Posts Tagged ‘oncology practice consulting’

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

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 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.

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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.

Get Social!

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.

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!