I invited readers of MMP, colleagues on LinkedIn, and Tweeps (friends on Twitter) to comment on my post “101 ideas for Increasing Revenue and Decreasing Expenses.” I’ve listed their ideas below and hope you’ll chime in on the comments with even more ideas! Thanks to everyone for contributing.
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Partner at B2B CFO® – Experienced CFO for Rent. Fast, Effective, Affordable.
Consider adding a part-time CFO to the mix. Many medical offices have very weak financial capability or understanding. Assistance can range from better financial reports, capital expenditure analysis, budgeting and exit plans.
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Eastern Region Sales Manager – Billing Tree
1) Build a relationship with the patient before he/she leaves the practice.
2) Make sure they know you are expecting payment on the portion they owe, and when you are expecting that payment.
3) Let them know what your process is for collecting, and when they will go to an outside agency.
4) Enable a web site to take payments 24 hours a day.
5) Set up an IVR system to take phone payments after hours.
6) Communicate your available payment acceptance methods in writing, on the phone and every time you speak with your patients.
7) Send the invoice or statement when you intend to send it.
Re-inforce the payment acceptance methods on the first and any subsequent invoices.
9) Adopt a plan for following up with any patients that don’t pay after 10 days.
10) Get email addresses from all of your patients and their permission to contact them in that manner.
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Sr. Product/Process Trainer and EDI Implementation Consultant
One suggestion would be to integrate the revenue cycle mangement function with your clearinghouse {for electronic billing} with integrated solutions like Coding database and Updates, Industry Broadcast, Performance and Audit reports for Claim Edits, Transmission and Rejects. Also, better training resources for billing staff actively into the practice management system.
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Consultant at Pacific Women’s Medical Group
I would add effective cash management (even if interest rates are so low).
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Medical and Business Consultant at Transworld Systems
Utilize a Flat Fee Collections Agency for Non-responsive Patient Pay concerns.
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Principal Consultant – Culbert Healthcare Solutions
- Do you collect co-payments on the way in rather than on the way out?
- Does your PM/Scheduling system show the patient co-payment and outstanding patient balance in the appointment screen? If not, then can you download a listing for your front desk staff?
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DPT Healthcare Consulting & Training
I’d like to add “acknowledge the patient with eye contact” and offer “polished customer service” and they will WANT to return = return on your $ $
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Managing Partner, Dynamic Grape Companies
One other thought… don’t be afraid to try new technology. For example, one of my clients has developed a kiosk that allows patients to take their own weight and bp and electronically feeds the data into their EMR. The whole set up costs about $3500 and can save a ton of staff time. Tele-health in general should also be considered.
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VP at Operations
If you select a reasonably priced EMR and you implement enhancements then you more than save on staff cost. Keep in mind that my practice rolled out the EMR five years ago, so we have had time to get it right. Here are some of the savings/revenue opportunities:1. We utilize our electronic technology to send text messages and emails to our patients to remind them of their appointments. This function alone saves my practice one FTE. Not only do we save with staff time we improve patient satisfaction, as our Blackberry users loves the email or text that they can directly add to their calendars. The revenue enhancement to this function, we decrease no shows and lag time in our physician’s schedules.
2. The robust reporting within the EMR allows the organization to assemble important quality measures that we use in contract negotiations. Without the EMR this would be a labor intensive task.
3. We are able to push a secure message to our patients regarding their pathology results saving staff time on the telephone and increasing patient satisfaction by eliminating a visit just to obtain a normal result.
4. No more chasing charts for a phone message. My call center takes ALL clinical messages. This is attached to the patient’s electronic chart and routed to either a nurse to respond or a physician. This process greatly reduces staff time, decreases the time it takes to respond to the patient’s issue and provides a legal record of the telephone call which is often missed in a paper environment.
5. We receive a discount on our mal-practice insurance because in an electronic environment it is guarantee that your notes are legible.
6. The formulary function built into most EMR’s provides the physician will a real time snapshot if a prescription that he/she is about to write is covered by the patient’s health plan and provides alternatives if available.
I have just highlighted only a couple examples of the administrative benefits. There are many more. It is tough to imagine going back to a paper chart.
I have done the math and we could cover our current EMR with the incentives offered through the government initiative.
I will comment that physicians need to be trained on how to use the EMR. You can lose site of the patient and focus the entire visit on the computer versus the patient, however, we teach our physicians that the patient first and then chart completion. We conduct patient satisfaction surveys and I rarely receive a complaint regarding the physician’s time at the computer. I do however, receive praises from patients regarding the ePrescribe as it decreases their wait times when the arrive at the pharmacy, the prescription is ready.
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Okay Readers, it’s your turn – what’s your secret weapon for increasing revenue or decreasing expenses?
Mary Pat
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. (more…)
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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
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:
- Compassion for patients (compassion for all people)
- A desire to continuously learn; if you stand still you’ll get moldy
- A sense of humor.
Here’s an interesting history of the field of medical practice management.
Photo credit: Mary Pat Whaley
It’s been both a long time and a short time since I decided to launch this blog. The idea dawned on me as I was returning from the East Coast in May – less than two months ago. I bought a Wired magazine to read on the plane and read it from cover to cover. After reading Wired and having a whole new awareness of web 2.0, I wondered how others in my field were keeping up with this new world.
I’ve always been keenly interested in IT and I have a special fondness for taking ideas from other fields and applying them to healthcare management. For years I’ve been reading Fast Company and recommending it to others. For years I’ve been involved in launching websites, practice management systems, and EHRs/EMRs/PHRs. But I’ve never found a place for healthcare executives to find information, read leading edge ideas and explore technology as it is changing the world. I hope I can bring these things together and stimulate lots of discussion at this site.
In the past two months, I’ve talked to people, searched the web, and tried to educate myself about what’s out there. I found some great sites related to technology, but so far, I haven’t found anything quite like what I hope this blog will become. I’ve been talking at length to my special advisers, my son and my husband, and they have been a great support in helping me and telling me I could indeed do this!
I’d like to end this first post by asking for your input:
What topics, links, resources and information would you like to see here?
Thanks, and visit again soon.
