Manage My Practice

Have you ever regretted a hiring decision?

You thought the individual would be a self-starter, but you found yourself having to give constant direction. Perhaps you needed someone with excellent customer service skills, and received complaints about the individual’s attitude and behavior.

One explanation for this dilemma can be found in the book “Now Discover Your Strengths” by Buckingham and Clifton. The authors differentiate between knowledge, skills, and talents. Talents are innate, whereas skills and knowledge can be acquired through learning and practice. You don’t teach someone to be a self-starter, no more than you teach someone to have a talent for empathy. This is why even after providing training on assertiveness skills, or how to provide excellent customer service, we don’t see much improvement or any at all.

I learned this lesson many years ago from a mentor named Bill. Bill was Vice President of Distribution and an excellent talent scout. During an off-site management retreat, Bill introduced his new warehouse supervisor. Bill explained that what he needed for this position was someone who has excellent communication skills, is decisive, and assumes accountability. Bill explained that he found the new warehouse supervisor in his health club. He had observed over several months how this individual communicated with others, the respect he was shown, and how he thought about resolving problems. Some of you might be thinking – “He found a manager while working out?” The point Bill was making is that he knew that he can provide the knowledge and skills required to be a warehouse supervisor, but he needed the talent to lead. I remember the day Bill asked me to move from the position of Quality Circle Facilitator (a staff position) to Customer Service Manager (with 30 direct reports). I said “Bill, I don’t know this operation, and I have never held a management position – why did you select me?” He looked me in the eye and said “Bob, people believe in you, and will follow you. You will learn the departmental functions, I can’t teach what you have.”

The point in sharing these stories from Bill is this – you must think about your hiring and promotional decisions very carefully. If you focus primarily on knowledge and skills which can be taught, and overlook an individuals talent, you can find yourself regretting the decision.

How do you find talent?

One strategy is to use behavioral-based interviews to assess whether or not this person has the talent you need. For example, if you require someone who is decisive, you might tailor your questions toward asking the candidate to discuss difficult decisions they had to make, and how they went about it. You might need to follow-up by asking for specifics. If empathy is an important talent, you might ask the individual to describe specific situations where a customer was very upset, and how they handled the situation. Pay close attention to how they describe the situation, and whether you get a sense that they fully connect with the importance of empathy. Although this is not an exact science, it puts the focus of your interview on the most important area – talent. We often make the mistake of looking at a resume and being overly impressed with the individual’s accomplishments. The real question is – how did they go about getting the job done? Are they consensus builders? Do they build strong teams? How did they overcome obstacles? Did they develop a successor? With an internal candidate, don’t make the mistake of promoting someone who has good technical skills and poor interpersonal skills, with the hope that they will learn to deal more effectively with others. Identify the talents needed for the role, and determine if this individual “owns” this or not. Don’t try to train them to be strategic, or nice, or anything else. They are who they are, and that’s OK. Select individuals who demonstrate on an ongoing basis the talents needed for success.

You might not find your next manager in a health club, but leaders should always pay attention to an individual’s talents.

Our role as leaders is to build on people’s strengths, not placing too much attention on improving weaknesses. Place individuals in jobs that allow them to leverage their strengths. If someone loves dealing with customers, and has a natural ability to do so, don’t put them in the back office. If someone doesn’t deal well with others, don’t force them into a position where they need to build consensus, and then be disappointed when it doesn’t happen.

I encourage you to use peer-interviewing as a strategy to find a good fit for a position. The person being hired will need to work well with colleagues, so why not engage the colleagues in the selection process. Teach your staff to also be talent scouts.

An organization is only as good as its people. Being a good talent scout is a competitive advantage. You build customer and staff loyalty, reduce turnover and the associated recruitment expenses, and build a winning team for the future.

Always be on the look out for talent, it’s always around you.

For a complete listing of our services, please visit us at www.rlcooperassoc.com

Bob Cooper
President
RL Cooper Associates
(845) 639-1741
www.rlcooperassoc.com
Innovations in Organizational Management

As we finish off another month here at MMP, we wanted to go back over some of our most popular posts from the month and get ready for another busy, productive, and meaningful month. Presenting, The Best of Manage My Practice, October 2011!

• Are you ready for the holidays? How about the New Year? Even though it’s still a few months off, make sure you don’t see an interruption in your practice’s cashflow by getting ready for the January 1st 5010 deadline!
• CMS has released the Premiums and Deductibles for Medicare patients for 2012, so you can start informing staff and patients now. More importantly, will 2012 be the year that you get serious about collecting deductibles at the time of service?
• Mary Pat’s “Collection Basics”series about the fundamentals of Revenue Cycle Management in Physician offices is now at part three! Check out Patient Collections Basics: Developing a Financial Assistance Program.
• One of Healthcare’s most misunderstood and underutilized documents- the Medicare Advance Beneficiary Notice- is changing for 2012. Make sure you’re ready.
• And finally, the Office of the Inspector General (OIG) of he department of Health and Human services has released its 2012 Work Plan for areas it will concentrate on investigating. Better safe than sorry! Mary Pat goes over the highlights here.

We’ve started this monthly wrap-up to make sure you don’t miss any of the great stuff we post throughout the month on Manage My Practice, but we also want to hear from you! What were your favorite posts and discussions this month? Did we skip over your favorite from October? Let us know in the comments!

As we finish off another month here at MMP, we wanted to go back over some of our most popular posts from the month and get us ready for another busy, productive, and meaningful month. Presenting, The Best of Manage My Practice, September 2011!

• With the weather getting chillier, and coats and sweater getting pulled out of the closets again, it’s time once again to get ready for your patients’ flu shots! The CMS has released coding and pricing information for Flu shots given after September 1st, 2011, so bookmark the page or print it out for easy reference.
• Did your providers get their e-Prescribing done to avoid your Medicare rate reduction? If not, you’ll probably want to apply for a CMS Hardship Exemption for 2012. Find out how here!
• Mary Pat continued her series “Collection Basics” about Revenue Cycle Management in Physician offices with “Part II: Implementing Your Financial Policy“
• Do you dread patient complaints? Don’t! Patients with complaints are a GOLDEN opportunity to learn about your practice, gain new perspectives on your operation and connect and learn about your customers. Learn how to get everything you can from a complaint in “Why I Can’t Wait to Hear Patient Complaints“!
• And finally, everything you always wanted to know but we’re afraid to ask about a common, but sometimes vague office routine: “The Right Way to Do Write-offs.”

We’ve started this monthly wrap-up to make sure you don’t miss any of the great stuff we post throughout the month on Manage My Practice, but we also want to hear from you! What were your favorite posts and discussions this month? Did we skip over your favorite from September? Let us know in the comments!

A write-off is an amount that a practice deducts from a charge and does not expect to collect, thereby “writing it off” the accounts receivable or list of monies owed them by payers or patients.

There are lots of reasons why write-offs are taken, and it is common practice to divide write-offs into two major categories.

Necessary or Approved Write-offs

These are write-offs that you have agreed to, either in the context of a contract, or in terms of your practice philosophy.

Contractual write-offs are the difference between the practice fee schedule and the allowable fee schedule you’ve agreed to accept.

Charity write-offs are the difference between the practice fee schedule and anything collected. Charity write-offs may be in accordance with a community indigent care effort, a policy adhered to in a faith-led healthcare system, or a financial assistance program.

Small balance write-offs are amounts left on the patient’s account that may not warrant the cost of sending a bill, which has been estimated to cost about $12.00 each, taking into account the statement process, as well as the cost to receive the check, post it, and deposit it. Many practices write off the small balance (usually $15 or less) and collect it when the patient returns. Others run a special small balance statement run once a quarter.

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How does a medical practice meet the patients’ healthcare needs while operating a highly-regulated business on less income? Start by examining one of the most expensive processes in the practice – billing. Billing requires skilled employees, sophisticated technology, and constant vigilance from everyone in the office. Let’s explore processes that can reduce your billing expense as well as increase your collection percentage.

Clear Financial Policy

If you don’t have a written financial policy, how do patients know when and how to pay? Your practice should have a very understandable (8^th grade level or less) financial policy that explains what your practice will do and what the financial responsibilities of the patient are. If you want a copy of the format I like to use, email me at marypat@managemypractice.com and I’ll send it to you. Use the same financial policy to train your entire staff on your policies. If any employee does not support your policies, that employee should not work for you.

How you save money: Everyone is on the same page, so there is no way a patient can game the system by claiming a staff member or physician told them no payment was needed. By the time the patient receives a service, they should have heard verbally about the policy 3 times (appointment, appointment reminder, check-in) and should have received at least one written copy of the policy, which they’ve signed.

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Note: This article was first published as PM, EMR and Portals: A Primer on Healthcare-specific Software for Ambulatory Care on Technorati.

Few industries are currently changing as much as the US healthcare system. While many perspectives and ideas are shaping the debate on how to change the system to meet current and future demands, most believe that technology can and will have a huge positive impact on the ability of the industry to deliver quality care in a cost-effective way. Network technologies that can support the ubiquitous exchange of health information in a secure, efficient and collaborative environment hold the potential to streamline and modernize the current system to maximize resources and positive patient outcomes.

The opportunities for improvement have generated a lot of buzz in both the private and public sectors, and incentivizing adoption of Healthcare Information Technology (HIT) through the American Recovery and Reinvestment Act of 2009 (the ARRA or Stimulus bill) has led to considerable interest in an industry often known for lagging behind in the adoption of new technologies.

For many, the healthcare-specific technical jargon and operational knowledge of how healthcare works can be as complex as the products themselves. Here then are descriptions of the three types of medical software used by ambulatory care providers.

Practice Management (or PM) Software

Practice Management (or PM) software has been in wide use in the healthcare industry for almost three decades. Its primary use is the collection of patient demographics, patient insurance detail and the healthcare services and related diagnoses provided. This information is formatted to conform to payer requirements and is submitted electronically to request reimbursement for services. PM software also manages the responses from the payers in electronic format and invoices any balance to the patient in the form of printed and mailed statements. PM systems can be all-encompassing in functionality or can be a la carte in modules.

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Some of worst horror stories in healthcare operations right now have to do with the failure of Electronic Health Record, (or EHR) installations. The high rate of EHR failures is being compounded by the pressure to attest in 2011 and start recouping some money against the EHR purchase and implementation.

To help organizations adopt EHRs smoothly and successfully, billing and management specialist Kris Jones, owner of Healthcare Management Services, is providing her clients with an innovative EHR program that she calls “Crawl. Walk. Run. Fly.” Kris told me “I found my clients so resistant to EHR, so paralyzed by the horror stories of money spent and productivity lost that I couldn’t help them move forward like we both knew they should.”

So Kris created the program that she thinks of as “Baby Steps” to make the process much more manageable and less intimidating. She brings the practice team on board a step at a time, removing the fear of the unknown and the greatest fear of all – change! Because Kris supplies the practice management software as well as the EMR, it is feasible for for her to let the practice take as much time as it needs to move through each stage.

Step 1. Crawl

The practice uses the EHR as a repository for medical record images. Staff makes first contact with the software.

Step 2. Walk

The practice adds e-prescribing and the staff enters data into the EHR for the problem list, the medication list and vitals. The software begins a functional role in patient interactions.

Step 3. Run

The physicians start with partial, then move to a full progress note. Physicians make first contact with the software.

Step 4. Fly

The practice achieves Meaningful Use with full implementation of the EHR.

What Kris has developed for her clients is the antithesis of the experience most practices have with the purchase of an EHR. It gives her clients the continual support and incremental change they need to preserve their workflow while slowly integrating the new software. This “slow and steady” approach has allowed her clients to be able to get their feet wet in the Electronic Health Record before being assured that the water’s fine and taking a full dip.

Click here to see the special free offer Kris and her team have put together for Manage My Practice readers.

Kris Jones-Bartley founded Healthcare Management Systems in 1985. Over the last 25 years, Kris built HCMS in to a multi-faceted practice management company with clients nationwide. Kris has personally managed every phase of a medical practice, from start-up to retirement, and including the recovery of practices on the brink of insolvency. Critical thinking, candor and eye-for-detail, make Kris a valuable partner in the business of medicine. HCMS is focused on specialty Revenue Cycle Management deployed in conjunction with E.H.R. capability.

HealthCareManagementSystems Experience. Expertise. Integrity. Determination. Results. Value.

What are the hallmarks of a well-managed practice? There are many, but here are 10 basics.

1. The practice has foundation documents appropriate to the corporate structure and written agreements describing how income and expenses are shared by physicians and/or other providers and how partners enter and exit the practice. The owners of the practice and management meet monthly.
2. The practice has documents that set the guidelines for operations such as a compliance plan, disaster plan, personnel handbook, job descriptions and requirements for annual evaluations, raises, bonuses and progressive discipline. Management and staff meet monthly.
3. The net collection percentage is 95% or more. This means that of the expected collectible dollars, 95% is collected.
4. The practice has a budget and variances are addressed.
5. The unfilled appointment percentage is 5% or less. This is in retrospect, so it includes no-shows. The practice has a marketing budget and a written marketing plan.
6. The practice has a line of credit or other means to draw upon in the case of unexpected cash flow drop.
7. A single commercial payer comprises no more than 50% of the practice business.
8. Employee turnover rate is 10% or less. New employees are onboarded with training, coaching and competency testing.
9. The practice has the ability to produce management reports to track and trend production, payments, adjustments, and denials. Process Improvement (PI) is used to address negative trends.
10. Patient satisfaction is prioritized and measured, and improvement is valued.

What other hallmarks would you add?

In addition to onsite and online undergraduate and graduate programs in healthcare administration and management, there are a number of programs that offer certification and registration (both terms meaning the same thing) for career healthcare managers.

When researching programs, some questions you should ask are:

1. How long has the program been in existence?
2. How many people have been credentialed through the program?
3. What are prerequisites (education, experience, references, other)?
4. Does the program have an education component in the form of mentoring, coaching, conferences, webinars, online classes, or in-person classes? Cost associated with each?
5. What information is covered in the exam? How can I learn this information?
6. What is the exam format (objective, essay, interview, presentation, other)?
7. What is the exam media (paper & pencil, online at home, online at testing center, other)
8. What are costs if the exams have to be repeated?
9. Do you have any data about the earning power or success of those credentialed through your program versus those from other programs?

*****

American College of Healthcare Executives (ACHE)

Cost: Membership requires a Bachelor’s degree. Annual dues are tiered and escalate from $150/year to $325/year over five years. Fellow exam is $450, recertification is every three years.

• Fellow American College of Healthcare Executives (FACHE)

*****

American College of Medical Practice Executives (ACMPE)

Cost: The education arm of Medical Group Management Association (MGMA), $275 annually (one-time $95 application fee), knowledge assessment $95, Body of Knowledge Review $29 each domain, exam workbook $119, objective exam $165, essay exam $165

• Certified Medical Practice Executive (CMPE)
• Fellow American College of Medical Practice Executives (FACMPE)

*****

American College of Physician Executives (ACPE)

Cost: Membership $280/year, Master’s degrees for physicians only

• University of Massachusetts, Amherst (online part-time MBA)
• University of Southern California (Master of Medical Management)
• Carnegie Mellon University (Master of Medical Management)

*****

International Association of Registered Health Care Professionals (ARHCP)

Cost: $120/year for membership, $385 per exam

• Registered Medical Manager (RMM)
• Registered Medical Coder (RMC)

*****

Physician Office Managers Association of America (POMAA)

Cost: Annual membership $110, study guides $100 each, exams $275 each

• Certified Practice Manager (CPM)
• Medical Coding Specialist (CPM-MCS)
• Human Resource Specialist (CPM-HRS)

*****

Practice Management Institute (PMI)

Cost: $799 – $999 for each program and exam – program available in-person, online or self-study. Annual recertification $75/year

• Certified Medical Office Manager (CMOM)
• Certified Medical Compliance Office (CMCO)
• Certified Medical Insurance Specialist (CMIS)

*****

Professional Association of Health Care Office Management (PAHCOM)

Cost: $195/year membership, study guide $150, practice test $150, exam $385, recertification every 2 years $75

• Certified Medical Manager (CMM)

*****

The American Academy of Medical Management (AAMM)

Cost: $378/year membership – certification is available with or without exam for $259, recertification is $179 every 3 years

• Certified Medical Staff Recruiter (CMSR)
• Certified Administrator in Physician Practice Management (CAPPM)
• Executive Fellowship in Practice Management (EFPM)
• Physician Fellowship in Practice Management (PFPM)
• Fellowship in Medical Staff Development (FMSD)

*****

You may also want to read an earlier post on Manage My Practice: “How Does One Become a Medical Practice Manager?”
and read the other posts in the Category : A Career in Medical Management by clicking on the category on the sidebar to the right.

Steps to digging under the meaning of EMR certification: 

Image via Wikipedia

1. Click to see the most recent alphabetical list (by product name not company) of all products certified here.
2. Find the company or companies you are using or are considering using.
3. Check that the exact name of the product is what you have or might purchase.
4. Check to find out if a module or part of the product is certified or if the complete product is certified.
5. Check to make sure the version of the product is the version you have or will have.

If you have questions about each company’s exact criteria met, you are in luck! On the ONC site here, you can click on each company’s detail (“View Criteria”) on the far right column labeled “Certification Status” to see what they have and don’t have. Compare this to how you are anticipating using your EMR to meet meaningful use. The more check marks a company has, the better-equipped they are (and more flexible) to meet your practice needs and to qualify for the stimulus money.

The ONC site with the Certified Health IT Product List (CHPL) is Version 1.0. Version 2.0 is now being developed and will provide the Clinical Quality Measures each product was tested on, and the capability to query and sort the data for viewing. The next version will also provide the reporting number that will be accepted by CMS for purposes of attestation under the EHR (“meaningful use”) incentives programs.

You can tell ONC what you think would be helpful in the new version by emailing your ideas to ONC.certification@hhs.gov, with “CHPL” in the subject line.

If you’d like a list of just outpatient/medical practice EMR products or just inpatient / hospital products, I’ve split the big list into two smaller printable lists here:

Medical Practice / Outpatient

Hospital / Outpatient

Tips On Buying An EMR

Remember that meeting meaningful use does not tell the whole story – if you are shopping for an EMR be prepared to go beyond a product’s certification status to consider:

• Flexibility – does it make the practice conform to it or can it conform to the practice? How?
• Templates and best practices – are you starting from scratch in developing protocols, templates and cheat sheets for your practice, or does it have a storehouse of examples to choose from or tweak?
• Built for the physician, or the billing office, or the nurses, but doesn’t really meet the needs of all three? Make sure the functionality is not too skewed to one user group, but if it is, it should be somewhat skewed to the provider.
• Interface and integration with your practice management system. Does the information flow both ways? Do you ever have to re-enter information because one side doesn’t speak to the other?
• Interface with other inside and outside systems: Labs, imaging, hospital systems, ambulatory surgical center systems?
• Built-in Resources: annual upgrade of HCPCS and ICD codes, drug compendium (Epocrates), comparative effectiveness prompting?
• Mobile applications - EMR on your providers’ phones?
• Data entry systems - laptops, notebooks, tablets, iPads, smartphones, voice recognition?
• Hosting – in your office? at the hospital? at the vendor’s data center? in the cloud of your choice?
• What’s the plan for ICD-10? Will they provide practice support and education for the change or will they just change the number of characters in the diagnosis code field?
• Price, including annual maintenance and additional costs for training, implementation, on-site support during go-live, and additional licenses for providers or staff.