Posts Tagged ‘Cardiology Practice Consulting’

During my last two cardiology consulting engagements I have led clinical staff through the major change of a computer conversion, challenged to keep them motivated and forward thinking through the painful process. The terms Norming, Storming and Forming have never been more appropriately used than when to describe the change journey through the labyrinth of emotions when practice workflows utilized for years come to an end!

Norming: Even bad workflows in a medical practice become a workable habit. Kind of like wearing shoes that are just a little too short for you. Insidious workarounds, like a sticky-note to pass important information that shouldn’t be lost, or taking 3 messages for the doctor or medical assistant when one would suffice, become the highly wasteful norm. When the specialty practice’s leadership announces a move from paper charts or outdated clunky technology to a new EMR, initially, people embrace the idea. (Of course, that’s because they don’t realize how long they will endure the chaos!)

Storming: Enthusiasm wanes and frustration mounts when staff is saddled with current work while concurrently learning a new system with the deadline of switchover looming. Status meetings and training sessions cause eyes to glaze over, and commonly heard statements like: “The paper chart took less time to document in” (never mind you can’t find it half the time); “Our old EMR took fewer clicks” (and had less flexibility); “What?! I have to re-enter the patient’s demographics and insurance information?! It’s going to take a lot longer to register a patient” (Management is aware and that’s why most clinics substantially reduce the first month or so of appointments, by as much as 50%).

Forming: Cries of alarm fail to sway management and the new EMR is adopted. Reality: some staff, not up to the challenge of change, will not make the transition. But gains are made and the faster aspects, like more in- depth management and clinical reports, outweigh the initially annoying ones. Tools once manual are now automated. Gains begin to outweigh the losses, become appreciated – particularly when physicians and staff can leave work on time for dinner dates with families and loved ones.

Norming: Many live in the “valley of despair” for 2 to 4 weeks post implementation. Old, comfortable ways seem preferable, despite the extra work. Then, something remarkable occurs. You overhear comments like: “Wow, I didn’t know we could get to that level of detail”; “Check out this short-cut!”; “Did you know if you just press the F5 key you get to…” Six months later, people feel proficient using the new EMR, and six months after that, the entire team is optimizing the new workflows.

Norming returns (without the inefficiencies of the past); medical and line staff are content again. My personal reward? Witnessing team spirit. During both assignments, champions emerged and rallied the team. People exhibited technical and creative skills that had been buried due to manual processes or outdated technology. As a whole, both cardiology organizations are experiencing the reward of less medication errors, providers able to easily share information, as well as having access to data off-site and Meaningful Use dollars becoming available. Those forward-thinking physician groups can now further invest in building customer (patient) service to platinum levels and marketing themselves to payors and patients for financial viability in our highly competitive, ever-changing healthcare market.

2012 was a busy year for us here at Derry, Nolan & Associates, LLC. As Barbara and I begin our 10^th year of business, medical practices nationwide have seen their bottom lines erode due to rising costs and declining reimbursement–oncology and cardiology, in particular.

Over the past year, Barbara has right-sized a local oncology clinic by ensuring that staffing ratios are commensurate with the number of providers and their productivity levels, ensured waste-free administration of high-priced oncology drugs (as well as negotiating better prices), plus she formulated a robust marketing plan that generated many new patients.

I answered a call in mid-September that took me to Texas, where I’ve been the interim manager for a large cardiology practice.  I’ve assisted them through a computer conversion, implemented many process improvements and helped the cardiology providers and staff “adjust” to hospital ownership and the loss of their thirty-year independence.

Once again, we’re proud to say we’ve met the goal of leaving our medical practice clients better off than we found them. And we very much appreciate the trust placed in us to implement the recommendations made. Now both of us have begun a new project where we’ll be assisting a large integrated healthcare system in Seattle. For this new multi-specialty project, we’ll use the Derry, Nolan proven business principles that have always served our clients well.

As we swing into 2013, the general state of the healthcare industry hasn’t changed. Healthcare organizations are challenged to eliminate waste, to ensure that people work smarter and to provide quality services that will now be measured—pay for performance!  To achieve those ends, we suggest that you follow our lead by:

1. Looking at year-end financials for the previous year; it’s a great time to consider how to improve the bottom line in 2013!
2. Scheduling ICD-10 Coding training to assure optimum reimbursement & coding compliance.
3. Reviewing staff functions to assure the right person is doing the right work – and is cross trained!
4. Scheduling privacy & security training – both new workforce and a refresher for current staff.
5. Spot-checking or “secret shopping” customer service – how happy are your patients?
6. Querying referring physicians, too—how happy are they with your services and communications?

Wishing you and yours health and happiness in 2013!

As we mentioned, Cardiology groups face up to 27% in revenue cuts from CMS and Congress in 2013. But have hope! Your cardiology group can counteract those cuts with internal process improvement strategies that help your specialty practice work smarter, not harder!

Six Survival Tips for Cardiology Groups

1. Eliminate manual processes. Achieve maximum Meaningful Use dollars; be sure your staff performs value-added work and optimizes your EMR.*
2. Build interfaces that transfer demographic data post-admission verification at the primary admitting hospital (not from the ER visit). That ensures your system gets correct data.
3. Authorize only appropriate tests (not every single one). Rather than medical office staff becoming bogged down in unnecessary authorization processes instead of revenue-enhancing work like researching denied claims and educating providers on non-covered diagnoses.
4. Cross-train staff. Beside obvious redundancy benefits, respect for your counterpart’s workload increases when you realize the scope of their responsibilities. Teamwork improves.
5. Streamline workflows – starting with the phone! A patient-friendly phone menu that allows the caller to bypass lengthy menus with a “0” or to enter a known extension improves satisfaction. Lines that “hunt” for available staff assure better customer service. Front-desk and clinical huddles each morning and at midday helps anticipate patients who may take more resources, and assures you stay on time.
6. Implement a service recovery plan that acknowledges lengthy patient wait times (>30 minutes) and empowers staff to give coupons to the local coffee shop or eatery along with a sincere apology.

With these simple strategies you not only help defuse effects of the 2013 CMS coding and bundling cuts but also improve patient satisfaction – making them happy marketers on your behalf!

*Resource(s) CMS eHR Tip Sheet

Cardiologists as job seekers? That’s one reaction when reviewing the newly released final 2013 Medicare Physician Fee Schedule. CMS estimates that the rule, which sets payment rates as well as related policies, has an overall -2% impact on cardiovascular medicine. This is piled on top of the 26.5% cut from the Sustainable Growth Rate (SGR) formula and the 2% cut associated with the Budget Control Act of 2011’s sequestration provisions. To be in compliance, cardiology practices will need to quickly absorb the new rules for payment of cardiovascular services:

New Codes & Payment Levels for PCI and Ablation-EP studies

As part of ongoing efforts to evaluate potentially mis-valued services, new CPT codes have been created to report PCI as well as to bundle EP studies with ablation. The physician work RVUs that CMS finalized result in physician work RVU reductions of roughly 20% to the family of PCI codes and roughly 27% to the family of EP/ablation codes. The impact will vary depending on practice patterns. CMS reduced payment for new ablation add-on codes and bundled PCI add-on codes into the base procedures.

Multiple Procedure Payment Reduction

CMS finalized its proposal to expand a multiple procedure payment reduction to cardiovascular services, so that if more than one cardiovascular service is provided on the same day to the same patient, the technical component of the less expensive service is reduced by 25 percent. This reduction does not apply to office visits but applies to most cardiovascular diagnostic and therapeutic services. It also does not apply to services billed under the hospital outpatient prospective payment system.

PQRS and E-prescribing Incentivized

CMS finalized provisions related to the Physician Quality Reporting System (PQRS). Physicians that successfully participate in PQRS in 2013 will receive a 0.5% bonus. They will also avoid a 1.5% penalty in 2015. Similarly for e-prescribing, successful participants will receive a 0.5% bonus for participation in 2013 and avoid a 1.5% reduction in 2014. New hardship exemptions for the Electronic Health Record Incentive Program allow participants to avoid the payment adjustment for e-prescribing, but a request must be filed with CMS first.

Value-Based Modifier

CMS finalized its proposal to begin to adjust payment for quality and cost of care starting with groups of 100 or more professionals in 2015. Because of data collection requirements, this payment adjustment will be based on performance in 2013. Physicians in large groups will have an option to participate in the payment adjustment but must participate in PQRS as a group to avoid being penalized as a low quality provider.

Need to get up-to-date on the latest CMS rules for cardiovascular service? The American College of Cardiology has announced a Cardiovascular Summit from Jan. 10-12, 2013 in Las Vegas – it will feature several sessions related to changes in the final rule. Registration is now open.

Communication is the key to unlock team performance and quality outcomes.

It seems a simple enough concept. In healthcare, everyone seems to be talking to each other – patients to doctors, nurses, staff and providers to each other. Yet, despite all the talking, actual communicating doesn’t always occur.

Communication gaps create service quality gaps. In turn, those service limitations lead to patient and staff dissatisfaction and frustration. The improvement and standardization of certain communication strategies can eliminate the costly wastes resulting from bad communication: inefficiency, ineffective and potentially unsafe care, rework, unintended outcomes and a diminished capacity for team performance.

Remember, healthcare systems deliver services. So, if you’re going to measure the quality of healthcare, then you have to go beyond clinical measures, incorporating patient’s perceptions and experiences. Taking this into account, we’ll add two dimensions to the usual five for measuring service quality:

1. Tangibles
2. Reliability
3. Responsiveness
4. Assurance
5. Empathy PLUS
6. Accessibility
7. Communication

Group approaches to the complex issues in healthcare help build cohesiveness. Working as a team allows for creativity, sharing expertise, developing new skills, increasing personal autonomy and influencing decisions. Bonus benefits: job satisfaction and communication improves, mutual respect grows.

If your healthcare organization can build high performance teams, you will naturally evolve to improved quality and outcomes.

Before we can work on the five key areas with 65 quality indicators of an ACO, we must improve our listening skills and really communicate!

by Loy Maslen, RN, MSN, NNP-BC, CPUM

“The single biggest problem in communication is the illusion that it has taken place.” – George Bernard Shaw

We live in an exciting time. Healthcare comprises trillions of dollars of the annual budget. Well, that’s not exciting, but the fact that the Government recognizes (no matter which side of the aisle) that we have to eliminate waste, is! We can keep trying to lower reimbursement, come up with innovative ways such as the Medical Home Initiative (more on this in a later blog), but ultimately it lies with every hospital and clinic to look at the way their work gets done on a daily, and sometimes minute-by-minute, basis.

Decrease Healthcare Organization Costs by 20%
Every healthcare organization can do it. There’s low-hanging fruit dangling savings everywhere: staffing ratios, benefits and supplies. Then there is what we call “gravy” savings, such as:

• Maintenance agreements (are you paying for things that might go wrong?)
• Is the lobby aquarium really worth $6,000 a year to maintain (plus replacing expensive fish found floating)?
• Do you really need to buy all the break room supplies?

Cutting these expenses can help offset increases in a couple of your most costly categories: malpractice insurance and employee benefits. Next, you’ll want to conduct a due diligence review on cash flow accuracies, reconciliation and safeguards against theft.

Though these initiatives seem obvious to Barbara and me, we understand why internal practice reviews don’t happen more often. It’s because when you’re doing the work, you don’t usually have the time to step outside of it to examine how it is that you’re working. If you’re a provider whose income is going down, you’re not going to want to pay overtime for employees to brainstorm. That’s unfortunate, too. So often, we’ve found that staffs are unaware of what others are doing. That ignorance is creating a natural outcome of duplicative work.

As the pressure increases from CMS and Congress to pass on the financial rewards for quality outcome measures, performance report cards and patient satisfaction, we think that Derry, Nolan & Associates is in a ripe position to help those organizations that finally realize they can’t ignore these trends, if they want to survive.

Unfortunately, another trend is the “quick and easy” decision to become employees of larger organizations and let someone else worry about the quality assurance programs, marketing, accounts receivable and accounts payable! Speaking candidly, whether you’re an independent group or a large integrated one, the same types of improvement efforts will need to prevail.

One reason Barbara and I work so hard is our hope of leaving a legacy to other healthcare and medical practice consultants who will carry on our work. This feeling resonates from our spirits… we want to win, take our “A” game to clients. It’s the most satisfying of all the reasons we work.

The flip side is that often we have had to fortify our spirits to get through adversity, setbacks and delays. In the midst of these difficulties, we don our mental armor and get stronger. (That isn’t to say that we don’t have our moments after the consultation ends!)

Three common obstacles we have encountered:

1. Weak teams—some members just have to go
2. Recalcitrant Providers—“we’ve been doing this for 35 years… who are you”
3. Bureaucratic Processes—”we will have to take that to committee”

Because many of our medical practice consulting projects involve team-building, we have to guide and work with the people we inherit. Some are weak links, not engaged in the process of change, or worse, down-right instigators. We have learned (the hard way) to eliminate these employees as quickly as possible, so the team can move ahead with change implementation.

We have far more challenges with older physicians (our age!) than the generation Xers, who almost always welcome change, along with technology advancements. As you may have guessed, most of our resistant encounters have come from taking “seasoned” providers kicking and screaming to an electronic health record.

Finally, the layers of committees and politics can be very frustrating. We’ll think we have a project based on the enthusiasm of our contact, only to find that they have decided to do it themselves with internal resources. Many times we eventually get called in because there really weren’t the internal resources, process redesign knowledge or team objectivity to pull it off.

Despite these challenges, eight years later, we are still in business. We have learned to be patient, politically correct (took us a few times to get that right) and always look for opportunities to win our client’s respect.

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“If you’re going through hell, keep going!” – Winston Churchill

Happy New Year to you, readers, fans and FB friends! So, what are your 2011 resolutions? Would one happen to be about life balance?

If not, think about where you are in work / life. Hopefully, this post will provide insight, even help you decompress. Work, home and social activities can easily become overwhelming (particularly for those in the healthcare and medical field). Barb and I are all too familiar with those feelings! Even when client work is most demanding, our “pact” for Life Balance means we take time to walk, work out, read and take regular vacations. In fact, we decided long ago to be choosey about our clients. Only those who truly are ready to listen, collaborate and work to improve their healthcare organization or medical practice win our utmost attention.

Clarify your priorities. It is the first and most essential step to achieving a well-balanced life. Here’s a simple 3-step exercise to use as a tool:

1. Write down your Top 5 priorities. Not what you think your priorities should be, but the ones you want!
2. Next, analyze where you spend the majority of your time. Does it align with your Top 5?
3. Finally, those that don’t align, consider how to eliminate them. After all, if they didn’t make it into the Top 5, perhaps it’s time they go away.

Every choice has a consequence. Each leads us down a particular path. Being at a crossroad of employment frustration led Barb and me to start our medical practice consulting firm. We knew we wanted to follow our energy, rather than exchanging it for a paycheck. When you find yourself at a crossroad, take the opportunity – it’s so important – to determine what really matters to you.

Remember: people who care about you want you to succeed – and be happy! Be courageous; ask for assistance and support from family and friends. You may be pleasurably surprised!

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See what our clients have to say about working with us! We’ve been consulting with integrated health systems, ASCs and medical practices since 2003.

It is a struggle to gain confidence (for most of us). In our case, it was an evolutionary process. We developed the trait and the skill to utilize it, through family circumstances, lessons learned (read: mistakes!), and the many talented mentors we worked with along the way.

Executive Coaching is increasingly popular among Fortune 500 organizations and others, but not every healthcare or medical practice organization has the kind of resources necessary to retain such a leadership resource. A professional coach may ask you to consider some of the following, things you can consider and work on as preparation for recognition or promotion. (These highlights are also useful to consider when trying to rectify a personal matter.)

• How you say something can be just as important as what you say
• Speak with conviction (but please, don’t shout!)
• Speak from the heart—be honest and forthright
• Be smooth yet spontaneous, don’t over rehearse
• Make eye contact
• Know your material
• Don’t hide behind a podium—stand at the edge of the stage and talk to your audience

Think about Approachability and Confidence

We want to evince competence and confidence when sharing our healthcare consulting knowledge and experience. That’s why in our consulting approach, when making a report or engaging in dialogue we like to sit next to the client (or those supervised), rather than across from or behind a desk. We’ve found that the desk not only detracts from optimal communication and outcomes, but also alienates the very folks we are trying to help.

Leadership, Confidence and Reward
Right now, we both hold interim leadership positions in healthcare organizations. Such roles, in our opinion, allow our consulting service to add value: through leadership styles, work redesign, policy and procedure updates, discovery of coding and billing opportunities, and so forth. All involve teaching and mentoring. For us, the biggest confidence builder comes from client feedback – subordinates to senior leadership – on the positive changes we make in their work environment. To hear about staff getting home earlier to families knowing there’s no pending “to do” list awaiting their return – that’s our true reward.

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“Confidence is preparation. Everything else is beyond your control.” – Richard Kline

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!