Category Archives: Fix My Practice

Customer Service Should Be Seen as A Process and Not A Project

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Fix My Practice – Customer Service Should Be Seen as A Process and Not A Project

The Physicians Practice S.O.S. Group® www.ppsosgroup.com

Customer Service Should Be Seen as A Process and Not A Project

How can you keep your patients satisfied? Is “good” customer service important? Do you ask for feedback from your patients?  Do you acknowledge the patient’s view of their experience at the doctor’s office?  These are questions that should be addressed in your office.

Patient’s view their visit as a “whole” patient experience. This begins with the call for an appointment to entering the main office door and everything else that happens before they exit the office.  The practice should ensure that every visit should be as pleasant as possible.  Why?  A practice could fail to keep or attract patients and receive low scores on patient satisfaction.

In healthcare, customer service should be viewed as important by all staff because every patient has a choice of who they want to see. If bad customer service has been experienced, then that is not only a reflection on the staff but the physician(s) as well.

Paying attention to patient experiences will help a practice to improve their customer service. To create a better impression of the practice and the physician the improvements needed may only be minor.  What you may discover is that these problems are not that challenging to fix, and these small things will make the patients feel better about you, your staff, and care/treatment they are getting.

There are several areas within the office that should be considered including:

– Scheduling – making an appointment

  • Never leave a call on hold longer than 2 mins
  • Always ask before putting someone on hold
  • Be courteous and kind in speaking with the patient
  • Physicians need to be mindful that other people time is as valuable as there’s  showing up late to the office and having patients wait, is the worse customer service you could give.

– Front Desk – checking in and out

  • Acknowledging the patient arriving and greeting them with a smile
  • If unable to assist the patient right away, let them know that you will take care of them as soon as you have completed your current task

– Waiting Room

  • Keep it clean and clutter free
  • Furniture in good condition
  • Stocked with current and recent magazines/reading material
  • Keep patient informed of any delays and give estimates as to when they will be seen

– Exam Room

  • See the patient in a timely manner or if there is a delay make sure the patient is informed
  • Provide literature or videos on current care options related to your specialty
  • Remember the new patient experience travels 5 times, what happens during their visit will be told 5 times to friends and family and potentially end up on line.
  • Prior to entering the room, the physician should know the patient’s history by reviewing their chart, listen and talk to them with respect, sit in front of the patient and make eye contact
  • Prior to the patient exiting the room, they should be made aware of what they should do next as well as direct them to check-out

Patients want to know that a physician knows them. The patients should be viewed as your guest. You want them to return as well as tell others about their wonderful experience.

Improving customer service should be seen as a process and not a project. Though the changes may be fairly minor, they shouldn’t all be done at once.  Continue asking for feedback and suggestions on customer service from your patients and staff as well.  In addition, physicians do have a significant role in setting the customer service tone.

The personality of the practice starts with the staff and the culture of the practice starts with the physicians. When a physician runs late constantly then staff thinks it is ok to do the same thing. If your first appointment is at 8:00am, then you should be in the office at 7:45am and your staff should be there at 7:30am. It is the little things that make a difference. Patients will remember these things.

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice startups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com

#iamMsSos #practicemanagementconsulting #practicemanagement #physicianconsulting #medicalconsulting

10 Key Points of a Well-Managed Practice

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The Physicians Practice S.O.S. Group® www.ppsosgroup.com

I often get asked by physicians what are some of the key things for me to know to determine if my practice is being well-managed? There are many, but here are 10 basics which are not in order of priority.

  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 90% or more. This means that of the expected collectible dollars, 90% 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 brought onboard 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 is used to address negative trends.
  10. Patient satisfaction is prioritized and measured, and improvement is valued.

How well did you rank with these?  If you didn’t meet them all what processes will you be putting in place moving forward?

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice startups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com

#FixMyPractice #practicemanagementconsulting #practicemanagement #physicianconsulting #medicalconsulting

Fix My Practice – Why You Should Welcome a Patient Complaint

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Why You Should Welcome a Patient Complaint

No one is ever excited to hear patient complaints. When I worked in a practice daily I absolutely dreaded when a patient wanted to speak to me because I knew 9 times out of 10 it was a complaint and I felt more times than not that I had little to offer a patient who was upset or frustration with something that had happened, not to mention, in the business of the practice I most likely had been interrupted from another pressing task that I really needed to get back to.

Today as a consultant working with a client on practice management, I can’t wait to hear patients’ complaints. Complaints are the only opportunity managers have to understand the patient’s experience and hear in their own words what went wrong for them. By listening carefully, you have the potential to deliver customer satisfaction around the following areas:

  • You can gain insight into an experience in the practice and dissect it to see why the problem occurred and what can be done to fix it.
  • You can model to the staff how essential patient objections are and how genuinely you take them.
  • You can retain the patient for the practice, and hopefully make them a fan who will recommend your practice to their friends and family.

In the past, it may have taken a series of events for a patient to complain to the manager or to the doctor, because many patients will not risk disenfranchising a physician they really like. Today is the advent of the consumerist patient, and people are feeling empowered to complain about problems in healthcare (this is a good thing!) Practice managers should step up to the plate to meet them and make sincere attempts to cultivate a positive patient experience from beginning to end. In addition to active listening here are suggestions for delivering a positive patient experience following a complaint:

  • Train staff to prioritize all patient calls with complaints to you. Unless you are in the middle of a meeting, take all patient calls as they come in. If you cannot take the call, ask the staff to make sure to document the best time to return the call and the best number to call back. Make sure you then prioritize returning the call.
  • Listen to the patient until they finish talking and then repeat the complaint and ask questions to make sure you understand what happened
  • Let them know that their experience is not what you want for patients.
  • Tell the patient you will investigate the complaint and give them a definite date and time when you will call them back with a follow up report.
  • Talk to all staff and physicians involved in the incident. Call the patient back and share any information that is appropriate. Most patients will be satisfied to receive a call back and hear that their complaint has been discussed and/or addressed.
  • If possible offer your direct number to patients and invite them to call you if they have any further problems and have them ask for you when they come in for their next appointment, so you can meet them.

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice start ups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com

#ReginaMixonBates #practicemanagementconsulting #practicemanagement #physicianconsulting

Fix My Practice – 8 Tips for Managing a Difficult Employee

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Without a formal HR department, many small practice owners and managers put off dealing with challenging employees. No matter how small your practice is, it is important to set formal policies, properly document job performance and follow any applicable regulations. Failing to properly document and deal with a problem employee could damage morale and your bottom line

  1. Set clear expectations with an employee handbook. A carefully written HR handbook will clearly define expectations for all employees and managers. An employee handbook will also help protect your business from litigation. Your handbook should outline everything from benefits, time away from work, harassment, non-discrimination policies, performance evaluations and workers’ compensation. Provide each employee with a copy of the handbook and have him or her sign a document stating that it was received.
  2. Create a personnel file for every employee.  Each file should contain the employee’s resume, job description, signed policy documents and any other documents related directly to job performance. A personnel file should not contain personal details such as medical information, financial history, social security number, race, gender, nationality, sexual orientation or any other personal information not directly related to job performance. Personal information should be kept in a separate file not to be used in evaluating an employee’s performance.
  3. Schedule regular performance reviews for all employees. It is important to set a standard performance baseline for all employees. Focusing only on problem employees will make your actions seem arbitrary rather than purposeful. Evaluations allow you to set realistic goals for improvement and growth.
  4. Be proactive in Addressing specific concerns when they arise.  It is vital to discuss matters when they happen instead of waiting for a review. Waiting may make the issue seem trivial or may catch the employee off guard. Use the annual review to address how the employee has responded to any issues that came up during the course of the year.
  5. Document your concerns in the employee’s personnel file. If you discuss a concern with an employee make a note in their file. Many companies hold off on terminating employees because they do not have any documentation. Any significant discussion of job performance or violation of company policy should be noted in the employee’s file.
  6. Provide feedback and set concrete goals for improvement. Avoid taking punitive action to correct a concern. Do not badmouth the employee around the office or talk to them in an unprofessional manner. Set specific goals and put them in writing for the employee to sign and acknowledge. If an employee fails to meet the goals you have set then you can take further action.
  7. Clearly define consequences for failure to improve or to take corrective action. Failing to define what will happen if the employee does not improve provides little incentive for improvement. If an employee will be terminated for not meeting specific goals, make sure they understand that is the consequence.
  8. When necessary do not hesitate to terminate an employee. Firing an employee is one of the most difficult jobs a business owner or manager can face, but sometimes there is no alternative. If an employee violates specific company policies involving harassment or customer privacy or if they steal or commit any other action that jeopardizes your clients, business or another employee’s safety, document what happened and take immediate action. If you are concerned the employee may become confrontational ask another owner or manager to sit in on the termination meeting.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com

#practicemanagementconsulting #practicemanagement #physicianconsulting #medicalconsulting

Fix My Practice – Understanding Business Structure Basics

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The Physicians Practice S.O.S. Group® www.ppsosgroup.com

Ready to start your practice? Have you asked yourself what type of business entity you should be? There are several types of business entities to choose from when starting a business. It is important to consider tax treatment and benefits, sale of interest in the business and limiting your personal liability.

  1. Partnerships expose you to greater liability than sole proprietorships. In a general partnership, you are also responsible for certain actions of your partner(s). Partnerships must also file yearly returns with the IRS to report losses, profits and deductions. Before conducting business, partners should draft an agreement outlining how profits, expenses and workload will be divided. Disputes between partners can become costly to resolve and damaging to your business. Setting terms early on will help minimize the risk of a dispute.
  2. Corporations are independent entities formed and owned by one or more shareholders. Corporations may raise capital by selling stock or rely upon capital contributions of its shareholders. Shareholders’ personal assets are protected from legal liability, including business debts and lawsuits. The corporation pays taxes, conducts business and distributes profits to shareholders. Starting and maintaining a corporation requires a great deal of time and paperwork. It is important to keep thorough corporate records and ensure your corporation is fully compliant. In some instances, corporations may be taxed both on profits and on dividends paid out to shareholders. It is vital to consult an accountant or tax attorney regarding your corporate taxes.
  3. Limited Liability Companies (LLC) offer protection to their members similar to that of a corporation. As the member of an LLC, your personal assets are protected from the LLC’s liabilities. The liability protection is limited and does not protect members from illegal or wrongful acts, even if that act was committed by an employee. LLCs require less record keeping than corporations. It is up to the members of the LLC to determine how profits are distributed. There are fewer restrictions on the distribution of profits than with a corporation.

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice startups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com

 

Tips on Avoiding Mistakes When Leasing Space for Your Practice

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The Physicians Practice S.O.S. Group ® www.ppsosgroup.com

Fix My Practice –  Avoiding Mistakes When Leasing Space for your Practice

The old adage may be, “Physician, heal thyself,” but when it comes to real estate, you are best served by an expert who will capitalize on market conditions to obtain the best possible real estate outcome for you and your practice.

As a physician, your time is best spent focusing on your practice and working with your patients. The same way you hire a practice manager to manage your practice, an attorney to handle your legal affairs, an accountant to handle your taxes, and a financial adviser to manage your wealth, find a qualified, conflict-free medical office expert, someone worthy of your trust, and then empower that real estate professional to guide you in your real estate planning and negotiations to save you time, risk, and money.

In a lawsuit, it is illegal, unethical – and even illogical — for an attorney to represent both the plaintiff and the defendant. There is an obvious conflict of interest. In real estate transactions this practice is called “dual agency,” and it carries with it the same inherent conflict of interest, except that it is legal and done all the time by so-called “full service” real estate agents. We are unique because we represent only tenants; never landlords.

Landlords hire the “full service” real estate agents to find doctors to fill their empty medical office buildings. These agents’ interests are in lock step with their landlord employers and their singular aim is to maximize the rent paid by the medical tenants.
On the other hand, tenants want to pay less rent. And yet many unsuspecting physicians trust these very same landlord/full service agents to advise them in their real estate negotiations.

These physicians are often later disappointed that their agent did not do more for them in the negotiations. But if they understood the agent’s true allegiance, they would understand their motivation.

The inherent conflict of interest that exists in dual agency relationships plagues the commercial real estate industry and should be avoided by physicians – and other tenants – at all costs.

Here are 3 items within your lease that we help you navigate through during the lease
negotiations. There are many more hidden or not so hidden items that we as your licensed real estate agent and health care consultant can help you through.

1. Signing a Personal Guarantee

Landlords love personal guarantees. However, as a tenant, you should not. A personal guarantee is a legal contract between a landlord and an individual to guarantee a specific obligation of a business, usually the remaining rental obligation under a lease. Personal guarantees provide the landlord with additional recourse in the event of a default on a lease agreement. The implications of a personal guarantee are significant because your personal assets (e.g., house, cars, retirement funds, etc.) are at risk should you default on your lease.

The landlord will tell you the high cost of the tenant improvements that are often needed for medical office space creates additional risk, and that you need to sign the personal guarantee to provide additional security for your full performance of the lease. We disagree. The landlord who owns a medical office building should expect a high level of tenant improvements will be required. Further, the rental rate for medical office space is typically higher because of the tenant improvement contribution by the landlord. This is nothing more than a simple application of risk and reward. Yes, there is risk to the landlord in a real estate lease transaction, but that is why the rental rates for medical office space are higher than those for traditional office space. At the end of the day, it all comes down to the negotiations.

If the landlord wants to reduce risk by requiring a personal guarantee, should there not be a corresponding reduction of the rental rate? Are the improvements highly specialized? Is the medical practice a new business, or is there a solid history of financial performance to ease the landlord’s concerns? Are there other suitable properties where a personal guarantee would not be required?

If some form of personal guarantee is warranted, there are steps you can take to protect yourself and limit your exposure. For example, if you are in a partnership with multiple doctors, try to limit your guarantee obligation to your percentage ownership in the practice. Also, you should be able to structure a guarantee that declines each year as the landlord’s exposure is reduced.

Additional weapons in your negotiating arsenal can include a release of the guarantee based on the percentage of the lease or loan paid off, a specific end date for the guarantee, exclusion of certain personal items from the guarantee, and in some circumstances, personal guarantee insurance.

2. Underestimating the Cost of Tenant Improvements

Tenant improvements for a medical office suite can be very expensive. Building out space to fit the unique needs of your practice can range anywhere from $50 to $250 per square foot, depending on myriad factors such as the current condition of the existing suite (warm or cold shell), the level of specialized requirements for the practice (e.g., plumbing in exam rooms, lead walls for x-ray units, surgery components, etc.), and personal choice of improvement finishes.

It is important to understand the implications of the current condition of the suite and how that affects the purchasing power of each tenant improvement dollar the landlord is providing. A $55-per-square-foot allowance for a second-generation dental practice may be adequate, but the same allowance will barely get you started if you are building out from a “cold shell.” The point is to understand what you are getting into before you sign a lease. Our team helps you assess the current condition of a space by developing a detailed and competitive budget for the construction project while you are still evaluating your options.

3. Underestimating the Timeline and Complexity of the Build Out

Just as the cost for tenant improvements varies by practice specialization and current condition of the suite, so does the project’s complexity, and ultimately, the timeline for delivery of the finished space. For example, a practice requiring a surgery suite and digital x-ray units will take substantially longer to design, permit and build than a family practitioner’s office that may just require individual exam rooms.

We typically advise our medical clients to plan for a minimum six-month build-out period in order to design, obtain the appropriate permits, and construct the suite. For expensive and complex medical projects, the build-out period can be a year or even longer. So it is crucial to deploy the right team of experts from the outset.
Time is one of your best leverage tools in real estate negotiations. If you run out of it, things can get expensive fast. Our team of licensed real estate professionals provides professional lease negotiation, construction, space design and project management so that you understand the complexity of the project and can plan accordingly.

By Regina Mixon Bates, Principal
Bates Realty Group and The Physicians Practice S.O.S. Group

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice startups, IRO needs, improving patient flow and providing practice management and compliance solutions. Feel free to call our office to discuss any needs you might have.

Streamlining Your RVU Calculations

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Relative Value Units (RVU) are part of the reimbursement formula, designed to measure the value of services provided by physicians. In hospitals, health systems or large group practices, a physician’s salary is often calculated on the number of RVUs provided. But independent physicians should pay careful attention to RVUs too – because RVU data can help you to set competitive prices, negotiate payer contracts, accurately predict payments, grow your practice, and evaluate mergers and acquisition opportunities.

Historically, Medicare paid physicians based on “usual, customary and reasonable” pricing. This meant that doctors nearly charged whatever they liked, and Medicare paid a percentage. Many argued that the result was procedures tending to be overpriced, while consulting, preventative and management services tended to be underpriced.

For example, a doctor making a complicated diagnosis might have been paid $40, while another doing a routine colonoscopy was paid $600. Procedural costs remained high even as technology reduced actual work times by 75% or more in many cases. As a result, insurance companies lobbied for changes and that is how RVU’s came about.

Three components make up what is known as the Total RVU, each adjusted by the Centers for Medicare & Medicaid Services (CMS) according to your geographic location.

Physician Work RVU evaluates the time and clinical skill necessary to treat a patient during a specific encounter. It usually runs about 52% of the total RVU.

Practice Expense RVU calculates the costs of labor, building space, equipment and office supplies. It typically comprises 44% of the total.

Professional Liability Insurance Expense RVU documents the cost of malpractice insurance premiums. It represents about 4% of the total.

Total RVU is simply the sum of these three component RVUs value which are added together. This number is multiplied by the Geographic Pricing Index (GPCI) to account for location. That result is then multiplied by a conversion factor (CF) that changes every year and is published by CMS to get a final dollar amount.

Calculating payments using RVUs can seem like a daunting task, but it’s not difficult if you’re prepared. Look up the current RVUs for the procedure in question as well as the year’s exchange rate and use the prescribed formulas. There are also calculators that can help, and all calculations can be validated on the CMS site.

Calculating RVUs is easier with the proper formula and values to put into it.

Values

  • PW: Physician Work
  • GPCI: Geographic Pricing Index
  • PE: Practice Expenses
  • PLI: Practice Liability Insurance
  • CF: Conversion Factor
  • PP: Physician Payment

 Formulas

  • For in-facility procedures: (PW x PW GPCI + PE x PE GPCI + PLI x PLI GPCI) x CF = PP
  • To calculate out-of-facility amounts: (PW x PW GPCI + Transitioned Non-Facility PE x PE GPCI + PLI x PLI GPCI) x CF = Out-of-Facility P

Doing a similar exercise for Code 99214 would result in a Total RVU of 5.10930. Note that this is quite a bit larger than the Total RVU for Code 99213, which makes sense. A moderate level of medical decision making (30-39 minutes) service should be valued higher than a low level of decision making (20-29 minutes).

There are other things to consider when you calculate RVUs:

  • Remember that the fee you come up with may not be the exact amount of money a physician earns. Bilateral or multiple procedure payment rules could change the final payment.
  • RVUs, conversion factors, and other parts of the process change from year to year. Stay up to date to get the most accurate numbers.
  • Using a tool to calculate RVUs for you can make the process easier.

It’s important to develop a standard process for billing and paying staff. RVUs are only one method of doing this but provide many advantages over their alternatives.

We recommend that administrator and physicians focus on calculating RVUs for their 10 most frequently used codes. Total RVUs can then be used to approximate your practice’s performance and compare it against other benchmarks nationally.

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice startups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com

Fix My Practice – Hiring the right person”ality” for your practice.

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The Physicians Practice S.O.S. Group® www.ppsosgroup.com

As a practice manager or physicians hiring new employees is never an easy process. One of our top complaints from practice manager and/or physicians is how do we get the right person in for the job. Managers can receive hundreds of applications for a single position, and weeding out the majority of those applications can be daunting, and tiresome.

If you’re in a larger organization then typically, human resources staff will make it a little easier on themselves by eliminating certain candidates based on their lack of experience. The applicants with the most relevant work experience will likely be called for an interview, while those with the least will probably not move to the next round. Other factors considered in the first round of application review typically include an applicant’s educational background and skill set.

Personality and interpersonal skills are not typically evaluated until the interview stage, if they’re taken into consideration at all. By then, the applicants whose personalities are the best fits for the position may already have been weeded out.

Although the interview is a great opportunity to evaluate personality, many employers also do not put much weight on this factor. In the end, experience and special skills often win out. However, an applicant’s personality can be a much better indicator of how well they’ll do in their job.

Here are 3 tips important reasons why personality should be given greater weight in the hiring process:

  1. Skills can be learned

An applicant’s skills and knowledge of the field are almost always considered more important than personality in a potential hire. However, the fact of the matter is this: skills can be learned, but people can’t change their personalities.

Once thrown in a job, most people can learn the required skills very quickly. According to LinkedIn, workers on average know all the ins and outs of a new position after about three months. However, personal qualities are rather ingrained and cannot be changed, at least not very easily or quickly. With this in mind, an applicant’s work ethic, honesty, willingness to learn, charisma, and compatibility with the rest of the team are often far more important.

  1. The right team can make all the difference

Few jobs are done totally alone. Even if your employees are fairly autonomous, they’ll still have to work together from time to time. Teamwork is often especially important for large and important projects.

With this in mind, you should do your best to hire a group of people that work well together. It can be difficult to decipher if a candidate will click with the rest of the department. However, personality is often a good first indicator.

When you interview a candidate, ask yourself how similar or different his or her personality is from the rest of your staff’s. That’s not to say that everyone working for you should have the same personality, but people with radically different personalities tend to clash more.

  1. Go for the positive

In my experience, the number-one personality trait to hire for is a positive attitude. If I’m looking to hire you, you don’t have to be overwhelmingly bubbly, but I also don’t want someone who’s going to be a complainer.

We’ve all worked in offices where the mood is absolutely dreadful because everyone is so negative all the time. It sucks the life out of the room and makes the days drag on an on. So go for the positive!

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider’s face daily. The Physicians Practice S.O.S. Group is committed to and has helped healthcare providers across the country with new practice startups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com

Fix My Practice –Can Independent Physicians Survive in the Current State of Healthcare?

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Fix My Practice –Can Independent Physicians Survive in the Current State of Healthcare?

The Physicians Practice S.O.S. Group® www.ppsosgroup.com

If you feel like you’re glued to your computer or tablet for much of the day, it’s not your imagination. Many independent physicians say mounting paperwork is keeping them from spending enough time with patients. According to the Practice Profitability Index, the percentage of physicians who spend more than one day per week on paperwork has increased. This trend is eroding physicians’ on-the-job happiness. The physicians I know truly enjoy spending time with patients and teaching, and anything that takes them away from that is a negative.

A Kaiser study a few years ago indicated physicians spend more than 868 million hours annually on prior authorization activities. Payers say prior authorizations hold down costs, improve treatment efficacy and ensure patient safety. To physicians, however, they are an obstacle to providing the best care for their patients.

It seems that payer interference is increasing and dictating healthcare. Physicians have to deal with a range of audits tied to meaningful use, and other programs. The federal government can audit Medicare patients’ charts, while individual states can audit the records of Medicaid patients (since they fund Medicaid), up to 10 years after a patient’s treatment. The audits are just one sign of a trend toward payers influencing—or some would say dictating— patient care that can erode job satisfaction for medical professionals.

Audits are not the only way payers insert themselves into the physician-patient relationship. Prior authorizations are another way payers attempt to take decision-making out of physicians’ hands. In addition, more payers are tightening their provider networks in an attempt to rein in costs. This move toward narrower networks results in more physician evaluations.

More and more physicians must decide whether to stay independent or join a hospital system.  For some, joining a large hospital system offers a haven from the rising administrative burdens of staying independent, and from competitive pressures that can drive a small practice into insolvency. But joining a hospital system is not a panacea for the challenges facing physicians.

Some physicians are returning to private practice because their compensation from hospitals were not as lucrative after their initial contract expired. During the initial “honeymoon period”, pay is typically based on the previous three years of tax returns. When physicians’ contracts ended however, hospitals would often switch to performance-based fee schedules, which are usually much lower.

Here are a few survival tips for Independent Practice and Employment Options:

INDEPENDENT PRACTICE                             

  • Join Forces:  Consider joining an IPA (Independent Physicians Association) to align with other physicians and create negotiating power.
  • Look for High Impact Saving:  Major expense items that practices can easily investigate are occupancy and personal cost. Look at your leases, overall expenses, and automatic deductions.
  • Revamp Billing Practices: Make sure someone on your staff is held accountable for checking that all services are billed and reimbursed, and that no claims go over 90 days.
  • Re-examine Fee Schedules:  This is much easier to do if you are part of an IPA.

EMPLOYMENT

  • Get It In Writing: No matter how minor it seems, delineate all responsibilities in writing.
  • Learn About Compensation Details:  It is to your advantage to be an expert on your compensation package and method. Knowing RVU’s and quality-based compensation are very important.
  • Find out Who to Call:  Going from a private practice to a large corporation is a big change in culture. One of the most helpful things to know is who to call when something goes wrong. Make a flow chart that shows who contact and how to do so depending on the problem.
  • Know Your Limitations: Sometimes other people really do know their stuff and can teach you quite a bit. When you find these people, listen to them.

Whatever your choice in practicing medicine make sure you do your leg work, read every contract in great detail, and hire the right consultant and/or attorney familiar with healthcare laws when needed.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com

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Vaccination of healthcare workers ~ is it mandatory?

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Healthcare Workers and Vaccines

At times, vaccines can become a controversial topic. There are strong opinions about where protecting society as a whole stops and an individual’s rights start. With COVID-19 in the news and the potential for a vaccine, the topic is not going away any time soon.

If you’re a healthcare worker, vaccine requirements are likely not new to you. But can employers mandate vaccines, and can you refuse?

Vaccine recommendations for healthcare workers
The Centers for Disease Control and Prevention recommend healthcare workers get the following vaccines:

  • Hepatitis B
  • MMR (Measles, mumps, and rubella)
  • Flu
  • Chickenpox
  • Tdap (Tetanus, diphtheria, pertussis)
  • Meningococcal

The flu vaccine, which is offered yearly, has come into debate as more healthcare facilities across the country enact policies for mandatory vaccines for healthcare workers.

One of the arguments for mandatory vaccines is that it is the responsibility of healthcare providers to vaccinate and protect patients from getting the disease. By refusing vaccination, it may cause harm and violate their duty as a healthcare worker to do no harm.

On the flip side of the debate is by mandating a vaccine, it strips workers of their rights to make their own health care decisions. Additionally, if an individual opposes a vaccine due to medical concerns or religious reasons, and he would lose his job, the mandate is discriminatory. Whichever side of the debate you fall on, there are legitimate arguments for both sides.

Amid COVID-19 the question as to whether vaccines are mandatory has been coming up more and more. The answer to whether vaccines are mandatory for healthcare workers is yes and no, which sounds confusing. That is because laws vary by state. According to the Centers for Disease Control and Prevention (CDC), currently 15 states have laws that require healthcare workers to have certain immunizations for employment.

But within each state, the law usually includes some type of exemption. The allowed exemptions vary. Some states are stricter than others on allowable exemptions. To further complicate things, if a state is under a “state of emergency,” such as with COVID-19, other mandates may be enacted to protect public health, which may impact enforcing vaccines. If you live in a state that requires mandatory vaccines for healthcare workers, can you refuse? You may be able to decline based on allowable exemptions. Again, state laws vary on exemptions.

In some cases, a facility may have specific policies in place for team members that do not get a vaccine due to an exemption. For example, medical practices and hospitals will require staff wear a surgical mask at work for the entire flu season if they refuse a flu vaccine.

We don’t have a crystal ball on what the future holds when it comes to mandatory vaccines for healthcare workers. If a COVID-19 vaccine becomes available, healthcare workers are likely to be one of the first populations vaccinated. Whether that vaccination will be mandatory is not clear.

Only time will tell the direction that mandatory vaccines will take. One thing we do know is that educating yourself as much as possible about any vaccine, including the risks and benefits, helps you make an informed decision

Practicing quality medicine while maintaining and managing the bottom line is a balancing act that providers face daily. The Physicians Practice S.O.S. Group is committed to helping healthcare providers across the country with new practice startups, IRO needs, and providing practice management and compliance solutions. Call our office to discuss any needs you might have.

Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com

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