Manage My Practice

Today I had to run to the drugstore to get a bunch of cough drops and cold medicine and some microwave chicken noodle soup for my husband, who has a nasty cold. I ran in, grabbed a bunch of stuff and juggled it in my arms (not taking the basket as always because I’m only getting a few things) and unloaded at the cash register. Not only did the cashier search through the Walgreen’s circular because she was sure there was a coupon for something I was buying, but another Walgreen’s employee came up to me, took a handful of coupons from her smock, and found two more for items I had on the counter. Between them, the two clerks saved me almost $3.00!

Neither one of the clerks had to help me in the way they did. I had no expectation that I would get to use coupons because I was in a hurry to get in, get out, get back home to ditch the stuff for my husband, and head back out to work. These Walgreen’s ladies thrilled and delighted me by offering me more than 10% off my bill, and I felt they wanted me to get the discount. If Walgreen’s instructs employees to help customers this way, they are brilliant. If the Walgreen’s in my neighborhood has a manager that promotes customer service, I commend him or her. If these ladies are the creators of this customer service ethic, I bow to their excellence.

What could be better than a customer service surprise? Something you didn’t require, or expect, but certainly appreciate. What could you do to create this in your practice?

• Validate parking on a special day (election day, the practice’s anniversary, veterans day, etc.) for a location where patients usually have to pay to park.
• Provide information on local pharmacies so patients can easily find the closest pharmacy to your office, or find a pharmacy that delivers. This could go hand-in-hand with helping patients to find the pharmacy with the lowest price for their prescription (see my post on getting started.)
• Send new patients an email thanking them for coming to your practice and making sure they know how to get back in touch with the practice if they have any questions or concerns. Most practices may not be ready to open this door, but I suggest you be one of the first and set the pace for your competitors.
• I suggest you take down the signs saying “no cellphones”, and recognize that patients are trying to multitask and get things done in exactly the same way that we are. Invite loud cell phone talkers to step outside and give them a pager to call them when you’re ready for them. Meet patients on their terms.
• What are your ideas?

BNET is Business Network and CNET is Computing Network and both sites are owned by CBS.

BNET is a great one-stop shop for information on business and management, and now the site has a category for healthcare described as:

…daily industry news coverage and insights for managers and executives, focusing on the major health care providers, hospitals and facilities, insurance companies, and medical device manufacturers. In addition to detailed company profiles, we bring you critical analysis on new alliances and partnerships, new products, health care cost control, partnerships and alliances, management and board changes, and a host of other important business issues.

That may be a bit much to consume on a daily basis, but don’t forget, information is a buffet, and you don’t have to eat everything!

Here are a few BNET goodies you might like to check out:

Marketing Secrets from Campaign ’08 (if you are in a competitive market, read this and think about your maketing!)

Finding Opportunity in Upheaval (if everyone at your practice is stressed and cranky, it’s a perfect time for you to think differently. Patients need healthcare – what are you going to do about it?)

And don’t forget to check out BNET’s Business Library and Videos (including “Motivating a Stressed-Out Staff” during an economic downturn – very solid advice – I give it 5 stars!)

CNET is all about cell phones, computers, audio, video, etc., and has the latest on gadgets, including reviews and prices. It’s also a great site to find software to download. This site might not be as appealing as BNET, unless you’re as geeky as I am, and the longer I write this blog, the geekier I get. One of my favorites on CNET is Tips & Forums.

And just in case you are geeky, check out Woot, the site I check daily for great geeky deals.

I just participated in my first webinar and really enjoyed discussing the 2008 MGMA Annual Conference with colleague Marshall Maglothin and FierceHealthcare.com Editor-in-Chief Anne Zieger. Click here to register with FierceHealthcare and launch the webinar. My part starts at about 16 minutes.

Let me know what you thought about the conference.

Another week, another barrage of interesting and helpful items on the web. I hope you enjoy today’s selections!

Getting Warmed Up: Employees Walk While They Work (Call it innovation in the staff wellness/insurance premium reduction program arena.)

This next resource comes with a “R” rating, because it gives you the word of the day and it covers everything! If you want to know what current lingo means, this is the place to find it. Remember, I warned you!

Have you ever thought about having volunteers at your facility? Volunteers might be just be what you need! Read about volunteers here.

And now for something green, read this article to learn about saving paper, toner, shredding service, time and trees!

I’m off to the MGMA meeting in San Diego, then off for a few days of vacation with hubby where we will attempt to “unplug” from all things electronic. When there’s no Monday Special next week, think of me somewhere with blue water and very expensive roaming charges.

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 practices 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.

For information on organizations that award credentials click here.

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

Photo credit: Mary Pat Whaley

An article authored by Kurt Cagle, online editor for O’Reilly Media, does a great job exploring telework which he defines as

…employees and contract workers performing their work out of the office – from home, from distributed work centers, from coffee-shops, indeed, from wherever those workers may happen to be at the time.

Probably the job most commonly performed off site for medical practices is transcription, with billing a close second. More recently I’ve heard of triage nurses and registrars teleworking and if you think about it, any job that can currently be filled by outsourcing (appointment reminders, appointment scheduling, switchboard, etc.) could be performed by your own employees offsite.

If you’re like me, you may have considered teleworkers for your practice, but worried about managing off site employees and keeping them bonded to the team. Cagle discusses the ever-growing list of technologies available to stay connected, but does not underestimate other problems historically associated with telework.

Telework requires a certain degree of self-starting and responsibility. Ironically, a number of studies, including one performed by Sun in 2007 showed that one of the older stereotypes of teleworkers as people who would tend to do a little work then skip to some other activity, watch TV or surf the web actually proved to be something of a myth – for the most part most teleworkers actually tend to put in longer days working than they would in the office …

Other benefits of teleworking for employees:

• Savings on gas, parking and wardrobe
• Ability to self-schedule
• Gain personal time eliminating commute
• Customized workspace for each person: temperature, light, sound
• Reduction of the carbon footprint

Other benefits of teleworking for employers:

• Saves on expensive medical office square footage
• Fewer distractions could increase productivity
• Allows practice to grow without physical expansion
• Expands employee pool – employees can live anywhere
• Reduction of the carbon footprint

Read the entire article here.

Google Health announced today that the newest version of its patient-managed medical record is accessible to visually-impaired users. Using voice prompts and auditory icons, users of assistive technology are now able to open Google Health profiles and populate them with their own medical information including vitals, conditions, medications, allergies, procedures, test results and immunizations.

Assistive technology such as screen readers, which translate text into speech or text into Braille, offer computer access to the blind, visually impaired and illiterate.

Writing about the launch of Google Health’s newest enhancement, Google Blogger and Research Scientist T.V. Raman, notes that

“Google Health gives me a single unified web interface to manage all of my health-related information. Kudos to the Google Health and GWT teams for creating an extremely useful and usable solution!”

T.V. Raman is also the author of Emacspeak, a speech interface available free on the Internet that allows visually-impaired users to access computer applications, including video gaming. T.V. Raman, himself a visually-impaired user, discusses the software requirements to use the Google Health.

“Note that the accessibility support in Google Health requires support from both the browser as well as the adaptive technology in use. At present, we recommend Firefox 3.0 with screenreaders that support ARIA, alternatively, you can also use Fire Vox, the self-voicing extension to Firefox 3.0.”

In addition to improving accessibility for users, Google Health continues to seek relationships with innovators in healthcare, including those developing applications for disease management, secure messaging, and research.

Look at Google Health here.

Have you ever discovered a new software shortcut you can use that improves your efficiency? Or someone is working with you and shows you a faster way to do something? What a great moment and a great feeling of success that is – it’s almost like winning a prize!

Sometimes I’ll be working with Excel and just KNOW there’s an easier way to do something, but don’t have the time, the energy, or the patience to find out what it is. Not that going to Help is that hard or time-consuming, but it’s a mindset that I will find out some other time how to do it faster. That “other time” never comes.

We’re getting ready to have Brown Bag Training classes (30 minutes, during lunch, staff bring their lunch, not mandatory) at my practice to bring staff up to speed on some basics. I’m sure we’ll give them some great tips, and I’m sure we’ll learn a lot too. The point is to get everyone together and build our group knowledge by sharing what everyone knows.

In preparing our handouts for the classes, we’ll use the great article by David Pogue, a tech writer for the NY Times. The article has 1228 comments full of tips from readers! Here a few to whet your appetite:

You can enlarge the text on almost any Web page. In Windows, press Ctrl and the plus or minus keys (for bigger or smaller fonts); on the Mac, its the Command key and plus or minus.

Instead of the painstaking task of highlighting a whole document or web page with the mouse cursor, hit Control + A to select all.

You can tap the Space bar to scroll down on a Web page one screenful. Add the Shift key to scroll back up.

If you are having a problem in Windows and need to ask somebody for advice, try this: in Windows, use the Print-Screen button on your keyboard to take a picture of whats on your computer screen. You can then paste that (CTRL-V) into a Microsoft Word document. Double click on it in Word and you will get options to crop it and resize it. Then email it. Showing somebody the problem you are having is a lot easier than trying to describe it.

What’s your favorite tip or trick?

David Williams has a podcast/transcripted interview with Nuance Communications’ Keith Belton on the new release of Dragon Medical. Here’s the pertinent information straight from the interview:

allows physicians to navigate their EMR via speech command and to dictate anywhere in the EMR

20 percent more accurate out of the box than Dragon Medical 9

first industrial strength version that allows a chief information officer to install it and deploy it enterprise-wide across hospitals and clinics

medical vocabularies that cover almost 80 specialties

listens to the speech of non-native speakers and automatically loads one of eight region-specific language accent models

new medical abbreviations wizard that presents a list of common specialty abbreviations and follows the Joint Commission guidelines on approved and unapproved expansions of abbreviations

can create text-based macros and text-based templates with personal variability

The list price of version 10 of Dragon Medical is $1599 per physician. The 18% annual maintenance fee includes upgrades. Here’s the original release notice from the Nuance website.

There remains a huge controversy over the fact that Dragon Naturally Speaking Version 10 (different from the Dragon Medical product) no longer works with EMR packages. At about $200, Version 9 of Dragon Naturally Speaking was the choice of many physicians using EMR.

He said, “I’m looking for a doctor that uses email.” He said he would not use a doctor that doesn’t use email because he doesn’t have the time to fool around on the phone when he needs an appointment or has a question. Of course, in the practice, we don’t have time to fool around on the phone either, and we’d LOVE to do everything via email, but this is something that seems hard to implement.

Why?

1. Everyone (including me) is uncertain about privacy and HIPAA when communicating with patients electronically.
2. Everyone (including me) worries about the liability issues related to electronic communication with patients. How do you index it on the EMR? Do you print it out if you’re using paper charts?
3. Systems that are designed to facilitate email with patients seem limited and restricted as to specific uses like making appointments.
4. Managers worry that email opens the door to patient communication falling through the cracks when we/they are already working very hard to keep that from happening.
5. Most wonder if it is worth adopting technology early when it’s expensive and untried.
6. Most wonder how many patients would really communicate electronically if given the chance.

If you could design a safe, low-risk system to communicate electronically with your patients, what would be the uses for this system? What are your communication logjams? Are you aware of or using any systems that have cracked the electronic communication conundrum?

Here’s another article on doctors using email: Why Doctors Don’t Email Patients.

Photo by Andi Berger/Dreamstime.com