Transcript Practice Management 101 - Health Management Association

Practice Management 101:
Boot Camp For New Managers
Our Work Stress Today
The Role of Practice Managers and Administrators Has Changed
 External Factors
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Reductions in Reimbursement
Regulatory/Compliance
Rising Technology Requirements
Increased Reporting
Patient Expectations Increasing
 Internal Factors
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MD Comp/culture
Increasing Burden of Administrative Function
Staffing: Cost, Benefits, Reporting, Taxation
Lack of Resources For Education/Training/Compliance
Practice Management Overview
Now more than ever physicians are relying on Practice
Managers and Administrators to run their practices
 The expectation is higher than ever that we perform
 The practice of medicine is both a business and a science that
is constantly evolving
 Physicians will not invest non clinical time in administrative
functions; they rely now more than ever on efficient
Administrators
 EVERYONE is being asked to do more with less resources
 We must be advocates for change and be effective leaders to
successfully manage all that needs to be done
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We are pleasers, remember you cant please everyone!
Admit when you are wrong or you don’t know
Listen to owner(s) and what their priorities are.
From that set reasonable measurable goals, pick 3 that will
have them most impact.
Set goals for yourself
Mentor other members of your staff to be better leaders
Stand up for yourself, and what you bring to the table.
Organize your days and keep to do lists so you can see that you
really did accomplish something even though your desk is a
mess you haven’t eaten and you cant remember when you last
time you went to bathroom.
Core Competencies
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Human Resources
Operations
Financial Management
Revenue Cycle
Regulatory/Compliance
Hiring
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Job Placement Advertising
Phone Interview
In Person Team Interview
Job Description/Orientation/Task List
 References
 Photo ID
 Job Shadow
 Skills assessment
 Vote off or on the island
 Job Offer
 Drug Screen
 Nicotine testing
 Hmm social media? Back ground?
Orientation
Bring a notebook and write it down!
 Mandatory Training OSHA BBP Emergency procedures
 EMR Training-overview login communication
 Customer Service/Corporate Philosophy
 Scavenger Hunt
 Round Robin day
 EMR intensive module select
 On floor one on one
 30 if needed for problems 60, usually just 90 day then yearly
from hire date review
30/90 Day Review
Name of Employee:
Department:
Supervisor/Reviewer Name:
Date:
Shows competence in his or her duties/knowledge of the job
Demonstrated ability to learn new skills
Able to work well independently and as part of a group.
Is punctual
Attendance record is within company guidelines
Sets goals to accomplish daily/weekly/monthly tasks
Concerns/areas for improvements
Goals
Annual Reviews
Purpose of annual reviews is to have time to sit down with an employee and
talk about their job performance. To thank them for all they do and for being
on the front lines day in and day out. It is also a time to look forward to the
coming year and set goals to move the practice forward. An honest opinion
of skill sets with goals set around areas of weakness for improvement or
strengths for possible promotion or kudos. Review positive patient feedback.
Survey providers, billers, check out, lab, and use their comments as they see
members from different angles, nice round view decreases your work load
too! Also good to know they are accountable to their peers not just managers
Annual reviews are not a time to slam someone for poor performance. This is
NOT a sneak attack. If you have issues with an employee that should be dealt
with by corrective action and should only show up on annual if corrective
action is not working. This should be no real surprises here!!
Sub par performance is a good time to set a goal for improving and to not
offer increase in pay due to sub par performance and that should not be a
shocker if you have done your job.
It will solidify that you do not reward poor behavior do it a few times and the
word will get out if it is fair and done well.
Performance Assessment:
1. Evaluate and discuss the employee’s job performance.
Base your evaluation upon the position requirements, achievements of the goals
established during the past year and your assessment of the employee’s
accomplishments.
1. Are there areas of exceptional performance that should be particularly noted?
1. Are there areas of performance needing more attention or improvement?
1. State and discuss the expectations and goal for the upcoming review period.
Give examples of how these goals can be met. How will you support the employee to
accomplish these goals?
Dealing with Behavior Issues
Yup its our favorite time sucking job!
Expectations are set upon hire and need to be at interview and in job
description. Sign job description and employee manual…..
Behavior examples need to be set by managers.
Corrective actions need to be non biased and equal and follow what is
laid out in employee manual depending upon severity of issue.
Always have someone with you
I generally read it over with them and also review the expectations and
the concerns to ensure they understand.
Issues that are seen during probationary period and are not improving
will continue during hire, so get rid of it during probationary
period….or live to pay unemployment there after or Morgan and
Morgan if you really mess it up.
Employee:____________________________________
Department:________________________
Verbal Warning ( )
Written Warning ( )
Final Warning ( )
1. Statement of the problem (violation of rules, policies, standards or practices or
unsatisfactory performance):
2. Prior, if any, discussion or warnings on this subject, whether oral or written (list dates):
3. Company policy on this subject:
4. Summary of corrective action to be taken by the company and/or employee:
5. Consequences of failure to improve or correct behavior:
6. Employee statement (continue on reverse, if necessary):
Provider Behavior Everyone is
Equal
Bet you didn’t think I had the courage did you??
Owner vs employed
Hiring process: Culture, shadowing, references-coworkers
Report to structure
Does behavior effect bottom line, a risk for litigation
or risk for patient safety
Evaluation who when how? Employee manual corrective action
is same.
Also remember numbers don’t lie, what you see in behavior you
can usually prove in numbers. Works on good and bad!!
Bonus calculation
50% based on financial meet
50% based on behavior and playing nice in sandbox
Provider Job Description that also moves to measurable parts
of evaluation for bonus calculation criteria
50% Finance 50% Behavior
 Work Habits. Demonstrate
 Staff and Management
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Interaction. Interacts
appropriately with staff members
and management team which
includes:
Treating staff members in a
courteous, respectful and friendly
manner.
Enable and support staff to
complete their jobs efficiently.
Offers constructive ideas to
improve current process.
Cooperates with management in
implementing new ideas.
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appropriate work habits which
include:
Arriving on time for office sessions.
Observing office hours
appropriately.
Returning phone calls the same day.
Utilizing appropriate infection
control measures.
Signing charts in a timely manner.
Participating appropriately in peer
review.
Arriving on time to meetings.
Maintaining appropriate patient
confidentiality.
Providers Must Set Example AND Play Nice In Sand Box
 Teamwork. Demonstrates
 Interpersonal Care. Provides
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appropriate teamwork, which
includes:
Contributes in training of the
clinical staff.
Meets with staff prior to the start
of a working day to promote
teamwork and ensure the smooth
running of the day.
Meet with staff on a regular basis
to elicit ideas on how to improve
operational flow.
Consistently works with staff to
utilize resources efficiently.
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appropriate interpersonal patient
care which includes:
Introducing oneself to new
patients.
Treating patients in a caring and
compassionate manner.
Treating patients in a fair manner
regardless of payer
Treating patients in a nonjudgmental manner.
Listening to concerns of patients.
Answering questions from
patients.
Explaining clearly the diagnosis
and treatment.
Charges
TC
GEL
RD
MD
CB
JA
Total Hours Worked
1550
1328
1830
563
1928
FTE equivilant
0.82
0.71
0.97
0.3
1.03
1
# of Patient Visits
4327
4265
3729
1628
4160
5041
Total Payments Received
708,185.41
719,743.92
Av. Payment Per Patient
579,238.29
228,991.63
712,635.86
1882
736,136.42
163
168.76
155.33
140.66
171.31
Patients seen per hour
2.79
3.21
2.04
2.9
2.16
146.03
2.13
Payments per pt/ hour
454.77
541.72
316.87
407.91
370.03
311.05
Payments
Office Visits
New
121,631
105,468
92,382
77,736
130,483
156,559
Established
251,466
312,576
259,838
103,722
246,998
284,699
Employment PE
16,323
19,868
3,845
19,629
11,955
6,935
Diagnostic Procedures
13,832
27,404
2,839
18,297
20,949
PE
Totals for Office Visits
12,195
40,535
77,991
46,977
2,218
41,823
35,534
443,787
543,307
415,237
206,144
449,556
504,676
Procedures
Ortho
3,696
2,251
1,423
1,227
3,491
2,826
Surgical
30,845
26,341
5,836
12,130
13,842
22,879
Total Procedures
34,541
28,592
7,259
13,357
17,333
25,705
478,328
571,899
422,496
219,501
466,889
530,381
Total Provider Payments
% of Benchmark met
147%
202%
110%
183%
114%
133%
Ancillary Services
Xray
67,767
84,313
57,419
Laboratory
72,726
68,279
74,041
Supplies
4,500
2,732
Pharmacy
13,237
16,293
Injectables
Total Ancillary
Total Payments Received
% of Benchmark Met
62,623
51,562
4,099
69,326
55,530
607
1,455
3,229
2,685
10,593
3,466
21,010
16,439
20,202
6,884
12,104
4,244
41,939
29,205
178,432
178,501
154,764
34,876
198,127
155,421
656,760
750,400
577,260
254,377
665,016
685,802
126%
166%
93%
MGMA Benchmarks
Median collections for professional charges FP per FTE
397,809
Median total medical revenue per FP FTE
636,536
Median gross charges per pt
21,612
355
Median total AR per MD
83,898
Median rev per FTE Total for single specialty Primary Care
603,257
Better performers
133%
101%
105%
Human Resource YIKES!!
 Area that time spent in doing good work and getting sound advise is
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money well spent in current environment.
Increased area of liability
For staff clear and detailed expectations followed through by fair
and equal treatment equal best case scenarios.
Good well written employee manual with Attorney review at least
every 3 years.
Clear chain of command for employees especially within sexual
harassment and or unfair treatment scenarios.
Every employee should be given a copy of employee manual upon
hire with sign off; if system supports you should maintain electronic
copy for reference within the work environment.
All write ups should include reference to which policy is at issue.
Great Resources For HR
 Henderson Franklin HR Law and Solutions Seminar
yearly usually in April often in Sanibel usually around
30.00 to attend all day well worth it to stay up on all
changes- Fantastic attorneys for employment law
issues-review handbook, etc.
 HR Collier-professional organization for HR. If in
your job you have any aspect of HR you can join.
 www.hrcollier.org
 Monthly meetings great topics
 Membership 45.00/year
First Impressions
Website
Up to Date
Content
Ease of Information
Personalized
Staff
Portal-ease of access and what does it provide?
Telephones- auto vs live-untapped way to market
Waiting Room- the good the bad and the ugly
Pushing patients to electronic versions of all paperwork when possible
E rx requests/ E appointment requests etc.
Backed up to paper for those not electronically savvy
Social Media/Web Marketing
Social Media Incredible when it is good really awful
when it is BAD!!!
Risks and rewards monitoring and using to your benefit
with patient comments both negative and positive.
Setting parameters to accounts and realistic
expectations of posts from staff.
Utilizes keyword searches as part of a strategic
marketing plan to enhance your web ranking.
Have you ever asked your patients how they heard of
you? Referral, website, friend, or the phonebook, really
does anyone use that anymore?
Good and Bad its what you do with it
Front Office
 Professionalism Set goals for accuracy of work-follow through from job
description to 90 day review/annual review
 Leading indicators
 Error rate on billing due to front end <2%
 TOS collection copay 100% all other TOS payments 70%
 Return all incorrect to originator to correct if possible
 Expect and or develop reporting from billing that helps improve front
desk performance work as team to improve overall performance
 Produce canned verbal statements for time of service
collection rules
 Rehearse difficult collection scenarios
 Stand up for and back up your staff in difficult interactions set
examples each and every time keep your providers away from
points of collection
Annual Wellness Consent Form
It is our understanding that you are here for your annual wellness exam. This does not include
treatment for any problems you are currently having OR your chronic care issues, IE: high
cholesterol, high blood pressure, diabetes, etc. The wellness is intended to be a preventative
checkup.
If you wish to have a visit that concerns something acute such as a cough, joint pain, etc., we
can use this visit to discuss any issues that you are currently having. We will reschedule you for
another time for your wellness. Please let the front desk know what you would like to do, if you
wish to discuss acute or chronic issues with your provider, so they can check you in accordingly
and let you know what your patient responsibility will be, IE: copay, deductible, etc.
Payment is due at time of service for any services performed that are not included in the
“annual wellness” exam, such as the chest x-ray, EKG or bone density if you chose to have them.
Please sign below indicating that you understand that if the provider determines that you are
NOT here for your annual wellness after discussion of any issues, that you will be charged
according to your office visit coverage. This may be a copay, deductible or coinsurance
depending on your plan.
Customer Feedback If You Don’t
Ask You Wont Know
Consider carefully what is important
that you know.
Staff, provider behavior, wait time,
efficiency, would you come back?
To ensure that you get the information
in an unbiased way you will need to
have many different ways of collecting
this information. Paper, electronic,
phone call, mailer, in office hand out,
drop box by check out. Call 3 random
patients a day with specific
questions…..
Collecting information is good but then
what do you do with it?
Post it and brag, use it to improve, use
it to recognize greatness
Post positive on bulletin board in
break room rotate monthly.
3 positive reviews or mentions by
patient =25.00 gift card most
mentions year end by
clinical/clerical/provider non
owned =150.00 gift cards.
Copies of all positives go into
employee file for reviews and are
given to them at review time
Brag about it on social media !!
Negatives are called back and
discussed with patient to
understand and are shared by
incident not specific employee
with all staff at monthly staff
meetings to improve what we do.
Organize Budget and Evaluate
 List all contracts for services
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and expiration dates
Organize calendar for renewal
Notify current vendor 90 days
of intent to renegotiate
Ask who biggest competitor is
and open up to bid or research
it ask other practices etc.
Set goal of cost reduction
service improvement
Ensure you review and
understand content fully, if not
ask!
 Leave your comfort zones and
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friendships
Evaluate relationship based on
merit, costs and benefits to
practice
Look for your education
benefit, cost reduction and
benefit for staff, provider,
owner
Look for experienced person
that you can learn from
Ask questions like crazy
How to Prioritize Where to Save$
 Depends on what you are allowed to price out.
 Set realistic goals you can’t do all try to get time
consuming contracts renewed off season when you can
breath.
 Learning and experience is always beneficial.
 Areas that always need to be looked at and bid are
 Malpractice
 Health Insurance and what agent/agency can do for you
 Payroll company and what they do for you
 Copiers and Toner/Service
 Credit Card processing, tricky so be careful
 Service Contracts
 GPO for medical and vaccine contracts
Organize Your Payer Contracts
 Yes, of course, first find them!
 If you cant then contact carrier and get them.
 Organize a spreadsheet by date signed and expiration date
 Note fee schedules and carve outs
 Look at language and note specifics to serve notice to
renegotiate or opt out and how and to whom you serve notice
 Evaluate each payer as a percentage of your payer mix by
provider and by ancillary services. Look at how they pay for
what you do for them. Look at opportunities to improve or
eliminate what you are doing to improve profits or workflow.
Sometimes it is exciting, sometimes it is TERRIFYING
Revenue Cycle Management
 Common RCM Reports
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A/R Summary – Shows charges, adjustments, and collections for a given
period
A/R Aging – Shows how old accounts receivable is from post date or date of
service usually in 30 day increments
Carrier Aging – Shows how old accounts receivable is by insurance carrier,
patient responsibility, or other grouping
Productivity Reports – Shows productivity by physician (or mid-level) to
include CPT utilization, wRVU, encounters, new patient visits, referrals, etc.
Denial and Adjustment Code Reports – Shows denied claims with remark
codes, or some other identifier, indicating why a claim denied
Expected Payment Reports – Compares what you were actually paid to the
allowable or expected reimbursement from the carrier
Charge Lag – Shows the number of days between the date of service and
when the claim is submitted for payment
Days in AR
 Translates the dollar value of the current AR into the
number of days of gross fee for service charges.
Expressing the business you have outstanding as
measured in days.
 Total AR divided by (12 months of gross charges divided
by 365).
Expected outcome 35 to 45 days. However, how you pick
your data will dramatically effect outcome by dos, date
charges entered, date claims filed. Pick one and stick with
it. Higher collection at TOS will decrease days in AR. If
seasonality is issue decrease to 30 to 90 days vs 365. Add
in credits. Credits should only be 2 to 5% of total AR.
Formulas you need to know
 Net collection rate: how much money you actually
collected of the money you could have collected cash
to net charges.
 Net collections(collections less refunds) divided by net
charges(gross charges less contractual adjustments).
This rate will increase over time 15, 30, 60 as payments
come in from dos to date run.
 Your rate will decrease if your billing is adjusting off
outside of contractual adjustments or bad debt…areas
you need to look at.
 Target 97%
Percent of AR >90
 Aging by carrier and patient receivable monthly as a
percentage of active AR not inclusive of credit
balances. 0-30, 31-60, 61-90, 91+.
 Goal 15-20% of total AR should be greater than 91
days.
 Track credit balances separately for both carriers and
patients. Insurance contracts mandate your return of
money due back time frames.
 Track bad debt separately as percent of AR and as
amount of increase per quarter. Some providers want
it per provider.
Routine Reports
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Monthly:
Visit volume/type/provider
Banking Balances
Review write offs, rejects and adjustments outside contractual.
Charges/Adjustments/Payments and % of Adjustments
Income/Expense
Budget overall and by department expense/revenue
Quarterly:
Aging AR, as % of total AR Credits, Bad debt, net collection
Provider productivity reporting new pt. established, ancillary
utilization and patterns.
 Payer mix analysis overall and by department
Things I wish Someone Told Me On
Insurances……
Employee Health Insurance
Up to 20% of base premium can be charged to employees who
smoke.(Depends on plan design and % of total cost share)
Up to 30% of cost of premium is based on risk so encourage staff to do
wellness, encourage disease management, simple things like filling
routine medications following up on conditions like spirometry on
asthmatics. A well controlled asthmatic avoids ER admits that decreases
risk and decreases renewal costs.
Workers Comp
You can pay actual due per pay period vs estimated and wait for audit to
get your money back. Just a little paperwork and you are on your way.
Ensure your owner and or owner(s) and wife are not on your w/c policy
they are excluded and it saves a lot on w/c costs.
Non Owned Auto update your drivers yearly to ensure covered.
Things I wish I knew about
insurance…..
Malpractice: Such a beast to sort out!!
Such a bone on contention upon hiring and leaving.
Sometimes it makes sense to have a corporate policy that you can
cover all ARNP/PA under. This stays with the corporation and does
NOT require a tail. It is a stand alone and cases can be settled under it
instead of naming PA/ARNP and MD in a suite. This further protects
MD’s and is usually less expensive than individual malpractice lines
depending on number of ARNP/PA.
Many good carriers offer education, CME for both MD and licensed
staff and education for administrators. They also offer free evaluations
of office for liability and work safety . It is an eye opener and can
often lead to a decrease in premium of up to 5%!! They also have a
ton of policy/procedure/best practice job descriptions Explore
opportunities and choose wisely based on all they offer!! Some offer
no tail to senior partners/owners something to consider as a benefit to
older providers that will be retiring and a net savings to practice.
Where can I get answers?
 Vendors
 Purchasing/GPO
 Revenue Cycle Management
 Work Flow
 Employee Training
 MGMA Florida State or National
 Conferences/Webinars and Books/ Magazine
 Certification Programs
Lori-Ann Martell, LPN, CMPE
Practice Administrator
Advance Medical Of Naples
[email protected]
QUESTIONS?