12 Ways to Supercharge Your Practice

Written by on December 31, 2012 in Practice tips - No comments

Here are the final 6 very actionable ways to make positive improvements in your practice. Read through all twelve ways (the first 6 are in our December issue) and 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.

#7 Take Care of Your Staff So They Can Take of Your Patients

“Employees are the most valuable resource in any business.” We hear that statement all the time. I believe it. Most managers would say they believe it. But a lot of managers don’t act as if they believe it. If you take it to heart and realize what the extreme cost of turnover is to your organization, then you are always trying to find new ways to find the very best staff, and once you’ve hired them, to keep them motivated and willing to stick with you. Each of us requires the basics – compensation and benefits must meet baseline needs for anyone to consider a job offer. Survey after survey tells us, however, that it is the needs beyond the basics that close the deal and keep employees satisfied going forward.

An article discussing the recent Society for Human Resource Managements (SHRM) Job Satisfaction Survey stated: “…there are more important factors [than money] that contribute to job satisfaction, such as relationships with immediate supervisors, management recognition of employee job performance, and communication between employees and senior management.”

Reason for Poor Job Satisfaction and How to Fix It

Lack of Formal Onboarding/Training. Have a written plan for new employees that takes at least 2 weeks and includes the new employee sitting in every department and hearing from the staff in that department what they do and how the new employee’s job relates to theirs.

Lack of Performance Standards and Incentives. The Fix: Develop a whole incentive plan and tie it into performance. An easier, less costly and more immediate way is to have teams (individual departments or the whole gang) work on specific goals and earn periodic rewards – a pizza party, leaving early on a Friday, gas cards, a bowling party.

Poor Communication. The Fix. Tell all employees (not just some) as much as you possibly can, as soon as you possibly can. Don’t leave out the details.

Doom and Gloom. Everything is on fire. The doctors are worried, preoccupied, consumed. The Fix. Realize you are always on stage and you set the tone for the practice. You exude calm, confidence and peace. You smile every morning when you come in and you smile every evening when you leave. This is not to say you are not serious, but, you never let them see you sweat.

Lack of One-on-One Time with You. The Fix: Invite employees passing your office to step in your office and sit down for 15 minutes now and then. Sit in a department when things are quiet. Ask how the latest project is going. Ask how their husband’s new job is or how their mother-in-law is doing after her stroke. Then listen. Look at and listen to your most valuable resource.

#8 Leverage the Cloud for Real Results

The technology trend that is creating big opportunities for healthcare providers and managers to improve their bottom line, drive savings, and empower a mobile workforce is the cloud.

The cloud is more than just a fashionable concept – this is a real change in the way people work- and leading organizations are looking past the buzz into the substantive improvements that technology can offer in work flow and cash flow. By relying on offsite computing power and a constant high-speed Internet connection, the cloud has all sorts of advantages over a traditional, on-premise model.

How can the Cloud change your practice today?

The cloud can actually protect things better than you can. For less money. If you have your valuable documents stored in on-site servers, or on personal desktops, you are at risk. Cloud services offer auditability, encryption, and redundancy, and with strong end-user security practices in place, can provide healthcare organizations with absolute top of the line data security AND put the replacement and maintenance back on the vendor. You pay for access, and pay only for what you need.

Moving documents to the cloud not only protects them physically, but keeps them at your fingertips and the fingertips of permissioned users. Separated data facilities, redundant storage, and professional grade encryption are all more secure than the traditional, “server in the closet” model. The cloud can mobilize your practice, but keep everyone on the same page. The modern medical practice employs providers and administrative and clinical staff that bring powerful mobile devices to work everyday – and take them home too. By giving your key decision makers access to their work files outside of the office, you give them the tools of a work computer anywhere they go.

Physicians can handle office tasks on their own schedule, and in their own setting. Administrators can access critical documents from a phone, or a home laptop as easily as they would their desktop. The access you pay for is everywhere: if you have a web or wireless connection, you can access your files.

Tedious, in-house FTP setups, or VPN’ing into the network can be complex and costly solutions; work-arounds like emailing yourself the work files you need, or loading USB flash drives can introduce security risks. And, how can you be sure you remembered to send the latest version? If your work data is hosted in the Cloud, the availability of what you are working on is as much of an afterthought as the lights and water at your office. Updates to files are pushed to everyone immediately too, so you know your team always has the latest. With mobile applications and network access, employees can not only work from home – they can work from anywhere they have a mobile device and service.

The Cloud turns computing power into a utility. In terms of your practice cash flow, cloud computing enables you to flatten IT spending into a much more predictable outlay. If you own your server, you are very familiar with the “update cycle”. Determining the right time for updates, upgrades, replacements and expansion to keep up with your needs, comply with new regulations, ease pain points for the staff, or improve security can be an endless loop of spending lots of time and money.

#9 Create a Credit Card on File Program

Having a credit-card-on-file program in your practice has the potential to simplify patient collections, as well as improving your cash flow. Let’s take it a step at a time:

•Evaluate your patient base to determine if a credit-card on file program will work for you. As of the end of 2011, creditcard.com says there was a total of more than 1 billion credit and debit cards (Visa, M/C and A/E only) in circulation in the U.S., and the average person has 2.7 cards. Almost everyone has a credit or debit card and they routinely use them to pay bills.
•Once you decide you want a credit-card-on-file program, decide on a time-frame to implement it.
•Start communicating to patients that you are going to a credit-card-on-file program.
•Shop for an online credit card processor that allows you to set up payment plans and process refunds.
•Develop your workflow for collecting at time of service, and for using the credit card on file to charge balances and make refunds after the EOBs arrive.
•Role play and practice with the staff to make sure they feel confident explaining the credit-card-on-file program to patients.

Go Live!

#10 Fix the Phones!

Any time I ask a practice about their pain points, they invariably name “the phones” as one of their toughest problems to solve. Phone calls are escalating as many patients are trying to avoid going to the doctor. That means instead of making an appointment, patients are calling hoping to be given advice or a prescription over the phone. Staffing up to answer the phones is rarely an option for most practices. In many cases, there is no payer compensation for healthcare for phone services, therefore adding more staff for no additional compensation is not tenable.

There is no best practice for number of phone receptionists to number of physicians and non-physician providers. Every practice is different based on the specialty, the practice culture and staffing structure.

When the problem is the phones, the issue is complex. Doing a poor job of answering the phones not only causes patient dissatisfaction, it snowballs as patients call back again looking for answers, causing confusion and inefficiency. Poor phone management also has the potential to compromise care if a patient’s question goes unanswered.

Where do you start to tackle the problem with the phones?

Contact your local phone service provider and order a phone study. Make sure you include all primary phone numbers that your main number rolls over to so you get a solid study. Exclude direct numbers that patients have unless it is routinely published. For instance, if each provider assistant takes patient questions directly from provider’s patients via a direct number, that number should be included in the study. If a billing person occasionally gives out their number to a patient having a problem, no need to survey that number.

Make sure the week that will be surveyed has no holidays. The survey will probably be scheduled about a month out and may take an additional several weeks to get back to you. Different companies call these studies different things – it could be called a busy study, a volume study or a traffic study. Whichever it is, it should include detailed information about everything that comes through your phone system in aggregate from, and by individual number.

Do your own side-by-side study during the same week. Measure the incoming calls for the same week as the service provider so you have comparison data and so you can break your data down into the specifics you need to determine what types of calls you are getting in what volume. Have everyone who is receiving calls on the lines you identified for the service provider document the calls that come in on the those lines in categories.

Once the two studies are completed, you’ll have lots of data to review. You will see when and why calls are coming in and will be able to strategize to address your practice’s needs.

Setting Patient Expectations for Callbacks

One of the keys to conquering the phone problem is setting realistic expectations and reinforcing those expectations. If patient calls are rated as HIGH, MEDIUM, or LOW urgency, staff can let patients know how soon their question will be answered. HIGH urgency might be a 4-hour callback, MEDIUM may be answered by the end of the day and LOW may be answered within 24 hours. If the practice can determine which calls fall into each category, and train the staff to identify the call correctly, patients can be told when their call will be returned.

Then these expectations must be met or exceeded.

#11 Get to Know SEO (Search Engine Optimization)

Search Engine Optimization is the way you market your practice so your practice shows up in searches as high on Page One as possible. Wikipedia defines SEO as the process of improving the visibility of a website or a web page in a search engine’s “natural,” or un-paid (“organic” or “algorithmic”), search results.

Everyone has seen the flesh-colored box at the top of Google search results. These are companies that have paid to be listed in this primo spot. Below the flesh-colored box are the search results that have appeared based on their relevance to the search terms entered. Everyone wants to know how a company arrives in that treasured first page of real estate. You need to know how to get your practice listed on page one.

Your website should be one of your primary SEO strategies. Word of mouth and personal recommendations are still a great way for patients to find you, but your website needs to be doing the heavy lifting to:

–Drive new patients to the practice.
–Drive established patients to return to the practice.
–Keep patients attached to you as their provider.

Your website should be providing B2C (business to consumer) marketing for you. How does a website accomplish these things? In a web search, being the first or one of the first unpaid results that appears in the search is the way to ensure searchers find your practice. The way to get to page one, even number one on page one, is through SEO.

You or your webmaster need to follow tried and true SEO rules. Even if you’ve had your website for years, you can rework your website to make sure you are following these rules:

–Optimize your website by making sure it has a strong structure, an easily navigable flow, and that everything is titled and tagged appropriately. Just like a well-organized cabinet of medical supplies, first-time visitors should be able to figure out how to find the information they want.
–Create useful, interesting and high-quality content that reflects who your practice is. Good content will positively affect your ranking on SERP (search engine results page.) Your content should be targeted to the interests and concerns of your patient demographic, as well as giving insights into office activities and news.
–Utilize images. Everyone loves images, both to illustrate information and to introduce readers to the people and activities of your practice.
–Utilize videos. Everyone really loves videos.
–Make it easy for readers to search your website for information by offering a search box.
–Make it easy for readers to share information they find on your site with others via email, Twitter, Facebook and Google+.
–Make your website available for mobile users.
–Keep your website fresh. Adding a blog and posting content (it doesn’t have to be lengthy) is one way to keep readers informed, entertained and coming back for more.

#12 Maximize Your Medicare Payments

Medicare has so many programs that have the potential to increase or decrease your payments that practices need a list to keep them straight. Here’s your list with information on which programs are mutually exclusive and which can be combined.

1. Electronic Health Records (EHR) Incentive Program

You must be the owner of the certified EHR, although you do not need to have paid for the EHR. You can choose to participate in Medicare (federally administered) or Medicaid (state administered) program. You must attest or document that you have adopted, implemented, upgraded or demonstrate meaningful use. Eligible professionals choosing to participate the Medicare program can each earn up to $44K over 5 years, and eligible professionals choosing to participate in the Medicaid program can each earn up to $63,750 over 6 years.

2. ePrescribing Incentive Program

Each professional needs to report 10 eRx events for Medicare patients for dates of service before June 30, 2012 OR apply for one of five exclusions or four exemptions before December 31, 2012. Successful e-prescribers can qualify to earn an incentive payment based on a percentage of their total estimated Medicare PFS allowed charges processed not later than 2 months after the end of the reporting period. For reporting year 2012, EPs who are successful e-prescribers can qualify to earn an incentive payment equal to 1.0 percent of allowed charges. For reporting year 2013, EPs can qualify to earn an incentive payment of 0.5 percent of allowed charges. Beginning in 2012, EPs who are not successful e-prescribers in 2011 and do not qualify for a hardship exception will be subject to a payment adjustment equal to 1.0 percent of their Medicare PFS allowed charges. The payment adjustment increases to 1.5 percent in 2013 and 2.0 percent in 2014.

3. PQRS (Physician Quality Reporting System)

Physicians may report individually or practices may choose a set of three measures that relate to the type of patients they see. Measures are performed and modifiers are attached to claims. Bonuses are available until 2014; starting in 2015 practices not participating in PQRS will receive a negative payment adjustment.

4. Medicare Wellness Visits

Many practices are losing money due to the confusion over what Medicare pays for and what Medicare doesn’t pay for. Medicare introduced three new visits in 2010 and many providers continue to have trouble understanding and providing them correctly.

The “Welcome to Medicare” visit is technically called the “Initial Patient Physical Examination” (IPPE), but to everyone’s dismay, it is not a physical examination at all, with the exception of basic visits such as height, weight, BMI, blood pressure and pulse, and the potential for an EKG and an Abdominal Aortic Aneurysm screening. The Annual Wellness Visit (AWV) and the Subsequent Annual Wellness Visit are not physical examinations either, yet almost ALL patients believe that Medicare now gives free annual physicals.

Practices must train all staff and physicians to use the correct terminology first. I suggest everyone stop using the phrases “annual physical” or “complete physical” with Medicare patients. Patients can request and receive:

• A Welcome to Medicare Visit with no exam (no deductible, no co-insurance)
• A first annual Wellness Visit with no exam (no deductible, no co-insurance)
• A Subsequent Annual Wellness Visit with no exam every year thereafter (no deductible, no co-insurance)

What patients think they want is either a preventive visit, which Medicare will NOT pay for, or a standard Evaluation & Management (E/M) visit, which their deductible and co-insurance will apply to.

The only way the practice can win is by driving home to patients what Medicare does pay for and doesn’t pay for and making sure your documentation matches the code you submit to Medicare.

5. The ABN (Advance Beneficiary Notice)

Many practices miss revenue when they provide services to Medicare patients that are statutorily excluded from Medicare benefits. These may be services that do not meet the Medicare definition of medical necessity or are provided at more frequent intervals than Medicare approves. Identifying these non-covered services is the hard thing, however, unless your EMR can alert you to a service that will not be paid by Medicare, and if the patient requests the service and signs an ABN prior to the provision of the service In this case, the practice may collect the full fee from the patient.

6. Primary Care Incentive Payment Program (PCIP)

Eligible Providers (Clinical Nurse Specialists, Nurse Practitioners, Physician Assistants, and Physicians who have their primary specialty designation in family medicine, internal medicine, geriatric medicine or pediatric medicine) can receive a 10% incentive payment for services under Part B. The PCIP program, which was created by the Patient Protection and Affordable Care Act, requires Medicare to pay primary care providers, whose primary care billings comprise at least 60 percent of their total Medicare allowed charges, a quarterly 10-percent bonus from Jan. 1, 2011, until the end of December 2015. Eligible primary care physicians furnishing a primary care service in a Health Professional Shortage Area (HPSA) area may receive both a HPSA and a PCIP payment.

7. HPSA (Health Professional Shortage Area)

Medicare makes bonus payments annually of 10% to physicians who provide medical care services in geographic areas that lack sufficient health care providers to meet the needs of the population. Payments are automatic; there is no need to register or report anything on the claim to receive it. If services are provided in ZIP code areas that do not fall entirely within a full county HPSA or partial county HPSA, the AQ modifier must be entered on the claim to receive the bonus.

8. HPSA (Health Professional Shortage Area ) Surgical Incentive Payment (HSIP)

The Affordable Care Act of 2010, Section 5501 (b)(4) expands bonus payments for general surgeons in HPSAs. Effective January 1, 2011 through December 31, 2015, physicians serving in designated HPSAs will receive an additional 10% bonus for major surgical procedures with a 10 or 90 day global period. Payments are automatic; there is no need to register or report anything on the claim form. –If services are provided in ZIP code areas that do not fall entirely within a full county HPSA or partial county HPSA, the AQ modifier must be entered on the claim to receive the bonus.

9. NEW! Comprehensive Primary Care Initiative (CPCi)

Payment model per beneficiary per month (PBPM) for care management of Medicaid and Medicare patients. Markets in Arkansas, Colorado, New jersey, New York, Ohio/Kentucky, Oklahoma and Oregon for Medicaid patients. Arkansas, Colorado, Ohio and Oregon are the four states for Medicaid pilots. Multiple payers, including CMS, will be paying a monthly care management fee to support the 5 primary care functions of:

• Risk-stratified care management
• Access and continuity
• Planned care for chronic care & preventive care
• Patient & caregiver engagement
• Coordination of care across the medical neighborhood

By Mary Pat Whaley, FACMPE

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