To get our readers ready for National Nurses Week, we wanted to share a great new video from the Robert Wood Johnson Foundation that asks the question “What is a Nurse?”
The traditional view of the nurse as direct caregiver and bedside attendant to patients is really a limited view of the expansive and critical role nurses play in our healthcare system. As more and more change arrives in our system, nurses have taken on a myriad of other roles in the care process: research, community outreach, education, counseling – all of these represent departures from a “stereotypical” view of the role of nursing, and the video highlights the growth in these and other areas.
At Manage My Practice, we would like to thank all of our readers in nursing for delivering quality patient care in so many of our healthcare settings. Happy National Nurses day on May 6th, 2013!
Most readers know that I have a special interest in helping physician practices survive and thrive, and have been writing recently about different models of care that physicians are adopting to make private practice financially viable. Here’s an interview with Scott Borden of Direct Care Consulting, who helps practices convert to a Direct Pay Model. ~ Mary Pat Whaley
Mary Pat: What is your background, Scott?
Scott: I am a passionate Health Savings Account (HSA) expert. My background has been in health insurance marketing and management for 23 years. I have been heavily involved with Consumer Driven Healthcare for the past 15 years. I have been both a talk radio show host and guest on hundreds of shows over the past 8 years. I have also been featured on several television broadcasts and been a guest speaker for dozens of organizations.
Mary Pat: Your company is calledDirect Pay Consulting and you help primary care practices transition to a Direct Payment Care (DPC) model – will you explain what that model is? (more…)
We recently had the opportunity to observe three Presidential debates. Undecided voters watched the responses from both President Obama and Governor Romney to determine who they would like to vote for. Some people were interested in learning more about each candidate’s policies on important issues. Others observed the poise shown when faced with the tough questions. In the final analysis, most individuals want to vote for someone they believe in.I In the final analysis, most individuals want to vote for someone they believe in. They want to develop a sense of trust. They want to believe.
In business, others will only “want” to follow if they believe that you truly have their best interests at heart. They want to know that you are moving the organization in the right direction. They wish to have the opportunity to be part of the solution. It’s up to you to convince them that they should believe in the message, and most important – they must believe in you.
The following are a few suggestions to communicate with authenticity:
Learning “mindful meditation and communication” skills may sound to some doctors like a luxury for which they don’t have time, but new research from the University of Rochester confirms it may be well worth the investment for physicians and their patients.
The study, published in Academic Medicine, is a follow-up to a paper the researchers published in the Journal of the American Medical Association in 2009. For the initial study, Howard Beckman, M.D., clinical professor of Medicine and Family Medicine at the University of Rochester Medical Center, and colleagues enrolled 70 physicians in a mindfulness training program that involved eight weekly sessions, followed by 10 monthly sessions. They found that participants were better equipped to handle psychological distress, fend off burnout and improve their well-being. For the follow-up, the team interviewed 20 of the physicians about their experience with the training.
Highlights from their feedback and the rest of the article can be read at FiercePracticeManagement here.
Photo credit: Wikipedia
Grand Rounds is a weekly summary of the best healthcare writing online, featuring stories, opinion and analysis from doctors, nurses, patients, researchers and administrators, as well as journalists. Each Tuesday, a different blogger takes the helm, publishing a new edition of Grand Rounds on their site. Each edition features the hosts picks for the ten best healthcare links of the week.
This week, one of my very favorite bloggers hosts Grand Rounds, Dr. Bryan Vartabedian of the famed blog 33charts.com. Dr. V. is a pediatric gastroenterologist at Texas Children’s Hospital/Baylor College of Medicine. If you’ve never read Dr. V’s blog, try it – his writing is excellent.
Here’s his intro:
Welcome to this edition of Medical Grand Rounds. I scoured the web and pulled together what I think are some of the more interesting posts and news items of the past couple of weeks. Ive tried to explore some voices that perhaps havent crossed your radar. Weve got sociologists, medical students, IT gurus, medical futurists and even a couple of doctors. Some of the discussions have related posts that you might find interesting. Posts are not listed in any particular order.
Give yourself a little gift and click here to read Grand Rounds.
It’s taken me a long time to realize that I’m part of a seriously small group that likes, or at least tolerates change well. People universally HATE change and will do most anything to avoid it. So what is a manager to do when charged with making change happen, or when leading your own change initiative?
Know the Change
Map out the change and do your best to understand every possible implication of the change. Have a trusted colleague or mentor review the map with you and see if you’ve neglected to consider any angle. For instance, if your plan is to offer Saturday clinic hours, make sure you’ve considered:
- A budget for the change – are all the stakeholders in agreement on the money that will be spent to make the change? Is this a pilot for a specific time period or will the Saturday hours be continued regardless of the patient volume?
- How will it be decided which staff will work Saturdays? Will working Saturdays be optional or mandatory? Will staff be allowed to earn overtime, or will they have to adjust their weekday schedule? Will there be a pay differential for Saturday hours? Will there be lots of staff wanting to work Saturdays or will there be no staff wanting to work Saturdays? Because they are so personal, staffing and payroll will always be the stickiest parts of making change happen, so assign them top priority!
- How will it be decided which physicians or mid-level providers will work on Saturdays? Have issues with pay, call, and time off been resolved?
- A marketing plan for the new Saturday hours. Letting people know that you will be open Saturdays is critical to the success of the plan.
- Will all services be offered on Saturdays, or will it be modeled after on an urgent care? If it is an urgent care model, will it be billed as an urgent care visit and will co-pays be collected for urgent care services? How will an urgent care model be communicated to patients so they are not surprised when there are different terms of service than they usually encounter?
- What, if any, changes will need to be made to forms, the computer system, HVAC, security, janitorial, lights, payroll system, etc. What workflows might need to be changed because the practice is not used to operating on Saturdays? Role play a patient coming for a Saturday appointment and map out all the possibilities.
Frame the Change Message
Let everyone know why the change is being considered/happening. Craft the change message into something repeatable. Everyone must understand the reason and must be able to attach the reason to a change message. It could be “We’re growing!” or “More service for our patients” or “We will thrive.” Whatever one or two messages you choose, repeat them in your Rule of Seven (see below) and throughout your change process. Explain that the change is coming because:
Click here to go to Medsider to hear Scott Nelson interviewing me on ways sales reps can help physicians in new ways. When I consult with companies who want to understand new ways to work with medical practices, I advise them to consider more carefully the role the staff play in making practice services happen. It may be the physician’s name on the referral, but it’s probably the referral clerk who is pulling all the strings!
There is no one, and I do mean no one, in your medical practice who does not need to know the basics of coding. Here is why:
- Providing services to patients is the business of healthcare. Every person who relies on healthcare for their living should understand something about the business they are in. This should not outweigh the fact that we are privileged to care for patients, but as the saying goes “No money, no mission.”
- It takes a team to produce care. The silos of front desk, billing, nursing and scheduling must come together to share their knowledge and produce a high-quality, reimbursable patient visit. Here are the roles each member of the team plays:
- The patient calls for an appointment and the scheduler matches the patients problem to an appropriate appointment type. The scheduler finds out if the patient is new or established and what the patient’s appointment is for.
- The patient arrives for the appointment and the front desk assures that all current demographic and insurance information is collected.
- The nurse rooms the patient, taking vitals, reviewing medications and reviewing the reason for the visit – the chief complaint.
- The physician or mid-level provider cares for the patient, documenting the visit and choosing the appropriate service and diagnosis codes.
- The patient completes the visit by paying any deductibles or co-insurance due and making any future appointments needed. The checkout staff enters the payments and/or charges if the service codes have not already been posted via the EMR.
- The biller scrubs the claim, checking for any errors and electronically submits the claim to the payer. The hope is that the claim is clean and will be accepted and paid immediately (within 30 days.)
When staff understands how important their contribution is to the financial viability of the practice and how all the pieces fit together, they are more incentivized to perform.
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.
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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.