Posts Tagged ‘medical practice consulting’

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.

Physicians are feeling the pain and frustration of lowering Medicare reimbursements, increased malpractice insurance costs, new patient influx on the decrease, and rising overhead. In the meantime, physician compensation is lower. And by the way, the staff would like annual raises. It’s enough to drive physicians and their medical practices nuts!

But, there is a method to relieve those frustrations, as the case study synopsis below shows.

Medical Practice Efficiency: Case Study
We recently completed a long-term engagement with a multi-specialty medical practice. Their situation will probably sound familiar to many of you:

• Multiple service delivery locations – some doing well, some not so much
• Flat revenue vs. climbing expenses (rent, staff, lab, inventory)

Their goals (ambitious, but do-able) were to:

1. Reduce Costs
2. Increase Revenues
3. Increase Efficiency
4. Improve Patient Satisfaction
5. Improve Staff Satisfaction

We began with a medical practice operational and financial assessment, to measure cost structures, service lines, governance and related operations. From there, we were able to implement process improvements that led to millions – yes, millions of dollars in savings.

Waste can kill a medical practice – just look at our overall healthcare system inefficiencies:

• Paper-based systems accounts for 6% of annual overspending
• Administrative inefficiency and redundant paperwork accounts for 18% of healthcare waste
• Billing and administration take up one-quarter of the average US hospital budget
• US doctors spend nearly 8 hours per week on paperwork and employ 1.66 clerical workers per doctor*

Approach and Results
Our approach with the multi-specialty practice was to eliminate non-value added work to achieve better patient, provider and staff satisfaction while increasing revenue opportunities. In other words, implement our mantra: “have the right people doing the right work in the right amount of time for the right pay.”

Using Lean principles (and MGMA cost data benchmarks), we benchmarked costs, redesigned processes, helped with organizational restructure (including executive leadership changes) and implemented new policies. You can find details in the presentation on our website’s media section, but the final results were:

• $3.8 million saved in expenses!
• Increased physician compensation
• Increased lab and imaging profitability
• Improved morale

We’re proud to report that the organization has sustained the improvement gains. Plus, they continue to benchmark and raise the bar with ongoing waste reduction efforts!

Snippet:
“Efficiency is integral to a more cost effective, productive medical practice.” — Barbara Derry & Crystal Nolan

Download the presentation that inspired this blog.

*healthcare inefficiency statistics taken from a report by Robert Kelley, vice president of healthcare analytics at Thomson Reuters.

Marketing is one of the biggest challenges a budding entrepreneur faces. One of the first rules is to make sure everyone you know is aware of what you’re doing. So when we began Derry, Nolan & Associates Medical Practice Consulting Services in 2003, our first step was to tell everyone we knew in the healthcare and medical field. After years in healthcare and being members of professional associations such as the Washington State Medical Group Managers Association (WSMGMA), that added up to a lot of breakfasts, lunches and dinners (Crystal gained 12 pounds)!

Next, realizing that a physician or medical practice group would likely contact their attorney or accountant if they were having financial issues or needed temporary practice management, we began visiting area firms. We set out to “wow” them with our LEAN training, our years of experience and of course, our bubbly personalities! Barbara went kicking and screaming – she did not like talking about herself. Crystal, being gregarious and a natural marketer, pulled her along.

Three months later, the phone began ringing and hasn’t stopped yet. Sure, there are days of no calls and we don’t land every prospective client, but we’re established and proven as a healthcare medical practice consulting firm. In fact, Derry, Nolan & Associates’ results-driven reputation is known in not only Washington, but also Oregon, Alaska and Montana.

Our marketing efforts continue to evolve with the times. We advertise our medical practice consulting services on industry-related websites, such as WSMGMA and Pierce County Medical Association’s Physician Directory. We present educational seminars at specialty medical practice and industry conferences. We write and publish many articles in medical journals such as King County Medical Society’s The Bulletin and the multi-state healthcare publication, Washington Healthcare News.

Most recently, we took the deep dive into social media with this blog. Plus you can find us on Facebook and follow us on Twitter!

That said, the best advertising remains word-of-mouth, for which we are very grateful to our many clients and colleagues who consistently recommend us to others!

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“Nobody becomes visible or in-demand by keeping quiet.” — Crystal Nolan

Get free consulting! Derry, Nolan & Associates’ offers a free, one-hour initial healthcare medical practice consultation.

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.

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:

1. Identify the problem – do you want to lower overhead? Increase collections?
2. Determine areas for attention – staffing ratios, 120-day A/R
3. Obtain buy-in from decision-makers
4. Know how you do things now, so you know what needs to change/improve
5. Compare to peer groups
6. Gather accurate data
7. Communicate the improvement action plan
8. 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.

DNA Snippet
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.

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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Things are changing in 2010 and our Oncology coding expert, Derry, Nolan & Associates’ medical practice consultant Gwen Davis, CPC, put together a few tips for our Oncology medical practice clients. It’s a good Evaluation and Management coding guidelines hotlist, so read on. Then, see today’s DNA Snippet for resources regarding Medicare Consults in 2010.

Manage Your Documentation (think EMR, Fee Tickets, MAR, Flowsheets & Coding)

• Keep updated tools and databases current
• Provide ongoing education to billing as well as clinical staff
• Hire certified coders and ensure regular interactions with physicians

Time-Based Billing Accuracy
Routinely, Oncologists have intense, sensitive “Life and Death” counseling sessions with patients and family members. For correct time-based billing, remember the following:

• More than 50% of the time you’re with a patient must be spent on counseling or coordination of care
• Face to face time counts, ancillary service provider time doesn’t – such as when a nurse is drawing blood. Also, should you leave Patient A to go check on Patient B and then return to Patient A, the time out-of-room does not count as Patient A time.
• Document clearly the time you spent and what was discussed, ensuring it is plausible and accounts for time claimed. No “cloning” from a previous patient or simple pasting of a generic statement about drugs and side effects, or using a blanket “spent 30 minutes counseling patient” statement.
  Suitable Documentation Example: Patient was here for 50 minutes; 30 minutes consisted of face-to-face counseling on end of life issues regarding his current diagnosis X, treatment options X, and side effects. Additional counseling discussing lifestyle changes (hospice, long term care) also took place.

Oncology Reimbursement Recommendations
Gwen mentions the importance of documentation as related to Oncology reimbursement and its associated regulations, “I routinely navigate complex regulations regarding expensive chemotherapy treatments. Right now, I’m developing tools that will help Oncology offices with the 2010 RAC and OIG regulations.” (Thanks, Gwen!) Her five quick recommendations are:

1. Know current FDA Indications (use the compendia!)
2. Document when you are going Off Label
3. Know current billing requirements
4. Watch those HCPCS Units
5. And finally, let your computer work for you. Flag your system to catch medically unlikely charges and work these audits prior to submitting claims. It will save time, money and headaches!

Understanding and Following Incident-to Requirements
This “last but not least” recommendation regarding documentation is about Incident-to criteria. Be sure to identify who rendered the service and that the direct supervision requirement was met. Show the physician’s initiation and continued involvement in the treatment, as well as showing that the services are reasonable and necessary. And be sure to show that the services are within the scope of practice for the non-physician practitioner.

Remember, correct documentation is the key to successful reimbursement!

DNA Snippet
Visit the Practice Resource Center at www.wsma.org for helpful guidelines to navigating Medicare Consults in 2010. Plus, the WSMA’s Coding Hotline gives great guidance on CPT, ICD-9 and HCPCS coding. Just call Michelle Lott, CPC at 1-800-552-0612.

As we’ve discussed, empathy is an integral part of customer (and patient) service. In fact, it’s critical for effective anger management. When we imagine ourselves in the other person’s situation, there’s an automatic shift in attitude, because we lower our own defenses. Companies who train employees to use empathy effectively win repeat customers.

Take Disney, for example. The company’s customer service attitude is explored in “If Disney Ran your Hospital: 91/2 Things You’d Do Differently,” by Fred Lee. Lee points to a process Disney employees use called L.A.S.T – Listen, Apologize, Solve the problem, Thank the person – as an example of effectively used empathy. Apologizing with empathy – “I wouldn’t like that either” or “If that happened to me, I would be upset too” – works. Rote, insincere apologies do not.

The same holds true in a medical practice. When you express empathy, you show acceptance of the patient’s feelings, you do not necessarily agree with how they express them. Empathetic phrasings like the below are examples:

“I hear what you’re saying”
“I know what you mean”
“I don’t blame you”
“I can understand that you…”

As part of the empathetic response, try re-framing, helping the patient change their point of view by sharing the benefits of the situation with them. For instance:

Patient: “Why do I have to drink this contrast; it’s tastes terrible!”
You: “I agree it doesn’t taste good. We have several flavors that might make it more palatable to you. Unfortunately, the contrast is necessary for accurate results.”

Selective agreement is another defusing skill. It allows you to agree in part with what the patient is saying and works well if they’re very angry and seem to be taking it out on you. It’s also a helpful tool when you feel yourself beginning to react negatively to the patient’s word or tone. Look for something you can agree with, even if it’s a very small part of what’s being said. Also, for selective agreement to work, remember to use a calm, quiet tone. Perhaps begin with:

“It does seem that way”
“I see your point”
“It’s tough to argue with that”

Empathy is appropriate for responding to frustration, fear or pain. The flip side is that you do not want to use empathy if the situation is out of control, with the patient attacking you, your team or your medical organization (more on this in a later post).

DNA Snippet
“When you choose to be pleasant and positive in the way you treat others, you have also chosen, in most cases, how you are going to be treated by others.” — Zig Ziglar

Medical practice staff juggle many responsibilities. Hectic days breed harassed and flustered employees, many of whom simply don’t have all the answers to patient questions. That’s when it’s easy for patience with the patients to slip.

The other side of the coin is policy. Many times, policy and procedures are set up without providing real life scenarios from which medical practice staff can draw. The simple solution is to be sure all employees have a good knowledge of not only policy and procedure, but also sample responses to tense or difficult situations.

There are all-too-common words to avoid that can kill patient loyalty and create unproductive interactions. But never fear, we’ve given you better words to use that can kindle patient loyalty. These power words and phrases let staff say, “Yes,” offer options, create confidence, get information, and be spontaneous and creative.

Notice the alternative phrasings of “helpful” invite cooperation, automatically placing staff in a positive, rather than adversarial, position.

unhelpful: “I don’t know.”
helpful: “I’m not sure I have the answer to that, but I can find out for you quickly.” or
“That’s a good question; let me get the answer for you.”

unhelpful: “That’s not my job.”
helpful: “Let me see what I can do to solve this.” or
“Let me get the expert for you!”

unhelpful: “We can’t do that” or “I don’t make the rules” or “It’s not our policy”
helpful: “I’m so sorry. I’m unable to because…” (give an explanation, not an excuse) or
“Well, you know what we could do.” or
“I wish I could do exactly that for you. Let’s see what we can work out instead.”

unhelpful: “It isn’t my fault.”
helpful: “That’s unfortunate. Let’s see how we can fix this.”

unhelpful: “The doctor is busy.”
helpful: “I’m so sorry. The doctor is with another patient right now, but I know this is something he’d want to know about. May I ask the nurse to help you in the meantime?”

unhelpful: “What’s your problem?”
helpful: “Why don’t you tell me about the difficulty you’re having.”

unhelpful: “I want you to…”
helpful: “Let me help you (do, get to) so we can figure this out.” or
“What would help us get this moving is if we could…”

Practice the sayings. Come up with ones that fit your particular medical practice and the situations your patients face. Practice some more. If you need help, give us a call! There’s a free one-hour consultation as part of every Derry, Nolan engagement.

DNA Snippet

“To my customer. I may not have the answer, but I’ll find it. I may not have the time, but I’ll make it.” — Unknown