Posts Tagged ‘interim executive practice management’
As revenue is squeezed and expenses expand, specialty groups such as cardiology or oncology practices seek financial “security” through hospital employment. Twenty – or even ten – years ago, such a trend would have been scoffed at. Unfortunately, what initially seems a reasonable solution eventually reveals many challenges. Physician groups who give up years of independent practice to become a hospital-owned entity, an “arm” of a hospital’s cardiology or oncology department, can kiss a straightforward salary good-bye. Hospitals pay on productivity models (most commonly RVUs and MGMA benchmarks), rather than a salary and the sharing of year-end profits. Then there’s the loss of autonomy, that hardest of all adjustments.
Diving deeper, other subtle yet insidious challenges come to light. When signing the employment contract, physicians may not have considered the loss of being able to make decisions that affect their schedules—remember, there’s accountability to hospital administration for strict productivity measures. Mundane tasks, like proof of insurance for mileage reimbursement, or adhering to per diem rates for Continuing Medical Education courses (which could make the difference between first and business class seating) are SOP. Specialists, long accustomed to informal yet collegial respect, might face arbitrary “higher” behavioral standards that if “not met” will find them facing a hospital disciplinary board.
Specialty practice staff face different sets of challenges. Rather than cost of living raises or performance bonuses, now their pay is tied to elaborate formulas. Myriad in-services not necessarily applicable to their specialty are suddenly required attendance. Manageable email traffic becomes a daily deluge to delve through.
If healthcare reform is sustained after this election, the trend for employment over independence will probably continue. Specialty physicians, such as cardiologists or oncologists, held to particular standards and paid on measures of quality outcomes, hospital readmissions and patient satisfaction will likely run to hospitals as their salvation, looking to them to provide the infrastructure needed to meet the standards.
An era of medicine is coming to an end, one where physicians held hospitals at arm’s length rather than asking to be embraced. Of course, the honeymoon will end, too, when the hospitals that promised high salaries and excellent benefits have to adjust compensation formulas to accommodate their own loss of state and federal funding.
Derry, Nolan & Associates works with medical practices and specialty groups to create revenue gains through expense reductions and efficiency improvements. The firm provides interim executive practice management, compliance assessments and program development, revenue cycle analysis, coding and billing audits, and customer service training, among other medical practice consulting services.
Margins for healthcare organizations are slim at best, particularly when it comes to Medicaid and Medicare reimbursements. Rather than compromising care quality, many healthcare systems, hospitals, specialty clinics and physician practices are looking at a common denominator – facilities overhead.
Operational efficiency audits often examine workflow, resource allocation and general costs, yet the most thorough ones don’t ignore facilities, which can include an array of possibilities. In one engagement, we uncovered a number of cost-saving logistical and facilities measures that were fairly simple to implement, yet contributed to significant bottom line savings.
Consider supplies. From paper to needles and syringes, what’s your outlay? Do you keep too much of one item on hand? Do you have multiple locations that could benefit from volume purchasing? Or are you a single location with space limitations that should look at just-in-time ordering?
What about energy output? For instance, larger healthcare organizations might consider new air handling systems that use considerably less energy yet improve patient and staff safety with fresh, clean air supply. Smaller clinics or physician practices in leased space may want to look at everything from thermostat settings and light bulbs to air flow in underused spaces, air filtration systems, or water usage (toilets, automatic faucets).
The savings opportunities aren’t always immediately obvious. Work closely with your healthcare facilities engineer to discover sensible changes or simple adjustments that will not only help the bottom line, but also improve your healthcare facility.
Derry, Nolan & Associates helps specialty clinics and groups, physician practices and healthcare systems discover new efficiencies and more effective use of resources. Email us to schedule your free, one-hour consult with our medical practice specialists.
Medical practice websites are a given but the old, brochure style site is going the way of the dodo. In the social media age, patients expect interaction from their doctor’s website. An eye clinic, for instance, may have special prices for contacts or glasses available to vision patients promoted not only on their website, but also on their Facebook and Twitter accounts. An oncology clinic may have an informative blog series on “What to Expect” to help chemotherapy patients and caregivers prepare for treatment sessions and aftermath. And nearly all practices and clinics have blank patient information and medical history forms available for download – it’s a simple yet helpful time saving tool.
If you’ve not updated your medical practice’s website lately, consider having an “audit” of your site and your medical group’s online presence. Seek out a web expert who has a solid book of medical and healthcare related websites in their client list. Visit physician practice or hospital websites that appeal to you (and check out the competition!) and share those with the web developer or your marketing project manager. Many times, they can point out why those sites work or why they don’t. Often, the snazziest medical practice sites aren’t search engine friendly, and if Google can’t find them, neither can patients!
Improve Your Medical Practice’s Profitability & Reach
In our interim practice management or clinic executive roles, we look at practice profitability holistically, from efficient processes to best practices in all aspects of operations and marketing. This includes being called upon to help physician groups and specialty clinics update their online presence or develop more effective, efficient medical and patient marketing practices. We help assure online and traditional marketing procedures follow healthcare privacy and marketing regulations, while also helping bring your medical practice’s online marketing methods up-to-date.
Barb and I are both filling interim management positions within specialty practices right now. There’s simply so much to do that for many physicians, finding the time to fill a much-needed leadership role becomes yet another burden for their practice.
In my particular engagement, I’m not only recruiting for a new manager as a function of my interim management position, I’m also performing an operational assessment. It’s not really unusual to combine the two services. When key personnel leave, often the physician practice finds itself not only needing the role filled, but realizing how much more there is to be done – and sometimes wondering how that one person managed!
In this situation, my goal is to provide a thorough assessment of where the practice is operationally, providing a new manager:
- The knowledge of where the medical practice stands, and
- The basis on which to make appropriately prioritized recommendations for change.
Times of transition can be the perfect time to discover what needs improvement, what’s redundant, and even what’s potentially placing a practice at risk. From coding to reimbursement practices and systems, self-auditing for OSHA compliance and consistent HIPAA training, to patient safety and satisfaction, or looking at how the front desk can better support clinical staff – it’s all fair game.
Remember, even uncovering small issues can save physician practices significant time and money, improve quality and satisfaction, and perhaps reduce risk (non-compliance, coding or reimbursement errors). It all comes down to early discovery, corrective action and a can-do attitude toward multi-tasking!
As the summer draws to a close, it seems as though everyone is already thinking about the holiday season, pushing forward to next year. Hold up – we’re not yet done with this one! There’s plenty still coming down the pike for 2011. Let’s look at your goals – what is there yet to achieve for yourself (and your healthcare organization)? And how are your professional relationships? Have you been able to build and strengthen those?
There are a couple of posts that may help as you continue to work on those 2011 goals. For instance, when it comes to professional relationships, we like one from January about connecting, which included these three tips:
- Be nice to everyone. Make the effort and never underestimate the value of being nice!
- Listen to every voice. When we build teams and redesign workflows, our belief is that every voice matters.
- Bring your ‘A’ game to work – every day.
Now, look at what you planned for this year – not only for your healthcare organization or medical practice, but also for you, personally and professionally. What’s the status? Is it time to revisit those plans and make some course corrections back to where priorities truly lie? Remember these tips from another January post:
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:
- Write down your Top 5 priorities. Not what you think your priorities should be, but the ones you want!
- Next, analyze where you spend the majority of your time. Does it align with your Top 5?
- 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. There’s still time to listen to every voice, including your own. If you need some assistance to complete a few “to do” items, give us a call!
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.
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?
Is your ASC compliant with CMS? We can get you there!
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
- Infection Control
- Patient Rights
- 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.
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:
- Empathy PLUS
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!
“The single biggest problem in communication is the illusion that it has taken place.” – George Bernard Shaw
ACOs are a type of payment and delivery reform model that begin to tie provider reimbursements to quality metrics (measures of quality indicators) and reductions in the total cost of care (performance and process improvement) for an assigned population of people; i.e. Medicare patients.
These indicators and data derive from 5 Key Areas:
- Patient and providers’ experience of care (patient and staff satisfaction scores)
- Care coordination (information sharing across the continuum of care)
- Patient safety (reporting, analysis and error prevention)
- Preventive health (treatments to minimize illness and hospital admissions)
- At risk population, frail and elderly health (using proven care standards to assist with care provision)
The overall quality performance score will be calculated on 65 quality metrics within the 5 defined key areas, equally weighted. CMS will define the quality performance benchmarks based on Medicare Fee-For-Service (FFS), Medicare Advantage or ACO perfomance data over time.
Note that the ACO is eligible for monetary compensation only if it demonstrates to CMS that it has fulfilled the required quality performance elements and achieves the other regulatory performance criteria.
“Quality is remembered long after the price is forgotten.” —Gucci Family Slogan