Posts Tagged ‘asc development’

The WASCA conference presentation was one that Derry, Nolan & Associates has been looking forward to for some time. We knew the material needed to be highly relevant to current compliance issues facing Washington State ASCs. Cathy Strauss, our ASC Specialist (and presenter!), has implemented ASC Infection Control Programs and felt strongly that the topic would be near and dear to many WASCA Conference participants.

As you continue to move forward to align your ASC with the 2009 updated CMS Guidelines, consider the experience and resources needed to properly implement the various ASC programs. Compliance makes everyone's life easier - and it certainly helps create a healthy, supportive ASC environment for patients, staff and physicians.

We hope those of you who missed the WASCA Conference, as well as those who attended, will download Cathy's WASCA presentation from our Media page. There are also helpful ASC handouts included on the page that may be useful as you begin to revamp your ASC's Infection Prevention and Control program.

Contact Derry, Nolan & Associates for assistance developing and implementing any of your ASC’s programs.

Patient Rights. We all have them. But what do they entail? When we walk into an ASC, what notifications should we receive?

Patient Rights is perhaps the most neglected of the CMS Guidelines, unintentionally. These rights state the responsibilities that ASC staff has towards patients and their families during care in their facility. A patient has the Right to Treatment with respect, the Right for an Informed Consent, the Right to have an Advance Medical Directive, the Right for Privacy and Confidentiality. Plus, the ASC must disclose if the physician has a financial interest or ownership in the ASC. All rights must be provided before the date of service. ASCs need to post patient rights in the facility and gain confirmation, by signature, from the patient that all information was given prior to the service-date.

Use these suggestions to help your ASC avoid overlooking and under-documenting the Patient Rights process:

• Implement a simple form that lists the Patient Rights requirements, and obtain the patient’s signature. Some ASCs include the opportunity for the patient to listen to the rights and notifications via a recording, to assure understanding. Post the recording on your website, too, under the Patient Rights section!
• Routinely ask the patient if they understand their rights and answer any questions promptly.
• Contact the Washington State Medical Association for Advance Directive informational brochures.
• Create small packets covering the Notice of Rights, Financial Disclosure and Advance Directive to mail to the patient prior to surgery. Include signature pages and collect them the day of surgery.
• Reiterate “any questions” on the day of surgery, maybe even include one final sign off!

Our Washington State ASCs have a choice. Either do nothing and risk everything ASCs have worked so hard to achieve. Or be proactive; recognize that we have fallen behind and need to get up to speed on regulations ASAP. The do-nothing approach simply isn’t feasible for any ASC committed to patient safety and quality. Frequent DOH visits affect morale and potentially the ASC’s reputation. The pro-active approach means a serious look in the mirror – assessments and very likely, corrective activities and training. But in the long run, your ASC, your staff and your patients win.

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Is your ASC Compliant with CMS? Contact Derry, Nolan & Associates; we can get you there.

Those three issues popped to the top for ASCs during the CMS/DOH surveys. Today, let’s look at Infection Control and Quality Assessment & Performance Improvement.

Is your ASC Infection Control program in compliance? Your ASC needs to go beyond having solid Infection Control policies and practices in place, you also need an IC officer – a licensed healthcare professional, such as a RN. An effective IC program will replicate guidelines from a nationally recognized one, such as APIC regarding hand hygiene, injection practices, sterilization guidelines and monitoring of environmental and infection control practices. Ongoing training is key to instilling good hygiene habits. Display hand washing posters, wash hands before and after meeting with a patient and use hospital approved germicide cleaners.

Have a program in place? Review the survey to see how well you’d do!

Quality Assessment and Performance Improvement programs require an ongoing effort of data collection, observation, documentation, reporting trends, findings and outcomes to the Governing Body Meetings – all in an ongoing effort to improve patient care services and the quality of that care. Implementing an ASC QAPI program takes time, and for it to work, vigilance. Begin with a specific topic and work through to the end of the current process, note issues, safety concerns, how often they occur, and how often they are in compliance (or not) with the ASC’s policy. Conduct a policy review meeting with staff to report findings and concerns, as well as train (and re-train). Then conduct regular follow-ups. Document the same process, and hold a Review meeting.

The data tells all! Have issues improved, or not?

Next time, Patient Rights – the often unintentionally neglected process. How does yours measure up?

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Is your ASC compliant with CMS? We can get you there!

Catching up or revisiting those updated CMS Guidelines? Great! Now let’s move on to Quality Communication. If you want your team to be the “most likely to succeed” in achieving a successful CMS/DOH survey, you need a firm foundation – which begins with Quality Communication. Only then do you begin to build the high performance team to take you into the future. Plus, communication excellence is critical to unlocking team performance and quality outcomes.

Ask yourself: “Does my ASC leadership team demonstrate these attributes?”

• Thoroughly understands principles and rationale of the CMS guidelines.
• Provides ongoing constructive communication with ASC staff.
• Conducts frequent, relevant staff meetings that discuss the quality improvement (QI) process and successes.
• Holds quarterly meetings that cover QI, infection control, peer review, fire drills, incident reports, sharps injury log, etc.
• Elicits ongoing feedback from the ASC team.

If your ASC Leadership lacks these attributes, expect communication barriers. Communication barriers prevent achievement of quality communication and successful outcomes. Quality Communication begins with the ASC Governing Body, particularly the medical director, administrator, nursing supervisor and physicians, who must take the time to read and thoroughly understand – and here’s where we continue to beat the drum – the updated CMS Guidelines.

It’s a lot to take in, and it often takes assistance to interpret. Don’t hesitate to ask for help – either from DOH, knowledgeable colleagues or ASC consultants who have experience working with the guidelines. After all, your ASC’s success and your patient’s safety and satisfaction rely on it.

Next, we’ll run through the Top 3 – Infection Control, Patient Rights & Quality Assessment and Performance Improvement.

Contact us if you need help getting in compliance with the updated CMS Guidelines. We can set you on your way to a successful survey!

ASCs Then & Now
Those of us who began ASCs under the previous regulations often saw ourselves as standing out from the pack. We broke away from a traditional hospital environment to provide better patient access and quality control over services provided and to use physician time more effectively. We took pride in our facilities and accomplishments. So it’s no wonder we were dismayed by recent survey results, which reflected an apparent lack of understanding of the 2009 guidelines.

Back when most ASCs received their CMS certification, the guidelines were around 44 pages. In 2009, that grew to 167 pages – a 73.6% content increase. And where the old guidelines gave us some leeway in interpretation – not so much in the new ones. They’re specific and detail-oriented. The result? Knowledge gaps that need to be filled – quickly.

Let’s look at where we go from here. To help your ASC address some of the key attributes necessary to achieve a successful DOH Medicare Survey, we’ve put together some key points. The state DOH (conducting surveys on CMS’ behalf) is understandably concerned with results to-date. We’ve taken 3 top areas to focus on (based on those results & DOH feedback ), as it’s apparent ASCs need more education and training in these areas to meet CMS guidelines:

Top 3 Areas for Improvement

1. Infection Control
2. Patient Rights
3. Quality Assessment & Performance Improvements

Before we dive into any of those , we’ll need to close the knowledge gap. So next blog, we’ll start with Quality Communication. As we’ve stated before – it lays the foundation for high performance teams. And those types of teams are the most likely to achieve a successful CMS/DOH survey.

In the meantime, if you’d like to get a head start on closing that knowledge gap, read through the updated CMS Guidelines.

From one inspiring book to another! Finzel’s Top Ten Mistakes Leaders Make was a great foundation for a series of blogs. Now we move to the subject of women inspiring and advising women, with Mary E. Stutts’ The Missing Mentor. Mary Stutts had an impressive healthcare background, with experience at Kaiser Permanente and then Bayer Pharmaceuticals. Having grown her department from 16 employees (and a $14M budget) to 43 (and $100M budget), Mary was ready for the next career leadership level.

The one thing missing? A mentor to help her navigate new cultures. Then she met two very smart and powerful women at Genentech who became friends and nurturers. Since then, Mary has risen to senior positions at UnitedHealth Group, and Elan, a global drug and biotechnology company looking for neurological therapies for diseases like Alzheimer’s, Parkinson’s and Multiple Sclerosis. She uses her own example and the example of other women throughout her book to help readers “thrive on the concepts of life-long learning and total self-reinvention.” We not only applaud her, but add our own stories that we hope help inspire you to become the person you dream of being—something we touted in our very first blog back in March.

The Missing Mentor is about women helping women. Mary Stutts’ stories are about her professional journey, along which she asked herself many questions. You may be asking yourself the same ones. We certainly recognized many we asked ourselves when launching Derry, Nolan & Associates nearly eight years ago:

• Can we really do this?
• What if we fail?
• Are we too small?

Today – there are still questions, but wow – have they changed in tone! Now it’s:

• What’s our next move?
• How can we help smaller clinics take advantage of healthcare reform?
• How do we best transition Derry, Nolan & Associates to new talent when we’re ready to retire?

We hope you enjoy this next series of blogs, as we share Mary’s stories, and our own, of mentorship. Women who crave advice from other women in leadership and ownership positions will discover some jewels over the course of the next few weeks.

Our last blog entry talked about how healthcare needs innovative, flexible leadership. Leadership that recognizes the need for eliminating waste in processes, looks for revenue increasing opportunities and has marketing acumen to promote their service and care providers. In this series, you’ll hear about our own stories (that we hope help you!) with topics like: “Confidence is Power – Using it or Losing It,” “Managing Power,” “Work and Life – Finding Your Balance!” and “Connecting and Achieving.”

And guys, you too will find “golden nuggets” in these women-centered stories. The goal is to inspire you – help you further your goals for professional success, no matter what forms they may take!

You think you were perfectly clear: "Do XYZ." Your employees hear: "Do ZXY." Communication chaos is a common mistake, according to revered leadership consultant Hans Finzel. I’ve been the unsuspecting, unintentional root of confused communication; it’s easy to do.

I was managing a medical clinic years ago, and a theft occurred. To be sure (I thought) that the message was clear and consistent, I called the front desk staff together to announce what had been reported. I assured them of my belief that they were innocent, that the perpetrator was none of them.

Imagine my surprise when I learned that at least one employee felt the front desk was being singled out! My sincere attempt at assurance backfired. (The janitor was the thief, by the way, as I originally suspected.)

If only I’d known Finzel’s rules of communication:

• Never assume that anyone knows anything
• The bigger the group, the more attention must be given to communication—(I should have called the whole staff together)
• Communication must be the passionate obsession of effective leadership
• When left in the dark, people tend to dream up wild rumors!

If you’re an executive, effective, sensitive communication is essential. Everything you communicate is weighed and analyzed. If not clear, expect assumptions and extrapolations, most erroneous and possibly harmful to the organization, or at the very least, non-productive.

Effective Communication Practices

Meetings, faxes, newsletters, emails and reports – all have the potential to improve understanding and strengthen your leadership, or create communication chaos. To avoid it, try the following:

• Use organizational charts to ensure proper communication channels – who reports to whom and who is in charge of what
• Meet regularly with your staff; allow and encourage tough, direct questions
• Use e-mail to keep communication fresh and up-to-date (faxes, too)
• Keep memos brief and to-the-point
• Include one page summaries on lengthy reports
• Use meeting time effectively and efficiently (read Death by Meeting by Patrick Lencioni – excellent “how to”)

— Crystal Nolan, FACMPE

Snippet
“Information is giving out; communication is getting through.” – Sydney J. Harris, Publishers-Hall Syndicate

Derry, Nolan & Associates’ pairs our deep healthcare experience with personalized evaluations to give your healthcare organization or medical practice the medical practice consulting services you need.

Last blog, we explored The Top-Down Attitude, and Putting Paperwork before People-work, two of Hans Finzel’s top ten mistakes. The respected leadership consultant hits the nail on the head time and again. Consider the next two:

The Absence of Affirmation

Research proves it over and again: affirmation motivates people more than financial incentives. Finzel reiterates it in his book. Back in college, a basic business class touted this fact, and I’ve never forgotten it, making affirmation part of my management method with staff.

The simplest words can make or break a situation. Just the other day, a client called to share the contents of an early morning email – a new employee quit. The employee shared that while she tried her best during the first two weeks of training, another employee made her feel unworthy. So much so that she quit without having another job – quite a risk in today’s employment market, as well as a strong statement on the situation.

Her actions drive home the point that people need encouragement the most at the outset of a new job or role. If only the other employee had instead chosen to say, “Don’t get discouraged, I know it’s a lot, it will get easier.” Or even a simple “Thanks for being part of the team.” Maybe the email wouldn’t exist.

Who really loses in this situation? Yes, the employee who quit loses. But the practice loses as well – recruiting, hiring and onboarding are time consuming, costly endeavors. Plus, the employee who quit may share her experience with others. If the critical employee is not counseled, expect a repeat performance. A few simple yet powerful practices need to become part of that person’s daily interactions:

• Be motivated to look for the good in others and in all situations
• When you find the good, point it out
• Thank people publicly and sincerely
• Remember everyone thrives on affirmation and praise

De-motivating the Mavericks

Maverick: “an independent individual who does not go along with a group or party.” Creative types who often have a hard time fitting into rigid bureaucracies – mavericks need the freedom to fly with ideas. Older organizations that have less room for the gifted, and those that focus too strenuously on policy, procedure and conformity, often squeeze out some of their most gifted people. This is tragic, because the “messy” maverick is essential to the creative energy of an organization – and only creative companies thrive.

If a “leader” has used these phrases – often used to put mavericks “in their place” – on you, you may just be a maverick!

• “That’s impossible”
• “I wish it were that easy”
• “How dare you suggest what we’re doing is wrong?”
• “That’s too radical a change for us”

The easiest way to kill a maverick is to send their idea(s) to committee. That’s a sure-fire method of stifling your brightest stars – endless committees, procedures and paperwork. In fact, those are the primary reasons Barbara and I struck out on our own, founding Derry, Nolan and leaving the world of corporate medicine behind. Two of our favorite comments about committees pretty much sum it up:

• A committee keeps minutes and wastes hours!
• A committee is a collection of individuals who separately do nothing and together decide that nothing can be done.

By Crystal Nolan, MHA, FACMPE

Snippet:
“I’m looking for a lot of men with an infinite capacity for not knowing what can’t be done.” —Henry Ford

Derry, Nolan & Associates’ healthcare and medical practice consultants can help your healthcare organization – medical practice, clinic or integrated healthcare system – with leadership recruitment, interim management, on-boarding and customer service training.

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.