I have been fortunate to have had some wonderful mentors in my life. One in particular influenced me greatly, and I owe him a debt of gratitude to this day. He is the one who taught me how to do a SWOT self-analysis.
Here is how Wikipedia defines the SWOT Analysis:
SWOT Analysis is a strategic planning method used to evaluate the Strengths, Weaknesses, Opportunities, and Threats involved in a project or in a business venture. It involves specifying the objective of the business venture or project and identifying the internal and external factors that are favorable and unfavorable to achieving that objective. The technique is credited to Albert Humphrey, who led a convention at Stanford University in the 1960s and 1970s using data from Fortune 500 companies.
I was familiar with the SWOT Analysis and had used it before, but I had never heard of a personal SWOT. It was a revelation to me to consider myself an entity and study my own Strengths, Weaknesses, Opportunities and Threats. My mentor also told me to imagine what I wanted for my life in 5, 10 and 20 years.
I took the assignment very seriously and spent quite a bit of time thinking about it and discussing it with my family. They had some surprising insights. When it was done, I gave it to my mentor. He read it over, then looked me in the eye and said, “You forgot something.” I looked it over again and for the life of me could not figure out he meant.
“Your biggest strength,” he said.” “Your husband. The reason you are where you are is because your husband supports you in everything you do. He is your partner and he is willing to help you go wherever you want to go in your career.”
That was 15 years ago and I still have my SWOT page. I go back to it now and again and think about who I was then and who I am now. I highly recommend that everyone do a self-SWOT analysis and dig deep into you!
Here’s how to do it.
1. Consider your strengths. What do you think you are particularly good at? Think about your professional and personal life, your hobbies, your relationships and things that make you uniquely you. Consider what about your life makes you strong.
2. Consider your weaknesses. You don’t have to share this, so go ahead and admit the things that may have held you back in the past, or things that embarrass you about yourself. What would you like to change about yourself?
3. Consider your opportunities. What opportunities do you have to improve yourself or improve your work situation? Take one of your strengths and think about how you can match your strength with an opportunity. Go back to school. Get certified in something that interests you. Write. Speak. Mentor someone else. Start a local managers’ group. Take a clinical course if you have an administrative background. Take a management course if you have a clinical background.
4. Consider your threats. What could derail your career? Who could derail your career? Could your job be at risk if a hospital bought your practice? Could your job be at risk if one or more of your physicians retired early, or left the practice. or if your practice merged with another? Are you well-networked in your community, your specialty, your state?
5. What would you like your life to be like in 5 years? 10 years? 20 years?
6. Now, taking the previous five questions into consideration, what is your plan to take what you know about yourself and make your vision of your future come true? What should you change, or fix, or strengthen? What can you leverage? What can you do to make your career as resilient as possible? What should you do to give yourself as many future choices as possible?
Here is a helpful article on SWOT, and a video and worksheet from MindTools.
Welcome Denise Price Thomas, practice administrator (32 years) and consultant. Throughout her career, Denise has been passionate about creating positive experiences for patients and customers. She enjoys teaching customer service and effective communication. She strives to inspire others by using heart-warming stories and humor gleaned from her management experience in her informational, inspirational and motivational presentations. In addition, Gladys Friday, (aka Denise), completes the package of Health, Hope & Humor by telling entertaining stories about funny moments in health care settings.
I received a call from a practice administrator who said, When I am observing the front desk staff, I find them to be helpful and attentive to our patients, however when the patients are visiting with the physician, he receives multiple complaints per day. I cannot be with them at all times. This is so true as is in many practices. The staff is on their best behavior when the administrator, manager or physician is around.
After meeting with the administrator and physicians, it was decided that they were in need of a practice evaluation, to see how things look from the other side of the desk.
I was to be there at 10:00 am. The administrator and physicians were aware but they had elected to keep the surprise to themselves.
I arrived to find the sliding window CLOSED. Although it was a clear glass (thinking the person on the other side could actually SEE through it) I just knew it would open…..it didnt. In fact, nothing happened. The receptionist was busy writing and her head was down. As I stood there waiting patiently (as she thought I WAS a patient), I looked around at all of the real patients, looking through magazines – angrily flipping pages. I could tell immediately that they had been greeted in the same manner. There were loud sighs, eyes rolling as they looked at their watch; people were not happy.
After giving it a few minutes, I decided to tap on the CLOSED window. Still without looking up, she said, Ill be with you in a moment! After waiting another minute or so…..I decided to put on my brave suit and go for it. I slid the CLOSED window open and said, May I see your administrator please? (still trying not to give it away). She said, (again without looking up – I still have NOT seen her eyes – nor has she seen mine) M’AM, I SAID I would be with you in a minute! I politely said, thank you.
BINGO! I had located the trouble, when suddenly there appeared before me….the administrator. I was so happy to see her. She said, Denise, come on back. She introduced me to the clinical staff and we made our way to the front desk. She said to the greeter at the front desk, this is Denise, she will be performing a practice evaluation to see how we may improve our services. The greeter said, It is SO NICE to meet you. No, it really wasnt. She decided at that point that she needed to be nice to me when she should have been NICER to her PATIENTS, the reason she was there.
Realizing that she wasnt really a people person to say the least, it was decided that she work in another area in the practice, where she was happier and the person from medical records was much happier working with the patients.
End result, happier patients, happier physicians, happier staff.
Moral of this story: You can have the most wonderful physicians but if you have a sub-standard staff, patients will not be happy.
Things to look for in a front desk applicant:
Fortune teller able to know when someone has changed insurance companies, divorced, remarried, deleted insurance, moved, etc.
Air traffic controller able to smoothly divert patient traffic in an attempt to keep them from running into others and finding out their time of arrival is the same as others. Able to handle maximum doses of STRESS!
Medi-copter pilot able to hover over an emergency, assess and remove the patient in distress and deliver them to the safest place AWAY from the lobby – seeking clinical assistance while remaining calm
Multi-lingual able to understand multiple languages and be able to effectively communicate
Coach able to motivate the team, support the team, protect the team while being part of the teams proactive plan, not the teams problem
One Ringy Dingy – Switchboard Operator able to pleasantly answer each phone call addressing each one as it is the only call
Multi-tasker able to effectively & efficiently perform multiple tasks while wearing a smile and a positive attitude with each patient
Juggler able to maintain balance while keeping eyes on the patient
Circus trainer able to be the master of MANY ceremonies
Reservation Concierge scheduling and rescheduling while exhibiting exceptional customer service skills, GLAD that the person has contacted their practice for reservations (an appointment)
Infection Control Officer ensures cleanliness and minimizes germs
Minimalist able to work without the clutter igloo around them
Walmart Greeter happy to see everyone that walks through the door
Helpful characteristics to look for when interviewing a medical front desk applicant:
Exhibit good eye contact
Nice soothing voice
Willingness to help others before themselves
Desire to be cross-trained
Does not have the words, Its not my job in their vocabulary
Most healthcare workers that have BEEN a patient or have been with their family member through sickness..make great healthcare employees. They KNOW how it feels to be on The Other Side Of The Desk
Denise Price Thomas
Note: Denise’s partner in DPT Consulting &Training is Gladys Friday, pictured here. If you are interested in contacting Denise or Gladys about their services, they can be contacted through their website here or by phone at 704-747-8699 or via email to email@example.com.
There’s a new ABN form required to be in use in January 2012 – read about it here in my article “Everybodys Favorite Form: New Advance Beneficiary Notice of Noncoverage (ABN) Form Begins in 2012″
Note from Mary Pat: The Advance Beneficiary Notice of Noncoverage (ABN) is a collection tool that many medical practices do not know how to implement. It is particularly difficult to determine who has ownership of this process, because the form must be completed and signed by the patient before the service is provided. The patient is in the exam room or the lab, ready for the service or test, and a knowledgeable staff person must step in, explain the rules and pricing and obtain the patient’s signature.
Blogger Charlene Burgett does a great job of explaining the ins and outs of using the ABN, and has agreed to share an article originally published on her blog “Conundrum” with MMP readers.
The use of the ABN is required by Medicare to alert patients when a service will not be paid by Medicare and to allow the patient to choose to pay for the service or to refuse the service.
If the practice does not have a signed ABN from the patient and Medicare denies the service, the charge must be written off and the patient cannot be billed for it. The only exception is for statutorily excluded services (those that Medicare never covers like cosmetic surgery and complete physicals for example). In this case, a practice can bill the patient for the non-covered service despite not having an ABN. It is, however, a good idea to have the ABN signed for non-covered services so the patient is made aware that they are responsible.
If the patient signs the ABN and is made aware of their financial responsibility you may require the patient to pay for this service on the date the service is provided. You may also charge the patient 100 percent of your fee. You do not have to reduce your charge to the Medicare allowable.
With a signed ABN, the practice has proof of the patient’s informed consent to provide the service and their agreement to be financially responsible for the service. In the past, Medicare had a Notice of Exclusion of Medicare Benefits (NEMB) that we could provide to the patient (no signature required) to alert them of Medicares non-covered services. The ABN has replaced the NEMB.
The typical reasons that Medicare will not cover certain services and that would be applicable are:
- Statutorily Excluded service/procedure (non-covered service)
- Frequency Limitations
- Not Medically Necessary
Statutorily Excluded items are services that Medicare will never cover, such as (not a complete list):
- Complete physicals (excluding Welcome to Medicare Screenings, with caveats)
- Most immunizations (Hepatitis A, Td)
- Personal comfort items
- Cosmetic surgery
For these items, it is a good idea (not a requirement) to complete the ABN and have the patient check the appropriate box under options and sign the ABN. For the sake of the billing department, I strongly encourage the use of ABNs for statutorily excluded items.
Frequency Limitations are for services that have a specific time frame between services. For example, Medicare allows one pap smear every 24 months if the pap is normal. If the patient wants one every 12 months for their peace of mind, Medicare will pay for year one and the patient will pay for year two and that pattern continues. The ABN needs to be on file for the year that the patient is responsible for paying. If the patient fits Medicares guidelines for high risk they are allowed to have the pap every 12 months and no ABN is required.
Services that are not considered Medically Necessary are those that do not have a covered diagnosis code based on Local Coverage Determinations (LCD). One example is for excision of a lesion. If the lesion is being removed because the patient just doesnt like how it looks, that is considered cosmetic surgery. If the lesion is showing some changes (i.e. bleeding, growing, changing color, etc), then it is considered medically necessary because it potentially can be malignant. The removal needs to have diagnosis coding to substantiate the medical necessity and Medicare has Local Coverage Determinations that list all the codes/coding combinations that Medicare will approve for payment.
A rule of thumb in trying to discern the necessity of ABNs is to ask yourself if there may be some times that the service isnt covered by Medicare. The times the service isnt covered, an ABN is required. To illustrate this point, here are two examples:
- EKGs are covered for certain cardiac and respiratory conditions. The only time an EKG is covered for preventive screening is during the patients first year enrolled in the Medicare program and when being done during the Welcome to Medicare screening. After that time, Medicare will never cover an EKG for preventive screening. To notify the patient of this and to show that the patient agrees to be financially responsible for the EKG, an ABN should be completed.
- Another example is for the Tetanus immunization. Medicare will cover tetanus when medically necessary; if the patient has cut themselves and the tetanus is provided due to that injury. If the tetanus is provided to the patient because it has been ten years since the last tetanus and the tetanus is not in response to a recent injury, then it will be non-covered because it is not medically necessary and the ABN will need to be on file.
ABNs need to be completed in their entirety. The Options box can only be completed by the patient and it states that We cannot choose a box for you. That would appear to be coercion.
A blanket ABN, one that is signed by the patient for all services provided within a certain time period, is not acceptable and is illegal.
In addition, there is a small area to provide additional information that can be used by either the patient or the providers office. This could be anything pertinent to the information that the ABN covers. The bottom of the form is where the patient signs and dates. We keep the original ABN in the chart behind the progress note for that day. Providers MUST provide a copy of the signed ABN to the patient.
The current ABN form with instructions can be found here.
If a service is denied by Medicare and the physician does not have a signed ABN prior to the service being rendered, the service can not be billed to the patient and will need to be written off. Sometimes a patient may refuse to sign the ABN – if this happens it is appropriate for the physician to document the refusal and sign, along with having a witness sign. Medicare will accept this and the patient can be billed for the service if denied by Medicare.
How does Medicare know whether or not you have a signed ABN? You tell them, by adding a modifier to the CPT code when completing the claim form. The appropriate modifiers are:
GA: The ABN is signed, but the service may not be covered.
GY: A statutorily excluded service.
GZ: The service is expected to be denied as not reasonable or necessary. This is typically used when there is a secondary payer that requires the Medicare denial before they pay benefits.
The use of the ABN is often misunderstood; however, it is the only way a patient can be informed about their financial responsibility prior to agreeing to a service being rendered. This is an issue that the OIG has reportedly been interested in investigating for fraud and abuse.
Charlene Burgett, MA-HCM
Note: Readers, how do you make the ABN work in your practice? Do you train the clinical staff, the physicians, or other staff to recognize the “ABN Moment”? How do you make it work? Please share your ideas by responding with a comment.
At last, here is what all the shouting’s about! A new website and a new book all in one day. Just for kicks, I interviewed myself about these changes.
Q: Mary Pat, why all the changes all at once?
A: I didn’t start out to publish a book and redo my website all at once, it just happened that way. My site has been online for almost a year and a half now and after spending lots of time on the web, I knew I wanted to make some changes to my site – clean it up a little, and hopefully make it easier to read and navigate.
Q: What about the book?
A: I’ve been working on the book for about 9 months, and every day I have been reading about practices struggling with less reimbursement and more expense. Medfusion asked me to do a webinar on patient collections and I thought it was a perfect time to get the book completed.
Q: Why an eBook?
A: I decided on an eBook because that’s what I prefer. I like information on a specific topic and I like to be able to get to it immediately. More of a cookie-sized topic, than a cake. I love big business books full of information, but it takes me forever to read them. I wanted something that a manager could see, buy and start using all in the same day.
Q: You mentioned a webinar for Medfusion – when is that happening?
A: The webinar was November 17th and is archived on the Medfusion website so you can listen to it whenever you want.
Q: I see you’ve added a new tab called “Vendor.” What’s that all about?
A: I’ve been wanting to give my readers access to vendor names in categories and now seemed like a good time to do that. Right now there are 6 categories: Employee Background Check, Eligibility Products, External Financing, Creditworthiness Products, Payment Portals, and Special Resources. As time goes on I will add more categories so readers can access vendors in a certain category in one place.
Q: Are these vendors that you are recommending?
A: No, these are vendors that I’ve checked to make sure they have the service or goods that fit in the category, but I’ve not screened the vendors for my readers at all. Maybe down the line I’ll have some sort of feedback on vendors, but for now, I’m just listing them.
Q: Why didn’t you put the vendors in your book?
A: Because the field is always changing and vendors are coming and going all the time. I don’t think that the print medium is the right place for listing vendors for such a fluid and changing market as healthcare.
From the Introduction:
It has never been more urgent or more difficult to collect patient-responsible balances. The combination of high-deductible health insurance plans increasing in popularity and the massive loss of medical benefits creates a pressing need for medical practices to re-evaluate patient collections. A strong collections program and the timely collection of patient balances are critical to the viability of the modern healthcare practice – important to the communities served as a source of patient care and a contributor to the local economy.
Healthcare has traditionally been a care-first and collect the money later type of business. Traditionally, payments from insurance companies were enough to keep medical practices viable, and many practices did not worry about patient collections. Today, the financial responsibility for payment for health services is swinging further and further toward the patient, and often without many patients understanding what is happening.
The Practice Should Assume Responsibility for Being the Insurance Expert for the Patient
Learn the payers, learn the plans, and help the patient understand what coverage and financial responsibilities they have. This book does not focus on filing claims, but insurance cannot be separated from the total payment process. To know the patient-responsible portion, the practice must know what the insurer/payer will pay. The ideal relationship is one where the patient relies on the practice for straightforward, non-biased information about paying for healthcare.
Disclose All Fees and Terms of Service Before the Patient Incurs a Financial Responsibility
Patients have the right to know your prices, compare your prices with other healthcare providers and make an informed decision about spending their money. It is part of the practice of healthcare that the patient acknowledges (whether they have the means to pay or not) that they have received something of value.
Remember Your Practice Is In the Business of Compassion
Patients are not buying televisions or cars from you, they are buying the most important thing in the world good, quality healthcare services and advice. Whether you believe that healthcare is a privilege or a right, always temper patient collections with the knowledge that paying for healthcare for themselves or their loved ones is a personal and often emotional transaction.
The Book: “The Smart Manager’s Guide to Collecting at Check-Out” $39.95
Released this Monday, November 16th, the book is only available for download here on this website.
This is not your traditional textbook! It is an eBook – downloadable in minutes and ready to start using immediately. It contains bookmarks that make it easy to jump to specific sections, and you can print only the pages you want.
This book will help any type of medical practice develop a front-end collections program. The 30 day program can be intense, but for most medical practices, the need to start a patient collections program is so pressing that the sooner the program can be launched the better.
The book addresses the components of setting up a front-end collection program that is ready to launch in 30 days. Depending on the resources (people, time, energy) that you have in your practice, your program could launch in more or less than 30 days. Your timetable could change if you have significant barriers or insufficient resources, or if you elect to take the planning more slowly.
An integral part of the book is the calendar that you will use to complete the program within the time frame. I supply the steps, the worksheets, the templates and the 30 day calendar, and you add or subtract days as needed. The steps are in order for a reason, but you should rearrange them based on your practices needs and resources.
Packed with templates, worksheets and examples, this book leads you every step of the way through designing a program appropriate for your practice or healthcare entity.
In conjunction with the book launch, I will also be unveiling my brand-new website! My tech guy has outdone himself in designing a more user-friendly and intuitive site. See you on Monday!
By William F. Jessee, MD FACMPE
MGMA President and CEO
Spend one day in the shoes of an MGMA member and you’ll experience the challenging, changing environment of a practice administrator. Our industry is always in flux: new healthcare information technology to implement; new CPT and ICD codes to bill; new insurance plans to support. MGMA is changing, too, to support new and current members and help them thrive in the face of change.
While 70 percent of our membership remains directly employed by medical practices, new member trends indicate that about a quarter of all MGMA members who joined in 2009 came from other types of healthcare organizations, including integrated delivery systems (IDS). Also this year, more than half our new members are 45 or younger. More current and new members are attaining or have attained Master’s degrees.
As our membership changes, so does the state of healthcare. Members frequently ask me about current healthcare trends. Here are four we’re watching and what MGMA is doing to support our members during these changes:
- Larger systems, influenced by the government, to become the norm
In 1975, 68 percent of physicians worked in one- or two-person practices (1). By 2005, that proportion had fallen to 32 percent and has probably declined more since then (2). I think group practices will increasingly merge to form larger groups, integrate with other specialties to form multispecialty groups or become fully integrated with hospitals (our new membership numbers reflect this) in order to compete in the marketplace.
Also, much of the Federal reform legislative language favors larger, more complex practices, e.g., incentives for implementing electronic health records, electronic prescribing and quality reporting. Penalties for not adopting new technology could hit smaller practices harder. There is even talk of exempting physicians in systems from any Medicare Part B payment caps that might otherwise apply.
- Hospital-owned groups already on the rise
MGMA’s physician compensation survey data indicate the proportion of physicians working in hospital-owned groups has steadily grown over the last several years. Both primary care and specialties are affected. The economic reasons for this are clear: Between 2001 and 2009, the Medicare conversion factor rose only 1.1 percent, while the consumer price index rose 24.2 percent; and median practice operating costs (for multispecialty groups) went up 43.1 percent. No matter the business, it’s a challenge to remain a viable, free-standing practice when revenue is flat and expenses increase by 6 percent or so a year.
This year we’ve ramped up efforts to provide practice management support for organizations that are part of IDSs. In our various print and electronic member publications, we’re featuring more stories and examples of what it takes to successfully run these health systems, and we recently published a book dedicated to the topic. At the MGMA 2009 Annual Conference, Oct. 11-14, we held IDS-specific sessions that drew more than 900 people, proving this aspect of practice management is here to stay.
- Practices increasingly collecting from patients
MGMA polled members earlier this year about their top challenges, and collecting from self-pay patients landed at number four (3). As high-deductible health plans, health savings accounts and uninsured self-pay patients have increased in recent years, collecting the patient’s share of the bill has become a greater challenge. MGMA is completing research on patient collections and we will release results early next year.
- Healthcare reform on the mind
We couldn’t forget about this topic. Impending healthcare reform legislation means even bigger changes to come ones that require adaptation so healthcare management professionals and their organizations won’t become irrelevant.
No matter what the outcome, health insurance is likely to expand, and new taxes and/or payment cuts seem likely. MGMA is monitoring the latest developments and sending weekly e-newsletters to members through the MGMA Washington Connexion (membership required.) Our public policy and advocacy staff in Washington, D.C., is advocating on behalf of medical practices and has sent numerous comments and letters to Congress and the Administration regarding proposed legislation, especially to assure that administrative simplification measures are included in any bill that is eventually passed.
1. Goodman L, Bennet E, Odem R. Current status of group medical practice in the United States. Public Health Rep., 1977;92 430-433.
2. Cook R. Finances driving physicians out of solo practice. American Medical News, Sept. 10, 2007.
3. Schneck L, Margolis J. Medical Practice Today: What you have to say. MGMA Connexion, July 2009, Vol. 9, No. 6, p. 28. www.mgma.com/medpracticetoday
June 1, 2010 Update: Red Flags Rule is delayed for the 5th time, now until December 31, 2010. Read my post here. Also see resources under the Library tab.
Mandatory adherence to the Red Flags Rule is delayed. Again.
So? So, why do medical practices have to be forced to do the right thing? Confirming patient identities is the right thing for so many reasons. Yes, it is one more thing in the long line of things that practices have had to fold into the mix of administrative tasks associated with, but not really related to, the care of patients. But it is the right thing to do.
Taking the role of the patient (because I am one), this is why I want my personal physician to adhere to the Red Flags Rule:
- I once had my driver’s license stolen and the thief or buyer of my information opened a cell phone account and ran up a $600 bill before I realized my driver’s license was gone. I got off easy, relatively speaking, but it took hours and hours on the phone to get everything straightened out. It was also frightening. I do not care to experience this again.
- If someone used my medical insurance to get care paid for, I wonder how I might find out. Maybe when my application for life insurance was turned down for illnesses or conditions I never had? Maybe when someone had run up a bill in my name and creditors came knocking? Maybe never, yet I could suffer the consequences without knowing the reasons why.
- I would wonder why my physician wasn’t implementing policies to protect me against identity theft. Is he too busy? Too lazy? Too complacent? What else is he lagging behind on?
So, why haven’t you implemented a program in your practice?
I took last week off to complete a project I’ve been working on since early this year – my first book!
It’s really a workbook and it guides the reader through a program to move their practice from a back-end collection process to a front-end collection process. What is the difference? A back-end program collects the majority of patient-owed balances after the payer has adjudicated the claim and has submitted payment to the practice. A front-end program takes all the available information about the payer/plan and collects payment or arranges future electronic payments with the patient at the time of service.
The book has step-by-step instructions for implementing the program in any practice, and more than a dozen worksheets and templates are included. Some examples are:
- Patient Collections Benchmarks
- 30-Day Project Calendar
- Responsibility Assignment Worksheet
- Budget Template
- Sample Job Description and Hiring Worksheet
- Product Evaluation Forms
- Sample Financial Policy and Financial Policy Template
- Patient Frequently Asked Questions (FAQ)
You really can implement a program like this in your practice. It’s hard work, but well worth the effort.