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
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 marypatwhaley@gmail.com. Your name will not appear in the article.
Now is the time to follow-up on those good intentions of yours to make sure your swine flu/pandemic illness policy is all that is should be. Things are calming down a bit (although US numbers are rising, cases are mild) and as we might have a bit of calm before the next storm, it is the ideal time to give yourself a policy and training check-up while the topic is fresh.
- Do you have a policy for dealing with a community illness that is more than your typical flu season?
- Does your policy include detailed information that most anyone in your organization could follow if you were not able to give directions?
- Do you know what the local hospitals’ plans and policies are?
- Have you clarified roles for each of your clinical and administrative staff and provided them with detailed information on their responsibilities during a community illness?
- Do you understand what your practice is required to do to report information to local, state and national authorities?
- Have you located resources for or designed patient education materials appropriate for your population?
- Have you integrated community illness information into your new employee orientation and your annual staff training materials?
If you answered “no” or “maybe” to any of the questions above, here are some resource links to help you (more…)
The HHS and the CDC have developed lots of widgets that you can place on your practice website to give your patients the latest information on the swine flu. You can get a widget for your practice website from HHS here or from CDC here. These sites also provide podcasts and other resources that you can use to develop your practice protocols and education materials for staff and patients globally for a pandemic illness, or specifically for the A(H1N1) swine influenza illness.
This article will provide resources for three areas:
- Protocol for your practice for potential pandemic illness (swine flu or other)
- Plan to provide information to your patients about swine flu
- Plan for your practice to function during the swine flu or a pandemic illness episode
The good news about the swine flu is (more…)
The Medical Home, also called the Patient-Centered Medical Home, and the Personal Medical Home, is a movement to solve the problem of fragmented care (one hand doesn’t know what the other is doing) by having a primary care physician or practitioner act as the center of all care information for the patient. Fragmented care is dangerous (lack of coordination of care causes mistakes and mistreatments), costly (repetition of diagnostic tests and regimens), and wasteful of healthcare resources. The Medical Home plan goals are to provide care for all individuals, improve care, and decrease healthcare costs.
“Crossing the Quality Chasm: A New Health System for the 21st Century” was published in 2001 by the Institute of Medicine. In this landmark book, the patient’s role and responsibility for navigating the healthcare system and acting as the information hub around which the spokes of primary, specialty and tertiary care providers revolve was denounced (more…)
New employees must complete the new I-9 form (Employment Eligibility Verification) beginning Friday, April 3, 2009. Here is the link for the new form: New I-9 Form
Managers, you do not need to to use the new form for employees whose hire date is prior to April 3.
What is the purpose of the I-9? The form states that it “is to document that each new employee (both citizen and non-citizen) hired after November 6, 1986, is authorized to work in the United States.”
Reading the instructions, I was surprised to learn (more…)
Launched just a year ago this month, the Health Care Notification Network is a fast and easy way for physicians and their staff to receive important information regarding medication recalls, warnings and national public health emergencies. Once physicians sign up and their information is validated against the AMA database, physician staff may be added to the database to receive alerts.
From the HCNN webpage:
The Health Care Notification Network (HCNN) mission is to improve patient safety and protect the interests of consumers and healthcare providers. The HCNN will pursue its mission by delivering important patient safety alerts to providers securely online, in a manner that is faster, more efficient and more reliable than the current paper-based systems that typically use the U.S. mail. The HCNN is a free service for healthcare providers. Provider emails will be kept secure and not be sold or disclosed to other 3rd parties.
And, today, from the Medical Group Practice Association (MGMA), encouragement to get signed up with HCNN so as not to miss an important alert this week:
The Health Care Notification Network (HCNN) is scheduled to communicate an important prescribing alert this week. This online alert will be distributed via the HCNN in advance of traditional paper-based alerts to approximately 600,000 physicians, targeting the following specialties:
- Emergency Medicine
- Family Medicine
- General Practice
- Internal Medicine
- NeurologyUnregistered members can enroll to view this alert and other alerts at any time but will continue to receive paper-based alerts until they are registered for the HCNN.
Many medical societies, medical liability carriers, patient advocacy groups, and other health care industry organizations support HCCN “because it improves patient safety and decreases practice liability.” At some point in the future, medical liability carriers may offer discounts to their clients who are registered with HCNN.
I just moved a practice from one hospital campus to another – down four floors, across three blocks and up nine floors. I’ve done this before, but what did I learn this time?
1. Coffee & Food – whatever it takes, keep everyone caffeinated, watered and fed. It may not make things go any better, but it’s one less thing that people will want to leave the building (and thus the move site) for.
2. Elevators – the movers told me that 50% of the time when an elevator is involved, it will fail. Be prepared, know who to call, realize that movers sometimes have to move things up and down stairs despite that they tell you they’re not supposed to do this.
3. Cell Phones – practice phones may not work despite the best planning in the world. Make sure you have all employees’ cell phone numbers, and make sure you can forward the practice phones somewhere if your phone system is not available during the move or on the first days after. If you’ve installed a paging system separate from your phone system, you’re in luck, because during the move you can announce things to everyone at once.
4. Toilet Paper – the old office housekeepers dump you and the new office housekeepers aren’t ready for you. Get some toilet paper because not having any in either facility makes a lot of people very cranky. No one will thank you for having it, but you will certainly get blamed if there isn’t any.
5. Keys and Parking Cards (old and new) – this one speaks for itself.
6. Tell Everyone – no matter how well you do your job telling patients about the move and reminding them via email or phone calls, some will still go to the old location. Give neighbor practices the moving flyer and ask them to direct patients that didn’t get the message. Tape notices and maps and phone numbers on the old practice door because no matter if you sent them a flyer and reminded them when you called them about their appointment, they’ll still forget! I know, I’ve done it myself.
7. Overtime – put this in your budget and be prepared to pay it. The only way I know not to pay overtime is to close the practice to business for a few days and have everyone work regular hours. Or, you could make all your salaried people do the move themselves (not recommended.)
8. Stickers & Labels – you will never need more labels, post-its and stickers than when you move your practice. Wearing carpenter aprons with labels, pens, blue painter’s tape, a tape measure and your cell phone will save you lots of steps. It will also help to let contractors, housekeepers, security guards, staff and doctors get the message.
9. Trash Bags – buy them and stash them everywhere. You will have almost as much trash in the place you’re leaving as you will in the place you’re moving in to.
10. Low Expectations – do not expect anyone to like anything you’ve done in the old or new office. Remember that being the manager is not a popularity contest.
What are your best practices for moving your practice?
I got the idea for this post from an article titled “18 Financial Terms Every Leader Should Know,” by Dan McCarthy at Great Leadership.I thought it was a great post and created one of my own, borrowing a few good ones from Dan and adding examples for typical scenarios in healthcare. Oh, and I decided on 17.
1. Cash Basis Accounting.This was a question on a management test I took a long time ago! In this method when you pay a bill it is accounted for and when you receive payment, it is accounted for. Your receivables are recorded when you make deposits and your payables are recorded when you generate your payments online or by checks. Most physician-owned practices use the cash method of accounting, give the doctors a draw against their earnings, then distribute any additional earnings on a quarterly basis. To smooth out expenses, any bills that are quarterly (malpractice sometimes is) or annual (profit-sharing usually is), are accounted for to make sure money is not distributed prematurely.
2. AccrualAccounting. In the accrual method, when you receive a bill, it is accounted for, and when you bill someone, it is accounted for at that time instead of when you are paid. Your receivables are recorded when you charge the patient and your payables are recorded when you receive a bill. (I’ve never worked in a practice that used this method of accounting.)
3. Allocation. The process of deciding how each expense should be attributed, whether to the practice at large or to an individual physician. For example, individual physicians may be allocated expenses for specific staff, or allocated overhead for resources that only they use.
4. Amortized expenses. The costs for assets such as medical equipment and computers, which are depreciated (expensed) over time to reflect their usable life.
5. Cost/benefit analysis. A form of analysis that evaluates whether, over a given time frame, the benefits of the new investment, or the new business opportunity, outweigh the associated costs. This could be an analysis for a new lab machine, or a new satellite office.
6. Gross Collection Ratio. The total collections divided by the total charges gives a gross collection ratio, but this number usually is not meaningful as most practices make significant adjustments for contractual rates with payers.
7. Net Collections Ratio. The total collections divided by the charges less contractual write-offs gives a net collection ratio. The number should be meaningful, and ideally is not decreasing in this high-deductible, medical bankruptcy, high-unemployment economy. Collections ratios are the least useful when used for a monthly analysis, and most useful when used to evaluate charges and collections over a year or more.
8. Revenue Cycle. The process of collecting insurance and billing information from the patient, collecting any monies due at the time of service, documenting the medical service provided, translating the service into ICD9 and CPT codes, filing the claim and collecting the contracted amount from the payer.
9. Equipment lease. A contract to purchase or rent equipment and/or purchase service over a period of time. The monthly cost includes the purchase price and interest and although the cost over the life of the lease is significantly more, it allows the practice to avoid a significant cash investment all at one time.
10. Capital expenses. The purchase of a piece of equipment, furniture or sometimes software (usually $500 or more) that will be expensed through depreciation. A capital budget is one that includes all large expenditures the practice anticipates making during the year.
11. Operating expenses. Expenses that occur in operating a business, for example employee salaries, benefits, rents, utilities and marketing costs. An operating budget is one that includes all expenses incurred in the daily running of the business.
12. Revenue Budget. A budget that estimates the revenue the practice expects to collect based on physician and ancillary productivity and applying the previous year’s average collection percentage to the anticipated charges.
13. Benchmarks or Key Indicators. Indicators such as cost per RVU (relative value unit), cost per case in surgery, or days in A/R (accounts receivable) allow practices to compare their performance to the performance of successful practices.
14. Return on investment (ROI). A financial ratio measuring the cash return from an investment relative to its cost. You may calculate the ROI on an automated appointment reminder system and calculate the cost of the system versus the reduction in no-show appointments over several years.
15. Time value of money. The principle that a dollar received today is worth more than a dollar received at a given point in the future. Even without the effects of inflation, the dollar received today would be worth more because it could be invested immediately, thereby earning additional revenue. This is important in collections, as getting a partial payment from a patient today may have more value than getting a full payment from a patient in 2 years.
16. Variable Costs. Costs/expenses that are incurred in relation to providing services to patients. Examples include the cost of medical consumables, patient education materials and merchant services fees for taking credit cards. As the volume of patients increases, the expenses increase.
17. Fixed Costs. Costs/expenses that are incurred regularly regardless of patient volumes. Examples include rent, utilities, and liability insurance.
