Archive for July, 2010

Patient care and the bottom line aren’t so far apart in a medical organization – be it physician practice, specialty clinic or hospital. In this instance, when a multi-provider Pediatric Oncology and Hematology Clinic engaged us, improvements within workflow and patient flow, plus (re)training in coding and documentation practices, meant the medical practice could enjoy happier patients and increased revenue. The clinic’s goals centered on enhancing their young patients’ clinic time and optimizing processes to increase revenue. We conducted an analysis and formulated a clinic improvement with active participation from both staff and leadership, focusing on:

• Patient flow and workflow processes
• Coding and documentation practices
• Staff satisfaction and communication needs

Phase I
Through chart audits and facilitated staff work sessions, we documented current processes and gathered clinic team input. Additionally, Derry, Nolan developed documentation and clinical templates to support coding best practices, then trained clinic staff on use.

Phase II
Our aim:

• Decrease patient wait time
• Decrease patient’s overall length of stay
• Increase staff satisfaction

The action plan continued the teamwork sessions, which revealed where new processes would provide the most benefit. Derry, Nolan developed clinic workflow recommendations that furthered a “Patient-driven Model” for optimal patient access. Team functions re-aligned to support the model, and re-arranged workspace promoted use of the newly implemented workflow.

A daily communication forum ensured the clinic team better anticipated patient needs and prioritized accordingly. Additionally, the newly developed Lead RN role was integral in implementing the changed processes, keeping communication channels open and upholding established standards within the nursing team. Physicians used compressed schedules to maximize both clinic time and patient “face time.”

Project Results

• Improved revenue by 30% per year
• Increased patient encounters/productivity up to 3 visits per day
• Decreased patient wait time by an average of 28 minutes

“Derry, Nolan & Associates helped us modify patient flow, scheduling efficiency, coding capture and staff members’ roles, improving both our care and our bottom line.”
Dr. Ronald Louie, Medical Director
Mary Bridge Children’s Pediatric Hematology/Oncology Clinic

Contact Derry, Nolan & Associates to learn how we can help your medical practice improve satisfaction metrics and the bottom line.

Physician practices are all-too-often the target of embezzlement. Physicians’ own traits of compassion, humanitarianism and a desire to help patients, are exploited, causing crippling of financial and morale status within the practice.

During our long career in healthcare, as clinic managers, administrators, CEOs and medical practice consultants, we’ve borne witness to the emotional and financial tragedy embezzlement takes on physicians, their staff and their medical practice’s well-being. It never fails to appall us that those who propagate such crimes are frequently the very individuals the physician entrusts with decision-making authority. Practice managers are, sadly, often major offenders – because a successful embezzler needs access to funds, such as the checkbook, patient accounts and cash. Sometimes it’s the receptionist, handling co-pays, or billing personnel, with the ability to siphon monies easily, who are the culprits.

Embezzlement isn’t always dramatic – like the administrator who lifted original business checks and wrote on duplicate copies names of the clinic’s larger medical vendors, eventually taking nearly $300,000, or the manager who fabricated a night-time employee to “pay.” Because physicians are often (and understandably) more focused on patient care than the business side of medical practice, tales like these are common.

Top 10 Embezzlement Warning Signs

1. Missing inventory (office and medical supplies, such as eyeglass frames)
2. Changes in practice revenues
3. Increased refunds, write-offs and adjustments
4. Checks that lack supporting documentation
5. Unusual medical practice staff relationships with vendors (kickbacks)
6. Fluctuations in the general ledger expense accounts
7. Increased patient complaints about billing issues
8. Increased practice clerical errors
9. Unusual employee behavior (suddenly showing signs of living beyond their means, not taking vacations, taking work home frequently)
10. Questionable purchases (petty cash variances, items unaccounted for, personal expenses found on company credit cards)

Prevent Overwhelming Loss – Bonding & Backgrounds

To help protect your physicians medical practice, consider bonding, a type of insurance that reimburses medical offices for losses. Health plans and other payers follow this practice already, due to a federal law that requires bonding of all staff with financial responsibilities. Unfortunately, small practices may not think to take this simple precaution, because the physicians may feel they “know” their employees too well and that it would be indicative of mistrust. But it’s just good business. Also, be certain to have fraud insurance.

Always conduct a thorough reference and criminal background check on any potential new medical practice employees. We often recruit for billing management and practice management during medical practice consulting engagements that involve interim practice management, and this common-sense step is standard operating procedure for us. Whether working with a medical recruiter or doing it yourself, take the time for this important follow-through. When you speak to a potential staff member’s former employer, pay close attention to what they don’t say as well as what they say. For instance, ask if they’d consider re-hiring the person if the opportunity arose; if they hedge…well.

Physicians want to focus on patient care, and the administrative headaches often seem as though they take time away from that. So think of it this way: The well-being of your medical practice is important to the continued care, and well-being, of your patients. If the business side is taken care of, then through it, you will be able to provide patient care for years to come!

For Further Reading
Minimizing the Risk of Financial Fraud
Busting Embezzlers

Medical practices: For more information about good audit practices, medical practice staff recruiting, and avoiding embezzlement, contact Derry, Nolan & Associates.