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Fix My Practice - Blog

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

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

#practicemanagementconsulting #practicemanagement #physicianconsulting #medicalconsulting

Fix My Practice – 10 Key Points of a Well-Managed Practice

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 – Hiring the right person”ality” for your practice.

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 – Understanding Business Structure Basics

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

 

Fix My Practice – 8 Tips for Managing a Difficult Employee

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 – Why You Should Welcome a Patient Complaint

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

The COVID-19 Vaccine

As members of the healthcare profession, we should ALL do our part to educate friends, family and coworkers on the safety of the vaccine and importance of being vaccinated and model trust by being vaccinated as soon as we are eligible! The technology behind the Moderna and Pfizer vaccine was developed by an African-American researcher, Kizzmekia Corbett.

It is not a live virus, only genetic information to trigger the body’s immune system, so the expected effects (site pain, fatigue, fever) are the body’s immune system waking up–and those are good signs. The genetic information does not interact with or change the body’s cells and so is safe for pregnant and lactating women. The vaccine is a two-dose regimen, and full efficacy (95%) is not achieved until about 2 weeks after the 2nd dose. The vaccine protects against symptomatic infection, but the virus can still enter the nose and mouth and be spread to others, so mask-wearing and social distancing are still required after vaccine administration.

There is a 4-phase rollout of vaccine availability, and Georgia is still in Phase 1a (high risk healthcare, law enforcement, care facilities, and age 65+). In February, Georgia will roll out a single-site registration process, consolidating existing registration through individual providers and public health departments. This is good news, since West Virginia has a single website to register for the vaccine and ranks 2nd in COVID vaccine administration, by contrast Georgia ranks 33rd among the 50 states tracked for COVID vaccine administration.

Getting the Covid-19 Vaccine for healthcare providers in Georgia

COVID-19 Vaccine

How do provider and their staff get the vaccine if they are independent and not connect to one of the hospital systems?

GA Provider COVID-19 Vaccine Registration

The first vaccination phase includes but is not limited to healthcare personnel likely to be exposed to or treat people with COVID-19, first responders, people at risk for severe illness and other essential workers. If you are linked to a hospital it’s an easy process to get your vaccine.

But what if you aren’t link to a hospital?

Healthcare Providers/Practices NOT enrolled as a COVID-19 vaccine provider or affiliated with a hospital can request to receive COVID-19 vaccination at your local public health department for themselves and their staff.

Each provider and staff member can get the vaccine now by enrolling their office at: https://dph.georgia.gov/provider-vaccine-registration-ph-district-list

There are multiple counties listed each one having a different registration process and link. https://dph.georgia.gov/document/document/provider-vaccine-registration-district-contact-list/download

Additionally, if you would like to be a COVID-19 vaccine provider you can enroll at: https://dph.georgia.gov/covid-vaccine-information-providers

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

 
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