I had a great time recently when Joe Hage of Medical MarCom interviewed me during a Twitter Chat. The topic was how medical device reps could help specialty physicians market to primary care physicians. You can read the interview here at Joe’s blog.

So, what is a Twitter Chat? It’s a one-hour event that gathers together Twitter users with a specific interest to share a discussion 140 characters at a time.

Twitter chats are organized by hashtags, and in this case, the discussion was marked by the hashtag #MedDevice. #MedDevice is facilitated by Joe Hage (@MedicalMarCom is Joe’s Twitter name) who is the founder and CEO of a medical devices marketing consulting firm specializing in marketing communications, marketing strategy, lead generation, web development, and social media.

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At long last, my two-year contract with my current cell phone carrier is over and I am free again! Of course, I immediately turned to my son & partner Abraham for some sage smartphone advice. Here’s the conversation we had.

Mary Pat: What things should I consider when choosing a smartphone?

Abraham: Smartphones are so much more than just telephones, so the first question is always “How will you be using it?”. If you really just need to make the occasional phone call from the road and nothing else, you probably don’t even need a smartphone. A simple, old-fashioned flip phone, or bar-style device will do just fine. For everyone else, picture the things you’ll want to do on the phone. Is it mostly a business device- checking emails, editing documents, and having access to critical data? Or will you also want to watch streaming videos in your downtime, play games, or take pictures and movies to send to friends and family? It’s easy to look at a phone’s capabilities and stereotype what the average user would be like: iPhones seem so hip, Blackberrys seem so serious, Androids seem so geeky. The reality is that all smartphones on the market today probably have enough muscle (and apps!) to make anyone happy. So choose a phone based on features, comfort, and specifications – not the label or the image that comes with it.

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My husband and I went to our favorite restaurant for Father’s Day last week and had an unusual, but delightful experience when we were visited by Ruth.

We had been to this restaurant a number of times since we moved to Cary last fall, but had never met Ruth. A petite, grandmotherly woman with a heavy German accent, Ruth came to our table soon after we settled in. My first impression was that she was the owner of the restaurant. She chatted with us for a moment, then asked if she might sit down at our table. We welcomed her and she explained her job as the restaurant host.

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It’s a stark reality – at this time in American history, we are at the (or near the) highest level of funding for health care. The Ryan Medicare proposal and continued debate inside the Beltway and by state lawmakers makes it clear that while experts estimate that by 2082 health care spending could be 49% of our gross domestic product, this is not a sustainable reality. Further, as baby boomers retire, the contribution of working aged people through taxes and direct employer contribution to health care costs will fall.

Thus, lawmakers have been investigating ways to reduce health care costs for America’s elderly. A report released by the non-partisan Medicare Payment Advisory Commission (MedPAC) last week includes a number of recommendations for reforms aimed at “explor[ing] every avenue for protecting the access of Medicare beneficiaries to high-quality care while reducing the rate of growth in Medicare expenditures.” Chapter 2 of the report addresses “Improving payment accuracy and appropriate use of ancillary services” with recommendations to the Stark law, interim payment reforms for imaging services and a requirement for “high-use practitioners to participate in a prior authorization program for advanced diagnostic imaging services.”

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Do your employees “get it”?

If not, add this simple form to your tool box. These three concepts – customer service, professionalism, and HIPAA – are the basis for 80% of your everyday performance issues.

Tweak the language to fit your workplace, then print it. Ask existing employees to sign it and hand it back to you personally so you have the opportunity to ask them if they have any questions, and so you can discuss any behaviors they currently exhibit where coaching is needed. This constitutes verbal counseling and you have documented it in writing. Depending on your discipline policy, if the employee continues to perform poorly in the same area, follow up with written counseling, a performance improvement plan, or specific consequences.

Have this form in your new employee packet and review it with new employees as part of the orientation process.

Notice of Performance Expectations

Demonstrate outstanding customer service

• Smile with your eyes.
• Follow the 5-10 Rule. When you are 10 feet away from a patient, make eye contact. When you are 5 feet away from a patient, greet them. Apply the 5-10 rule to everyone.
• Thank patients, sincerely.
• Ask patients how you can help them.

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CMS will host a national provider call on the upcoming mandatory accreditation program for all suppliers that furnish the technical component of advanced diagnostic imaging on Thursday, June 23, 2011 from 2:30 – 4:00 p.m. EST. Subject matter experts will discuss what the requirements are to meet the Sunday, January 1, 2012, deadline; who these requirements effect; and how to become accredited. CMS will update information previously discussed on Open Door Forums that will streamline the requirements. See my original post on this topic here.

The target audience for this call includes physician office staff and all Medicare fee-for-service providers; the agenda will include:

• the law;
• deadlines;
• suppliers effected;
• the accreditation process;
• the enrollment process; and
• a question and answer session

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Podcaster Dr. Polack of Medical Practice Trends

Peter Polack, MD of Medical Practice Trends interviewed me recently for a series of podcasts for his site. Here’s the first one, on Why Does a Physician’s Practice Need a Website?

Based on a great conversation I had on LinkedIn recently, I decided to write about physician productivity models and the hybrid model (encounters and work RVUs) I developed for a hospital-sponsored family practice program. This bonus model rewards providers seeing less patients with more acute needs as well as providers seeing more patients with less acute needs.

Here are the components of this model:

1. SCHEDULE: The providers are available (have an open schedule) four 8-hour days per week, or 32 face-to-face patient hours per week. Providers are expected to work four 10-hour days, with the additional 2 hours per day used for reviewing records, approving prescriptions, etc. This was pre-EMR for this group.
2. ENCOUNTERS: The providers have an agreed-upon schedule which averages 22 patients per 8-hour day. (In this model, new patient visits are 40 minutes and established patient visits are 20 minutes.) Subtracting the providers time off, the schedule works out to 3828 patients per year, or 957 patients per quarter. For every patient they see over 957 patients per quarter, they receive $10 per patient. The providers receive encounter credits for nursing home and indigent care clinic work during office hours.
3. WORK RVUs: Based on the encounters, work RVUs are calculated at 4073 per year, or 1018.25 per quarter. Every work RVU over 1018.25 per quarter receives a bonus of $10.
4. EXCLUSIONS: The providers did not get credit for anything they did not do personally – no credit for ear lavage, vaccines, allergy shots or laboratory tests. They did not get credit for any no charge visit, either as an encounter or as a work RVU.
5. VALIDATION: Both encounters and wRVUs were also matched up to physician productivity surveys to make sure the base salary was comparable to the base productivity.
6. EXAMPLE: A provider seeing the 23rd patient of the day – perhaps a 99214 (work RVU 1.50) will get $10 for the encounter and $15.00 for the wRVU for a total of $25.00. By seeing an additional 99214 every day during the quarter, the bonus would be $1600 for the quarter. Because the appointment times were generous, there was a high probability that additional patients could be worked in daily, allowing the providers to see more than 22 patients per day without killing themselves.

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My post from 2010 on how much healthcare managers make is one of my most-visited posts ever. It’s time to revisit the data and talk about the direction healthcare jobs are taking.

First, some clarification on Office Manager, Site Manager and Practice Administrator titles and job descriptions.

The Office Manager title applies in two situations:

1. The first is the top position in a small medical practice (three physicians or less) supervising at least two employees. In addition to managerial duties, the office manager often functions in a full-time or part-time staff position, either at the front desk or as a biller. The Office Manager in this situation does just about everything including the three Ps – Payroll, Payables and Purchasing.
2. The second situation is the #2 position in a larger practice. The title could also be Assistant Administrator or Operations Manager. This person is responsible for all day-to-day operations, human resource functions and all department activities. S/he typically directly supervises all supervisors and leads and/or all staff if no middle management position exists.

A Site Manager or Site Administrator is responsible for one or more locations of a multi-location practice or a group of hospital-owned practices. S/he has all the responsibilities of an Office Manager for the day-to-day operations of a practice, but typically has a central support system. Duties deferred to the central support may include finance, human resources, billing and purchasing. Policies emanate from central administration, therefore the Site Manager does not have the autonomy of the Office Manager or Practice Administrator.

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