12 Ways to Supercharge Your Practice – Part 1 of 2

Written by on November 30, 2012 in Practice tips - No comments

There are 12 very actionable ways to make positive improvements in your practice.  In this issue we’ll present the first 6 and will continue and complete the final 6 ways in our January 2013 issue. After reading through all twelve ways next month, rank them in order of importance and priority for your group. Bring them to your strategic planning meetings and discuss ways to implement them, or use them as a springboard for other ideas to improve your practice and gain a competitive edge.

 #1 Create a Practice Dashboard

You’ve probably heard the adage “You can’t manage what you can’t measure!” The Dashboard is a way to capture key pieces of data in your practice and demonstrate your management skills to your stakeholders.

A Practice Dashboard is a one-page look at the key indicators being monitored that are necessary for the practice to thrive financially. As an administrator, I have typically presented the Dashboard Report (sometimes called a Snapshot Report) to the physicians at the monthly meeting. The Dashboard keeps the physicians operating at a high level and usually keeps them from descending into the deep detail that can derail a monthly meeting like nobody’s business!

What should be included in my Practice Dashboard?

  • Gross charges, collections and adjustments for the month and year-to-date (YTD) and the same month last year and YTD last year.
  • Aged Accounts Receivable (typically written A/R)
  • Collection % – how much of what you can collect, do you collect?
  • New patient referral breakdown by type (referred by doctor, patient, employee, website, direct mail, TV, radio, yellow pages, etc.)
  • Cumulative money turned over to third-party collectors and money collected by the outside firm
  • Status of any loans (remaining principal) or line of credit outstanding
  • Sales and returns if you are selling anything in the practice – medication, vitamins, supplements, books, beauty products, etc.
  • Appointments – % of appointments filled, % of no-shows, % of appointments booked the same day or the day before.
  • Money collected at check-in and check-out versus what should have been collected

#2 Stop Sending Patient Statements

Today the process of sending statements to patients is largely outsourced along with electronic claims, but it’s not very electronic. If we can get paid by insurance companies electronically, why not get paid by patients electronically? I suggest that the practice of sending patient statements is not only resource-intensive, but it is also a 20th century business practice unsuited for a 21st century business. Why do practices insist on clinging to an outdated method of billing?

Setting up a statement-free practice is relatively easy
Use an online payment system that allows electronic payment plans. An electronic payment plan enables a practice to enter a payment plan once, and have the system draft the credit/debit card appropriately without staff management. It should also be able to send a receipt to the patient’s email, or to send a message to the patient to pick up the receipt through a secure portal.

Load your contract allowables into your practice management system. If your system doesn’t have that capability, create a cheat sheet of your top codes for each contracted payer, so your check-out staff can calculate what the patient owes. There are also systems that can put together your contract information and the patient information into an estimate of what the patient owes for you.

Get online eligibility access that includes information about the patients’ benefits, deductibles, co-pays and co-insurance. This is available through your practice management system, your clearinghouse, or from a separate system that reads from your appointment schedule.

Practices that offer procedures or surgery should employ a financial counselor to sit down with patients and talk through financial responsibility and set up payment plans.

Coach staff on talking to patients about money. Teach them to become comfortable with collections.

People pay their bills via their credit/debit card routinely – this is not new or unusual for the majority of people. The ability to “set it and forget it” via electronic payment plans simplifies the payment system and speeds up cash flow. The ability to adjust a patient plan once insurance pays means no waiting to refund the patient or collect the remaining dollars. Your staff will still have to post the payments into the practice management system (although a few have integrated posting), but eliminating statements will save your practice money and time.

#3 When Do You Think About Customer Service in Your Practice?

The problem with not thinking about customer service every day is that customer service is a day-to-day relationship. If you wait until you recognize the signs of things heading in the wrong direction, it could be too late. Just like other relationships, customer service in your practice needs consistent attention and creativity to keep things fresh and in the forefront of everyone’s mind. Just like other relationships, customer service is a living thing that needs care and feeding.

 Customer Service is:

  • Seeing people as individuals and remembering something about each one of them (yes, you probably will have to note it in the computer)
  • Setting the practice thermostats to a comfortable level for the patients, not the staff. If you can’t get the thermostat to cooperate, tell every patient that the office is chilly and to bring a sweater or jacket. Buy a new or refurbished blanket warmer. Everyone loves a warm blanket, especially when they are partially undressed!
  • Inviting patients to roundtables to tell you what they like and don’t like about your practice. Don’t forget to invite patients who are really upset with the practice – they will give you the best information and can become your greatest advocates – if you are willing to listen.
  • Telling patients when they call for their first appointment what the routine wait time is (be honest). If the doctor always runs late, tell them how to plan for that. Some patients are willing to wait and some patients either won’t wait, or can’t wait – try to align expectations early on.

Excellent customer service means patients will feel good about coming back, they may tell 3 or more people about their experience and they might even give your practice a very good review on Twitter, Facebook, Yelp, Angie’s List, and 1 or 2 other rating sites.

Customer Service is WHATEVER MAKES PEOPLE FEEL BETTER.
It is anything from saying “I’m sorry we didn’t do the best that we could have for you,” to providing a drink or a place to have a private conversation. We don’t have to be perfect, we just have to have the desire to provide the perfect experience for each patient. Compassion is having no preconceptions about the other person and being willing to serve the other person’s needs regardless of your own feelings about the person. It is taking “you” out of the equation.

#4 Consider Running an Urgent Care Within Your Practice

Many stakeholders are questioning what the advent of insurance for all Americans in 2014 will mean for patients whom have not had access to a medical home and coordinated care. The primary care physician is the de facto center of the ACO model, and the hub of care coordination. The influx of patients being encouraged (and hopefully wanting) to abandon the ED for a practice with expanded hours may overwhelm primary caregivers who do not have the potential to provide care seven days per week.

Challenges of Urgent Care
For many patients, going to the ED is a community norm, and one that may be difficult to redirect. The marketing budget for the Urgent Care may need to be significant to overcome long-standing community routines and to educate patients about the new Urgent Care.

For the practice operating Urgent Care hours at the same location as non-urgent care services, patients may find it frustrating to understand when the practice is a practice and when it is an urgent care. Patients may also resent that an appointment at 4:30 p.m. has a co-pay of $25 and walking in for service at 5:00 may require a $50 co-pay.

Other models of care that practices should contemplate, as adjuncts to face-to-face care, are a robust nurse triage program, telemedicine, and virtual visits.

Statistics on Urgent Care in America*

  • Number of Urgent Care Centers in the U.S. 8,700
  • Number of visits per center per week 342
  • Ownership 50 percent physicians/physician group, 13.5 percent corporation, 7.7 percent hospital
  • Comparative Visit Fees Urgent Care Center $156, Primary Care Physician Clinic $166, Emergency Room $414

*Courtesy of Urgent Care Association of Americas Urgent Care Industry Information Kit, 2011 (www.ucaoa.org)

 #5 Create a Patient Advisory Board

Call it an Advisory Board, a Focus Group, a Patient Board or Patient Council. Whatever you choose to call the group of patients you meet with regularly, you need to have a group of patients you meet with regularly.

How do you start an Advisory Board?

  • Budget. Have name tags made for Board members. Have lunch (nothing fancy) at every meeting. When they leave the Advisory Board, present them with a plaque and a gift. Have a special thank you lunch (fancy) once a year for the Advisory Board.
  • Have the staff keep a continuous list of patients they think would be good for the Advisory Board. Naysayers, Question Askers and Perpetual Devil’s Advocates are all good choices. That one patient (or two) you couldn’t do anything right for. Don’t forget parents or children of patients, caregivers and spouses.
  • Set a standing meeting date and time for the Advisory Board. The third Thursday of every month at noon. The first Tuesday of every month. Send invitations and/or emails for each meeting.
  • Take minutes and keep an issues log. Get answers for questions. Provide Board members with written records of the meetings.
  • Invite staff members to attend on a rotating basis. Make sure staff have the opportunity the introduce themselves (everyone should introduce themselves at every meeting) and tell what they do in the practice.
  • Experiment with physician attendance and gauge if the physicians’ presence is detrimental to open communication. You may be able to introduce a physician into the group after the Board has meet several times and everyone feels comfortable.
  • You may get to a point when all the pithy issues have been addressed and the conversation doesn’t fill the Board meeting agenda. This is the time to start introducing short programs on new practice services, new physicians, or special topics you want the Board’s input on.

What is the right size for an Advisory Board?
Start with 12 people. Not everyone will come to every meeting, and some will probably drop off due to other commitments. If you target 12 people, have 10 stick with it and 8 people attend most meetings, it will be about right. If it isn’t, you can expand or shrink the number by inviting more people, or not filling vacant spots. Don’t forget to set a service term that you can exercise if you need to.

#6 Use Remote Employees

If you can’t find the right part-time or full-time employees, maybe you’re not looking in the right places. One of the great things about business today is that a portion of your workforce can be anywhere. Your best employees may not live in your town, your state or your time zone.

Many employers can’t handle offsite employees, but study after study shows that both employers and employees win when employees work from home.Slaughter Development notes:

“The real reason why telecommuting makes people more productive and more satisfied is this: outside of the office, employees are automatically in control their environment and workflow. There is no better way to build satisfaction than to give people authority and responsibility, and no better way to destroy productivity than to require people to work in environments and structures which do not leverage their expertise.”

What are other positives about remote employees?

  • Employees spend less money and have less non-productive time (e.g. commuting), get more sleep and have a better life-work balance working from home, so they feel they win as employees.
  • Not having to provide office space for employees mean freeing up space to become revenue-producing. “Given that it costs more than $15,000 per year to provide an employee with 200 square feet of cubicle, the savings would be significant so great, in fact, that companies would still come out thousands of dollars ahead after springing for workers’ broadband and VoIP expenses.” (Wired Magazine)
  • Having employees work from home means staff can be scheduled to cover early or late shifts without the safety concerns of working in an empty building.
  • Remote employees can be part-time or prn and have floating hours to help cover busy times of the year, medical leaves and unexpected shortages.
  • Not being exposed to office germs, office politics and negative behavior reduces stress and absenteeism and increases loyalty and retention.
  • Telecommuting is green.

What are the negatives about remote employees?

  • Some managers have no experience managing a remote workforce and may find it uncomfortable managing staff they cannot see.
  • If the employee hasn’t worked from home before, s/he may experience feelings of being isolated and out of the loop.
  • Most employers will choose to supply remote workers with computers, and therefore must to take responsibility for maintaining and repairing offsite computers.
  • Communication with remote employees must be very strong and very consistent. Managers must pick up the phone, have Skype talks and video conferences.
  • Remote employees will need performance standards just as onsite employees do, but their standards may be more production-oriented than time-oriented.

What are the medical practice positions that lend themselves to remote employees?

  • Transcription
  • Coding and billing
  • Nurse triage
  • Scheduling
  • Any task that does not require face-to-face time with patients

By Mary Pat Whaley, FACMPE

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