Posts Tagged ‘customer service platinum standard’

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.

Remember in our first blog entry, we told you that one part of our blog is about being true to yourself and taking risks? It’s part of being a successful entrepreneur. Well, some of our setbacks, and successes, are attributable to very personal stories that led us to quit our jobs and pursue the dream of owning our own business.

In 2002, hit with serious health issues, as well as personal loss, we each took a step back to re-examine our lives and reconsider our careers. Barbara, dealing with the stress of ever-increasing responsibilities in a new position and new boss stress, learned she had “pre” breast cancer. After a painful stereotactic breast biopsy, surgery and several months’ regimen of Tamoxifin, she was miserable. Severe hot flashes, depression, anxiety and loss of concentration – all supported her breast oncologist’s very clear message: If you want to prevent getting breast cancer, you need to remove the major stressor in your life. When leaving her doctor’s office one day, her husband turned to her and said, “Barb, you make a great salary, but no job is worth your life. I think it’s time you start your own business.” That was seven years ago, and Barbara has had no further episode.

Around the same time, Crystal’s right leg began swelling to the point she could barely walk, plus she was having chest pain and difficulty breathing. Unknown to her, a life-threatening deep vein thrombosis and pulmonary embolism was brewing. Told there was a very real possibility she would not survive more than 48 hours, she was hospitalized for a week, but all she could think of was relieving the excruciating pain. Both sons were called to her side, one flown in by naval aircraft carrier. When released, instead of resuming her customary healthy lifestyle, she went to months of doctor’s appointments, strictly monitored Coumadin levels, and dealt with chronic leg swelling. So when her younger brother, dying of lung cancer, told her that “people who don’t take risks, don’t have shit!” she listened.

Very scary incidences paired with heartfelt advice from loved ones. What more catalyst did we need? So in March 2003, Derry, Nolan & Associates, Healthcare Medical Practice Consulting Services, became a reality. We’ve never looked back.

Today, our client list includes Oncology, Cardiology, Multi-specialty, Family Practice, and Plastic Surgery Clinics, as well as Ambulatory Surgery Centers. We use a structured, consultative approach to eliminate waste, help clients become more profitable, more flexible in scheduling, and most importantly, happy in their daily work. Knowing how invaluable family time is, we help providers get home at a reasonable hour – that’s much more important than dictation or paperwork. Sometimes (one of our favorite roles) we act as healthcare interim executives and help healthcare organizations as they recruit for a permanent replacement.

In seven years of healthcare medical practice consulting, we learned to cherish our freedom to be creative, to laugh, to mentor others, and to help ensure our clients have the right people, doing the right work, in the right amount of time. We also learned – and take this to heart – never settle for less than your full potential!

Next time…our approach to marketing and how we launched Derry, Nolan & Associates!

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.

DNA Snippet
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.

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.

DNA Snippet
“Achievement is largely the product of steadily raising one’s level of aspiration and expectation.” —Jack Nicklaus

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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?

DNA Snippet

“Measure to improve, not to impress.” — Fred Lee, author

Visit derrynolan.com to learn more about our medical practice consulting services.

Other consumer-dependent businesses, such as retail, hotels and airlines, drive loyalty through courtesy (or they could and should) but how does a medical practice do so? The same way, with a healthy dose of empathy and compassion to acknowledge people’s feelings. A medical practice that wants to invite patient loyalty must have staff that understands those values and puts them into daily practice.

Making courtesy and service excellence the drivers for your medical practice means you place those values in line with what patients indicate are the key drivers of their satisfaction and loyalty. As in the old corollary where when everything goes right, no one mentions it, in healthcare, no one notices a safe experience. Only when things do not seem safe, or “right” do patients notice. And patients do notice when processes are broken and staff are unhappy. It’s revealed through the service, or lack thereof.

Think about it: No organization ever became a great service organization with managers who place service and courtesy at the bottom of the priority list. There is no such thing as a sacred department or an untouchable staff member. If you want to attract and retain patients, you need to attract and retain the best and brightest staff for your medical practice.

Too, if the value of a happy customer (patient) is an invisible number – because how can you put a number on loyalty – then so is improved employee morale, as well as the subsequent productivity, that comes from cooperation and process improvement. There are two frequent barriers to service excellence:

1. Lack of communication between departments (the right hand doesn’t know what the left is doing)
2. Lack of cross-functional teamwork (the absence of one person halts an entire process because no one else understands how they contribute)

Both of these barriers lead to frustration and broken processes, and are often revealed not only in the bottom line, but also in employee attitude. If courtesy is in short supply within your medical practice, it’s a sign of a larger issue and should be explored more deeply.

Also, take notice of how all employees interact with each other, as well as with patients. Common courtesy shouldn’t be uncommon – “Please,” “Thank you,” “If you don’t mind” – all go a long way toward smoothing waters and soothing ruffled feelings. Management and physicians are not above the fray and should set the example to emphasize its importance.

Remember: People do not do what their organizations expect; they do what their managers pay attention to!

DNA Snippet
“Life is not so short but there is always time for courtesy.” — Ralph Waldo Emerson

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