Congratulations on your promotion to Office Manager!

It can be very hard to successfully move from being a co-worker to being the office manager, but it can definitely be done.  It took me a long time to be able to separate my relationships with the staff from my responsibilities as a manager.  I tell people who work for me that if we have a personal friendship, it will in no way change any decision I make as a manager and I stick to that.

This is my recommendation:
Meet with each of the staff one on one and talk to them about your concerns.  Tell them you value their friendship and the relationship you’ve had, but in your new role you might be called upon to fulfill some duties that they would classify as “unfriendlike.”  Let them know that you are taking your new responsibilities seriously and that you will need to protect the organization first and foremost.  Tell them that the best outcome for everyone is a win-win situation where the employee and the organization are both winners, but if it comes down to a hard decision, you will need to act in the best interest of the practice.

As far as how you act:
Read my article on eating lunch with the staff.  Do not get drawn into discussions about work with the staff when at social events.  Try never to drink with co-workers so you don’t say something you’ll regret in the morning! No matter what, keep things confidential.  Be careful what you share, even with the physicians, as they sometimes are unable to keep confidences.  Make sure to tell the same thing to all staff, for instance, put policy changes or protocol changes in writing so everyone hears the same thing.  Be very careful to not be seen as having favorites.

I hope this helps and please write back with more questions!

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The American Recovery and Reinvestment Act of 2009 was signed by President Obama on February 17, 2009.  The Law includes the Health Information Technology for Economic and Clinical Health Act or the HITECH Act.  The HITECH Act establishes programs under Medicare and Medicaid to provide incentive payments for the Meaningful Use of Certified Electronic Health Records technology.

The goal of the HITECH legislation is to improve healthcare outcomes, to facilitate access to care and to simplify care.  It is believed that the installation of electronic health records in medical practices is only the beginning.  The goals of HITECH will be met when the EHR is used in a meaningful way.

What is Meaningful Use (MU)?

There are three  identified components of Stage I Meaningful Use.  They are:

1. Use of a certified EHR in a meaningful manner such as e-prescribing.
2. Use of Certified EHR Technology for the exchange of health information (exchange data with other providers of care or business partners such labs or pharmacies)
3. Use of Certified EHR Technology to submit clinical quality and other measures.

The first stage of Meaningful Use is capturing and sharing the data.  Meaningful Use Stage II is advanced clinical processes and Stage III is starting to look Meaningful Use of an EHR in the context of improved healthcare outcomes.

There are 25 specific criteria for MU Stage I listed in this article in Healthcare IT News:

[1] Objective: Use CPOE (Computerized Physician Order Entry)
Measure: CPOE is used for at least 80 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks
Measure: The EP (Eligible Provider) has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[6] Objective: Maintain active medication allergy list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[7] Objective: Record demographics.
Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data

[8] Objective: Record and chart changes in vital signs.
Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[9] Objective: Record smoking status for patients 13 years old or older
Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded

[10] Objective: Incorporate clinical lab-test results into EHR as structured data.
Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[11] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
Measure: Generate at least one report listing patients of the EP with a specific condition.

Have the Details of MU been finalized?

The comment period for the NPRM (Notice of Proposed Rule Making) for Meaningful Use is currently open but will close on March 15, 2010. You can read the NPRM here.  Many individuals and organizations have expressed concern that the timeline for implementing EHR and meeting MU criteria is too short for the majority of providers. The American Academy of Family Physicians (AAFP) recently sent a 7-page letter to acting CMS Administrator Charlene Frizzera (see story here) that included the following concerns:

1. The administrative burden of reporting computerized physician order entry measures “is excessive to the point of being unachievable for most eligible providers.”
2. The rule could require manually entering results from laboratories that don’t have an interoperable interface with the physician’s electronic health record.
3. The term “health information” is used throughout the proposed rule, but is never defined.
4. A requirement that a patient’s health information be shared with that patient within 48 hours doesn’t take in account that physicians or their staff may not be able to process the information if that 48-hour period includes weekend days.
5. There is no incentive for physicians who meet less than 100% of the proposed requirements, so it is an all-or-nothing approach.

The Medical Group Management Association recently surveyed (see Modern Healthcare story here) 445 physician practice administrators in February 2010 with the following feedback:

1. Nearly all are aware of the upcoming incentive programs for meaningful use of electronic health records, but fear the programs will reduce physician productivity.
2. 68% of respondents expect physician productivity will decrease if all 25 proposed meaningful use criteria are implemented.
3. Nearly one-third believe the decrease in productivity will be greater than 10 percent.
4. Almost 25% of practices without an EHR doubt some of their providers will ever attempt to qualify for incentives.
5. Among practices with an EHR, nearly 84 percent believe some of their physicians will attempt to qualify for Medicare or Medicaid incentives by the end of 2011.

How Do I Comment on the MU Standard?

You can submit your comments on the NPRM on MU here.

You can read comments already submitted here.

How Do I Know if My EHR is Certified?

No EHRs have been certified for the CMS Incentive Program and the certifying bodies have not yet been announced.  It seems reasonable that CCHIT will be one certifying body, but there are expected to be others.  If your vendor tells you that his EHR is certified before the rule has been finalized and the certifying bodies have been announced, ask him “For what?”

What Does it Mean to Be Eligible? (description courtesy of Everything HITECH)

This term encompasses three general types of payers to establish eligibility: 1) Medicare Fee For Services (FFS), 2) Medicare Advantage (MA) and 3) Medicaid.

For hospitals to be eligible, they can be acute care (excluding long term care facilities), critical access hospitals, children’s hospitals.

For providers, these include non-hospital-based physicians who receive reimbursement through Medicare FFS program or a contractual relationship with a qualifying MA organization. The Act defines the term “hospital based” eligible professional to mean an EP such as a pathologist, anesthesiologist,or emergency physician, who furnishes substantially all of his or her Medicare covered professional services during the relevant EHR reporting period in a hospital setting (whether inpatient or outpatient) through the use of the facilities and equipment of the hospital, including the hospital’s qualified EHR’s (Fed Reg p. 1905). The determining factor is the site of service as to whether the service is hospital based or not. If the EP provides at least 90 % of their services in a hospital inpatient, hospital outpatient or hospital emergency room setting (Point of Service codes 21, 22, 23), then they are considered a hospital based EP and not eligible for EHR incentive payments (i.e. providing substantially all of his or her Medicare covered professional services).

There is a difference between Medicare and Medicaid when it comes to defining an eligible professional for EHR incentive payment purposes. Medicare defines an eligible professional as (Fed Reg p. 1996):

1. doctor of medicine or doctor of osteopathy
2. doctor of dental surgery or dental medicine
3. doctor of podiatric medicine
4. doctor of optometry
5. chiropractor

Medicaid, on on the other hand, defines an eligible professional as (Fed Reg p. 2001):

1. physician
2. dentist
3. certified nurse-midwife
4. nurse practitioner
5. physician assistant practicing in a Federally Qualified Health Center (FQHC) or a Rural Health Clinic, led  by a physician assistant.

What are the Guidelines for Providing Patients With Their Medical Records Electronically?

Under HIPAA, patients currently have the ability to access their medical records.  Meaningful Use does not change HIPAA in that regard.  You may charge patients for the expense related to providing paper or electronic medical records.  Each state has its own schedule for charging for medical records (state-by-state schedule here.)

Do Eligible Providers Have to be Participating With Medicare to Receive the Incentive Money?

No, the eligibility requirements only relate to the benchmarks for the percentage of Medicaid patients you have, or amount of allowed Medicare charges you have.

Can Eligible Providers Work at Locations Other Than Hospitals and Private Practices and Receive the Incentive Money?

The location where the provider works is not the issue.  The issue is whether or not the provider meets the requirements, either for Medicare or Medicaid, to be considered eligible for the program.

It doesn’t matter where the provider accesses the certified EHR.  If they meet the eligibility criteria, and they are using a certified EHR, they can collect on the stimulus money.

What Are Health Provider Shortage Areas?

Physicians practicing in determined “health provider shortage” (detailed info here) areas will be eligible for a 10% bonus payment.

How Does This Incentive Relate to ePrescribing or PQRI?

If the PQRI Program is extended in its current form, practices can participate in both PQRI and an EHR Incentive Plan.

If the EP chooses to participate in the Medicare EHR Incentive Program, they cannot participate in the Medicare eRx Incentive Program simultaneously.  If the EP chooses to participate in the Medicaid EHR Incentive Program, they can participate in the Medicare eRx Incentive Program simultaneously.

Also, e-prescribing penalties sunset after 2014, so that no physician will be subject to penalties for failing to both e-prescribe and use an EHR!

How Do EPs Get Paid For Meaningful Use of a Certified EHR?

For the first payment year only, all an EP or hospital has to do is to be a “meaningful user” for a continuous 90-day period during the payment year. Hospitals’ payment year is October 1 to September 30 and EPs’ payment year is the calendar year.  You must start and complete the 90-day period within the payment year with no overlapping.

Also, if  you can qualify as a Medicaid Eligible Provider (or Hospital), are in the process of adopting, implementing or upgrading your EHR  and your Medicaid patient volume is at least 30% (Pediatricians only need 20% minimum and Hospitals need 10% minimum), you can collect your incentive money without meeting Meaningful Use criteria.

Attestation forms and forms of other types are most likely the way that EPs will provide information to apply for the incentive funds, although the details have not yet been released.

What Does it Mean to Transition From One Program (Medicaid or Medicare) to Another?

EPs who meet the eligibility requirements for both the Medicare and Medicaid incentive programs will be able to participate in only one program, and will have to designate which one they would like to participate in.  After their initial designation, EPs are allowed to change their program selection only once during payment years 2012 through 2014.

To Recap:

How Do I Get My EHR Stimulus Money?

1. Decide whether you are an eligible provider for any of the programs.
2. If you are, buy a certified EMR (once certification has been defined.)
3. Use your EMR in a way that demonstrates your meaningful use of the product.
4. Pass “GO” and collect your money.

ARRA (Stimulus Bill) Acronyms

• A/I/U –Adopt, implement or upgrade
• CAH –Critical Access Hospital
• CCN –CMS Certification Number
• CDS –Clinical Decision Support
• CMS –Centers for Medicare & Medicaid Services
• CY –Calendar Year
• EHR –Electronic Health Record
• EP –Eligible Professional
• eRx –E-Prescribing
• FFS –Fee-for-service
• FY –Federal Fiscal Year
• HHS –U.S. Department of Health and Human Services
• HIT –Health Information Technology
• HITECH Act –Health Information Technology for Electronic and Clinical Health Act
• HITPC –Health Information Technology Policy Committee
• HIPAA –Health Insurance Portability and Accountability Act of 1996
• HPSA –Health Professional Shortage Area
• IFR –Interim Final Rule
• MA –Medicare Advantage
• MCMP –Medicare Care Management Performance Demonstration
• MITA-Medicaid Information Technology Architecture
• MU –Meaningful Use
• NPI –National Provider Identifier
• NPRM –Notice of Proposed Rulemaking
• OMB –Office of Management and Budget
• ONC –Office of the National Coordinator of Health Information Technology
• PQRI –Medicare Physician Quality Reporting Initiative
• Recovery Act –American Reinvestment & Recovery Act of 2009
• TIN –Taxpayer Identification Number

To see the full transcript of the CMS Audio Conference Call from February 23, 2010 which this article drew heavily upon, view the handout, or listen to the audio of the call click here.

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Stay tuned for possible additional delays: earlier today Senator Max Baucus (D-Mont.) and Senate Majority Leader Harry Reid (D-Nev.) unveiled a $150 billion jobs bill that would delay the 21% cut in Medicare reimbursements until August.

CMS is not processing claims until March 12 so they can pay the correct amount and not have to make additional payments to providers.  Payments will still reach providers within the 14-day time frame required.

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One of the hallmarks of a well-designed office, today or tomorrow, is flexibility.  You want as much functionality as you can possibly get out of each space and use each space for as many purposes as possible.

For instance, a large room with lots of voice and data jacks or wireless and electrical outlets might be used for:

1. Physician meetings, staff meetings or parties
2. Group patient visits
3. In-house health fair
4. Staff or patient training
5. Public meetings
6. War room for disaster management or ad hoc project (medical record scanning prior to an EMR go-live)
7. Conversion to workstations for a merger with another group
8. Place to do group sports or college physicals, flu shot clinics, DOT physicals

I see reception and waiting areas getting smaller as patients have less time and are less willing to wait.  Patients may not have to wait at all if you are sending them a text message or Twitter when the doctor is ready to see them.  Some practices will not have waiting areas as patients will be escorted directly into exam rooms where the entire visit, from soup to nuts, will take place.  Instead of going to the lab, the lab might go to the patient – see a phlebotomy application on a handheld device here.

Registration may be replaced by check-in kiosks that totally automate the process, including a vitals booth which takes the patient’s weight, blood pressure, oxygen levels and temperature.  Patients and their demographic and insurance information may be identified by fingerprints or iris scans. You may have a receptionist avatar greeting patients.  Here’s a cool video that shows a virtual administrative assistant (the first 2 minutes of the video.)

Fixtures are movable – storage cabinets are on wheels and not permanently attached to walls.  Any room can be an exam room, a treatment room, a test room, a procedure room, simply by moving the cabinet with the needed items and the machines, which will be handheld.  See an example here.

Providers’ phones are their everything.  Their mail, patient records, test results, journals, phone calls, and their family pictures are on their phone, so no need for an “office.”

As always, non revenue-producing space is minimized and revenue-producing space is maximized.

The need for storage of paper (records, forms, etc.) is minimized because everything is digitized and stored on the cloud.  The need for staff workstations is minimized because many staff work for the practice from home.

Medical records are not viewed on computer screens, they are projected onto walls in any room, at any time.  See the TED Talk on the Sixth Sense technology here.

Many patients are seen at home or in the nursing home, with the provider in the office using telemedicine technology or virtual office visits.

Medication samples will not be given at the physician office – they will be distributed at the pharmacy.  All medications will be samples (no cost) until it is established that it is the effective medication for that patient’s problem.

Here’s a neat video from Microsoft about healthcare of the future.  It will get your mind racing about the possibilities.

Microsoft Health – Future Vision from Microsoft Feed on Vimeo.

It’s frightening and exciting – might there be no need at all for brick and mortar physician offices?  I think it’s very likely.

What are your ideas about the medical office of the future?

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But I know I’m probably in the minority.  Many managers do not approve of employees using their phones for social media (Twitter, Facebook, etc.) at work, but I am actually okay with it when used with discretion. Unlike computers, with smart phones you do not need to worry about viruses infecting the office network.

Most managers accept and allow employees who smoke to step outside at least twice a day to smoke a cigarette.  Doesn’t it seem fair to allow everyone else to take a phone break to check messages, make calls and text a few people?

Here are some objections I’ve heard to allowing staff to use their phones at work, and my answers.

“They’ll never get any work done if you let them play on their phones all day.”

My Answer: I only hire adults.  I expect adults to have a reasonably well-formed work ethic that is demonstrated by doing work first, and doing non-work on breaks and briefly other times.  If the practice can’t run without me peeking over their shoulders every hour or so to see if they’re working, then I am not a very good manager.

Performance measures are a great way to set guidelines for what work must be done.  If the employee is meeting their performance goals appropriately, why shouldn’t they be able to take a micro-break to catch up on life?

“Employees should do work at work and save their home life for home.”

My Answer: Employees are people with busy lives, lots of commitments and lots of responsibilities outside of work.  Every single one of us needs to attend to our personal lives for some part of the day.  Most of it can be dealt with at lunch or during breaks, but sometimes people need to attend to their lives at work.  I want them to be able do that, within reason, because it is a realistic response to life in 2010.

“What if staff using the Internet on their phones puts the practice at risk?”

My Answer: If you have done a good job of educating your staff about confidentiality and HIPAA, you should have no worries.  In short, staff should not reveal any patient information (via spoken, written or digital communication) to any third party for any reason besides those dictated in your Notice of Privacy Practices (NPP).  Your HIPAA education plan should be reviewed and updated annually to include any policy changes due to the use of social media for personal and practice purposes.

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•    Hey, is that nurse filling my loved one’s water pitcher?
•    She’s trying to make the water not too cold or hot, that’s good.
•    Oh, no, she is letting the water run over her hands and into the pitcher!  Should I say something?
•    She’s probably going to dump out that water and fill it up with water her hands haven’t been in.
•    Nope, she’s turning off the water.  Do I say something?
•    Me: “Hey, that water ran over your hands!”
•    Nurse: “Don’t worry, I wash my hands all the time.”
•    Me: “No, I don’t think we should take that chance.”
•    Nurse: ‘I’m really hurt that you would think I’d do something like that.”

This was a personal seminal moment.  I could not believe that after working with physicians and nurses in healthcare for 25 years that I would be intimidated about saying something about cleanliness.  I was worried about the potential impact that my questioning would have on the care of my loved one.  That made me hesitate about saying something until a situation came up where I could not keep quiet.  I could not suppress my concern based on the possible impact to my loved one.

What about the nurse’s reaction?  It was defensive, and she was telling me in essence “I can’t believe you’d question my decision-making.”  In discussing the situation later with my husband (not the patient), he assured me that I had done the right thing.  He asked me if I saw the waiter in a restaurant washing his hands at my table, would I then let him dip his hands in my soup?

This hospital experience was 99% wonderful. I thought the hospital paid excellent attention to the needs of the patient and the family.  I thought it was clean, the caregivers were very good, and I would recommend the hospital.  But the wall is still up about questioning at this hospital and probably every hospital across the US.  It is a hard call to tell the professionals that they are doing something wrong.  A cleanliness episode can happen so fast that you don’t have time to debate yourself about saying something.

How can we make it okay to question caregivers for the benefit of the patient?


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Part B MACs (Medicare Administrative Contractors) will be sending revalidation letters to all providers who have not updated their Medicare enrollment since November of 2003, asking them to submit a paper enrollment form or to use the electronic enrollment system PECOS (Provider Enrollment, Chain and Ownership System.) This proactive stance on the part of CMS should help the many managers who have been desperately trying to determine if their providers are in PECOS or not.

An audio recording of today’s call will be available on the ODF website here and will be accessible for downloading on or around Monday March 1, 2010 and available for 30 days.

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions click here.

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I have to admit that at one time I felt strongly that patients needed to take responsibility for understanding their medical benefits plan and advocating for themselves.  Everything has become much more complex though, and I have come to believe that as the experts it is our job to understand patients’ benefits and help them receive them.  Patients have difficulties understanding their own coverage for a myriad of reasons:

Reasons Why Patients Don’t Understand Their Benefits:

1. The benefit book is not written in a way that many subscribers can understand.
2. Most subscribers will not take the time to read the benefit book and ask questions about the plan at the time they receive the benefit.
3. The benefit book is usually accompanied by a sheet or two of paper that alters the verbiage in the basic book  to describe the exact information for the patient’s plan.
4. Not all businesses have an assigned employee to translate benefit books for the staff.
5. Many employers change their plans annually.
6. Most plans do not send representatives to workplaces to review plans with new employees.

To be sure there is the self-serving aspect of advocating for the patient in that we have less to collect from the patient, but I believe it is our job to minimize the patient’s out-of-pocket for them.

Who Are The Stakeholders?

The employer, the insurer/payer, and the healthcare service provider each have different motivations when it comes to paying for patient’s medical service.  There is little motivation for each to communicate and collaborate for a good outcome for all.  Assuming we are taking for granted each of these entities’ desire to make sure the patient receives excellent quality care, what is the viewpoint of each of these stakeholders?

The employer is concerned with keeping monthly health insurance premiums affordable, and minimizing claims experience.  Employers try to keep premiums from increasing at a rapid rate so they can afford the coverage and satisfy employees.

The insurer/payer is concerned with paying out less money in claims than it collects in premiums.  Because most insurance companies are for-profit, there is extreme pressure to deliver dividends to shareholders and bonuses to executives.

The healthcare service provider is concerned with charging an amount that does not leave any money on the table, making up for the underpayments of Medicare and Medicaid by the charges to other insurance companies, and keeping expenses as low as possible to offset decreasing reimbursement.

The patient is the ultimate stakeholder and the one responsible for paying an average of 30% of the contracted charge.  The patient is typically the least knowledgeable and the least able to walk the maze of terminology and rules to achieve the needed outcome.

How Do Insurers Avoid Paying Claims?

1. Pre-existing condition (if no proof of continuous coverage exists)
2. Other payer responsible (worker’s comp, auto accident, liability)
3. No pre-certification or pre-authorization
4. Did not advise of emergency within 24 hours
5. Not medically necessary
6. Medical records must accompany claim
7. Provider not in network
8. Ineligible on date of service
9. Untimely filing – did not file within deadline which is different for every insurer
10. Non-covered service
11. Not enrolled within timeframe (babies)
12. Escalating premiums to the point that employers seek other coverage.

What Can Medical Offices Do to Advocate for Patients?

1. Provide patients with a brief handout explaining health insurance terminology.  Have this information on your website.
2. Compile information about each insurer and each plan that your patients have.  A wiki is ideal for this, but a good old-fashioned 3 x 5 card file will do.  Yes, the patient has the agreement with the insurer so technically knowing their plan is not your job, but who loses if the insurer doesn’t pay?  Yep, you do.
3. Use eligibility software or call the insurers to get the plan information and document this in your master file AND on the patient’s record.  Include deductible, co-pay, co-insurance, network information and non-covered services.
4. When the patient arrives in the office, let them know you’ve checked on their plan and what you found out that will relate to this visit.  If you find out something that will alter the patient’s payment requirement, call them before the appointment to let them know about it and give them a chance to cancel or reschedule.  No surprises!
5. Thoroughly explain any waivers or ABNs (Advance Beneficiary Notice for Medicare patients) you have patients sign for services that their insurers may not pay for.
6. Make sure that any test or service (including lab work) that you send the patient for is provided by an entity approved by their insurer.
7. If you are scheduling the patient for a procedure with your provider, give patients complete information on your charges.  Also give them information on estimated charges from any other provider involved in the procedure (assistant surgeon, physician assistant, radiologist, anesthesiologist, pathologist) as well as any facility charges from the hospital or ASC (ambulatory surgery center.)  Help patients to check on physician/practices to make sure they are approved for the patient’s plan.
8. If you plan to send the patient a statement for any services, give the patient a sample bill and review how to read it.  Have the same thing on your website for patients to refer to.
9. Encourage patients to call, email or make an appointment to talk to you face-to-face about their billing questions.  Make it clear your office is glad to help them.  Do not become defensive if a patient asks about their bill or questions if it is correct.
10. Don’t be afraid to admit to the patient that your office made a billing mistake if indeed you did.  Everyone makes mistakes and as long as you apologize and do not try to shift the blame to the patient or the insurance company, all should be well.
11. If need be, help the patient take the next step in filing a complaint against their insurance company if the company is not fulfilling their responsibility in paying the claim.  As the insurance companies often do, arrange a three-way call to discuss the patient’s claim and why it is not paid. Medicare patients receive a quarterly notice that lists claims for the previous 90 days and lists appeal details on the back of the notice.

Photo Credit: © Artur Gabrysiak | Dreamstime.com

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The real answer to this question is  “it depends.”  Two people in different parts of the United States could have the same job description and one could make $50,000 and another could make $100,00.  Most experienced, capable medical practice managers make a good living somewhere in the middle.

What differentiates medical practice managers (and I use this term in a generic sense to cover the variety of titles used in the healthcare field) from other office managers is that they are expected to know something about almost everything.  A typical day in the life of a medical manager might well include tasks in the areas of:

• human resources
• risk management
• coding and billing
• credentialing
• accounting
• information technology
• facilities management
• conflict resolution
• physician compensation plans
• marketing
• physician/provider recruiting
• and more! (see my post on what managers do here.)

The medical practice manager is often in the unique position of both answering to the owners (physicians) and managing them – a phenomenon not seen in other industries.

What a medical practice manager earns relates to:

• what the decision maker(s) believes the job is worth, or what they’re willing to pay
• what a consultant or financial adviser has said the job is worth
• what other local practices are paying their managers
• what the previous manager made

Factors influencing the posted salary for a position are:

• the specialty or specialties (single-specialty vs multi-specialty and primary care vs. sub-specialty care)
• the number of physicians/providers
• the number of sites or ancillary services (imaging, physical therapy , medical spa, ambulatory surgery center)
• hospital-owned vs. non-hospital-owned
• if hospital-owned, how the position is graded, or where it fits in the management structure
• billing in-house or outsourced
• financial soundness of the entity
• the entity’s competition in the community
• cost of living factor for region

Factors that might influence the salary ultimately offered YOU for a position are:

• Years of experience in healthcare management
• Years of experience managing the same or similar specialty
• Years of experience managing the same or similar # of physicians
• Stability of jobs over the past 10-15 years
• Special degrees: Master’s, CPA, CPC, Compliance, RN, Lean, Black Belt (Six Sigma)
• Having installed an EMR (electronic medical record)
• References

Where does one look for specific information on what managers make?

The Bureau of Labor Statistics’ (BLS) most recent information reports:

Median annual wages of wage and salary medical and health services managers were $80,240 in May 2008. The middle 50 percent earned between $62,170 and $104,120. The lowest 10 percent earned less than $48,300, and the highest 10 percent earned more than $137,800. Median annual wages in the industries employing the largest numbers of medical and health services managers in May 2008 were:

General medical and surgical hospitals	$87,040
Outpatient care centers	74,130
Offices of physicians	74,060
Home health care services	71,450
Nursing care facilities	71,190

According to a 2009 survey by the Professional Association of Health Care Office Management (PAHCOM), the median salary for health administrators in small group practices is $56,000; for those in larger group practices with 7 or more physicians the median is $77,000.

The silver-back of healthcare salary surveys comes from the Medical Group Management Association (MGMA). The Management Compensation Survey is one of the “golden trio” of surveys that I’ve used throughout most of my professional life.  You can view a sample page here: Sample Table (pdf).  The survey information is free if you are a MGMA member and participate in the survey yourself.  You can purchase the Compensation Survey here.

Many state MGMA groups also sponsor state salary surveys and sell them to non-members.  In addition, some local manager groups do limited surveys and make the information available for a fee.

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1. BE NICE TO EVERYONE: patients and their families, staff, hospital staff, vendors, janitors, everyone.  What do people say when they recommend someone?  “You’ll like him, he’s nice.”
2. Have an open house and offer BP checks, cane/walker checks, free H1N1 shots, etc.
3. Offer free meet and greet visits to let patients meet you before establishing.
4. Take extra unassigned ER call or fill-in for other docs (the ER staff will recommend you to patients.)
5. Visit nursing homes and meet administrators and staff, leave brochures.
6. Do home visits.
7. Have a Saturday morning clinic.
8. Do a radio interview or talk show taking callers’ questions about a medical topic.
9. Visit the pharmacies and introduce yourself to pharmacists, leave brochures.
10. Visit high school guidance counselors in the spring and leave information about college physicals.
11. Place brochures with the Welcome Wagon or Newcomers Club.
12. Join the Chamber of Commerce and attend meetings.
13. Join the Lions, Kiwanis, or Rotary Club.
14. Join the worship center of your choice and become involved.
15. Join a journal club.
16. Join a business leads organization.
17. Take credit cards, offer payment plans and offer a financial hardship program.  My book has advice about collecting from patients.
18. Call schools and volunteer to do sports physicals in the spring.
19. Contact the local Parish Nurses and meet them.
20. Volunteer to be available at local school sports events.
21. Start a medical issue support group that meets at your practice.
22. Call local employers and offer to come on site to do physicals, flu shots, wellness talks.
23. Do DOT physicals and take worker’s comp patients.
24. Go visit the home health equipment stores and leave brochures.
25. Specialize in difficult conditions and disease states and advertise that you do.
26. Volunteer at the local free clinic.  The volunteers will refer patients to you.
27. Offer to be “on tap” for the local TV station to provide sound bites on the latest topic: vaccines/autism, radiation exposure
28. Send out info to the newspaper every time you attend a meeting, speak, write, or do anything notable.
29. Take Medicaid and insurances offered by local large employers.
30. Tap into social media and have a great website, blog, online registration, online scheduling, online drug refills, etc.
31. Speak about any medical topic, anytime, anywhere.
32. Give travel vaccines.
33. Place a sign outside your practice saying “Now Accepting New Patients.”
34. Meet the local hospitalists group.
35. Offer virtual visits to your established patients.
36. Talk to the local managers group.
37. Make friends with potential referring practices, take lunch, leave brochures.  Don’t forget practices in surrounding areas.
38. Have a private line into your practice just for other physicians and practices.
39. Make it incredibly easy for staff from other practices to refer patients to you. Many referral decisions are made based on ease of entry to the practice.
40. Ask satisfied patients to log on to a physician review site and leave a review of your services.
41. Visit daycares and leave information for parents on kindergarten physicals in the summer.
42. Develop “loss leaders” and advertise them: free/discounted flu shots, inexpensive physicals for <19 year olds, etc.
43. Take students in your practice: medical assistants, nurses, phlebotomists, healthcare career students.  When they get jobs they will recommend you.
44. Place small ads in the local professional, amateur or high school theater playbill.
45. Round twice a day on your inpatients. Satisfied patients refer other patients.
46. Give a talk at your practice for anyone who thinks they might like to be in healthcare.
47. Moonlight at a local Urgent Care.
48. Give a talk for local nurses.  Everyone asks nurses which doctor they would go to.
49. Let local (nice) hotels know you will make house calls over lunch or after clinic hours.
50. SMILE.  Never underestimate the value of a smile.

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