Posts Tagged ‘medical practice consulting’
Dear Clients and Colleagues,
Ten years ago we struck out on our own as partners in medical practice consulting. Through clinic turnarounds, physician compliance training, customer service training and interim executive management, we’ve learned from our clients and each other.
However, “to everything there is a season” and after a wonderfully rewarding decade of working together, we’ve reached a stage in our lives where we have different professional goals.
To that end, we’re excited to announce that Derry, Nolan & Associates, LLC, is spinning off into two separate medical practice consulting firms:
- Derry & Associates, LLC
- Crystal Nolan, Medical Practice Consultant, LLC
We are heartily grateful to the healthcare clients who refer us to other medical offices, physicians and health systems. Likewise, we deeply appreciate the Derry, Nolan Associates who have worked alongside us over the years.
Please continue to call on us to help you with your healthcare and medical practice consulting needs.
Barb & Crystal
Derry & Associates, LLC
Crystal Nolan, Medical Practice Consultant, LLC
With potentially significant changes in Medicare reimbursement for oncologists being addressed this year, it’s imperative that your oncology practice closely examines its current billing and coding practices to assure that your claims house is in order.
The American Society for Clinical Oncologists takes the proposed reforms very seriously and offers educational opportunities to oncologists to understand and prepare for the inevitable changes to reimbursement for cancer patient care.
Oncologists in private practice not only face mounting pressures of administrative costs and staying abreast of the latest compliance regulations, but also now face reimbursement rates falling. Many times, these physicians, who just want to be able to focus on their patients’ cancer care, under prioritize (understandably) business management essentials.
We’ve worked with a number of oncology clinics and consistently find that the billing and coding, revenue cycles and collection are a common source of lost revenue. Correcting bad habits in billing and coding practices, establishing systematic processes, and keeping an eye on reducing general oncology practice expenses all can make the difference in whether your oncology practice succeeds, folds or becomes absorbed in a nearby hospital’s local acquisition efforts.
Derry, Nolan suggests practice managers, executives and billing management meet regularly to review the practices’ income and expense trends. If the net income trend looks more down or flat than up for several months, don’t wait, act! Take these measures to get your practice’s billing and coding house in order before reimbursement changes:
- Call for an external audit of your current billing and coding practices
- Proactively train for transition from ICD-9 to ICD-10 code sets
- Conduct a revenue cycle analysis
- Examine and reduce operational expenses
- Assess and optimize workflow practices to increase efficiency & patient satisfaction
Does your physician practice or medical clinic have a social media policy in place? Have your providers and in fact, the entire care and administrative staff undergone training on appropriate use of social media as it relates to healthcare and patient interactions?
While many healthcare providers are eager to engage with their patients via technology and reap the benefits of a more interactive relationship, physicians (and clinical staff) need to understand what’s appropriate and where to draw the line when it comes to social media.
Social media and medical or health information are a combination worth caution and preparation. Recently released policy guidelines from the Federation of State Medical Boards (FSMB) provide more information about what needs to be secured, as well as examples of what is and isn’t appropriate to share (i.e. PHI) via social media. Additionally, a November 2011 ECRI supplement goes into detail about social media and other risk control issues.
The evidence, unfortunately, indicates that physicians regularly breach online professionalism standards, if not also restrictions around PHI (recent Robert Wood Johnson Foundation and FSMB study). In fact, 92% of state medical boards report they’ve received violation of online professionalism notifications.
Before you post information about a patient or interact with them on Facebook or other online outlets, stop.
- Is the discussion / exchange occurring on a network or smart phone that is compliant with HIPAA and HITECH privacy and security standards?
- Do your staff and providers thoroughly understand your organization’s social media policy?
The world of social media broadens our horizons and helps us to connect more spontaneously. It can benefit you, your patients and your practice if done correctly, respectfully and securely.
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!
With the NYSE resembling a roller coaster ride, 2011 was another tumultuous year for the global economy. It put us much in mind of Derry, Nolan’s own beginnings in 2003. The economy was less than ideal and President Bush had declared war on Iraq. Despite those challenges, we remained focused on our goal to help medical practices.
In the first six years of business, we did a lot of medical practice assessments. We were busy helping physician practices eliminate wasteful processes, streamline staff and improve their bottom line through clean-claim submissions–on the first attempt! Many times we recommended consolidation of resources, right-sized the staff to productivity and restructured practice billing departments.
Over the past couple of years, however, we’ve witnessed a disconcerting trend of physician specialty groups running for cover and entering into employment agreements with hospital systems. We’ve also seen several hospital systems merge—the recent purchase of Swedish Medical Center by Providence, for example. Is the entrepreneurial, independent physician spirit being squashed by such threats as 27% Medicare cuts? (Particularly in light of thirty-three million baby-boomers readying to apply for Medicare benefits!)
Never before has it been more important for physician practices and hospital systems to work as efficiently as possible. If recent trends lead to that, it will be a good thing.
We wonder, though, if hospital leadership can keep promises made, as their institutions face continued dwindling reimbursement. We well remember how in the mid-90s, the trend of HMOs and hospitals purchasing primary care practices resulted in an average loss of $90,000 per physician. Then, many physicians went back into private practice; whether this will happen with specialty services remains to be seen. One thing is certain, whatever form healthcare reform takes, all healthcare providers will need to meet the challenge to deliver quality-driven services, because their reimbursement will be based on outcome measurements.
As for Derry, Nolan, for the past eight years, our initial business goals have not wavered. We hope that medical practices choosing to remain independent will continue to assess how they perform daily work to ensure it is meaningful and value-added.
We end 2011 with fondest wishes to you and your families for a wonderful holiday season. We hope that 2012 will be a better year economically for all of us and that you achieve any New Year’s resolutions you set for yourselves!
Barbara and Crystal
P.S. As you plan 2012 business activities, check to see the last time you had a practice assessment. We’re scheduling operational “check ups” for our physician clients now!
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.