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Should You Spy on Your Employees?

September 2, 2010 By Peter Polack Leave a Comment

As medical practices become more advanced, staff members gain improved access to the Internet during work hours. Cyber-slacking is a well-known problem in corporations; in fact, one study found that over thirty-five percent of employees admit to using the Internet for personal surfing at work.

The New York Times cited that twenty-five percent of Net use on work computers isn’t actually work-related. Although it is unknown how severe the problem is in medical practices, the trend continues to grow.

Beyond basic productivity loss, there are other dangers which result from employees abusing the Internet at work. At one company a staff person was fired for visiting adult websites and distributing the content to co-workers. Apart from the potential embarrassment over such an incident, a practice could be liable to sexual harassment lawsuits. But even if your employees use the Internet in a ‘decent’ manner, simply downloading personal data onto a work computer can increase costs for your practice in terms of bandwidth and storage.

So what can you do about it?

Create clear policies for network use. Does your company have a well understood policy regarding Internet use on work computers? And is this tied to a clearly-delineated disciplinary process? These policies should be included in the employee manual. These same policies are great protection for your practice in the instance of a lawsuit. Also, be sure to get acquainted with applicable privacy laws, normally found under the jurisdiction of state laws, since these vary state to state. [see more about privacy issues in MySpace in the Workplace

You should understand your rights and limitations as an employer. If you have doubts about a particular issue, contact a lawyer who specializes in employment law. In general, all the computers that staff use, along with the content, are company property. In the case of legal issues, as in allegations of harassment or discrimination, e-mail correspondence can be subpoenaed.

Make sure you understand your options before deciding to monitor Internet use. There are third-party monitoring software solutions, but the value of this depends on the size of your practice. Keep in mind that monitoring will add both complexity and cost to your day-to-day operations. Although there are free software solutions available for monitoring your network, operation and installation costs could make monitoring more of a hassle than it is worth.

Hospitals Wooing Doctors with EMR

August 26, 2010 By Peter Polack 2 Comments

A report from American Medical News reports that hospitals are increasingly courting local physicians with free or subsidized EMR systems. Why?

A recent report by the American Hospital Assn. on the effects of the recession found that 72% of hospitals reported a decline in the number of elective procedures, and 70% reported a drop in patient volume from 2009.

A major criterion of meaningful use is proving the ability to communicate and share health information electronically. For hospitals, this means demonstrating that they are sharing this information with physicians. And the quickest way to achieve that is to help doctors get up-to-speed with EMR. Experts say that this also a good way for hospitals to strengthen relationships with the very physicians they count on for referrals.

Other experts urge caution on the part of medical practices. Hire a consultant and make sure the potential system fits in with your overall EMR implementation strategy. As J. Ryan Williams, a healthcare attorney from Cleveland points out:

You could be in a position of accepting the donated technology, share in that cost, then one, two or three years down the road that technology, God forbid, doesn’t allow you to meet your meaningful use criteria. [Then] what good have you done?

Patients Cite Costs for Not Keeping Appointments

August 25, 2010 By Peter Polack 1 Comment

Is your practice business a bit slow these days? It might not be your fault. The AMA reports on a study by Deloitte Center for Health Solutions that found that a patient group they surveyed had fewer doctor visits this year than last year (79% vs 85%). And the main reason they cited for skipping their appointments – cost- was more likely to be the deciding factor (40% vs 38%).

Insurers are noticing this as well. According to the article, Aetna President Mark Bertolini told analysts:

We are seeing it everywhere, in every segment of the business at this time. There are a number of impacts, but the economy does definitely have an impact here.

And a BlueCross BlueShield of North Carolina survey…

… found that 15% to 17% of those surveyed were skipping routine checkups and preventive care….[and] twice as many were taking fewer prescriptions, skipping prescription doses or not filling prescriptions because of cost.

Four Essential Steps to Improve Accounts Receivable

August 19, 2010 By Peter Polack 3 Comments

If your medical practice accounts receivable is sapping your profitability, you may need a billing makeover.  And if you’re not sure where to begin, consider enlisting the services of a company that specializes in medical billing management. Chicago Lake Shore Medical Associates, a multi-specialty physician group with 43 physicians, partnered with RMK Holdings’ medical billing team, to improve its days in accounts receivable (A/R) by 34.5%, resulting in improved cash flow.

Chicago Lake Shore was experiencing A/R of 55 days when RMK took over its billing. Initially, the practice was sending out bills once a month rather than weekly.  One third of its electronic claims had to be rebilled because of incorrect insurance or incomplete information.  RMK realized the office staff scheduling appointments was simply too busy to accurately record information.

The hectic pace a front office staff experiences often makes it difficult to verify insurance information and patients themselves can easily be confused by changes in their insurance plan. Once these problems were identified, the following steps were taken to implement and improve Chicago Lake Shore’s A/R:

  1. New patients should contact medical billing. When all patients called for an appointment, the staff booked the appointment, and requested that the new patients, as well as patients not seen in several months, contact RMK’s insurance verification department to update their insurance and demographic information. This practice alone decreased rebilling dramatically.
  2. Use batch eligibility verification. While initially this (Step Number 1) reduced a lot of the rebilling issues, too many claims were still not up to RMK’s accuracy standard. To improve claims submission, RMK shifted to a batch eligibility verification system that would begin two days before each patient appointment. With batch eligibility, a list of all patients and their information is submitted via an electronic file to each insurance carrier for that day. A report is then returned, showing each patient’s current coverage and eligibility status. Inaccurate information was immediately corrected or updated in the patient’s record by RMK. Moreover, the client and patient were provided with current deductible and coinsurance information along with well coverage information prior to the appointment. This enabled Chicago Lake Shore to reduce incorrect claims submissions by 98%.
  3. Call patients with long past due balances before their next appointment. Chicago Lake Shore Medical Associates and its medical billing partner also implemented a program to call any patient with a 90-day past due balance prior to their next scheduled appointment to arrange payment options. The physician’s office is notified via email if the patient states they will pay at the time of service, and if the patient is unreachable by phone, a notice with that patient’s past due balance is forwarded to the physician’s assistant. The assistant is also notified if the patient promised to pay at the time of service.
  4. Offer credit card or online bill pay.  Finally, patients were given the choice to pay online with the option of storing credit card information to collect deductibles, coinsurance or past due amounts automatically.

According to RMK’s CEO Ron McLaughlin, when providers clearly inform patients about their financial obligations in advance, patients are more likely to fulfill their responsibility and the practice’s profitability or cash flow is more likely to be optimized.

What Can You Learn From JetBlue?

August 11, 2010 By Peter Polack 1 Comment

A neat post from Pediatric Inc demonstrates how a keen eye and an open mind can pick up some great business tips from seemingly unrelated industries. In this case, a pediatrician’s experience on JetBlue Airlines teaches him how customer service is done right and how it can be applied to a medical practice.

Some of his ten tips include: Service with a smile, cross-train your employees, have a nice environment, and always ask “How can I help?” instead of “It’s not my job.”

We are constantly training our employees on the importance of customer service and it can never be over-emphasized.

Five Ways to Scan Your Paper Charts into an EMR System

July 27, 2010 By Peter Polack Leave a Comment

We are a little over two years into our electronic medical records implementation at the time of this writing. Since we have been performing a gradual rollout, the entire process has been relatively uneventful. Most of the credit for this goes to our chief information officer (technospeak for the head of our IT department) and our practice administrator.

One of the biggest challenges we have been facing is how to convert all of the paper records into electronic ones. Since we started our EMR implementation with just new patients, we initially were entering brand-new data on those patients and there wasn’t anything to convert. But as we started adding established patients – those patients that had an existing paper chart – we had to deal with two issues: how much of the paper chart do we convert to a digital format and how do we make the majority of the existing clinical history available to the physician? Before I tell you what we did, let’s discuss some options for dealing with conversion of paper records to electronic records.

  1. All patient charts are scanned into the electronic medical records (EMR) system. If your practice is running out of physical office space, as we were, this is an attractive option. Unfortunately, it is easy to [Read more...]

Take Our Survey: Are You Using EMR?

December 22, 2009 By Peter Polack Leave a Comment

EMR Implementation – How do you stack up against your colleagues?
We’ll post the results in a week or so.
Click the Next button after you answer each question

[SURVEYS 1]

Change Management: Preparing Staff Members for EMR

September 29, 2009 By Peter Polack Leave a Comment

In order to implement important changes at your practice, you must gain buy-in from the staff. The executive search firm Korn/Ferry International cites a lack of employee buy-in as one of the most common management mistakes a new executive makes when trying to implement any new strategies or changes. If this executive fails to take the existing culture into consideration, the initiatives often fail.changes sign.jpg

For example, consider the controlling manager who arrives at a business only to discover that the employees work collaboratively. This combination can lead to significant struggles. Alternately, let’s consider the savvy executive who approaches the situation with an ability to acclimate, and who discovers ways to work in harmony with the existing culture and style at the firm. The latter approach can significantly assist your efforts to gain cooperation from staff when implementing the transition from paper records to electronic medical records (EMR).

Proper planning and the ability to adjust during the process are two tools that can help you avoid the need to pull the plug on your EMR project, with a potentially disastrous economic effect on your practice. The ‘Change Management’ process, which touts navigating change in a careful and systematic way, is a great tool to employ during this time.

Change Management: 10 Key Factors

  1. Be clear and concise in speaking to each individual. Everyone should understand what is happening and what is expected from each. As long as having confidence doesn’t mean being unrealistic, it can be good for morale when problems arise. Be prepared to calm the fears of some staff.
  2. The need for change will not go unquestioned. Present your case in a formal, referenced way which proves the benefits of changing over to a paperless system. Users need an incentive to change their habits, and will actually resist using the new tool otherwise.
  3. Maintain good communications by keeping a dialogue channel open, encouraging participation at each step. The plan should also include a time line of actions for completion. Make sure to give the staff all the required information in the implementation process.
  4. Address the aspects of the culture with explicit intent and detail. People can be expected to learn new skills on a gradual basis, taking baby steps toward learning more about more basic technology (using a computer, using a mouse. etc.), then advancing to more complex systems such as EMR.
  5. Problems are a given; expect the unexpected. These may push back the system go-live date, and the effects will reverberate throughout the organization. Use the correct degree of flexibility to manage these effects.
  6. When gaining acceptance, start at the top. The top tier of staff members, especially physicians and administrators, should be on board with the program, including any champions for the cause. If you have strong allies with the right technological skill and without a naive level of optimism, that is especially helpful.Resistant doctors in particular can be detrimental to the project, so stay on top of the nay-sayers.
  7. Always acknowledge the human aspects. Without acceptance from the staff, a change to a new system could ultimately fail. The prospect of change often adds anxiety to the mix of human emotions, and this should be acknowledged during the process.
  8. People should get involved at every level, so that everyone feels they contributed to the outcome. A committee of staff members, formed to create a proposal for delivery to the physicians, is another excellent tool. This committee should be representative of those who will ultimately use the EMR: administrators, business staff, and medical assistants.
  9. Always make identifications and assessments of core values and beliefs in a cultural assessment, including possible sources of conflict or resistance. People often become set in their ways, resisting change as a general rule.
  10. The leaders of the group should take ownership over project elements. As these staff members have better credibility with their subordinates compared to the physicians, these people are crucial and should be the first trained in the new system (‘super-users’), then passing the info on through training.

Ultimately, every employee needs to buy-in to the change, and for this to occur successfully, a helpful framework is known as the ADKAR model (Prosci):

  • A = Awareness of why the change is needed
  • D = Desire to support and participate in the change
  • K = Knowledge of how to change
  • A = Ability to implement new skills and behaviors
  • R = Reinforcement to sustain the change

Have you already implemented EMR in your practice? Did you have issues related to the Change Management? Post a comment below and let us know.

EMR Implementation Rollout

September 18, 2009 By Peter Polack 5 Comments

Do you plan on implementing electronic medical records (EMR) at your medical practice? If so, you’re taking on a sizable project. Something this large must stay on a time-line or it may never reach completion. At our practice we experienced some setbacks including back-to-back hurricanes, construction of two new buildings, and hiring of a couple of partners -calendar-pushpin.jpg all of these events pushed the date of launch back over a year. Even so, having a firm date to ‘go live’ helps get everyone on board, allowing them to team together to engage in what could be one of the more challenging changes in their career.

Choose someone to be the project manager in charge of implementing the project. It could either be someone from staff such as an IT person or supervisor, or you could hire an outside consultant. Next, you want a comprehensive plan which covers the how, who, what, where, when, and why of the project from start to finish. Before going forward on your EMR plans, be sure your assets are ready. It just takes one poorly-prepared component to send well-laid plans down the path to failure.

Regardless of the practice, physicians’ attitudes towards EMR will range from gung-ho optimistic to downright resistant. Whoever is in charge of leading the project must decide when all of the physicians will roll-out on EMR, whether in unison or staggered on various launch dates or locations.

Some doctors may be quite comfortable allowing colleagues to test the waters first; but this may lead to more work and stress for the staff. If one doctor sees a patient using EMR, and the patient returns on a follow-up visit with another doctor using a paper chart, how will the patient’s chart be reconciled?

If there are multiple locations at your practice, you may want to implement EMR at one office before going on to the others. However, if your employees rotate between locations, your training plan must take this into account; if too much time passes between the launches at different locations, training may suffer.

Again, a project this large requires a firm commitment from the top authority at your practice, typically a physician ‘champion’, along with buy-in at all levels. One single voice of negativity from someone in a power position can drag down the entire campaign. A managing partner may have to intervene if the practice discovers that a doctor is actively working against the project – your administrator should not be put in this no-win situation. It’s also important that patients are well-informed of  the practice’s goals, so that they are more likely to tolerate the expected delays and hiccups while your team is working out the kinks in the system.

If you’d rather not make the big switch to digital all in one day, you may prefer to see only some patients using EMR. At our practice, we began with new patients requiring complete exams only, to prevent our clinics from grinding to a halt. As these patients gradually return for follow-ups, they continue to be seen using the EMR system. In this way, we were able to launch all locations simultaneously so clinics would not suffer from disparities in employee training and skills. This has also allowed us to gradually ramp up EMR with little effect on productivity.

Other items which shouldn’t be left to the last minute:

  • Are your desktop machines or wireless tablets configured correctly?
  • Has the software been installed and tested?
  • Is there a proper disaster recovery plan in use?
  • Is your infrastructure (wiring and wireless networks) ready to go? Adequate bandwidth?

Your schedule should include at least a month of intensive training for staff, which concludes well before the launch date. You may have to rotate staff during the day, or train people after hours at the usual overtime rate. Supervisors must have the ultimate word to ensure that the employees are trained to work with the EMR system in a live clinical setting. Naturally, they will need to practice to keep their skills sharp.

Do You Treat Your Patients Like Customers?

March 8, 2009 By Peter Polack Leave a Comment

A consultant once asked me “What is the purpose of your business?”

Have you ever asked yourself this question? Pause a second before you actually answer.

My response to her question was, “Keeping customers satisfied.” And I think that this would apply to you as well – regardless of your specialty.

A colleague of mine didn’t particularly like my answer. “Customers? Don’t you mean ‘patients’?”

Now, perhaps if you are in an academic environment where all of your patients are by referral only, your schedule is always full, and your bedside manner has no bearing on your practice…perhaps then your patients are merely patients.

But, for the rest of us, patients are more than just patients. They are also customers. And like the customers of any other type of business – retail, restaurant, service, etc. – they can take their business elsewhere, if they’re not satisfied with your business.

Patients have a certain expectation when they go to see a doctor, but it is their experience with that doctor which determines whether or not they will continue as a patient. Ira Blumenthal , an expert on personal branding, describes this in a formula

PROMISE + EXPERIENCE = RELATIONSHIP

Have you thought about what your patients experience when they come to your practice?

Shag carpet and wood paneling from the 1970s? A rude, inattentive front desk person? Extremely long waits before seeing the doctor? By the way, these are what John Pinto, a practice management consultant, refers to as ‘coffee stains.’ They make a patient have second thoughts about their choice of medical practice.

It is something you must be ever vigilant about. One of our partners pointed out that we had a sign with the name of a doctor who left our practice more than six months ago. He also discovered that one of the waiting rooms didn’t have any current magazines – apparently the subscription service stopped doing an automatic renewal without informing us and nobody caught the mistake.

Business experts say that, in the future, the customer experience is what will separate the winners from the losers. So, take a good look at what a person would experience visiting your practice from the perspective of a patient, especially a new patient. Is there any way this can be improved? You’ll be pleasantly surprised by how your practice can benefit from this exercise.

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