there is such a thing as appeal insurance.

Q: Will a claim be audited if a practice/entity self-audits, finds an error and corrects it?

A: As long as an amended claim is filed by the provider, RAC will not audit the claim.

Q:Who sets the guidelines for medical necessity?

A: The medical director of the RAC.

Q: Are the number of claims that can be audited in each period counted by transaction lines (5 per CMS form) or by claim/single CMS form?

A: By transaction lines.

Q: Will the RACs extrapolate their findings?

A: The RACs are entitled to extrapolate their findings if they so choose.

Q: Are the RACs paid on a percentage of their findings?

A: Yes, RACs are paid a percentage of both overpayments and underpayments.  The percentage ranges from 9% to 12.50% based on each RAC’s bid.

If this information is new to you, I suggest you click on some of the links provided in this article, start developing your RAC plan, and start educating your providers and staff.  This topic is also a good one for sharing of best practices between local and regional groups.  To get email updates on RAC from CMS, sign-up here. Remember to bookmark your RAC’s website and visit often!

Photo credit: © Milosluz | Dreamstime.com

Generally, doctors either think it’s okay to be late (and usually are) OR they don’t think it’s okay to be late and only are in rare cases.  That’s who they are as people, just like us, and it’s rare to be able to change them.

What I usually find is that certain patients are okay with doctors who are late, and will wait as long as it takes to see that doctor.  Others will not wait, and therefore, will not return.  I would let new patients know that the doctor takes his time with patients and that he often runs late and see if they can live with that.  If that can’t, then they should be scheduled with another doctor or seek care elsewhere.  If the doctor has a problem with that, he needs to know that a good practice manages patients’ expectations and that patients deserve to know that he typically does not run on time, and not have a surprise when they come to the practice.

One thing that is helpful is a very skilled nurse or assistant who keeps the doc on track so that he doesn’t run any later than necessary if he gets easily distracted.

I have seen some practices give patients beepers to page them when the doctor is ready so they don’t have to sit in the waiting room (especially with a sick child) any longer than necessary.  You could also tell patients that someone will call them 20 minutes before their appointment – it’s hard to have someone keep track of this and do all the calling – but it might be worth it if it keeps the patients and the doctor happy.

Photo credit: © Torchdesigns | Dreamstime.com

One of my secret weapons to save time and get things done efficiently is Jott. Jott Assistant is a simple way to translate my thoughts into mail using my phone.  When I think of something that I need to do, or an email I want to send to someone, I call Jott (I have it on speed dial) and record my message and it shows up in my email, or in someone else’s email at a time of my choosing.

For instance: I am driving to a clinic and suddenly remember I need the office supervisor to schedule a staff meeting next week.  I call Jott, say who it is I want to Jott, when I want the message to be sent, what the message it, and it is done.

Jott is not free, but based on the time it saves me, I think it is a very good value.  You can try it for free for a week and see if you like it, but, like most applications, it does take a while to really explore all the ways you can use it.  Jott says:

Jott turns your voicemail messages into text and delivers them as text messages and emails that are actually useful. You can forward and reply to them, screen calls when you’re in meetings, set call-back reminders and more! Set-up only takes a few minutes and Jott works with most major US carriers.

Interestingly,  as recently reported by Inga on HIStalkPractice, Nuance (owner of Dragon Naturally Speaking speech recognition programs) just acquired Jott:

a voice-to-text transcription application aimed at mobile users to create notes, use e-mail tools, and update application databases. While general cell phone users are its target audience, there certainly are healthcare possibilities there (nurses calling in vital signs to the EMR, maybe, or doing progress notes by cell phone).

Jott will interface (usually called a “mashup”) with the following tools and applications, allowing you to post to your favorite web services with your voice (Twitter, Facebook, Remember The Milk, Quicken) and listen to your RSS feed updates on the go (Yahoo, New York Times, The Huffington Post, Major League Baseball, CNet.)

Photo credit: © Theodor38 | Dreamstime.com