Whether the title is manager, medical practice manager, physician practice manager, administrator, practice administrator, executive director, office manager, CEO, COO, director, division manager, department manager, or any combination thereof, with some exceptions, people who manage physician practices do some combination of the responsibilities listed here or manage people who do.

Human Resources: Hire, fire, counsel, discipline, evaluate, train, orient, coach, mentor and schedule staff. Shop, negotiate and administer benefits.
continue reading "What Does a Medical Practice Manager Do?"

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I wrote this article for the Physician Office Managers Association of America (POMAA) March/April 2009 Newletter.  If you don’t know POMAA, check out their website.

Each of us have areas of expertise based on our experience, our education and what we find interesting and fun.  IT knowledge and skills are no longer optional, however, and I suggest every medical practice manager learn as much as possible about the following five areas.  Your work life and the life of your practice may depend on it!

Skill 1: Email Etiquette and Management

Email can rule your work life if you don’t make good choices with your messages.  Managers need to know how to use the Rules Tool (Outlook) to automatically move messages into folders, and how to turn emails into Tasks and Appointments.  Work communication can succeed or fail if you don’t have the basics under your command.  Knowing how to archive your email will not only save you time when looking for important information, but will save you from the frustration of searching through hundreds of emails.  Here are the basics of email management:

1. Most organizational experts recommend looking at your email twice a day, and turning off the setting that notifies you immediately when you have new email.  Email can be very addictive, and can suck your time away from projects and other work.
2. Just like paper, try to only touch an email once.  Once you read the email, decide whether to delete it, answer/forward it and delete it, or do something else with it like dragging it to the task list or calendar.  Don’t get caught in the ugly cycle of reading it once, and going on to the next email without doing anything about it.  If you do that, you’ll end up with lots of emails that you have to read again…and maybe a third time.
3. Never put anything critical (of a criticizing nature) in an email.  If you need to have that type of conversation with a colleague, pick up the phone.  A critique to an employee is best done in person, with a follow-up email for the file.
4. Always check your outgoing email for tone.  The best tone for business email is professional. This means a greeting, a message, a “thank you” and footer with your full name, title, and contact information.  Some organizations are more formal, and some are less formal, but I would err on the side of being more professional.  You can always set your email signature to include the greeting and thank you and your name, so all you have to do is complete the middle.
5. For emails that do need to be saved for reference, make subfolders under your Inbox to place reference email. Even better, copy the email to a Word document, and delete the email.
6. Have high priority (your boss or bosses) and low priority (listservs, subscriptions) email automatically come into their own folders.  The low priority email can wait and the high priority email can be dealt with first.
7. Group emails with jokes, homespun wisdom, clever tests and unbelievable pictures are a waste of your time.  If you need a break from work, go for a walk, but get rid of the group emails.  They take personal and server email space and can border on or be outright offensive, causing a problem if you don’t nip it in the bud.  Remember that email is legally discoverable.
8. Be careful about answering emails off the top of your head, possibly when you’re angry, or rushed.  If you need to delay answering an email because of your mood, drag the email over to the task list and set the to-do for tomorrow.

Skill 2: Understanding Medical Office Software

Acronyms come and go, but the basic software that supports medical practices remains the same.  Practice Management Systems (PMS) typically include registration, scheduling, billing and reporting as one component.  Today’s systems are built around the billing function, with scheduling and registration supporting the ability to generate electronic claims and post payments back to the transactions.  Because billing is becoming more standardized, it is the reporting that can make or break a practice.

Electronic Medical Records (EMR) are sometimes referred to in a broader sense as EHR (Electronic Health Records) and range from the simplest of systems which act as a repository for the electronic chart to the most sophisticated systems which may include  digital imaging, e-prescribing, complex messaging, medication reconciliation, and test alerting, among others.  EMR and PMS can be totally integrated, or can interface with each other, populating the other uni-directionally or bi-directionally.  Those mangers with a deeper understanding of their own software systems will find it easier to implement pay for performance measures such as PQRI and e-prescribing, and will not have to rely on vendors to educate them.

PACS is Picture Archiving and Communication System and allows easy indexing and retrieval of images.  PACS exists primarily in radiology and surgical specialty offices, but as more hospitals extend EMR and PACS privileges to physician offices, managers will need to understand something about the technology.

Other systems that will interface to your system are transcription, outsourced billing systems, data warehouses, claims clearinghouse, electronic posting systems, and web services interfaces.  Get or make a graphic representation of your software and hardware system/network so you can talk knowledgeably about it and understand the effects of adding new servers, workstations or software modules.

Skill 3: Using Technology to Stay Current in Your Field

Magazines, newspapers and even television news is losing favor as people find the latest and most in-depth news on the Internet.  For physician office managers, news and important information is available through websites, newsletters, newsfeeds, webinars, podcasts, listservs and blogs. How does a manager sift through all these options and stay current with the demand of running a day-to-day practice?

One of the most important ways to consolidate this information is to subscribe to a feedreader or email from websites you like and have the news come to you (called “push technology”), instead of you checking the website every few days or whenever you remember (aka “pull technology”). These are the programs that will eventually do away with most, if not all, of your magazine subscriptions.  You know that guilty pile of professional magazines that you have in your office or at home that you have scanned but still plan to read in-depth?  Gone!

Most websites offer email or RSS options to their users.  An email option asks you to enter your email address and will email you when new information is available, typically offering the full content inside the email itself.  This is ideal for anyone who has these emails automatically placed into an email subfolder to read later.

RSS stand for Really Simple Syndication and is a way to push the content of many sites into a feedreader, which is an organizer of website feeds.  There are many feedreaders available at no cost and adding a new website feed to your personal feedreader is as simple as clicking on the orange RSS icon on the website page and identifying the feedreader you use.  The nice thing about using RSS is that you can group sites into categories you decide upon, it is easy to add new sites and drop sites that you find a waste of your time, and you do not clog up your email program with lots of emails.

Webinars and podcasts are another way to stay current. Many webinars are free and allow you to dip your toe into the pool of knowledge on a particular topic.  Webinars with a fee attached are usually longer and more in-depth, and can replace the traditional go-to conference which has become a budget breaker for many practices.

eBooks are quickly becoming the way to get just the information you want when you want it.  Most eBooks are reasonably priced (some are free) and can be stored or printed.

Skill 4: Online Patient Interactions and Web 2.0 Applications

Patient interactivity via practice websites is growing exponentially.  Many practices are using web functionality to communicate with their patients via secure messaging.  This allows bi-directional communication such as:

1.      Request an appointment (patient) or appointment reminders (practice)

2.      Send statements;  patients pay online with a credit card (practice & patient)

3.      Inform patients of test results (practice)

4.      Create personal health records (patient)

5.      Request a prescription refill (patient)

6.      Virtual office visits (practice & patient)

7.      Complete registration via fillable .pdf forms and download to practice management system (practice & patient)

8.      Request medical records; send an electronic copy of same (practice & patient)

9.      Complete a history of present illness prior to the on-site visit (patient)

10.  Ask & answer questions for the doctor, nurse, or staff (patient & practice)

If you’re not looking into ways to communicate with your patients electronically, start now.  Web 2.0 is now more typically referred to as social networking, social media or new media. What started out as a way for friends to communicate with each other is now an amazing, ever-expanding ability to connect/market to businesses, patients and referrers.  Very few medical practices are using social media, but they should, because it is the way of the future, and in many cases, very affordable.

Skill 5: Knowledge Management and Retention

Most medical offices try hard to document processes such as “How To Make An Appointment For Dr. Jones,” but find it difficult to keep up with documenting changes to those written protocols.  Documentation is crucial for operations in that it supports job performance and consistency, and is a basis for training new employees.  The traditional documentation method for most practices is use of Word documents, which can create an immediate usability logjam.  Due to cost, Microsoft Office is not installed on many workstations, and many office employees are not trained to use Word, so the onus for original creation of and changing of protocols falls to one person.  Changes in healthcare are happening so quickly that it is not reasonable for one person to be able to update all documentation, unless they are dedicated to it on a full-time basis.

Better and more affordable solutions are becoming available.  Speech recognition and office wikis are two possibilities for documenting office processes.  Speech recognition (you may already be using it for your transcription) is a very affordable solution, but it does take time to train the program to recognize your voice.  If you are not used to dictating, it may also be a learning curve, but it is one that will pay dividends down the road.  Doctors can use it to help you by dictating their preferences, such as appointments, patient intake, room set-up, procedure set-up, patient phone protocol and after-hours call contact protocol.

Private wikis are another good bargain in the marketplace, as many are available at no cost, and may be installed and managed on the web.  Wikis need at least one person to function as editor. Since you can have your entire staff work on documentation, the staff becomes very invested in the process of keeping the wiki fresh and up-to-date.

There are other free or low-cost project management web programs that can also be used to track changes and remind staff to document changes later.  The one area that is most important for tracking changes and managing knowledge in the practice is in billing.  Many practices are held hostage by their billers as their knowledge is so specific and proprietary that the manager feels s/he could not recoup it if they left.  No practice should be vulnerable based on knowledge any single employee has, including the manager.

I am very interested in technology that creates value in medical office practices.  If you are using something new and different in your practice, please email me and let me know.  Also, if you have any questions about the ideas I discuss in this article, I am glad to answer them: marypatwhaley@gmail.com.

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I’ve completed 50 posts since I launched this blog in July, and now is a great time to pause and send out some thanks.  I appreciate the help and support of many colleagues and friends, and sincerely thank the readers who are subscribed to my blog via email or RSS.

I love to hear from you – leave a comment or email your ideas, questions, or suggestions for information, resources or topics.  I’m listening!

 

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Most people who ask what I do have never heard of managing medical practices.  Many people say “I didn’t know there was a job like that.”  Medical Group Management Association’s (MGMA) definition of medical group practice and medical practice management is helpful:

Medical group practice is defined as three or more physicians engaged in the practice of medicine as a legal entity sharing business management, facilities, records and personnel. This includes single- and multispecialty physician offices, ambulatory surgery and diagnostic imaging centers, hospital-based practices and academic practices. (Medical Practice Managers) … are part of a large and growing field that requires broad knowledge, skills and experience for long-term success. And the decisions they make directly affect nearly every aspect of a practice’s operations, from financial performance to patient care.

The next question many people ask is “How do you learn to do that?”  People who do what I do come from lots of different professional backgrounds.

It has been a fairly recent development that there are undergraduate and graduate programs for this field.  Many physicians who are business-minded have pursued degrees that allow them to manage their own practices while practicing medicine, or enter the healthcare management field and leave active clinical practice.  According to a recent Times article, there are 49 schools that currently offer a dual MD/MBA degree.

Here a few ways other than formal healthcare management training that medical managers enter the field.

Nursing/Clinical: I have known some excellent medical practice managers who have four-year nursing degrees, but I don’t know a lot of them.  It seems that most nurses want to be nursing, not managing, and that they became nurses to care for patients in a hands-on way.  I have observed that some managers with nursing backgrounds are instant fixers, and have trouble taking the contemplative route to problem-solving.

Management Experience: There is no question that private practices are coming late to the business party and that experienced managers bring a lot to the field.  It can be hard, however, to jump into managing a practice with no former healthcare experience because so much is so different.  The owners of the business (the docs) are also the ones producing the revenue.  As my husband says, the job is very much like being the Commissioner of Baseball.

MBAs: Having a MBA brings a lot of tools and resources to the table, but is not the be-all and end-all, especially when it comes to people-management.  The best managers in any field truly like and value people, have time for people, are collaborative with people, and care about people.  Can this be learned?  I don’t know.  Probably not genuinely.

Technology: Managers who understand and embrace technology will have the advantage over every other manager.  Healthcare and technology are becoming more and more wedded.  Every priority technology function that healthcare managers have to outsource is an aspect of the practice that is somewhat out of their control.  Think practice management systems, EMR, phones, PACS, email, knowledge management, lab interface, hospital interface, patient communication, etc.

Up through the ranks: Managers who have come up through the ranks have a big plus in their favor and a big minus.  The plus is that they understand healthcare, the nitty-gritty functions of the practice, have experience relating to administrative and clinical staff, and know how to network.  The minus is that they are usually undervalued due to the lack of formal education, and may also undervalue themselves for the same reason.

In the end, it’s not where a person comes from that makes the biggest difference, it’s who they are and what they’ve made of their career.  Anyone can enter the field of healthcare management, but I do suggest  these three prerequisites:

1. Compassion for patients (compassion for all people)
2. A desire to continuously learn; if you stand still you’ll get moldy
3. A sense of humor.

Here’s an interesting history of the field of medical practice management.

Photo credit: Mary Pat Whaley

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What have you done for your career lately?  Are you comfortable in your current job?  Are you happy?  Happy with your income?  Happy with your level of challenge?  What would you do if you lost your job tomorrow?

Do yourself a favor and invest a little time in your future.

At WordCamp recently, Lorelle VonFossen said “You need to think about having a digital presence.”

I suggest that signing up with LinkedIn (free) and building your online presence is a good start.  LinkedIn could be called the business version of FaceBook although many people use FaceBook as their business networking tool.  The general consensus is that for business LinkedIn is probably the most-used (25 million people) and best-known of the social networking websites.  Social networking uses the theory that we’re all connected to each other through those we know and that every other person on the Earth is connected by six other people, thus the term you’ve heard “six degrees of separation.”  You use these connections to network and meet people, ask and answer questions, and possibly, find jobs.

There’s a lot to completing your LinkedIn online profile, but you don’t have to do at all at one time.  I think my LinkedIn profile is about 75% complete and I’ve been working on it for a couple of months.  Take your time, do it right, then start to look into joining some LinkedIn groups to see what people are talking about.  The trick is not to get hundreds of people in your network (unless you’re a recruiter), but to build authentic relationships with people you think well of.

If you’re not sure what social networking can do for you, check out these articles:

Jobseekers are Beginning to Favor Social Networking Over Online Career Sites to Find Jobs

The Social Network as a Career Safety Net

LinkedIn: Old-School Network Isn’t Short of Fans

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It seems that my most popular post to date has been the one I wrote on the difference between its and it’s.  This tells me that managers are looking for ways to improve their writing and communication skills.  Not being one to overlook the obvious, I thought I would write a post about the difference between your and you’re.

I’ve been reading blogs and blog comments so much lately that my eyes are almost crossed, but one thing that does jump out at me is the tendency for many writers to confuse the two words your and you’re.

Remember the rule for its and it’s?  This one is almost the same.

If you can substitute the words “you are” in the sentence, use the apostrophe.  For example, “You’re reading my blog” can also be expressed as “You are reading my blog.”

If the words “you are” make no sense whatsoever as a substitution, do not use the apostrophe.  For example, “You’re blog is fascinating,” sounds fine, but makes no sense when you substitute it with  “You are blog is fascinating.”  This is the place to use “your”, as in “Your blog is fascinating.”

Your choice of words makes all the difference, and you’re the one to make that choice.

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I’ve always advised my children that if they can use its and it’s appropriately, if they can balance their checkbooks and can fry an egg, then they can be wildly successful in the world.  In other words, if they paid attention briefly in English, Math and Home Economics, success is within reach.

Now most people balance their checkbooks online and there are hundreds of websites to guide you in the cooking of a fried egg, but it is still clear to me that many people don’t know the difference between its and it’s.

Here’s how I remember which one to use, because it doesn’t come naturally to me either.

If you can substitute the words “it is” in the sentence, use the apostrophe.  For example: “It’s my blog” can also be expressed as “It is my blog.”

If the words “it is” make no sense whatsoever as a substitution, do not use the apostrophe.  For example: “The kitten licked its paw,” cannot be expressed as ‘The kitten licked it is paw.”

In this instance, you have my permission to forget the rule that “’s” means “belongs to.”

Okay, I feel much better having gotten this off my chest.

Oh, and p.s. I also taught my kids to look people in the eye when they give them a firm handshake. Maybe I should have taught them the fist bump instead – it’s (it is) more sanitary.

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This is the curse of many working woman with children, and one that I struggled with until both kids moved out of the house (for the second and third times.)

Here’s a heartfelt and interesting post and comments from Penelope Trunk’s blog Brazen Careerist.  She is frank, funny, and worth the time to read.  Her tag line is “Advice at the intersection of work and life.”

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LifeHacker had a great post today that I thought was worth sharing.  It’s about using the change of seasons as a catalyst to get yourself reconoitered and back on track.  The article advises you to:

• De-clutter your computer
• Empty your Inbox – he uses the trusted trio of Followup, Archive and Hold.  I like Followup, and Do Not Delete and Archive.
• Reorganize your paper filing cabinet
• Teach yourself keyboard shortcuts (*My son taught me Ctrl+C (copy) and Ctrl+V (paste) not too long ago and I have no idea how I ever did anything without these two friends – try them instead of using right click or tool bar icons and you might be surprised how automatic it becomes and how fast it is)
• Consolidate your email addresses, phone numbers, and calendars

Here are my additions to the list:

• Learn three things about Excel that you continue to do the long/hard way because you’re too busy to learn the shortcut (yes, I’m talking to myself here.)  Try this site, this one, or this one.
• Catch up on your shredding (at home I have a box of to-do shredding, and a to-be shredded drawer that needs emptied – yes, I’m talking to myself again.)
• Reorganize your online filing cabinet – here’s a great beginner article about files and folders, and here’s a short video tutorial from Expert Village on organizing files in Windows.
• Delete unneeded email or understand archiving – here’s a website with information on using AutoArchive in Outlook (me again.)

What’s your secret weapon to getting/staying organized and ahead of the information deluge?

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If you are working in practice management, you might want to explore the gold standard in certification through the American College of Medical Practice Executives (ACMPE). Disclaimer: I am Board Certified and a Fellow in the ACMPE but I receive no compensation for writing about the College or having a link to them on my blog.

Why certification as opposed to an undergraduate degree? I think this week’s opinion piece in the Wall Street Journal by Charles Murray says it better than I can. Read the article here.

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