Archive for April, 2010
Want to raise eyebrows? Advise a physician or medical practice that they’ll be paying to update, or implement, their compliance program. As medical practice consultants, we frequently discover that our healthcare and medical consulting clients need to update their compliance program. Here’s an anecdote “from the trenches” that demonstrates how consternation can turn to understanding.
Recently, Barbara Derry presented a proposal to a specialty group. Afterwards, one physician chastised her, feeling that our fees were too high for a coding and documentation audit. She left thinking that DNA wouldn’t win the project. Imagine our surprise when the practice not only hired us for the project, but also added compliance program redesign to the engagement’s scope. To top it off, they paid us in full by year-end!
The Office of Inspector General (OIG) and CMS dictates the guidelines that medical practices and other healthcare organizations must follow related to governance, coding and billing practices, and auditing and monitoring reporting structures. Some providers object, but there is no denying that rampant fraudulent billing occurs nationwide – particularly in the four test states (Florida, California, Texas and New York) of the 2005-2008 Recovery Audit Contractors (RAC) demonstration program. An effective compliance program can help avoid fraudulent billing.
How can you tell if your healthcare organization’s compliance program is effective? Here are common areas that DNA examines:
- Organizational behavior: Is the business philosophy compliance-driven? How is employee awareness and support? Physician compliance? Overall compliance program credibility?
- Compliance Awareness: What is the overall employee awareness of your compliance program? Its policies and activities?
- Oversight and response: What’s the activity level of the compliance officer and management in the regulatory process? Disciplinary consistency? Discovery and investigation? Error documentation? Employee satisfaction?
- Education Program: How many employees are educated, how often, and what are standard attendance percentages?
- Coding and claims accuracy: How well does the practice audit and monitor findings, such as coding and documentation errors, claim errors and claim rejection/denial percentages?
- Coding and claims processes: How many services are un-billable due to poor coding practices? How many claims are processed and properly use charge master and coding/claim technology?
- Corrective action: How usable and accessible are reporting mechanisms? What’s the interaction with carriers and intermediaries? How efficiently are reported concerns resolved?
- Quality Improvement Program: How responsive and adaptive is it to industry and regulatory changes? Does it efficiently distribute information? How is the business and financial success of the practice?
The OIG is very busy, determined to curb fraudulent billing practices and recuperate monies paid incorrectly over the past several years. There are literally hundreds of healthcare providers now under corporate integrity agreements (CIAs) that last five years. If a healthcare organization is under a CIA with the OIG, it means they must closely follow specified methods and activities that ensure they meet statutory and regulatory standards, and report properly. Discover the targeted areas at http://oig.hhs.gov/fraud/cias.asp.
Our advice? Be ready; be in compliance.
The Obama Administration says that it is going to crack down on improper payments made by all government programs, which in 2009 totaled $98 billion according to federal agency estimates. (GovernmentExecutive.com)
For help assessing or updating your medical practice’s compliance program, contact Derry, Nolan & Associates.
Webster’s dictionary says benchmarking is “a standard by which something can be measured or judged.” In a recent post, we mentioned the need to use the right yardstick to measure patient loyalty. Benchmarking is one of the best tools to see how your medical practice stacks up against others in a similar specialty or size.
Blame it on Xerox Corporation – in addition to copiers, they began official benchmarking practices. Now, in addition to corporate America, medical practices, clinics, hospitals, and pretty much any healthcare organization uses benchmarking to compare processes (coding, overhead, staffing ratios, accounts receivable) with others in the same or similar specialty. Using such high performer comparisons helps the medical profession raise the bar for best practices.
Why is it important? Quite simply, benchmarking provides a structured approach to data gathering and analysis. It helps you, in practice/clinic management, to develop the best strategies, and points you in the direction of the best operational decisions, too. Because it quantifies the measures of performance, medical practices are able to truly measure the gap between their own organization and “best practices,” not to mention competitors. Best of all, knowing what you’re up against encourages creative thinking and stimulates innovation.
To benchmark, follow these steps:
- Identify the problem – do you want to lower overhead? Increase collections?
- Determine areas for attention – staffing ratios, 120-day A/R
- Obtain buy-in from decision-makers
- Know how you do things now, so you know what needs to change/improve
- Compare to peer groups
- Gather accurate data
- Communicate the improvement action plan
- Develop dashboard indicators and continuously measure against them!
Start with realistic goals – like reducing patient wait time by 15 minutes or introducing Just-in-Time ordering to reduce overstocked inventory. And benchmark based on factors that relate to cost, quality and timeliness – internal factors. Monitor and re-evaluate at set intervals so Continuous Quality Improvement becomes the culture.
Above all, remember: Benchmarking is not a one-time event but a continuum.
For the complete presentation of “Why Benchmark?” given by Crystal Nolan at the WA-OR MGMA meeting in 2009, visit the Derry, Nolan & Associates website.
You’ve measured loyalty, not just satisfaction, in your medical practice. You have a responsive, patient-service oriented staff. Your practice staff is happier than they’ve ever been; retention is solid. Now what?
In an earlier post, we mentioned how airlines, retail stores and luxury hotels – such as the Ritz-Carlton* – can and should drive loyalty through courtesy, but that healthcare’s differentiator is the use of empathy. Empathy, caring and compassion through acknowledgement of patient’s feelings.
So what can your medical practice learn from a world-class hotel? World-renowned service standards. After all, the Ritz-Carlton and healthcare are similar in the way they both deliver a product/service that the customer wants defect-free, when and how the customer wants it, and through providing genuine care and concern for that customer.
Then there’s benchmarking, also familiar to healthcare organizations, the Ritz-Carlton’s leadership constantly seeks out businesses to benchmark, always looking for the best metrics to ensure that their employees find work meaningful.
Last but not least is staff satisfaction, hugely important to success. Management recognizes that helping employees as they seek to deliver genuine care to guests, or swiftly fix breakdowns in a compassionate manner, gives employees satisfaction (hence, retention and happy customers). How do they help employees? By acknowledging what they learn, data-wise, and sharing it.
- Objectives are manageable and anchored to the company’s core values, always open to refinement.
- Corporate storytelling demonstrates how staff can personally make a difference and deliver “Wow” experiences.
- Leadership and staff view the entire business as a two-way relationship – with mutual accountability.
- Corporate values and financial objectives align, clearly showing how living the values results in business success.
Mutual accountability and transparency works – whether in the luxury hotel business or in your medical practice. Think about how you help your staff deliver genuine care and swiftly fix breakdowns. Do you share good and bad feedback? Look for the best in competitors and measure against it? Live the values you promote at work?
We know that achieving Platinum Level Customer Service is one thing, but that keeping it takes practice. It’s definitely do-able, so persevere! If you need an objective, professional helping hand, Derry, Nolan & Associates is here to help you reach and sustain your customer service goals.
“Achievement is largely the product of steadily raising one’s level of aspiration and expectation.” —Jack Nicklaus
Have you been thinking about a Patient or Employee Survey for your medical practice? Great idea! But be sure you’re measuring what counts and why. Just logging a score of 5 out of 5 isn’t enough.
In If Disney Ran Your Hospital, author Fred Lee points out that competing for the best numbers because there are bonuses tied to their rankings is a recipe for disaster. Why? Because it sends managers the message that a high score is more important than honest feedback. Even if a healthcare organization pushes patients to tell staff how to improve enough to earn the high marks, they’re still not getting the real picture.
What a medical practice or any healthcare-related business needs to know is the percentage of loyal patients who will promote the business. As we’ve said before, meeting expectations isn’t enough – it’s the unique, the special, experience that generates feelings of loyalty.
Yes, world class organizations like Disney count only the “5s” but they don’t make those numbers say anything other than “very satisfied” on a scale that has two other numbers for those who are merely “satisfied.” That’s because they do not want to combine loyal customers with satisfied but not loyal customers – after all, satisfied customers still defect! Instead, Disney genuinely tries to measure loyalty, not satisfaction.
Customer loyalty authority Frederick Reichheld purports to have found the ideal yardstick with which to determine customer and employee loyalty after researching 14 companies across six industries. What do you think it is?
Well, in this brave new world of social media, the answer should come as no surprise – “How would you recommend [our medical practice, our company] to a friend or colleague?” His scale says 10 means “extremely likely” to recommend (Promoter), 5 means neutral and 0 means “not at all likely” (Passive and Detractor ranges).
Simple, intuitive and reliable as a predictor – the personal recommendation. We all want to have Promoters in our corner, right? Plus, frontline managers (practice managers, administrators) gain a clear goal to increase the number of Promoters and reduce Detractors. So when developing that upcoming survey, think “loyalty” not “satisfaction.”
Remember, Facebook, Yelp, RateMDs, PhysicianReports, and a plethora of other free, online sources already let your patients (and employees) speak up – are you ready to listen?
“Measure to improve, not to impress.” — Fred Lee, author
Visit derrynolan.com to learn more about our medical practice consulting services.