http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 Most Recent Submissions from jbee on Modern Medicine Community Thu, 23 Feb 2012 16:25:12 GMT Thu, 23 Feb 2012 16:25:12 GMT modmedadmin@advanstar.com (ModernMedicine) modmedadmin@advanstar.com (ModernMedicine) KickApps Feed Builder 2012-02-23T16:25:12Z 44 http://community.modernmedicine.com/service/searchEverything.kickAction?as=33379&includeVideo=on&includeAudio=on&includePhoto=on&includeBlog=on&sortType=recent 0 http://community.modernmedicine.com/_Data-Trumps-AngstAgain/blog/5803185/33379.html We were privileged to be asked to review the year’s results for a client.  The charges were down about $78,000 from 2010, collection down about $350,000, and net to the MD down $360,000. Time for Valium? Nope. The good news is this client is a tiger about data.  He collects everything and this time we made great use of it. Here is the rest of the story:  He worked 28 fewer days in 2011 than 2010; no long memorable vacations, just some extra time with the family and some courses.  When we divided the charges by the number of days worked he was actually more productive on the days he worked.  Comforting. The collection was down and the A/R up.  Due to a billing error on a particular code there were several large appeals pending to insurance carriers.  Assuming he would win at least some of them (average with Medicare is 60%), the collection will come up. This physician is solo, one of the most efficient we have ever met, and his overhead is HALF the average.  At the end of the day, he still has twice the average return to the physician after paying overhead. Times are tough but step back from the edge of the building.  This is when keeping your perspective is crucial.  If your results indicate you need to do some work on your operations, get to it. If your results are really not bad compared to the rest of the pack, be grateful. Among all the rest of his attributes he has a great sense of humor.  He sent back this message after reading our analysis, "Better than Prozac!" Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] We were privileged to be asked to review the year’s results for a client.  The charges were down about $78,000 from 2010, collection down about $350,000, and net to the MD down $360,000. Time for Valium? Nope. The good news is this client is a tiger about data.  He collects everything and this time we made great use of it. Here is the rest of the story:  He worked 28 fewer days in 2011 than 2010; no long memorable vacations, just some extra time with the family and some courses.  When we divided the charges by the number of days worked he was actually more productive on the days he worked.  Comforting. The collection was down and the A/R up.  Due to a billing error on a particular code there were several large appeals pending to insurance carriers.  Assuming he would win at least some of them (average with Medicare is 60%), the collection will come up. This physician is solo, one of the most efficient we have ever met, and his overhead is HALF the average.  At the end of the day, he still has twice the average return to the physician after paying overhead. Times are tough but step back from the edge of the building.  This is when keeping your perspective is crucial.  If your results indicate you need to do some work on your operations, get to it. If your results are really not bad compared to the rest of the pack, be grateful. Among all the rest of his attributes he has a great sense of humor.  He sent back this message after reading our analysis, "Better than Prozac!" Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 23 Feb 2012 16:29:21 GMT http://community.modernmedicine.com/_Data-Trumps-AngstAgain/blog/5803185/33379.html jbee 2012-02-23T16:25:12Z Managing Your Practice Modern Medicine Community We were privileged to be asked to review the year’s results for a client.  The charges were down about $78,000 from 2010, collection down about $350,000, and net to the MD down $360,000. Time for Valium? Nope. The good news is this client is a tiger about data.  He collects everything and this time we made great use of it. Here is the rest of the story:  He worked 28 fewer days in 2011 than 2010; no long memorable vacations, just some extra time with the family and some courses.  When we divided the charges by the number of days worked he was actually more productive on the days he worked.  Comforting. The collection was down and the A/R up.  Due to a billing error on a particular code there were several large appeals pending to insurance carriers.  Assuming he would win at least some of them (average with Medicare is 60%), the collection will come up. This physician is solo, one of the most efficient we have ever met, and his overhead is HALF the average.  At the end of the day, he still has twice the average return to the physician after paying overhead. Times are tough but step back from the edge of the building.  This is when keeping your perspective is crucial.  If your results indicate you need to do some work on your operations, get to it. If your results are really not bad compared to the rest of the pack, be grateful. Among all the rest of his attributes he has a great sense of humor.  He sent back this message after reading our analysis, "Better than Prozac!" Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] managing your practice nonadult false Data Trumps Angst...Again text blog managing your practice 1340 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 5803185 2771849 Member 0 http://community.modernmedicine.com/_This-Isnt-High-School/blog/5661984/33379.html The doctors are driving the manager nuts.  She describes them as cranky teenagers.  They tell her privately that they don’t like each other and to “keep that one away from me”.  One doctor is giving orders that the manager knows the others would not support.  We get a mayday call from the manager.  What is she supposed to do??The first maxim of medical management is:  Don’t get between the dog and the fire hydrant; there is only one reasonable outcome.  She is standing right in the line of fire with the dog and the hydrant representing physicians.  We told her to step away from the scene.  Her mantra should be, “This is clearly a physician to physician issue, I’ll put it on the agenda for the next meeting, unless you want to handle it directly on your own.”Managers should work on operations and increasing physician communication in whatever way works best.  That does not mean adding being a snitch, or back biter, or any other adolescent typical behavior to the problem.  There is no win for the manager or the practice if she sides with either faction.  Tactfully give a physician direction in the most appropriate and effective solution possible.Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] The doctors are driving the manager nuts.  She describes them as cranky teenagers.  They tell her privately that they don’t like each other and to “keep that one away from me”.  One doctor is giving orders that the manager knows the others would not support.  We get a mayday call from the manager.  What is she supposed to do??The first maxim of medical management is:  Don’t get between the dog and the fire hydrant; there is only one reasonable outcome.  She is standing right in the line of fire with the dog and the hydrant representing physicians.  We told her to step away from the scene.  Her mantra should be, “This is clearly a physician to physician issue, I’ll put it on the agenda for the next meeting, unless you want to handle it directly on your own.”Managers should work on operations and increasing physician communication in whatever way works best.  That does not mean adding being a snitch, or back biter, or any other adolescent typical behavior to the problem.  There is no win for the manager or the practice if she sides with either faction.  Tactfully give a physician direction in the most appropriate and effective solution possible.Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 21 Dec 2011 17:16:26 GMT http://community.modernmedicine.com/_This-Isnt-High-School/blog/5661984/33379.html jbee 2011-12-21T17:06:05Z Managing Your Practice Modern Medicine Community The doctors are driving the manager nuts.  She describes them as cranky teenagers.  They tell her privately that they don’t like each other and to “keep that one away from me”.  One doctor is giving orders that the manager knows the others would not support.  We get a mayday call from the manager.  What is she supposed to do??The first maxim of medical management is:  Don’t get between the dog and the fire hydrant; there is only one reasonable outcome.  She is standing right in the line of fire with the dog and the hydrant representing physicians.  We told her to step away from the scene.  Her mantra should be, “This is clearly a physician to physician issue, I’ll put it on the agenda for the next meeting, unless you want to handle it directly on your own.”Managers should work on operations and increasing physician communication in whatever way works best.  That does not mean adding being a snitch, or back biter, or any other adolescent typical behavior to the problem.  There is no win for the manager or the practice if she sides with either faction.  Tactfully give a physician direction in the most appropriate and effective solution possible.Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] management, managing your practice, mmglobal, practice nonadult false This Isn’t High School text blog management,managing your practice,mmglobal,practice 4087 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 5661984 2771849 Member 0 http://community.modernmedicine.com/_Jump-on-Your-Horse-and-Ride-Off-in-All-Directions/blog/5661934/33379.html We commonly send a report with 50 or more recommendations to solve the problems identified by the physicians in a client office.  We invited a newly promoted manager of a client office to a Medical Group Management Association meeting and asked her how it was going on our report. She then started rattling off at least 15 recommendations that she was trying to implement.  Ambitious?  I’ll say. Change is hard on everyone.  One of the problems with getting to the entire list is to try to do all of it at once.  We had to talk her down, and tell her to breathe. We love “can do” people but they can burn out all the rest of us and eventually burn themselves out in the process.  Set up some doable goals attack them with vigor, and give yourself another 60-90 days to get on your feet after those changes are made and entrenched. Ready, set, GO.Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] We commonly send a report with 50 or more recommendations to solve the problems identified by the physicians in a client office.  We invited a newly promoted manager of a client office to a Medical Group Management Association meeting and asked her how it was going on our report. She then started rattling off at least 15 recommendations that she was trying to implement.  Ambitious?  I’ll say. Change is hard on everyone.  One of the problems with getting to the entire list is to try to do all of it at once.  We had to talk her down, and tell her to breathe. We love “can do” people but they can burn out all the rest of us and eventually burn themselves out in the process.  Set up some doable goals attack them with vigor, and give yourself another 60-90 days to get on your feet after those changes are made and entrenched. Ready, set, GO.Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 21 Dec 2011 17:16:24 GMT http://community.modernmedicine.com/_Jump-on-Your-Horse-and-Ride-Off-in-All-Directions/blog/5661934/33379.html jbee 2011-12-21T16:53:57Z Managing Your Practice Modern Medicine Community We commonly send a report with 50 or more recommendations to solve the problems identified by the physicians in a client office.  We invited a newly promoted manager of a client office to a Medical Group Management Association meeting and asked her how it was going on our report. She then started rattling off at least 15 recommendations that she was trying to implement.  Ambitious?  I’ll say. Change is hard on everyone.  One of the problems with getting to the entire list is to try to do all of it at once.  We had to talk her down, and tell her to breathe. We love “can do” people but they can burn out all the rest of us and eventually burn themselves out in the process.  Set up some doable goals attack them with vigor, and give yourself another 60-90 days to get on your feet after those changes are made and entrenched. Ready, set, GO.Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] change, managing your practice, mmglobal nonadult false Jump on Your Horse and Ride Off in All Directions text blog change,managing your practice,mmglobal 1226 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 5661934 2771849 Member 0 http://community.modernmedicine.com/_Fix-the-deficit-by-cutting-hours-and-wages/blog/5450716/33379.html This can be tempting, but you are missing the main point:  practices make money by seeing patients.  Closing the office to save salaries is an expensive proposition because now you make no money to pay the fixed costs.  Also, if you have patients waiting to be seen the answer should be "Yes, now come on in!" Think about how much you generate in an hour, how that pays the fixed costs and variable.  If you close for a half day does the rent go down?  Does the phone bill?  How about malpractice insurance?  The extra charge to see a patient is not very much. Don’t get distracted. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] This can be tempting, but you are missing the main point:  practices make money by seeing patients.  Closing the office to save salaries is an expensive proposition because now you make no money to pay the fixed costs.  Also, if you have patients waiting to be seen the answer should be "Yes, now come on in!" Think about how much you generate in an hour, how that pays the fixed costs and variable.  If you close for a half day does the rent go down?  Does the phone bill?  How about malpractice insurance?  The extra charge to see a patient is not very much. Don’t get distracted. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 09 Nov 2011 01:36:13 GMT http://community.modernmedicine.com/_Fix-the-deficit-by-cutting-hours-and-wages/blog/5450716/33379.html jbee 2011-11-09T01:21:03Z Managing Your Practice Modern Medicine Community This can be tempting, but you are missing the main point:  practices make money by seeing patients.  Closing the office to save salaries is an expensive proposition because now you make no money to pay the fixed costs.  Also, if you have patients waiting to be seen the answer should be "Yes, now come on in!" Think about how much you generate in an hour, how that pays the fixed costs and variable.  If you close for a half day does the rent go down?  Does the phone bill?  How about malpractice insurance?  The extra charge to see a patient is not very much. Don’t get distracted. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] managing your practice nonadult false Fix the deficit by cutting hours and wages! text blog managing your practice 1387 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 5450716 2771849 Member 0 http://community.modernmedicine.com/_Minutes-That-Work/blog/5294039/33379.html “You never told us!” “We discussed it in the meeting!” “No we didn’t.” And on and on and on. When we look at meeting minutes it sometimes feels like you need to be Sherlock Holmes to figure out what actually happened. The solution:  Divide the decisions made into three columns: What was decided? Who is going to do it? When will it be done? When you have that, look at the decisions.  Are any of them new policies?  If so, those should be isolated and copied into a policy/procedure reference. At the top of the minutes should be a section for new or changed policies, and the lower portion should be the tasks assigned, not including policy-related decisions.  Microsoft Excel works great for this purpose.  You can sort it by who, date, or tasks, or policies.  One tool, many uses. Publish the minutes to all the members of the meeting right away.  File the minutes from oldest to newest in a binder or online so that anyone who should have been at the meeting can catch up.  Review the last minutes to carry forward topics that need to be covered or reviewed.  That starts the agenda. Gone are the days of “you never told us”!  Peace and serenity prevail.  That’s a stretch but see how much you can improve the communication in your office by taking minutes for that purpose. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] “You never told us!” “We discussed it in the meeting!” “No we didn’t.” And on and on and on. When we look at meeting minutes it sometimes feels like you need to be Sherlock Holmes to figure out what actually happened. The solution:  Divide the decisions made into three columns: What was decided? Who is going to do it? When will it be done? When you have that, look at the decisions.  Are any of them new policies?  If so, those should be isolated and copied into a policy/procedure reference. At the top of the minutes should be a section for new or changed policies, and the lower portion should be the tasks assigned, not including policy-related decisions.  Microsoft Excel works great for this purpose.  You can sort it by who, date, or tasks, or policies.  One tool, many uses. Publish the minutes to all the members of the meeting right away.  File the minutes from oldest to newest in a binder or online so that anyone who should have been at the meeting can catch up.  Review the last minutes to carry forward topics that need to be covered or reviewed.  That starts the agenda. Gone are the days of “you never told us”!  Peace and serenity prevail.  That’s a stretch but see how much you can improve the communication in your office by taking minutes for that purpose. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 13 Oct 2011 19:23:48 GMT http://community.modernmedicine.com/_Minutes-That-Work/blog/5294039/33379.html jbee 2011-10-13T19:18:53Z Managing Your Practice Modern Medicine Community “You never told us!” “We discussed it in the meeting!” “No we didn’t.” And on and on and on. When we look at meeting minutes it sometimes feels like you need to be Sherlock Holmes to figure out what actually happened. The solution:  Divide the decisions made into three columns: What was decided? Who is going to do it? When will it be done? When you have that, look at the decisions.  Are any of them new policies?  If so, those should be isolated and copied into a policy/procedure reference. At the top of the minutes should be a section for new or changed policies, and the lower portion should be the tasks assigned, not including policy-related decisions.  Microsoft Excel works great for this purpose.  You can sort it by who, date, or tasks, or policies.  One tool, many uses. Publish the minutes to all the members of the meeting right away.  File the minutes from oldest to newest in a binder or online so that anyone who should have been at the meeting can catch up.  Review the last minutes to carry forward topics that need to be covered or reviewed.  That starts the agenda. Gone are the days of “you never told us”!  Peace and serenity prevail.  That’s a stretch but see how much you can improve the communication in your office by taking minutes for that purpose. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] managing your practice, meetings nonadult false Minutes That Work text blog managing your practice,meetings 1071 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 5294039 2771849 Member 0 http://community.modernmedicine.com/_You-Have-Taken-Your-Jet-Pack-Lessons-Havent-You/blog/5076826/33379.html Those of us who are long on “life experience” will recognize the Jet Pack reference.  Since the 50’s (1950’s not 1850’s) we have been told that very soon we will all be getting around by Jet Packs strapped to our backs.  I have actually seen it at football games and theme parks.  I won’t say it won’t happen, but I will take my lessons when it is in place and will probably not be a “pioneer”. ICD-10 is being pushed by organizations providing training, and advice.  Not a bad thing. But if you take the courses now, without being able to use your new training for months—maybe years—how much “meaningful use” will you get from that training? When I looked up the new deadline I found an article dated 2003, “AMA fearful of ICD-10 even though the deadline is three years away”.  Here we are, four years after that deadline (see what I mean about Jet Packs?).    Currently the implementation date is set for October 2013 (that’s twenty seven months from now) and if history is any guide, it is likely to be pushed back even further to accommodate physicians and payers who are slow to respond.  While you will definitely need training, now is not the time to spend money and effort on it.  BUT, what is appropriate to do now?  Keep the pressure on your PM software vendor to make sure they can make the changes required by Medicare (setting the standard for the whole third-party industry). Watch carefully how fast the non-federal programs (insurance companies) adapt to use it.  You may be stuck straddling both systems for some time.  Think about the RVU levels used from different years that complicate coding for commercial insurers. Don’t take a class sooner than you have a participating payer program to practice on at your office. Learn something else now!  Are you an Excel spreadsheet whiz?  Now that’s a skill that you need right now and you have lots of applications that will make you a better manager. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Those of us who are long on “life experience” will recognize the Jet Pack reference.  Since the 50’s (1950’s not 1850’s) we have been told that very soon we will all be getting around by Jet Packs strapped to our backs.  I have actually seen it at football games and theme parks.  I won’t say it won’t happen, but I will take my lessons when it is in place and will probably not be a “pioneer”. ICD-10 is being pushed by organizations providing training, and advice.  Not a bad thing. But if you take the courses now, without being able to use your new training for months—maybe years—how much “meaningful use” will you get from that training? When I looked up the new deadline I found an article dated 2003, “AMA fearful of ICD-10 even though the deadline is three years away”.  Here we are, four years after that deadline (see what I mean about Jet Packs?).    Currently the implementation date is set for October 2013 (that’s twenty seven months from now) and if history is any guide, it is likely to be pushed back even further to accommodate physicians and payers who are slow to respond.  While you will definitely need training, now is not the time to spend money and effort on it.  BUT, what is appropriate to do now?  Keep the pressure on your PM software vendor to make sure they can make the changes required by Medicare (setting the standard for the whole third-party industry). Watch carefully how fast the non-federal programs (insurance companies) adapt to use it.  You may be stuck straddling both systems for some time.  Think about the RVU levels used from different years that complicate coding for commercial insurers. Don’t take a class sooner than you have a participating payer program to practice on at your office. Learn something else now!  Are you an Excel spreadsheet whiz?  Now that’s a skill that you need right now and you have lots of applications that will make you a better manager. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Mon, 29 Aug 2011 18:43:22 GMT http://community.modernmedicine.com/_You-Have-Taken-Your-Jet-Pack-Lessons-Havent-You/blog/5076826/33379.html jbee 2011-08-29T18:42:09Z Managing Your Practice Modern Medicine Community Those of us who are long on “life experience” will recognize the Jet Pack reference.  Since the 50’s (1950’s not 1850’s) we have been told that very soon we will all be getting around by Jet Packs strapped to our backs.  I have actually seen it at football games and theme parks.  I won’t say it won’t happen, but I will take my lessons when it is in place and will probably not be a “pioneer”. ICD-10 is being pushed by organizations providing training, and advice.  Not a bad thing. But if you take the courses now, without being able to use your new training for months—maybe years—how much “meaningful use” will you get from that training? When I looked up the new deadline I found an article dated 2003, “AMA fearful of ICD-10 even though the deadline is three years away”.  Here we are, four years after that deadline (see what I mean about Jet Packs?).    Currently the implementation date is set for October 2013 (that’s twenty seven months from now) and if history is any guide, it is likely to be pushed back even further to accommodate physicians and payers who are slow to respond.  While you will definitely need training, now is not the time to spend money and effort on it.  BUT, what is appropriate to do now?  Keep the pressure on your PM software vendor to make sure they can make the changes required by Medicare (setting the standard for the whole third-party industry). Watch carefully how fast the non-federal programs (insurance companies) adapt to use it.  You may be stuck straddling both systems for some time.  Think about the RVU levels used from different years that complicate coding for commercial insurers. Don’t take a class sooner than you have a participating payer program to practice on at your office. Learn something else now!  Are you an Excel spreadsheet whiz?  Now that’s a skill that you need right now and you have lots of applications that will make you a better manager. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] icd-10, managing your practice nonadult false You Have Taken Your Jet Pack Lessons Haven’t You? text blog icd-10,managing your practice 839 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 5076826 2771849 Member 0 http://community.modernmedicine.com/_How-Do-You-Fight-The-Internet/blog/4970908/33379.html I got a call recently from a distraught physician. She has had multiple new patient appointments canceled with short notice. She was up to six weeks out for new patient visits and now she is only about 1 week out, and because of the back log she didn't notice her referrals were dropping. What the heck happened? A nice patient called her to tell her that someone was bashing the physician on the internet. She went online and sure enough there was probably one person, judging from the tone and writing style, excoriating her as a bad doctor. “She had bad teeth and was heavy. She said I was depressed and I think she is depressed probably because she is a bad doctor. I waited hours in her office.” Here's the facts, Jack: The physician has a beautiful smile and is medium build. The interesting thing is the patient said she came in for a pain in her knee. This physician doesn't treat knee pain…ever. So, putting the best face on it, some malcontent has posted some bad stuff on the wrong physician. Worst case scenario, someone is out to wreck a good practice. How do you fix that? The complaints are anonymous. I suggested that she write to her referring physicians, alerting them to this erroneous review. She should warn them that this could happen to them, too, so they should have their staff check the internet frequently. She should keep the tone solicitous about the patient who clearly has problems, but make it clear that there is an error: she does not treat knee pain, she has great teeth, and there is never—and I mean never—a wait in her office. Then she should ask her wonderful, loyal patients to help counteract the negative by posting a good review, if that is how they felt. I also suggested that she write a review of herself saying the patient who is so upset may be on the wrong site as she does not treat knee pain. Tell the complainer that she hopes she gets better, and perhaps talking to the physician directly might be more effective. This is the second case I have heard about in the last six months. The internet is fast, and ubiquitous. Nobody said it was accurate. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] I got a call recently from a distraught physician. She has had multiple new patient appointments canceled with short notice. She was up to six weeks out for new patient visits and now she is only about 1 week out, and because of the back log she didn't notice her referrals were dropping. What the heck happened? A nice patient called her to tell her that someone was bashing the physician on the internet. She went online and sure enough there was probably one person, judging from the tone and writing style, excoriating her as a bad doctor. “She had bad teeth and was heavy. She said I was depressed and I think she is depressed probably because she is a bad doctor. I waited hours in her office.” Here's the facts, Jack: The physician has a beautiful smile and is medium build. The interesting thing is the patient said she came in for a pain in her knee. This physician doesn't treat knee pain…ever. So, putting the best face on it, some malcontent has posted some bad stuff on the wrong physician. Worst case scenario, someone is out to wreck a good practice. How do you fix that? The complaints are anonymous. I suggested that she write to her referring physicians, alerting them to this erroneous review. She should warn them that this could happen to them, too, so they should have their staff check the internet frequently. She should keep the tone solicitous about the patient who clearly has problems, but make it clear that there is an error: she does not treat knee pain, she has great teeth, and there is never—and I mean never—a wait in her office. Then she should ask her wonderful, loyal patients to help counteract the negative by posting a good review, if that is how they felt. I also suggested that she write a review of herself saying the patient who is so upset may be on the wrong site as she does not treat knee pain. Tell the complainer that she hopes she gets better, and perhaps talking to the physician directly might be more effective. This is the second case I have heard about in the last six months. The internet is fast, and ubiquitous. Nobody said it was accurate. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 28 Jul 2011 19:23:58 GMT http://community.modernmedicine.com/_How-Do-You-Fight-The-Internet/blog/4970908/33379.html jbee 2011-07-28T19:22:05Z Managing Your Practice Modern Medicine Community I got a call recently from a distraught physician. She has had multiple new patient appointments canceled with short notice. She was up to six weeks out for new patient visits and now she is only about 1 week out, and because of the back log she didn't notice her referrals were dropping. What the heck happened? A nice patient called her to tell her that someone was bashing the physician on the internet. She went online and sure enough there was probably one person, judging from the tone and writing style, excoriating her as a bad doctor. “She had bad teeth and was heavy. She said I was depressed and I think she is depressed probably because she is a bad doctor. I waited hours in her office.” Here's the facts, Jack: The physician has a beautiful smile and is medium build. The interesting thing is the patient said she came in for a pain in her knee. This physician doesn't treat knee pain…ever. So, putting the best face on it, some malcontent has posted some bad stuff on the wrong physician. Worst case scenario, someone is out to wreck a good practice. How do you fix that? The complaints are anonymous. I suggested that she write to her referring physicians, alerting them to this erroneous review. She should warn them that this could happen to them, too, so they should have their staff check the internet frequently. She should keep the tone solicitous about the patient who clearly has problems, but make it clear that there is an error: she does not treat knee pain, she has great teeth, and there is never—and I mean never—a wait in her office. Then she should ask her wonderful, loyal patients to help counteract the negative by posting a good review, if that is how they felt. I also suggested that she write a review of herself saying the patient who is so upset may be on the wrong site as she does not treat knee pain. Tell the complainer that she hopes she gets better, and perhaps talking to the physician directly might be more effective. This is the second case I have heard about in the last six months. The internet is fast, and ubiquitous. Nobody said it was accurate. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] criticism, doctor reviews, internet, managing your practice nonadult false How Do You Fight The Internet? text blog criticism,doctor reviews,internet,managing your practice 1096 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 4970908 2771849 Member 0 http://community.modernmedicine.com/_I-Hate-To-Go-On-Vacation/blog/4434420/33379.html This is a common complaint of physicians and managers.  They are thinking that they are dealing with one week and they are really dealing with three. For the physician, the week before the vacation should be blocked at the same time you block the vacation week.  Why?  You will need time to squeeze in the last minute patients that just have to be seen before you go.  Release the time about a week before you actually leave.  That gives you control of the pre-vacation hassle.  The week after vacation should be opened the day you leave.  You will get calls for appointments for the week the physician is gone so you want a fast response for the next week when he or she returns. Managers should schedule no meetings or optional projects the week before or after the vacation.  The first two days back will be filled digging out of email and paper mail.  Give yourself time to read and respond quickly.  By the way, read all the mail first and then decide what to do.  For example, if you read an email and go to work on the task, then do another, it might take you several hours or a day or two to get to the last one.  What if it says, "See me as soon as you return, signed the boss"?  So although you only get a week or two of vacation you can enjoy all of it knowing that you have organized the launch and the re-entry. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] This is a common complaint of physicians and managers.  They are thinking that they are dealing with one week and they are really dealing with three. For the physician, the week before the vacation should be blocked at the same time you block the vacation week.  Why?  You will need time to squeeze in the last minute patients that just have to be seen before you go.  Release the time about a week before you actually leave.  That gives you control of the pre-vacation hassle.  The week after vacation should be opened the day you leave.  You will get calls for appointments for the week the physician is gone so you want a fast response for the next week when he or she returns. Managers should schedule no meetings or optional projects the week before or after the vacation.  The first two days back will be filled digging out of email and paper mail.  Give yourself time to read and respond quickly.  By the way, read all the mail first and then decide what to do.  For example, if you read an email and go to work on the task, then do another, it might take you several hours or a day or two to get to the last one.  What if it says, "See me as soon as you return, signed the boss"?  So although you only get a week or two of vacation you can enjoy all of it knowing that you have organized the launch and the re-entry. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 24 Jun 2011 23:26:44 GMT http://community.modernmedicine.com/_I-Hate-To-Go-On-Vacation/blog/4434420/33379.html jbee 2011-06-24T20:13:48Z Managing Your Practice Modern Medicine Community This is a common complaint of physicians and managers.  They are thinking that they are dealing with one week and they are really dealing with three. For the physician, the week before the vacation should be blocked at the same time you block the vacation week.  Why?  You will need time to squeeze in the last minute patients that just have to be seen before you go.  Release the time about a week before you actually leave.  That gives you control of the pre-vacation hassle.  The week after vacation should be opened the day you leave.  You will get calls for appointments for the week the physician is gone so you want a fast response for the next week when he or she returns. Managers should schedule no meetings or optional projects the week before or after the vacation.  The first two days back will be filled digging out of email and paper mail.  Give yourself time to read and respond quickly.  By the way, read all the mail first and then decide what to do.  For example, if you read an email and go to work on the task, then do another, it might take you several hours or a day or two to get to the last one.  What if it says, "See me as soon as you return, signed the boss"?  So although you only get a week or two of vacation you can enjoy all of it knowing that you have organized the launch and the re-entry. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] managing your practice, vacation preparation nonadult false I Hate To Go On Vacation text blog managing your practice,vacation preparation 840 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 4434420 2771849 Member 0 http://community.modernmedicine.com/_She-Is-A-Lousy-Employee/blog/3661686/33379.html And, she has been a lousy employee for four years. Really? If she has been so bad, why is she still working for you? This is not an unusual conversation with managers and physicians. Q—Have you done reviews? A—I repeatedly tell her where she makes errors. Prove it. The manager set out to reconstruct the facts for a review to cover the practice's backside. Alas, another employee—doing the same job with lower volume—makes the same number of errors. That is a shocker because the other employee is a sweetheart. Look out for these traps. The Halo effect: Ordinary performance for 11 months but recently hit one out of the park. Being cooperative, cheerful, and maybe even having a little brown stuff on the end of the nose can make up for a bunch of deficiencies. Beware the Horn effect: Excellent performance but recent ugly meltdown. The employee could be tedious, moody, and generally a pain, but technically does good work. As a manager, you place a value on some of the tasks, but the employees think everything has the same importance. When the manager filled out a review form that had some numbers assigned for good to bad work he found out that the sum did not tell the story. There were items on a job description that were far more important and, if done poorly, had huge consequences. Both of the workers mentioned in this post covered the front desk and scheduled surgeries. If authorization and determination of the amount of insurance benefits left was not done, the consequences were costly and the surgeon would blow his stack. (Oddly, the surgeon didn't want to operate for 8 hours for free. Go figure.) The worker who did a sensational job scheduling office appointments and answering the phone, and a poor job at surgery scheduling, was actually failing. The details that were missed were usually on rushed work (emergency surgery, scheduled quickly). The reasons for the errors: "I forgot", "I overlooked it", or "I didn't know I needed to do it". These are workers that can do good work. They could do better work if there were a checklist of "must do" steps to help as reminders. The checklist would also provide ideas about where and how to start helping in a crisis. Very important procedures should not be subject to someone's memory. A performance review that contains facts, a common understanding of what a good job looks like, and a frank discussion about both failures and successes is not a quick event. Good employees are hard to find and you need to make sure that you are not dismissing a good employee because you are blinded by personality, or because you didn't take the time to really measure the performance. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor's Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] And, she has been a lousy employee for four years. Really? If she has been so bad, why is she still working for you? This is not an unusual conversation with managers and physicians. Q—Have you done reviews? A—I repeatedly tell her where she makes errors. Prove it. The manager set out to reconstruct the facts for a review to cover the practice's backside. Alas, another employee—doing the same job with lower volume—makes the same number of errors. That is a shocker because the other employee is a sweetheart. Look out for these traps. The Halo effect: Ordinary performance for 11 months but recently hit one out of the park. Being cooperative, cheerful, and maybe even having a little brown stuff on the end of the nose can make up for a bunch of deficiencies. Beware the Horn effect: Excellent performance but recent ugly meltdown. The employee could be tedious, moody, and generally a pain, but technically does good work. As a manager, you place a value on some of the tasks, but the employees think everything has the same importance. When the manager filled out a review form that had some numbers assigned for good to bad work he found out that the sum did not tell the story. There were items on a job description that were far more important and, if done poorly, had huge consequences. Both of the workers mentioned in this post covered the front desk and scheduled surgeries. If authorization and determination of the amount of insurance benefits left was not done, the consequences were costly and the surgeon would blow his stack. (Oddly, the surgeon didn't want to operate for 8 hours for free. Go figure.) The worker who did a sensational job scheduling office appointments and answering the phone, and a poor job at surgery scheduling, was actually failing. The details that were missed were usually on rushed work (emergency surgery, scheduled quickly). The reasons for the errors: "I forgot", "I overlooked it", or "I didn't know I needed to do it". These are workers that can do good work. They could do better work if there were a checklist of "must do" steps to help as reminders. The checklist would also provide ideas about where and how to start helping in a crisis. Very important procedures should not be subject to someone's memory. A performance review that contains facts, a common understanding of what a good job looks like, and a frank discussion about both failures and successes is not a quick event. Good employees are hard to find and you need to make sure that you are not dismissing a good employee because you are blinded by personality, or because you didn't take the time to really measure the performance. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor's Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Mon, 23 May 2011 16:08:54 GMT http://community.modernmedicine.com/_She-Is-A-Lousy-Employee/blog/3661686/33379.html jbee 2011-05-23T16:07:55Z Managing Your Practice Modern Medicine Community And, she has been a lousy employee for four years. Really? If she has been so bad, why is she still working for you? This is not an unusual conversation with managers and physicians. Q—Have you done reviews? A—I repeatedly tell her where she makes errors. Prove it. The manager set out to reconstruct the facts for a review to cover the practice's backside. Alas, another employee—doing the same job with lower volume—makes the same number of errors. That is a shocker because the other employee is a sweetheart. Look out for these traps. The Halo effect: Ordinary performance for 11 months but recently hit one out of the park. Being cooperative, cheerful, and maybe even having a little brown stuff on the end of the nose can make up for a bunch of deficiencies. Beware the Horn effect: Excellent performance but recent ugly meltdown. The employee could be tedious, moody, and generally a pain, but technically does good work. As a manager, you place a value on some of the tasks, but the employees think everything has the same importance. When the manager filled out a review form that had some numbers assigned for good to bad work he found out that the sum did not tell the story. There were items on a job description that were far more important and, if done poorly, had huge consequences. Both of the workers mentioned in this post covered the front desk and scheduled surgeries. If authorization and determination of the amount of insurance benefits left was not done, the consequences were costly and the surgeon would blow his stack. (Oddly, the surgeon didn't want to operate for 8 hours for free. Go figure.) The worker who did a sensational job scheduling office appointments and answering the phone, and a poor job at surgery scheduling, was actually failing. The details that were missed were usually on rushed work (emergency surgery, scheduled quickly). The reasons for the errors: "I forgot", "I overlooked it", or "I didn't know I needed to do it". These are workers that can do good work. They could do better work if there were a checklist of "must do" steps to help as reminders. The checklist would also provide ideas about where and how to start helping in a crisis. Very important procedures should not be subject to someone's memory. A performance review that contains facts, a common understanding of what a good job looks like, and a frank discussion about both failures and successes is not a quick event. Good employees are hard to find and you need to make sure that you are not dismissing a good employee because you are blinded by personality, or because you didn't take the time to really measure the performance. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor's Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] bad employees, managing your practice, staff issues nonadult false She Is A Lousy Employee! text blog bad employees,managing your practice,staff issues 756 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 3661686 2771849 Member 0 http://community.modernmedicine.com/_We-Are-Understaffed/blog/3544079/33379.html The nursing supervisor has cut staff and the staff is squealing that they are over worked. It sounds like there is a case here and the supervisor is ready to do battle for them. This practice has had a slowdown in patient flow. What the nursing supervisor didn’t realize is that she still had more staff per patient than before. Her analysis needed to include number of staff per patient seen. That might have changed the staff attitude. In another case the revenue was down. The physicians felt that they were overstaffed. Here is the rub: if you go by income alone you are apt to make an error when deciding the need for staffing. In this case the change from consult codes to standard E&M codes had a major effect in the charges and the income. The volume of patients actually went up slightly. If they reduce staff and the service degrades the volume might just follow the income. There may be other ways to fix the problem. The point is that not analyzing the situation correctly can be a big mistake. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] The nursing supervisor has cut staff and the staff is squealing that they are over worked. It sounds like there is a case here and the supervisor is ready to do battle for them. This practice has had a slowdown in patient flow. What the nursing supervisor didn’t realize is that she still had more staff per patient than before. Her analysis needed to include number of staff per patient seen. That might have changed the staff attitude. In another case the revenue was down. The physicians felt that they were overstaffed. Here is the rub: if you go by income alone you are apt to make an error when deciding the need for staffing. In this case the change from consult codes to standard E&M codes had a major effect in the charges and the income. The volume of patients actually went up slightly. If they reduce staff and the service degrades the volume might just follow the income. There may be other ways to fix the problem. The point is that not analyzing the situation correctly can be a big mistake. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 29 Apr 2011 17:20:16 GMT http://community.modernmedicine.com/_We-Are-Understaffed/blog/3544079/33379.html jbee 2011-04-29T16:28:22Z Managing Your Practice Modern Medicine Community The nursing supervisor has cut staff and the staff is squealing that they are over worked. It sounds like there is a case here and the supervisor is ready to do battle for them. This practice has had a slowdown in patient flow. What the nursing supervisor didn’t realize is that she still had more staff per patient than before. Her analysis needed to include number of staff per patient seen. That might have changed the staff attitude. In another case the revenue was down. The physicians felt that they were overstaffed. Here is the rub: if you go by income alone you are apt to make an error when deciding the need for staffing. In this case the change from consult codes to standard E&M codes had a major effect in the charges and the income. The volume of patients actually went up slightly. If they reduce staff and the service degrades the volume might just follow the income. There may be other ways to fix the problem. The point is that not analyzing the situation correctly can be a big mistake. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] managing your practice, staff issues, staffing nonadult false We Are Understaffed! text blog managing your practice,staff issues,staffing 576 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 3544079 2771849 Member 0 http://community.modernmedicine.com/_They-Never-Help-UsThey-Never-Ask-For-Help/blog/3320313/33379.html Huh?  How could this be true in the same office?  It's very interesting how both sides see a situation.  In this case the front desk and clinical suite are in the office next door to the billing office.  There are two employees in each place.  When the phones go nuts or a line forms at check in or check out, the billing office staff are supposed to help.  Since the billing staff can’t see the patient flow, they depend upon a call for help.  However, when the front desk is knee deep in phone calls the last thing they want to do is stop answering so they can call the other office to get help.  Meanwhile, the billing staff goes over to the clinical area a few times a day wanting to give staff a break.  Usually the front desk staff says “I don’t need a break”.  You guessed it; it is driving the doctor nuts.  He gets an earful from the receptionist and the MA.  The doctor then goes to the billing staff and relates the complaint.  Now the billing staff feels persecuted when they are trying to help. Here are some not so obvious solutions:             Those needing help should have a non-phone button that rings a bell in the billing office, no oral communication needed, to say MAYDAY. It is like a code called in the hospital.   There is no fingerpointing implied when you get a tsunami of patient flow.  It is similar to the checkers at a market making an overhead page, “All checkers up front please”. It doesn’t mean anyone is loafing.  The people called to help are doing work somewhere in the market and customers waiting take a priority.  Period. When the help only goes one way it can make those getting the help feel like welfare recipients.  That makes it hard to say. “I need help”.  When billing is swamped, perhaps with lots of posting, or when they are short staffed, asking for a hand from the front desk is strategically effective. Finally physicians and managers should be careful about listening to one side of an issue and deciding what action to take.  In this case both sides are right and there needs to be some creative thinking on all sides.   Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Huh?  How could this be true in the same office?  It's very interesting how both sides see a situation.  In this case the front desk and clinical suite are in the office next door to the billing office.  There are two employees in each place.  When the phones go nuts or a line forms at check in or check out, the billing office staff are supposed to help.  Since the billing staff can’t see the patient flow, they depend upon a call for help.  However, when the front desk is knee deep in phone calls the last thing they want to do is stop answering so they can call the other office to get help.  Meanwhile, the billing staff goes over to the clinical area a few times a day wanting to give staff a break.  Usually the front desk staff says “I don’t need a break”.  You guessed it; it is driving the doctor nuts.  He gets an earful from the receptionist and the MA.  The doctor then goes to the billing staff and relates the complaint.  Now the billing staff feels persecuted when they are trying to help. Here are some not so obvious solutions:             Those needing help should have a non-phone button that rings a bell in the billing office, no oral communication needed, to say MAYDAY. It is like a code called in the hospital.   There is no fingerpointing implied when you get a tsunami of patient flow.  It is similar to the checkers at a market making an overhead page, “All checkers up front please”. It doesn’t mean anyone is loafing.  The people called to help are doing work somewhere in the market and customers waiting take a priority.  Period. When the help only goes one way it can make those getting the help feel like welfare recipients.  That makes it hard to say. “I need help”.  When billing is swamped, perhaps with lots of posting, or when they are short staffed, asking for a hand from the front desk is strategically effective. Finally physicians and managers should be careful about listening to one side of an issue and deciding what action to take.  In this case both sides are right and there needs to be some creative thinking on all sides.   Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 18 Feb 2011 02:39:12 GMT http://community.modernmedicine.com/_They-Never-Help-UsThey-Never-Ask-For-Help/blog/3320313/33379.html jbee 2011-02-18T02:30:37Z Managing Your Practice Modern Medicine Community Huh?  How could this be true in the same office?  It's very interesting how both sides see a situation.  In this case the front desk and clinical suite are in the office next door to the billing office.  There are two employees in each place.  When the phones go nuts or a line forms at check in or check out, the billing office staff are supposed to help.  Since the billing staff can’t see the patient flow, they depend upon a call for help.  However, when the front desk is knee deep in phone calls the last thing they want to do is stop answering so they can call the other office to get help.  Meanwhile, the billing staff goes over to the clinical area a few times a day wanting to give staff a break.  Usually the front desk staff says “I don’t need a break”.  You guessed it; it is driving the doctor nuts.  He gets an earful from the receptionist and the MA.  The doctor then goes to the billing staff and relates the complaint.  Now the billing staff feels persecuted when they are trying to help. Here are some not so obvious solutions:             Those needing help should have a non-phone button that rings a bell in the billing office, no oral communication needed, to say MAYDAY. It is like a code called in the hospital.   There is no fingerpointing implied when you get a tsunami of patient flow.  It is similar to the checkers at a market making an overhead page, “All checkers up front please”. It doesn’t mean anyone is loafing.  The people called to help are doing work somewhere in the market and customers waiting take a priority.  Period. When the help only goes one way it can make those getting the help feel like welfare recipients.  That makes it hard to say. “I need help”.  When billing is swamped, perhaps with lots of posting, or when they are short staffed, asking for a hand from the front desk is strategically effective. Finally physicians and managers should be careful about listening to one side of an issue and deciding what action to take.  In this case both sides are right and there needs to be some creative thinking on all sides.   Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] managing your practice, staffing issues nonadult false "They" Never Help Us..."They" Never Ask For Help! text blog managing your practice,staffing issues 744 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 3320313 2771849 Member 0 http://community.modernmedicine.com/_Would-You-Hire-Her/blog/3283302/33379.html The resume came to our fax machine from a client. Their biller had given 2 weeks’ notice, and the new manager was already swamped getting settled in. The wife of a patient walked in the same day. She presented a resume and reams of glowing reference letters. Was this a gift from above??? Maybe, but here’s the rub: If they hire her, they’re choosing her out of a universe of one. They don’t know if a better skilled and experienced person is available. A closer reading of the resume revealed a long list of relevant skills, but the candidate had only 7 months of experience and a recent certificate from a medical billing program. I suspect there would be a lot of training required of the time-pressed manager to bring this candidate up to speed. I know that recruiting is a pain—but do the work, and find the best you can. Actually, I told the manager that since they were in a huge pinch, they could hire the applicant on a per diem basis while they did the recruiting. Who knows? Maybe this person is a super star!! But won’t she and they feel better about confirming that? Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] The resume came to our fax machine from a client. Their biller had given 2 weeks’ notice, and the new manager was already swamped getting settled in. The wife of a patient walked in the same day. She presented a resume and reams of glowing reference letters. Was this a gift from above??? Maybe, but here’s the rub: If they hire her, they’re choosing her out of a universe of one. They don’t know if a better skilled and experienced person is available. A closer reading of the resume revealed a long list of relevant skills, but the candidate had only 7 months of experience and a recent certificate from a medical billing program. I suspect there would be a lot of training required of the time-pressed manager to bring this candidate up to speed. I know that recruiting is a pain—but do the work, and find the best you can. Actually, I told the manager that since they were in a huge pinch, they could hire the applicant on a per diem basis while they did the recruiting. Who knows? Maybe this person is a super star!! But won’t she and they feel better about confirming that? Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 28 Jan 2011 16:51:38 GMT http://community.modernmedicine.com/_Would-You-Hire-Her/blog/3283302/33379.html jbee 2011-01-28T16:43:07Z Managing Your Practice Modern Medicine Community The resume came to our fax machine from a client. Their biller had given 2 weeks’ notice, and the new manager was already swamped getting settled in. The wife of a patient walked in the same day. She presented a resume and reams of glowing reference letters. Was this a gift from above??? Maybe, but here’s the rub: If they hire her, they’re choosing her out of a universe of one. They don’t know if a better skilled and experienced person is available. A closer reading of the resume revealed a long list of relevant skills, but the candidate had only 7 months of experience and a recent certificate from a medical billing program. I suspect there would be a lot of training required of the time-pressed manager to bring this candidate up to speed. I know that recruiting is a pain—but do the work, and find the best you can. Actually, I told the manager that since they were in a huge pinch, they could hire the applicant on a per diem basis while they did the recruiting. Who knows? Maybe this person is a super star!! But won’t she and they feel better about confirming that? Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] hiring, managing your practice, mmglobal, recruiting, staffing pitfalls nonadult false Would You Hire Her? text blog hiring,managing your practice,mmglobal,recruiting,staffing pitfalls 1348 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 3 Managing Your Practice 1 3283302 2771849 Member 0 http://community.modernmedicine.com/_Multi-Tasking-Boon-or-Bane/blog/3111500/33379.html Do you have a busy signal problem? Most practices don’t because they have an automatic voice mail if the phone call is not answered after a specified number of rings. Sound like it solves a problem? Nope. Here’s is issue: You may not have enough ears to answer the volume of calls you have. If your staff cannot get to the calls the first time, how will they have time to call back (a disappointed caller) while they are supposed to be available to answer incoming calls? Two ears can generally handle two lines simultaneously and give acceptable service. Adding more lines into infinity with the voice mail system gives you the opportunity to irritate more callers simultaneously. It also accounts for front desk/phone burn out and turnover. Technology is great but it doesn’t substitute for having enough qualified staff with “doable” jobs. Study the types of calls answered, the volume per hour, and the staffing availability to answer before you add more access. There may be other solutions that won’t kill the phone staff or turn off good patients. The surgeon is knee deep in a surgical case and he stops to review text messages or take phone calls. Not! Why? Distractions from the case at hand jeopardize the outcome. While allowing a reasonable amount of personal calls for staff, why on earth would you permit a worker to be distracted when working with patients and physicians? Younger employees (though not only younger employees) think they can multitask when using the computer, driving, and while working. We are not convinced. We recommend that pages, phones, iPods, or other electronic gear be stored away from the employee, on silent mode, and accessed only at breaks or mealtimes. Some practices provide a laptop, not on the practice network, for the staff to use when on break. The point is, just because you can use technology to cure every ill doesn’t mean you should. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Do you have a busy signal problem? Most practices don’t because they have an automatic voice mail if the phone call is not answered after a specified number of rings. Sound like it solves a problem? Nope. Here’s is issue: You may not have enough ears to answer the volume of calls you have. If your staff cannot get to the calls the first time, how will they have time to call back (a disappointed caller) while they are supposed to be available to answer incoming calls? Two ears can generally handle two lines simultaneously and give acceptable service. Adding more lines into infinity with the voice mail system gives you the opportunity to irritate more callers simultaneously. It also accounts for front desk/phone burn out and turnover. Technology is great but it doesn’t substitute for having enough qualified staff with “doable” jobs. Study the types of calls answered, the volume per hour, and the staffing availability to answer before you add more access. There may be other solutions that won’t kill the phone staff or turn off good patients. The surgeon is knee deep in a surgical case and he stops to review text messages or take phone calls. Not! Why? Distractions from the case at hand jeopardize the outcome. While allowing a reasonable amount of personal calls for staff, why on earth would you permit a worker to be distracted when working with patients and physicians? Younger employees (though not only younger employees) think they can multitask when using the computer, driving, and while working. We are not convinced. We recommend that pages, phones, iPods, or other electronic gear be stored away from the employee, on silent mode, and accessed only at breaks or mealtimes. Some practices provide a laptop, not on the practice network, for the staff to use when on break. The point is, just because you can use technology to cure every ill doesn’t mean you should. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 16 Dec 2010 20:42:35 GMT http://community.modernmedicine.com/_Multi-Tasking-Boon-or-Bane/blog/3111500/33379.html jbee 2010-12-16T20:32:54Z Managing Your Practice Modern Medicine Community Do you have a busy signal problem? Most practices don’t because they have an automatic voice mail if the phone call is not answered after a specified number of rings. Sound like it solves a problem? Nope. Here’s is issue: You may not have enough ears to answer the volume of calls you have. If your staff cannot get to the calls the first time, how will they have time to call back (a disappointed caller) while they are supposed to be available to answer incoming calls? Two ears can generally handle two lines simultaneously and give acceptable service. Adding more lines into infinity with the voice mail system gives you the opportunity to irritate more callers simultaneously. It also accounts for front desk/phone burn out and turnover. Technology is great but it doesn’t substitute for having enough qualified staff with “doable” jobs. Study the types of calls answered, the volume per hour, and the staffing availability to answer before you add more access. There may be other solutions that won’t kill the phone staff or turn off good patients. The surgeon is knee deep in a surgical case and he stops to review text messages or take phone calls. Not! Why? Distractions from the case at hand jeopardize the outcome. While allowing a reasonable amount of personal calls for staff, why on earth would you permit a worker to be distracted when working with patients and physicians? Younger employees (though not only younger employees) think they can multitask when using the computer, driving, and while working. We are not convinced. We recommend that pages, phones, iPods, or other electronic gear be stored away from the employee, on silent mode, and accessed only at breaks or mealtimes. Some practices provide a laptop, not on the practice network, for the staff to use when on break. The point is, just because you can use technology to cure every ill doesn’t mean you should. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] managing your practice, mmglobal, policies”, procedures”, “office, “phone nonadult false Multi-Tasking: Boon or Bane text blog managing your practice,mmglobal,policies”,procedures”,“office,“phone 630 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 3111500 2771849 Member 0 http://community.modernmedicine.com/_I-Need-A-Gorilla/blog/3011622/33379.html Diagnosis: “The manager is great but swamped. She is superb with projects and accounting but not so good with the staff. The staff is acting out, and I am afraid the manager will blow her stack and all will walk out, including the manager.” Prescription: “I need a gorilla—er, I mean—a personnel manager to get the troops in line.” Most small practices don’t have need a full-time manager and a full-time HR person. In large practices, the HR person is more clerical. Forms filled out, events on the calendar, recruiting, salary surveys, etc. Rarely are these folks first on supervision. It is a nomenclature thing. What this client needs is a production, operation, or patient-flow supervisor. This is a foreman on the line (front desk, phones, and medical assisting positions). This person works well with people, patients, and other workers. S/he knows how to do the work and can do a reasonable job anywhere in the production cycle. What the person doesn’t have is training in performance reviews, coaching, and management techniques. That can be learned. What you don’t saddle this wonder woman with is paper work for the file! Leave that to the manager. You might have one of these leaders right now, who, with some training investment, can grow into this role. Even if you find a person with the supervisory skills/experience outside the practice, s/he will still need to learn your production process. We recommend investing and growing your own leaders. Either way, most practices have a manager who is good at the financial side because managers move up from the ranks of billing, usually. There is not enough emphasis on production (moving patients in and out of the practice). Front desk, phones, medical assisting work can make or break your practice. Get the best quality you can. You and your patients deserve it. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Diagnosis: “The manager is great but swamped. She is superb with projects and accounting but not so good with the staff. The staff is acting out, and I am afraid the manager will blow her stack and all will walk out, including the manager.” Prescription: “I need a gorilla—er, I mean—a personnel manager to get the troops in line.” Most small practices don’t have need a full-time manager and a full-time HR person. In large practices, the HR person is more clerical. Forms filled out, events on the calendar, recruiting, salary surveys, etc. Rarely are these folks first on supervision. It is a nomenclature thing. What this client needs is a production, operation, or patient-flow supervisor. This is a foreman on the line (front desk, phones, and medical assisting positions). This person works well with people, patients, and other workers. S/he knows how to do the work and can do a reasonable job anywhere in the production cycle. What the person doesn’t have is training in performance reviews, coaching, and management techniques. That can be learned. What you don’t saddle this wonder woman with is paper work for the file! Leave that to the manager. You might have one of these leaders right now, who, with some training investment, can grow into this role. Even if you find a person with the supervisory skills/experience outside the practice, s/he will still need to learn your production process. We recommend investing and growing your own leaders. Either way, most practices have a manager who is good at the financial side because managers move up from the ranks of billing, usually. There is not enough emphasis on production (moving patients in and out of the practice). Front desk, phones, medical assisting work can make or break your practice. Get the best quality you can. You and your patients deserve it. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Mon, 22 Nov 2010 16:24:59 GMT http://community.modernmedicine.com/_I-Need-A-Gorilla/blog/3011622/33379.html jbee 2010-11-22T16:17:06Z Managing Your Practice Modern Medicine Community Diagnosis: “The manager is great but swamped. She is superb with projects and accounting but not so good with the staff. The staff is acting out, and I am afraid the manager will blow her stack and all will walk out, including the manager.” Prescription: “I need a gorilla—er, I mean—a personnel manager to get the troops in line.” Most small practices don’t have need a full-time manager and a full-time HR person. In large practices, the HR person is more clerical. Forms filled out, events on the calendar, recruiting, salary surveys, etc. Rarely are these folks first on supervision. It is a nomenclature thing. What this client needs is a production, operation, or patient-flow supervisor. This is a foreman on the line (front desk, phones, and medical assisting positions). This person works well with people, patients, and other workers. S/he knows how to do the work and can do a reasonable job anywhere in the production cycle. What the person doesn’t have is training in performance reviews, coaching, and management techniques. That can be learned. What you don’t saddle this wonder woman with is paper work for the file! Leave that to the manager. You might have one of these leaders right now, who, with some training investment, can grow into this role. Even if you find a person with the supervisory skills/experience outside the practice, s/he will still need to learn your production process. We recommend investing and growing your own leaders. Either way, most practices have a manager who is good at the financial side because managers move up from the ranks of billing, usually. There is not enough emphasis on production (moving patients in and out of the practice). Front desk, phones, medical assisting work can make or break your practice. Get the best quality you can. You and your patients deserve it. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] managing your practice, operations, patient flow, production manager, staffing nonadult false I Need A Gorilla text blog managing your practice,operations,patient flow,production manager,staffing 526 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 3011622 2771849 Member 0 http://community.modernmedicine.com/_Whats-Wrong-with-the-Satellite-Office/blog/2868160/33379.html One of the physicians lives 45 minutes away from the main office. He grouses about traffic and being on call. He’s a great guy, a superb physician; how can we make him happy so he’ll stay? I’ve got it! Let’s open a satellite in his community, staff it with a nurse practitioner, and he can work there half time. That will be a new market for us and we can grow from there. Three years later—the satellite is staffed by the physician on Mondays, and until recently, all day Friday. The office is now open only Friday morning. Here’s the rub about satellites: The first priority for building a practice is Availability. Affability is the second priority--nice doctors and staff, easy-to-deal-with phone system, parking, etc. Ability of the physician/provider is the final priority. So many practices miss the vital order of things. This is the universal problem with satellites; staffing any location part time blows Availability priority. It also often results in the inability to get full staff privileges at a hospital for a regular round of ER coverage or to get on the list for “Find a Physician” call centers provided by the hospital for the attending staff. There are not enough patients to stay open full time, and you can’t grow because you aren’t available enough. Sort of a Catch-22. It also sets up a nice increase in new patients for the other competing fully available practices. Our rule of thumb: A satellite should produce more income per hour staffed than the mother ship. If it doesn’t, it becomes the source of the sucking sound you hear when reading your profit and loss statement. It is also a productivity drain for your manager. Other than that, a satellite is a great idea. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] One of the physicians lives 45 minutes away from the main office. He grouses about traffic and being on call. He’s a great guy, a superb physician; how can we make him happy so he’ll stay? I’ve got it! Let’s open a satellite in his community, staff it with a nurse practitioner, and he can work there half time. That will be a new market for us and we can grow from there. Three years later—the satellite is staffed by the physician on Mondays, and until recently, all day Friday. The office is now open only Friday morning. Here’s the rub about satellites: The first priority for building a practice is Availability. Affability is the second priority--nice doctors and staff, easy-to-deal-with phone system, parking, etc. Ability of the physician/provider is the final priority. So many practices miss the vital order of things. This is the universal problem with satellites; staffing any location part time blows Availability priority. It also often results in the inability to get full staff privileges at a hospital for a regular round of ER coverage or to get on the list for “Find a Physician” call centers provided by the hospital for the attending staff. There are not enough patients to stay open full time, and you can’t grow because you aren’t available enough. Sort of a Catch-22. It also sets up a nice increase in new patients for the other competing fully available practices. Our rule of thumb: A satellite should produce more income per hour staffed than the mother ship. If it doesn’t, it becomes the source of the sucking sound you hear when reading your profit and loss statement. It is also a productivity drain for your manager. Other than that, a satellite is a great idea. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 28 Oct 2010 13:46:24 GMT http://community.modernmedicine.com/_Whats-Wrong-with-the-Satellite-Office/blog/2868160/33379.html jbee 2010-10-28T13:33:42Z Managing Your Practice Modern Medicine Community One of the physicians lives 45 minutes away from the main office. He grouses about traffic and being on call. He’s a great guy, a superb physician; how can we make him happy so he’ll stay? I’ve got it! Let’s open a satellite in his community, staff it with a nurse practitioner, and he can work there half time. That will be a new market for us and we can grow from there. Three years later—the satellite is staffed by the physician on Mondays, and until recently, all day Friday. The office is now open only Friday morning. Here’s the rub about satellites: The first priority for building a practice is Availability. Affability is the second priority--nice doctors and staff, easy-to-deal-with phone system, parking, etc. Ability of the physician/provider is the final priority. So many practices miss the vital order of things. This is the universal problem with satellites; staffing any location part time blows Availability priority. It also often results in the inability to get full staff privileges at a hospital for a regular round of ER coverage or to get on the list for “Find a Physician” call centers provided by the hospital for the attending staff. There are not enough patients to stay open full time, and you can’t grow because you aren’t available enough. Sort of a Catch-22. It also sets up a nice increase in new patients for the other competing fully available practices. Our rule of thumb: A satellite should produce more income per hour staffed than the mother ship. If it doesn’t, it becomes the source of the sucking sound you hear when reading your profit and loss statement. It is also a productivity drain for your manager. Other than that, a satellite is a great idea. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] business of medicine, managing your practice, new practice nonadult false What’s Wrong with the Satellite Office? text blog business of medicine,managing your practice,new practice 426 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 2868160 2771849 Member 0 http://community.modernmedicine.com/_Prevailing-Wages-Oops-How-Did-That-Happen/blog/2601424/33379.html Two seasoned workers, key to the office, are moving away; time to recruit. These employees had been with the practice six and ten years, respectively. They were happy in their jobs, beloved by the patients, and they are hard to replace. When I checked the competitive salaries in the county, I found these two were woefully underpaid. Because the practice did not have to recruit, the manager had become complacent about wages. To attract good employees and retain them, we would have to offer $3.00 more per hour, just to start! But what about the remaining employees? The most experienced—and the ones we would look to for training—would be making $4.00 per hour less than the new hires. This is an expensive lesson. Not only would the payroll be increased substantially overnight with the hiring of the replacements, the practice has to adjust the remaining workers’ wages, and fast. This practice is very lucky that the good employees weren’t looking, or they all might have left over time. Put a note on your calendar every year to check the prevailing rates. Contact the state MGMA to see if there is a state survey, Google the state employment site to look for prevailing wages, or do a survey yourself. You must know what the median and the high rates are so that you can make your practice too good to leave. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Two seasoned workers, key to the office, are moving away; time to recruit. These employees had been with the practice six and ten years, respectively. They were happy in their jobs, beloved by the patients, and they are hard to replace. When I checked the competitive salaries in the county, I found these two were woefully underpaid. Because the practice did not have to recruit, the manager had become complacent about wages. To attract good employees and retain them, we would have to offer $3.00 more per hour, just to start! But what about the remaining employees? The most experienced—and the ones we would look to for training—would be making $4.00 per hour less than the new hires. This is an expensive lesson. Not only would the payroll be increased substantially overnight with the hiring of the replacements, the practice has to adjust the remaining workers’ wages, and fast. This practice is very lucky that the good employees weren’t looking, or they all might have left over time. Put a note on your calendar every year to check the prevailing rates. Contact the state MGMA to see if there is a state survey, Google the state employment site to look for prevailing wages, or do a survey yourself. You must know what the median and the high rates are so that you can make your practice too good to leave. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Tue, 31 Aug 2010 15:46:02 GMT http://community.modernmedicine.com/_Prevailing-Wages-Oops-How-Did-That-Happen/blog/2601424/33379.html jbee 2010-08-31T15:44:44Z Managing Your Practice Modern Medicine Community Two seasoned workers, key to the office, are moving away; time to recruit. These employees had been with the practice six and ten years, respectively. They were happy in their jobs, beloved by the patients, and they are hard to replace. When I checked the competitive salaries in the county, I found these two were woefully underpaid. Because the practice did not have to recruit, the manager had become complacent about wages. To attract good employees and retain them, we would have to offer $3.00 more per hour, just to start! But what about the remaining employees? The most experienced—and the ones we would look to for training—would be making $4.00 per hour less than the new hires. This is an expensive lesson. Not only would the payroll be increased substantially overnight with the hiring of the replacements, the practice has to adjust the remaining workers’ wages, and fast. This practice is very lucky that the good employees weren’t looking, or they all might have left over time. Put a note on your calendar every year to check the prevailing rates. Contact the state MGMA to see if there is a state survey, Google the state employment site to look for prevailing wages, or do a survey yourself. You must know what the median and the high rates are so that you can make your practice too good to leave. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] business operations, human resources, managing your practice, prevailing rates nonadult false Prevailing Wages: Oops, How Did That Happen? text blog business operations,human resources,managing your practice,prevailing rates 674 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 2601424 2771849 Member 0 http://community.modernmedicine.com/_Recession-Responses/blog/2577579/33379.html Patient visits are down; what can you do? This is getting to be a more consistent question these days. We start with reviewing the recall program to make sure that reminder cards for maintenance care are sent and followed up. This focuses on the patients we have. Then we look at the new patient volume and referral sources. This focuses on new patients and new business. Doing the steps in this order helps a practice work on the right thing. Many want to market for new patients when they can’t retain the ones they have. It may be time to look at patient service, and possibly get creative with payment plans for patients who have lost jobs and insurance. Let’s say that you have done all you can to shore up the flow, but it’s not enough. Now look at expenses. The largest expense is personnel. What if you could cut your payroll 20%? You can, and it may not require a layoff at all. If you analyze the number of patients you can see per day versus the number that actually come in you may be able to do the same volume per week in fewer work days. Here’s how it works: Choose the lightest day of the week (often mid-week), and do not schedule any appointments on that day. You can distribute the lower volume of that day among the remaining work days. Require one staff member to work that day answering the phones and making it look like a normal day to callers. All other staffers take a day without pay (and now you are already working with lower pay). Hold a staff meeting and tell the staff that you are struggling with the lower volume and lower income, and you do not want to fire anyone. They are good people and well trained, and it would be hard to replace them when the volume returns. Announce the new schedule and allow volunteers to work a shorter week. If you have no volunteers you can rotate the off day among the staff. When all the days are filled to the max, you can add back the lost day. Start with a half day, and then grow into your regular schedule. This may just encourage the staff to keep a keen eye on patients who cancel and do not reschedule, call the patients who have not responded to the reminder card, and generally get creative about patient service. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Patient visits are down; what can you do? This is getting to be a more consistent question these days. We start with reviewing the recall program to make sure that reminder cards for maintenance care are sent and followed up. This focuses on the patients we have. Then we look at the new patient volume and referral sources. This focuses on new patients and new business. Doing the steps in this order helps a practice work on the right thing. Many want to market for new patients when they can’t retain the ones they have. It may be time to look at patient service, and possibly get creative with payment plans for patients who have lost jobs and insurance. Let’s say that you have done all you can to shore up the flow, but it’s not enough. Now look at expenses. The largest expense is personnel. What if you could cut your payroll 20%? You can, and it may not require a layoff at all. If you analyze the number of patients you can see per day versus the number that actually come in you may be able to do the same volume per week in fewer work days. Here’s how it works: Choose the lightest day of the week (often mid-week), and do not schedule any appointments on that day. You can distribute the lower volume of that day among the remaining work days. Require one staff member to work that day answering the phones and making it look like a normal day to callers. All other staffers take a day without pay (and now you are already working with lower pay). Hold a staff meeting and tell the staff that you are struggling with the lower volume and lower income, and you do not want to fire anyone. They are good people and well trained, and it would be hard to replace them when the volume returns. Announce the new schedule and allow volunteers to work a shorter week. If you have no volunteers you can rotate the off day among the staff. When all the days are filled to the max, you can add back the lost day. Start with a half day, and then grow into your regular schedule. This may just encourage the staff to keep a keen eye on patients who cancel and do not reschedule, call the patients who have not responded to the reminder card, and generally get creative about patient service. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Tue, 24 Aug 2010 19:07:02 GMT http://community.modernmedicine.com/_Recession-Responses/blog/2577579/33379.html jbee 2010-08-24T18:19:21Z Managing Your Practice Modern Medicine Community Patient visits are down; what can you do? This is getting to be a more consistent question these days. We start with reviewing the recall program to make sure that reminder cards for maintenance care are sent and followed up. This focuses on the patients we have. Then we look at the new patient volume and referral sources. This focuses on new patients and new business. Doing the steps in this order helps a practice work on the right thing. Many want to market for new patients when they can’t retain the ones they have. It may be time to look at patient service, and possibly get creative with payment plans for patients who have lost jobs and insurance. Let’s say that you have done all you can to shore up the flow, but it’s not enough. Now look at expenses. The largest expense is personnel. What if you could cut your payroll 20%? You can, and it may not require a layoff at all. If you analyze the number of patients you can see per day versus the number that actually come in you may be able to do the same volume per week in fewer work days. Here’s how it works: Choose the lightest day of the week (often mid-week), and do not schedule any appointments on that day. You can distribute the lower volume of that day among the remaining work days. Require one staff member to work that day answering the phones and making it look like a normal day to callers. All other staffers take a day without pay (and now you are already working with lower pay). Hold a staff meeting and tell the staff that you are struggling with the lower volume and lower income, and you do not want to fire anyone. They are good people and well trained, and it would be hard to replace them when the volume returns. Announce the new schedule and allow volunteers to work a shorter week. If you have no volunteers you can rotate the off day among the staff. When all the days are filled to the max, you can add back the lost day. Start with a half day, and then grow into your regular schedule. This may just encourage the staff to keep a keen eye on patients who cancel and do not reschedule, call the patients who have not responded to the reminder card, and generally get creative about patient service. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] lower income, managing your practice, patient volume, staff schedules nonadult false Recession Responses text blog lower income,managing your practice,patient volume,staff schedules 531 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 1 Managing Your Practice 0 2577579 2771849 Member 0 http://community.modernmedicine.com/_Office-Move-Where-Have-All-the-Patients-Gone/blog/2496329/33379.html A solo specialist decides to focus on “non in-patient services,” refining the scope of her practice. Because the hospital requires ER coverage to remain in their medical office building, she decides to move. She finds a great new space, better parking, more space for less money off the hospital campus, yet very near to the hospital, freeways, and other popular landmarks. She makes the move and sends change of address cards to all referrings. And she waits, and waits, and waits. The new patient volume is sliding precipitously. After 10 months of decline, she gets very concerned and writes a newsy one-page letter to send to all referring sources. It contains the newest ideas in her subspecialty and mentions her reduction in time commitment to the hospital, which gives her much better access in the office. She describes her new office location. Finally, she invites any of the referring physicians to call her personally if they have no opening for a new patient within 5 days of the call. She will make room for their referrals. It worked! She found that many of her referral sources had been told (rumors are faster than Fed-Ex) that she had retired or “left practice.” Here is a cautionary tale to those wondering where the patients went…. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] A solo specialist decides to focus on “non in-patient services,” refining the scope of her practice. Because the hospital requires ER coverage to remain in their medical office building, she decides to move. She finds a great new space, better parking, more space for less money off the hospital campus, yet very near to the hospital, freeways, and other popular landmarks. She makes the move and sends change of address cards to all referrings. And she waits, and waits, and waits. The new patient volume is sliding precipitously. After 10 months of decline, she gets very concerned and writes a newsy one-page letter to send to all referring sources. It contains the newest ideas in her subspecialty and mentions her reduction in time commitment to the hospital, which gives her much better access in the office. She describes her new office location. Finally, she invites any of the referring physicians to call her personally if they have no opening for a new patient within 5 days of the call. She will make room for their referrals. It worked! She found that many of her referral sources had been told (rumors are faster than Fed-Ex) that she had retired or “left practice.” Here is a cautionary tale to those wondering where the patients went…. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Mon, 26 Jul 2010 20:00:14 GMT http://community.modernmedicine.com/_Office-Move-Where-Have-All-the-Patients-Gone/blog/2496329/33379.html jbee 2010-07-26T19:49:36Z Managing Your Practice Modern Medicine Community A solo specialist decides to focus on “non in-patient services,” refining the scope of her practice. Because the hospital requires ER coverage to remain in their medical office building, she decides to move. She finds a great new space, better parking, more space for less money off the hospital campus, yet very near to the hospital, freeways, and other popular landmarks. She makes the move and sends change of address cards to all referrings. And she waits, and waits, and waits. The new patient volume is sliding precipitously. After 10 months of decline, she gets very concerned and writes a newsy one-page letter to send to all referring sources. It contains the newest ideas in her subspecialty and mentions her reduction in time commitment to the hospital, which gives her much better access in the office. She describes her new office location. Finally, she invites any of the referring physicians to call her personally if they have no opening for a new patient within 5 days of the call. She will make room for their referrals. It worked! She found that many of her referral sources had been told (rumors are faster than Fed-Ex) that she had retired or “left practice.” Here is a cautionary tale to those wondering where the patients went…. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] managing your practice, marketing, new patients, office relocation nonadult false Office Move: Where Have All the Patients Gone? text blog managing your practice,marketing,new patients,office relocation 1273 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 4 Managing Your Practice 0 2496329 2771849 Member 0 http://community.modernmedicine.com/_Life-After-Florence-When-Your-Key-Employee-Leaves/blog/2409882/33379.html A small practice is often dependent upon a very few employees. What happens when that person retires, or should?A call from the physician’s spouse described the situation this way:“Florence has been with my husband’s practice for 10 years.I cannot get her to separate her duties for financial control purposes, and it is driving me nuts.She has announced that she will be retiring in November because she is so overworked. We can’t change anything because she cries (yes, real tears) every time we discuss making her job easier. What will we do?”No practice should be held hostage by a key employee. Even if Florence is Wonder Woman, you are too vulnerable if she changes her mind or behavior. Not only do you need protocols for financial controls in billing, banking, etc., you also need cross-training or at least written protocols for the other things each employee does. We create primary tasks and secondary tasks. The secondary tasks are the “cross-trained help when needed” type. The crying thing gives me the willies. This Wonder Woman sounds unstable. We always start with organizing the work so that the average employee can succeed doing it and then consider the people available to do the work. It is amazing how this helps create doable jobs, good coverage, and some security for the small practice. Sometimes in a one-employee office, a physician’s spouse is the only one available, and so we train him or her to pinch hit.Although it is great to have a super employee, it is awful to try to find another. Make sure that Wonder Woman has a well-trained understudy to fill the role in an emergency or a transition.Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] A small practice is often dependent upon a very few employees. What happens when that person retires, or should?A call from the physician’s spouse described the situation this way:“Florence has been with my husband’s practice for 10 years.I cannot get her to separate her duties for financial control purposes, and it is driving me nuts.She has announced that she will be retiring in November because she is so overworked. We can’t change anything because she cries (yes, real tears) every time we discuss making her job easier. What will we do?”No practice should be held hostage by a key employee. Even if Florence is Wonder Woman, you are too vulnerable if she changes her mind or behavior. Not only do you need protocols for financial controls in billing, banking, etc., you also need cross-training or at least written protocols for the other things each employee does. We create primary tasks and secondary tasks. The secondary tasks are the “cross-trained help when needed” type. The crying thing gives me the willies. This Wonder Woman sounds unstable. We always start with organizing the work so that the average employee can succeed doing it and then consider the people available to do the work. It is amazing how this helps create doable jobs, good coverage, and some security for the small practice. Sometimes in a one-employee office, a physician’s spouse is the only one available, and so we train him or her to pinch hit.Although it is great to have a super employee, it is awful to try to find another. Make sure that Wonder Woman has a well-trained understudy to fill the role in an emergency or a transition.Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 24 Jun 2010 16:24:58 GMT http://community.modernmedicine.com/_Life-After-Florence-When-Your-Key-Employee-Leaves/blog/2409882/33379.html jbee 2010-06-24T15:28:11Z Managing Your Practice Modern Medicine Community A small practice is often dependent upon a very few employees. What happens when that person retires, or should?A call from the physician’s spouse described the situation this way:“Florence has been with my husband’s practice for 10 years.I cannot get her to separate her duties for financial control purposes, and it is driving me nuts.She has announced that she will be retiring in November because she is so overworked. We can’t change anything because she cries (yes, real tears) every time we discuss making her job easier. What will we do?”No practice should be held hostage by a key employee. Even if Florence is Wonder Woman, you are too vulnerable if she changes her mind or behavior. Not only do you need protocols for financial controls in billing, banking, etc., you also need cross-training or at least written protocols for the other things each employee does. We create primary tasks and secondary tasks. The secondary tasks are the “cross-trained help when needed” type. The crying thing gives me the willies. This Wonder Woman sounds unstable. We always start with organizing the work so that the average employee can succeed doing it and then consider the people available to do the work. It is amazing how this helps create doable jobs, good coverage, and some security for the small practice. Sometimes in a one-employee office, a physician’s spouse is the only one available, and so we train him or her to pinch hit.Although it is great to have a super employee, it is awful to try to find another. Make sure that Wonder Woman has a well-trained understudy to fill the role in an emergency or a transition.Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] cross-training, managing your practice, mmglobal, problems”, resources”, “human, “staffing nonadult false Life After Florence: When Your Key Employee Leaves text blog cross-training,managing your practice,mmglobal,problems”,resources”,“human,“staffing 935 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 6 Managing Your Practice 0 2409882 2771849 Member 0 http://community.modernmedicine.com/_How-much-is-too-much/blog/2358194/33379.html In a 5-physician practice, all new patients are registered completely (all insurance numbers, etc.) while making the appointment on the phone. This makes the new patient calls very long, and so they need 3 to 4 people on the phones just to schedule appointments. The practice has 1.5 FTEs, verifying every new patient’s coverage and determining if the deductible is met after the call. If there is not enough time to do that prior to seeing the patient, they do it at the time of the visit. They also do that with every patient in January and July. Sounds thorough. Here’s what they find: The insurance is valid and most errors result from data entry problems by the phone schedulers. They are collecting co-pays and 20% of the total due if the deductible has not been met. The phone schedulers suggest that the patient download the registration and health forms from the practice’s website and complete them before arrival. Sounds convenient. The website has old forms, however, and has only 3 of the 7 they require. So patients have given all the demographics over the phone, filled out the forms from the Internet, asked to refill out several more forms, and asked to present a copy of the card. The registration process for new patients can take up to one hour if the verification step has not been done ahead. They tell patients to come in 30 minutes early. The physicians are pacing waiting for the new patient, the patients are irate about the delay, and the kicker? Average collection. The average office bill is all that is at risk. If you are not finding that patients are bringing you bad cards, and your bad debt does not exceed 2%, why not skip so much bureaucracy, and do the verification only if there is a big bill like a surgery, or expensive DME? Diligence is good but what problem are you trying to solve? Make rules for the usual situations, not for the rare exception. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] In a 5-physician practice, all new patients are registered completely (all insurance numbers, etc.) while making the appointment on the phone. This makes the new patient calls very long, and so they need 3 to 4 people on the phones just to schedule appointments. The practice has 1.5 FTEs, verifying every new patient’s coverage and determining if the deductible is met after the call. If there is not enough time to do that prior to seeing the patient, they do it at the time of the visit. They also do that with every patient in January and July. Sounds thorough. Here’s what they find: The insurance is valid and most errors result from data entry problems by the phone schedulers. They are collecting co-pays and 20% of the total due if the deductible has not been met. The phone schedulers suggest that the patient download the registration and health forms from the practice’s website and complete them before arrival. Sounds convenient. The website has old forms, however, and has only 3 of the 7 they require. So patients have given all the demographics over the phone, filled out the forms from the Internet, asked to refill out several more forms, and asked to present a copy of the card. The registration process for new patients can take up to one hour if the verification step has not been done ahead. They tell patients to come in 30 minutes early. The physicians are pacing waiting for the new patient, the patients are irate about the delay, and the kicker? Average collection. The average office bill is all that is at risk. If you are not finding that patients are bringing you bad cards, and your bad debt does not exceed 2%, why not skip so much bureaucracy, and do the verification only if there is a big bill like a surgery, or expensive DME? Diligence is good but what problem are you trying to solve? Make rules for the usual situations, not for the rare exception. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 28 May 2010 22:40:04 GMT http://community.modernmedicine.com/_How-much-is-too-much/blog/2358194/33379.html jbee 2010-05-28T22:38:31Z Managing Your Practice Modern Medicine Community In a 5-physician practice, all new patients are registered completely (all insurance numbers, etc.) while making the appointment on the phone. This makes the new patient calls very long, and so they need 3 to 4 people on the phones just to schedule appointments. The practice has 1.5 FTEs, verifying every new patient’s coverage and determining if the deductible is met after the call. If there is not enough time to do that prior to seeing the patient, they do it at the time of the visit. They also do that with every patient in January and July. Sounds thorough. Here’s what they find: The insurance is valid and most errors result from data entry problems by the phone schedulers. They are collecting co-pays and 20% of the total due if the deductible has not been met. The phone schedulers suggest that the patient download the registration and health forms from the practice’s website and complete them before arrival. Sounds convenient. The website has old forms, however, and has only 3 of the 7 they require. So patients have given all the demographics over the phone, filled out the forms from the Internet, asked to refill out several more forms, and asked to present a copy of the card. The registration process for new patients can take up to one hour if the verification step has not been done ahead. They tell patients to come in 30 minutes early. The physicians are pacing waiting for the new patient, the patients are irate about the delay, and the kicker? Average collection. The average office bill is all that is at risk. If you are not finding that patients are bringing you bad cards, and your bad debt does not exceed 2%, why not skip so much bureaucracy, and do the verification only if there is a big bill like a surgery, or expensive DME? Diligence is good but what problem are you trying to solve? Make rules for the usual situations, not for the rare exception. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] business operations, insurance verification, managing your practice, mmglobal, new patient registration nonadult false How much is too much? text blog business operations,insurance verification,managing your practice,mmglobal,new patient registration 772 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 2 Managing Your Practice 0 2358194 2771849 Member 0 http://community.modernmedicine.com/_Sometimes-You-Just-Cant-Win/blog/2311507/33379.html Did you hear the one about the new manager who goes into the surgery scheduler's area to discuss a miscommunication on a case? She perceives that the scheduler is giving her “attitude” and tells her so. The two are standing in an area that would allow wandering ears to become involved. Now what? The manager asks the scheduler to come into the physician's empty office to continue the encounter in privacy. The scheduler does go in the office but proceeds to tell the manager that she is being humiliated and harassed and that she is going home. Manager tries to explain that she did not intend to be offensive; rather, she was trying to get to a solution and not do it in public. The manager thinks that the absence is just for the day. The PA calls the manager to tell her that the scheduler is cleaning out her desk. The scheduler hands in her keys and leaves. The manager feels like she is in the Twilight Zone. She tells the physician; he calls the scheduler and gets her to return to her job. Now this is a great place to work for the scheduler and the manager—not. How could this have been avoided? The manager could start the discussion with “I have a problem” rather than, “You have a bad attitude.” The manager could describe what she considers to be “attitude” and why it is not acceptable. When it gets out of control and communication not working, call a time out and schedule a three-way meeting with another powerful person. In this case, the powerful person is the physician since this is a solo practice. That shows the willingness to solve the problem and give both sides the opportunity/risk to plead her case to the physician. (Many times the attitude comes from resenting a manager or any leadership other than the physician. This solves that.) Realize that sometimes your best intentions and reasonable process does not work. Sad but true. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor's Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Did you hear the one about the new manager who goes into the surgery scheduler's area to discuss a miscommunication on a case? She perceives that the scheduler is giving her “attitude” and tells her so. The two are standing in an area that would allow wandering ears to become involved. Now what? The manager asks the scheduler to come into the physician's empty office to continue the encounter in privacy. The scheduler does go in the office but proceeds to tell the manager that she is being humiliated and harassed and that she is going home. Manager tries to explain that she did not intend to be offensive; rather, she was trying to get to a solution and not do it in public. The manager thinks that the absence is just for the day. The PA calls the manager to tell her that the scheduler is cleaning out her desk. The scheduler hands in her keys and leaves. The manager feels like she is in the Twilight Zone. She tells the physician; he calls the scheduler and gets her to return to her job. Now this is a great place to work for the scheduler and the manager—not. How could this have been avoided? The manager could start the discussion with “I have a problem” rather than, “You have a bad attitude.” The manager could describe what she considers to be “attitude” and why it is not acceptable. When it gets out of control and communication not working, call a time out and schedule a three-way meeting with another powerful person. In this case, the powerful person is the physician since this is a solo practice. That shows the willingness to solve the problem and give both sides the opportunity/risk to plead her case to the physician. (Many times the attitude comes from resenting a manager or any leadership other than the physician. This solves that.) Realize that sometimes your best intentions and reasonable process does not work. Sad but true. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor's Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Sat, 24 Apr 2010 00:13:02 GMT http://community.modernmedicine.com/_Sometimes-You-Just-Cant-Win/blog/2311507/33379.html jbee 2010-04-23T23:32:14Z Managing Your Practice Modern Medicine Community Did you hear the one about the new manager who goes into the surgery scheduler's area to discuss a miscommunication on a case? She perceives that the scheduler is giving her “attitude” and tells her so. The two are standing in an area that would allow wandering ears to become involved. Now what? The manager asks the scheduler to come into the physician's empty office to continue the encounter in privacy. The scheduler does go in the office but proceeds to tell the manager that she is being humiliated and harassed and that she is going home. Manager tries to explain that she did not intend to be offensive; rather, she was trying to get to a solution and not do it in public. The manager thinks that the absence is just for the day. The PA calls the manager to tell her that the scheduler is cleaning out her desk. The scheduler hands in her keys and leaves. The manager feels like she is in the Twilight Zone. She tells the physician; he calls the scheduler and gets her to return to her job. Now this is a great place to work for the scheduler and the manager—not. How could this have been avoided? The manager could start the discussion with “I have a problem” rather than, “You have a bad attitude.” The manager could describe what she considers to be “attitude” and why it is not acceptable. When it gets out of control and communication not working, call a time out and schedule a three-way meeting with another powerful person. In this case, the powerful person is the physician since this is a solo practice. That shows the willingness to solve the problem and give both sides the opportunity/risk to plead her case to the physician. (Many times the attitude comes from resenting a manager or any leadership other than the physician. This solves that.) Realize that sometimes your best intentions and reasonable process does not work. Sad but true. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor's Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] managing your practice, miscommunication, mmglobal nonadult false Sometimes You Just Can't Win text blog managing your practice,miscommunication,mmglobal 653 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 4 Managing Your Practice 0 2311507 2771849 Member 0 http://community.modernmedicine.com/_Beware-the-Po-ZoneA-Time-Management-Tip/blog/2193585/33379.html The patients were irate about the long waits to see Dr Po. And he was ready to fire all the schedulers for overbooking his schedule and making him late. The employees were ready to walk out because Dr. Po always made them check with him for work-ins. He’d authorize the work-in/overbook and then explode when the day went to the dogs! Sound familiar? Actually everyone was right in this situation. The problem was that the staff members were allowed to ask Dr. Po whenever they needed the permission. He would be knee deep in patient care and impatiently nod “Yes, do what you need to do.” And they did. This is a common situation that occurs when managers or bookkeepers bring checks to be signed, time-off requests for approval, yada yada. The physician is not listening (sometimes that is done on both sides, intentionally), and the staff has done as directed. It’s sooooo not good. The solution was inspired by the good doctor himself. He declared himself in the “Po Zone” when he is in clinic. No one is permitted to ask him for anything. He would create work breaks to allow him to attend to messages and other urgencies. Unless there was a referring physician on the phone or a live dinosaur in the reception room, the staff knew to hold the questions for the next break (every 2 hours). Think about what decisions you make on the fly. Are they critical? Are you really listening? Get in the groove and stay there. Stop to look up, listen, evaluate, and then answer. Everyone will enjoy the office a lot more. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Have you had an experience like this? Please Log in and Comment in the box below.] The patients were irate about the long waits to see Dr Po. And he was ready to fire all the schedulers for overbooking his schedule and making him late. The employees were ready to walk out because Dr. Po always made them check with him for work-ins. He’d authorize the work-in/overbook and then explode when the day went to the dogs! Sound familiar? Actually everyone was right in this situation. The problem was that the staff members were allowed to ask Dr. Po whenever they needed the permission. He would be knee deep in patient care and impatiently nod “Yes, do what you need to do.” And they did. This is a common situation that occurs when managers or bookkeepers bring checks to be signed, time-off requests for approval, yada yada. The physician is not listening (sometimes that is done on both sides, intentionally), and the staff has done as directed. It’s sooooo not good. The solution was inspired by the good doctor himself. He declared himself in the “Po Zone” when he is in clinic. No one is permitted to ask him for anything. He would create work breaks to allow him to attend to messages and other urgencies. Unless there was a referring physician on the phone or a live dinosaur in the reception room, the staff knew to hold the questions for the next break (every 2 hours). Think about what decisions you make on the fly. Are they critical? Are you really listening? Get in the groove and stay there. Stop to look up, listen, evaluate, and then answer. Everyone will enjoy the office a lot more. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Have you had an experience like this? Please Log in and Comment in the box below.] Fri, 19 Mar 2010 13:54:06 GMT http://community.modernmedicine.com/_Beware-the-Po-ZoneA-Time-Management-Tip/blog/2193585/33379.html jbee 2010-03-19T13:48:54Z Managing Your Practice Modern Medicine Community The patients were irate about the long waits to see Dr Po. And he was ready to fire all the schedulers for overbooking his schedule and making him late. The employees were ready to walk out because Dr. Po always made them check with him for work-ins. He’d authorize the work-in/overbook and then explode when the day went to the dogs! Sound familiar? Actually everyone was right in this situation. The problem was that the staff members were allowed to ask Dr. Po whenever they needed the permission. He would be knee deep in patient care and impatiently nod “Yes, do what you need to do.” And they did. This is a common situation that occurs when managers or bookkeepers bring checks to be signed, time-off requests for approval, yada yada. The physician is not listening (sometimes that is done on both sides, intentionally), and the staff has done as directed. It’s sooooo not good. The solution was inspired by the good doctor himself. He declared himself in the “Po Zone” when he is in clinic. No one is permitted to ask him for anything. He would create work breaks to allow him to attend to messages and other urgencies. Unless there was a referring physician on the phone or a live dinosaur in the reception room, the staff knew to hold the questions for the next break (every 2 hours). Think about what decisions you make on the fly. Are they critical? Are you really listening? Get in the groove and stay there. Stop to look up, listen, evaluate, and then answer. Everyone will enjoy the office a lot more. Judy Bee is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Have you had an experience like this? Please Log in and Comment in the box below.] managing your practice, office scheduling nonadult false Beware the “Po Zone”—A Time Management Tip text blog managing your practice,office scheduling 762 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 2 Managing Your Practice 0 2193585 2771849 Member 0 http://community.modernmedicine.com/_Straight-Talk-Improving-Staff-Performance/blog/1927862/33379.html “Can you come to our office to do a training session that will make everyone get along?” Sure, and I’ll bring my magic wand. We get calls like this in various versions, but what it boils down to is “Let’s tell everyone—not just the one who is misbehaving—to shape up.” Here’s the problem with this approach: The bad boy/girl will think you are talking about everyone else. The good workers will think you are lily-livered for not dealing with the problem head on. In the case I mentioned, the problem rests with an LPN who works with only one of the physicians. My advice is to confront the LPN in the presence of her “angel” so that she knows that he supports the intervention. When you have a stream of complaints about one person, confirm what you can and deal with that one person privately. Tell the offender what the unacceptable behavior is, and talk about the complaints from many others. Then tell the offender what you want instead. You may create a signal to tell her when she is “doing it again.” For example, everyone is on a first name basis in the staff, and Carol is the LPN’s first name. When you call her Ms. Austin, she will know that she is falling back into her old pattern. I can still hear my mother saying, “Judith Ann, if you continue we are going to come to blows.” It was a signal that got my attention. She was an HR genius. Judy Bee, is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do have any thoughts to share on this topic? See the Comment box below.] “Can you come to our office to do a training session that will make everyone get along?” Sure, and I’ll bring my magic wand. We get calls like this in various versions, but what it boils down to is “Let’s tell everyone—not just the one who is misbehaving—to shape up.” Here’s the problem with this approach: The bad boy/girl will think you are talking about everyone else. The good workers will think you are lily-livered for not dealing with the problem head on. In the case I mentioned, the problem rests with an LPN who works with only one of the physicians. My advice is to confront the LPN in the presence of her “angel” so that she knows that he supports the intervention. When you have a stream of complaints about one person, confirm what you can and deal with that one person privately. Tell the offender what the unacceptable behavior is, and talk about the complaints from many others. Then tell the offender what you want instead. You may create a signal to tell her when she is “doing it again.” For example, everyone is on a first name basis in the staff, and Carol is the LPN’s first name. When you call her Ms. Austin, she will know that she is falling back into her old pattern. I can still hear my mother saying, “Judith Ann, if you continue we are going to come to blows.” It was a signal that got my attention. She was an HR genius. Judy Bee, is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do have any thoughts to share on this topic? See the Comment box below.] Tue, 09 Mar 2010 18:28:03 GMT http://community.modernmedicine.com/_Straight-Talk-Improving-Staff-Performance/blog/1927862/33379.html jbee 2010-03-02T20:47:32Z Managing Your Practice Modern Medicine Community “Can you come to our office to do a training session that will make everyone get along?” Sure, and I’ll bring my magic wand. We get calls like this in various versions, but what it boils down to is “Let’s tell everyone—not just the one who is misbehaving—to shape up.” Here’s the problem with this approach: The bad boy/girl will think you are talking about everyone else. The good workers will think you are lily-livered for not dealing with the problem head on. In the case I mentioned, the problem rests with an LPN who works with only one of the physicians. My advice is to confront the LPN in the presence of her “angel” so that she knows that he supports the intervention. When you have a stream of complaints about one person, confirm what you can and deal with that one person privately. Tell the offender what the unacceptable behavior is, and talk about the complaints from many others. Then tell the offender what you want instead. You may create a signal to tell her when she is “doing it again.” For example, everyone is on a first name basis in the staff, and Carol is the LPN’s first name. When you call her Ms. Austin, she will know that she is falling back into her old pattern. I can still hear my mother saying, “Judith Ann, if you continue we are going to come to blows.” It was a signal that got my attention. She was an HR genius. Judy Bee, is a medical practice management consultant with the Practice Performance Group, La Jolla, CA. Since entering consulting in 1977, Ms Bee has developed a client reference list which numbers more than 700 physicians in 37 states of the United States. [Editor’s Note: Do have any thoughts to share on this topic? See the Comment box below.] human resources, improving performance, managing your practice, staff problems nonadult false Straight Talk: Improving Staff Performance text blog human resources,improving performance,managing your practice,staff problems 493 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 1927862 2771849 Member 0 http://community.modernmedicine.com/_Embezzling-Economic-Indicators/blog/1694855/33379.html I have had my second call in a month about discovered embezzlement. As far as we know, the employees had not done this before. One was known to be in big financial trouble, living out of her car. The other had some vague hint of family trouble and perhaps some big psychotherapy bills to pay. In any event, the option of dipping into the practice income was too tempting. The first case concerned a manager who took collections made at the time of the service from 3 offices and deposited them separately from mailed-in checks. When trying to reconcile the income for end-of-year bonus distributions, the accountant discovered that income posted to the accounts did not match that deposited in the bank. If the accountant had received monthly payment summaries along with the bank reconciliations, this scam would not have worked. This lack of information is not unusual. Most profit and loss statements begin with what was deposited with no tie-in to what was collected. It is even worse when practices use Quick Books to create reports, and the CPA only sees them once a year at tax time. The second case was a bit different. The bookkeeper was overwhelmed, and she could not get all the work done. She refused help. Instead, she posted what she could and made the deposit equal the posting. What was missing was the number and amount of checks she didn’t post. Payment posters also make adjustments. It is too early to tell if she had a phantom bank account where she deposited the “extra” checks, making adjustments on patient accounts instead of posting the payment. How did the manager discover this problem? She was concerned about the “rat’s nest” in the billing office; so, while the bookkeeper was away, the manager started opening cabinets and drawers. She found many unposted checks, unposted EOBs, and overpayment refund requests from insurance companies hidden months’ prior. This bookkeeper also paid the bills! Big surprise, she “advanced” herself $1,500 when the manager was away. That was discovered at the end-of-the-year reconciliation with the payroll service account showing $1500 less than the expense summary for payroll. Moral: Get several people involved in opening the mail, totaling the checks, posting, and making the deposit. Make sure the CPA gets a summary by day of the collection posted to the computer as well as the bank rec. Recognize people in trouble and take the opportunity for creative solution. I have had my second call in a month about discovered embezzlement. As far as we know, the employees had not done this before. One was known to be in big financial trouble, living out of her car. The other had some vague hint of family trouble and perhaps some big psychotherapy bills to pay. In any event, the option of dipping into the practice income was too tempting. The first case concerned a manager who took collections made at the time of the service from 3 offices and deposited them separately from mailed-in checks. When trying to reconcile the income for end-of-year bonus distributions, the accountant discovered that income posted to the accounts did not match that deposited in the bank. If the accountant had received monthly payment summaries along with the bank reconciliations, this scam would not have worked. This lack of information is not unusual. Most profit and loss statements begin with what was deposited with no tie-in to what was collected. It is even worse when practices use Quick Books to create reports, and the CPA only sees them once a year at tax time. The second case was a bit different. The bookkeeper was overwhelmed, and she could not get all the work done. She refused help. Instead, she posted what she could and made the deposit equal the posting. What was missing was the number and amount of checks she didn’t post. Payment posters also make adjustments. It is too early to tell if she had a phantom bank account where she deposited the “extra” checks, making adjustments on patient accounts instead of posting the payment. How did the manager discover this problem? She was concerned about the “rat’s nest” in the billing office; so, while the bookkeeper was away, the manager started opening cabinets and drawers. She found many unposted checks, unposted EOBs, and overpayment refund requests from insurance companies hidden months’ prior. This bookkeeper also paid the bills! Big surprise, she “advanced” herself $1,500 when the manager was away. That was discovered at the end-of-the-year reconciliation with the payroll service account showing $1500 less than the expense summary for payroll. Moral: Get several people involved in opening the mail, totaling the checks, posting, and making the deposit. Make sure the CPA gets a summary by day of the collection posted to the computer as well as the bank rec. Recognize people in trouble and take the opportunity for creative solution. Wed, 06 Jan 2010 22:21:31 GMT http://community.modernmedicine.com/_Embezzling-Economic-Indicators/blog/1694855/33379.html jbee 2010-01-06T21:42:02Z Managing Your Practice Modern Medicine Community I have had my second call in a month about discovered embezzlement. As far as we know, the employees had not done this before. One was known to be in big financial trouble, living out of her car. The other had some vague hint of family trouble and perhaps some big psychotherapy bills to pay. In any event, the option of dipping into the practice income was too tempting. The first case concerned a manager who took collections made at the time of the service from 3 offices and deposited them separately from mailed-in checks. When trying to reconcile the income for end-of-year bonus distributions, the accountant discovered that income posted to the accounts did not match that deposited in the bank. If the accountant had received monthly payment summaries along with the bank reconciliations, this scam would not have worked. This lack of information is not unusual. Most profit and loss statements begin with what was deposited with no tie-in to what was collected. It is even worse when practices use Quick Books to create reports, and the CPA only sees them once a year at tax time. The second case was a bit different. The bookkeeper was overwhelmed, and she could not get all the work done. She refused help. Instead, she posted what she could and made the deposit equal the posting. What was missing was the number and amount of checks she didn’t post. Payment posters also make adjustments. It is too early to tell if she had a phantom bank account where she deposited the “extra” checks, making adjustments on patient accounts instead of posting the payment. How did the manager discover this problem? She was concerned about the “rat’s nest” in the billing office; so, while the bookkeeper was away, the manager started opening cabinets and drawers. She found many unposted checks, unposted EOBs, and overpayment refund requests from insurance companies hidden months’ prior. This bookkeeper also paid the bills! Big surprise, she “advanced” herself $1,500 when the manager was away. That was discovered at the end-of-the-year reconciliation with the payroll service account showing $1500 less than the expense summary for payroll. Moral: Get several people involved in opening the mail, totaling the checks, posting, and making the deposit. Make sure the CPA gets a summary by day of the collection posted to the computer as well as the bank rec. Recognize people in trouble and take the opportunity for creative solution. embezzlement, income reconciliation problems, managing your practice nonadult false Embezzling: Economic Indicators? text blog embezzlement,income reconciliation problems,managing your practice 1234 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 2 Managing Your Practice 1 1694855 2771849 Member 0 http://community.modernmedicine.com/_Who-DID-This/blog/1621332/33379.html When it comes as a shock to find that the end-of-year bonuses are paltry—if even available—the questions all start with who is responsible. When the practice is owned by physicians who are making decisions, the answer is in the mirror. Consider this: 6 surgeons, 3 offices (already an expensive operation). One leaves and triggers a buy-out. The practice recruits another surgeon in the same subspecialty of two others in the group rather than trying to find another subspecialty surgeon. But wait; there’s more. Dr. Newbie will work in yet another new office across town. Dr. Newbie is on salary and 5 months into the first year of charging Dr. Newbie, with only the direct costs of employment and the overhead in the new office, is $70,000 in the hole. The credentialing was not done well, and the practice had to write off 6 weeks of Medicare services because they would not retro the credentialing date back to the first date. Dr. Newbie’s name and the new office are not yet appearing on the practice Web site. The physicians did not like the ups and downs of in-house billing, so they decided to use a billing service. On the brink of firing the entire A/R team, a new manager suggested they should leave someone in-house to collect the old A/R. The IT expenses would not be reduced because with 4 locations, they had to stay connected for appointment scheduling and access to each other. So far, the billing service has cost over $100,000 and the 2 people who were laid off saved $25,000. And, oh yes, they had a big bill for hardware replacement to enable the use of the billing service software for appointments. Because of the cash flow troubles in the previous year, no quarterly contributions had been made to the retirement plan. Now that is due. They decided to close one office but will have to pay a huge penalty by the end of the year to break the lease. This is a good practice, solid doctors, and stellar reputation. What happened? Too much too soon; the actions were taken without firm projections of the short-term results. Sad story; but not terminal. Moral to the story: Slow down, think it through, and easy does it. Most physicians underestimate how hard it is to manage change, and they get rude surprises when they learn the lesson. [Editor’s Note: Know of a similar experience that you want to share? Login and Comment in the box below.] When it comes as a shock to find that the end-of-year bonuses are paltry—if even available—the questions all start with who is responsible. When the practice is owned by physicians who are making decisions, the answer is in the mirror. Consider this: 6 surgeons, 3 offices (already an expensive operation). One leaves and triggers a buy-out. The practice recruits another surgeon in the same subspecialty of two others in the group rather than trying to find another subspecialty surgeon. But wait; there’s more. Dr. Newbie will work in yet another new office across town. Dr. Newbie is on salary and 5 months into the first year of charging Dr. Newbie, with only the direct costs of employment and the overhead in the new office, is $70,000 in the hole. The credentialing was not done well, and the practice had to write off 6 weeks of Medicare services because they would not retro the credentialing date back to the first date. Dr. Newbie’s name and the new office are not yet appearing on the practice Web site. The physicians did not like the ups and downs of in-house billing, so they decided to use a billing service. On the brink of firing the entire A/R team, a new manager suggested they should leave someone in-house to collect the old A/R. The IT expenses would not be reduced because with 4 locations, they had to stay connected for appointment scheduling and access to each other. So far, the billing service has cost over $100,000 and the 2 people who were laid off saved $25,000. And, oh yes, they had a big bill for hardware replacement to enable the use of the billing service software for appointments. Because of the cash flow troubles in the previous year, no quarterly contributions had been made to the retirement plan. Now that is due. They decided to close one office but will have to pay a huge penalty by the end of the year to break the lease. This is a good practice, solid doctors, and stellar reputation. What happened? Too much too soon; the actions were taken without firm projections of the short-term results. Sad story; but not terminal. Moral to the story: Slow down, think it through, and easy does it. Most physicians underestimate how hard it is to manage change, and they get rude surprises when they learn the lesson. [Editor’s Note: Know of a similar experience that you want to share? Login and Comment in the box below.] Tue, 26 Jan 2010 16:18:25 GMT http://community.modernmedicine.com/_Who-DID-This/blog/1621332/33379.html jbee 2009-12-18T18:05:29Z Managing Your Practice Modern Medicine Community When it comes as a shock to find that the end-of-year bonuses are paltry—if even available—the questions all start with who is responsible. When the practice is owned by physicians who are making decisions, the answer is in the mirror. Consider this: 6 surgeons, 3 offices (already an expensive operation). One leaves and triggers a buy-out. The practice recruits another surgeon in the same subspecialty of two others in the group rather than trying to find another subspecialty surgeon. But wait; there’s more. Dr. Newbie will work in yet another new office across town. Dr. Newbie is on salary and 5 months into the first year of charging Dr. Newbie, with only the direct costs of employment and the overhead in the new office, is $70,000 in the hole. The credentialing was not done well, and the practice had to write off 6 weeks of Medicare services because they would not retro the credentialing date back to the first date. Dr. Newbie’s name and the new office are not yet appearing on the practice Web site. The physicians did not like the ups and downs of in-house billing, so they decided to use a billing service. On the brink of firing the entire A/R team, a new manager suggested they should leave someone in-house to collect the old A/R. The IT expenses would not be reduced because with 4 locations, they had to stay connected for appointment scheduling and access to each other. So far, the billing service has cost over $100,000 and the 2 people who were laid off saved $25,000. And, oh yes, they had a big bill for hardware replacement to enable the use of the billing service software for appointments. Because of the cash flow troubles in the previous year, no quarterly contributions had been made to the retirement plan. Now that is due. They decided to close one office but will have to pay a huge penalty by the end of the year to break the lease. This is a good practice, solid doctors, and stellar reputation. What happened? Too much too soon; the actions were taken without firm projections of the short-term results. Sad story; but not terminal. Moral to the story: Slow down, think it through, and easy does it. Most physicians underestimate how hard it is to manage change, and they get rude surprises when they learn the lesson. [Editor’s Note: Know of a similar experience that you want to share? Login and Comment in the box below.] change management, managing your practice, mmglobal nonadult false Who DID This? text blog change management,managing your practice,mmglobal 781 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=2771849&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_1733228_33379_2771849_ap_160X120.jpg false 0 Managing Your Practice 0 1621332 2771849 Member 0