Spend one day in the shoes of an MGMA member and you’ll experience the challenging, changing environment of a practice administrator. Our industry is always in flux: new healthcare information technology to implement; new CPT and ICD codes to bill; new insurance plans to support. MGMA is changing, too, to support new and current members and help them thrive in the face of change.

While 70 percent of our membership remains directly employed by medical practices, new member trends indicate that about a quarter of all MGMA members who joined in 2009 came from other types of healthcare organizations, including integrated delivery systems (IDS). Also this year, more than half our new members are 45 or younger. More current and new members are attaining or have attained Master’s degrees.

As our membership changes, so does the state of healthcare. Members frequently ask me about current healthcare trends. Here are four we’re watching and what MGMA is doing to support our members during these changes:

• Larger systems, influenced by the government, to become the norm

In 1975, 68 percent of physicians worked in one- or two-person practices (1).  By 2005, that proportion had fallen to 32 percent and has probably declined more since then (2).  I think group practices will increasingly merge to form larger groups, integrate with other specialties to form multispecialty groups or become fully integrated with hospitals (our new membership numbers reflect this) in order to compete in the marketplace.

Also, much of the Federal reform legislative language favors larger, more complex practices, e.g., incentives for implementing electronic health records, electronic prescribing and quality reporting.  Penalties for not adopting new technology could hit smaller practices harder. There is even talk of exempting physicians in systems from any Medicare Part B payment caps that might otherwise apply.

• Hospital-owned groups already on the rise

MGMA’s physician compensation survey data indicate the proportion of physicians working in hospital-owned groups has steadily grown over the last several years. Both primary care and specialties are affected. The economic reasons for this are clear: Between 2001 and 2009, the Medicare conversion factor rose only 1.1 percent, while the consumer price index rose 24.2 percent; and median practice operating costs (for multispecialty groups) went up 43.1 percent. No matter the business, it’s a challenge to remain a viable, free-standing practice when revenue is flat and expenses increase by 6 percent or so a year.

This year we’ve ramped up efforts to provide practice management support for organizations that are part of  IDSs. In our various print and electronic member publications, we’re featuring more stories and examples of what it takes to successfully run these health systems, and we recently published a book dedicated to the topic. At the MGMA 2009 Annual Conference, Oct. 11-14, we held IDS-specific sessions that drew more than 900 people, proving this aspect of practice management is here to stay.

• Practices increasingly collecting from patients

MGMA polled members earlier this year about their top challenges, and collecting from self-pay patients landed at number four (3).  As high-deductible health plans, health savings accounts and uninsured self-pay patients have increased in recent years, collecting the patient’s share of the bill has become a greater challenge. MGMA is completing research on patient collections and we will release results early next year.

• Healthcare reform on the mind

We couldn’t forget about this topic. Impending healthcare reform legislation means even bigger changes to come – ones that require adaptation so healthcare management professionals and their organizations won’t become irrelevant.

No matter what the outcome, health insurance is likely to expand, and new taxes and/or payment cuts seem likely. MGMA is monitoring the latest developments and sending weekly e-newsletters to members through the MGMA Washington Connexion (membership required.)  Our public policy and advocacy staff in Washington, D.C., is advocating on behalf of medical practices and has sent numerous comments and letters to Congress and the Administration regarding proposed legislation, especially to assure that administrative simplification measures are included in any bill that is eventually passed.

Notes
1.    Goodman L, Bennet E, Odem R. Current status of group medical practice in the United States. Public Health Rep., 1977;92 430-433.
2.    Cook R. Finances driving physicians out of solo practice. American Medical News, Sept. 10, 2007.
3.    Schneck L, Margolis J. Medical Practice Today: What you have to say. MGMA Connexion, July 2009, Vol. 9, No. 6, p. 28. www.mgma.com/medpracticetoday

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So?  So, why do medical practices have to be forced to do the right thing?  Confirming patient identities is the right thing for so many reasons.  Yes, it is one more thing in the long line of things that practices have had to fold into the mix of administrative tasks associated with, but not really related to, the care of patients. But it is the right thing to do.

Taking the role of the patient (because I am one), this is why I want my personal physician to adhere to the Red Flags Rule:

• I once had my driver’s license stolen and the thief or buyer of my information opened a cell phone account and ran up a $600 bill before I realized my driver’s license was gone.  I got off easy, relatively speaking, but it took hours and hours on the phone to get everything straightened out.  It was also frightening. I do not care to experience this again.
• If someone used my medical insurance to get care paid for, I wonder how I might find out. Maybe when my application for life insurance was turned down for illnesses or conditions I never had? Maybe when someone had run up a bill in my name and creditors came knocking?  Maybe never, yet I could suffer the consequences without knowing the reasons why.
• I would wonder why my physician wasn’t implementing policies to protect me against identity theft.  Is he too busy?  Too lazy? Too complacent?  What else is he lagging behind on?

Luckily for us, superstar Maria Todd has made implementation of the Red Flags Rule as painless as it can be.  She is generously  sharing her Identity Theft Prevention Program (ITPP)  materials with managers who haven’t gotten their program launched yet.  Click here for everything you need to get started.

So, why haven’t you implemented a program in your practice?

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I took last week off to complete a project I’ve been working on since early this year – my first book!

It’s really a workbook and it guides the reader through a program to move their practice from a back-end collection process to a front-end collection process.  What is the difference?  A back-end program collects the majority of patient-owed balances after the payer has adjudicated the claim and has submitted payment to the practice.  A front-end program takes all the available information about the payer/plan and collects payment or arranges future electronic payments with the patient at the time of service.

The book has step-by-step instructions for implementing the program in any practice, and more than a dozen worksheets and templates are included.  Some examples are:

1. Patient Collections Benchmarks
2. 30-Day Project Calendar
3. Responsibility Assignment Worksheet
4. Budget Template
5. Sample Job Description and Hiring Worksheet
6. Product Evaluation Forms
7. Sample Financial Policy and Financial Policy Template
8. Patient Frequently Asked Questions (FAQ)

You really can implement a program like this in your practice in 30 days.  It’s hard work, but well worth the effort.

Special Note: On Monday, November 16th the book will be available for purchase and download here on my site.  For my readers who are subscribed to this blog via email, I have a special gift for you – $10 off the price of the book to thank you for your support.  If you’re reading this and are not subscribed to this blog, sign up before November 16th and I’ll give you the same discount.  As soon as the book launches, this great deal is gone!

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Hi Mary Pat,

Here at Software Advice, we’ve been getting a lot of questions about the HITECH Act and how practices can get a piece of the Stimulus pie. This got us thinking about EMR adoption rates. Has the stimulus influenced practices to buy? Or has it just reinvigorated research?

We may get some insight this Friday. Recovery.gov is supposed to post their report on stimulus spending. This will include information on any grants awarded between February 17th (the signing of the bill) and September 30th.

In the meantime, we’d like to know your anecdotes. Are more doctors buying because of Stimulus incentives? Take our survey at: Obama’s EMR/EHR Stimulus of 2009 – Creating Buyers or Tire Kickers? Be sure to come back Friday to see the results!

Thanks again for your help.

Best,
Houston
________________________
Houston Neal
Software Advice
www.softwareadvice.com

Office:     (512) 364-0117
Fax:         (360) 838-7866
Skype:     hjneal
Email:    houston@softwareadvice.com

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Listen here.

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So you’ve been trying to become employed in healthcare, or you’ve tried to enter healthcare management, or you’re trying to move from one job in healthcare to another.  You’ve read my post about my search for a job in healthcare and have been soldiering on, but you’re just not getting anywhere.  You might have education, but no experience or you might have experience but no formal education.

Healthcare is no different from any other field.  It’s a hodgepodge of what you know and who you know.  What everyone is looking for is expertise and authority and that can’t always be demonstrated by a degree or years of experience.  A new buzz phrase is “What is your value proposition?” or “How will you pay for your salary and make me (doctor, practice, hospital, health plan) money besides?”

If you want to enter the field or climb the ladder in healthcare management, you need to demonstrate that you have something of value that someone wants.  Try some non-traditional ways of gaining expertise and demonstrating value, like the ones I list here.  Yes, each of these will take time in addition to your current job, but it has the potential to give you a hand up to your next job.  If you don’t currently have a job, you have lots of time to work on the list below, and when potential employers ask what you’ve been doing while unemployed, you have a great answer!

1. Blog about the field you want to enter – learn about the field and write about it.
2. Write about being in the middle of a transitional field and your experiences along the way – if you’re a compelling writer, I’ll publish it as a series on my blog!
3. Create a site of resources for others that already do what you want to do.
4. Interview others in the field you want to enter and publish the interviews.
5. Ask people if you can shadow them for one day or a half day to understand what they do to see if you’re on the right track (who would say “no”? I wouldn’t.)
6. If you haven’t used voice recognition, invest in a basic copy of Dragon and learn it inside and out.
7. Learn how electronic health records (EHRs) work.  If you’ve never used one, gain experience by finding someone who has one and volunteer your time to write a user’s guide for them, or to use their user’s guide and critique it for them. Do that for as many different EHRs as you can find.
8. Think creatively about jobs in a department you want to be in, just not in the job you want to be in – call temp agencies, computer schools, software companies, any healthcare entity going through a conversion, etc.
9. Tell everyone (if you’re free to talk about it) what you’re looking for – you never know who might help you find it.
10. Volunteer to do an informal project for someone in the field – some topic they need information about but never have the time to do.
11. Join the American College of Medical Practice Executives (ACMPE) and pursue board certification and become a Fellow in the college.  These credentials are quickly becoming the standard in the field.
12. Get a Google Health account and learn how to use it inside and out.
13. Get a Microsoft Health Vault account and learn how to use it inside and out.
14. Get accounts on any other personal health record (PHR) platform you can find.
15. Publish case studies on common problems in other fields and how they were solved, and apply those solutions to healthcare problems.
16. Put a chart on your resume showing each skill you have and how it transfers to healthcare and brings added value to your potential employer.
17. If you don’t yet, get a Twitter account (free) and start conversations with others in the field.
18. If you don’t yet, get a LinkedIn account (free) and join groups that are talking about the things you want to learn about (Twitter will give you more info and friends, LinkedIn will make you more business connections)
19. If you aren’t already, sign up for websites that focus on what you are interested in, read them religiously and comment on their posts.
20. If you don’t already, get your resume on visualcv.com (still free I think) Add any goodies you can to your visualcv that demonstrate you know your stuff – recommendations, videos, charts, white papers, etc.
21. Find someone to mentor you who is well-positioned (locally, regionally and nationally.)
22. Volunteer to do some pro bono work for your local professional group – your state MGMA, your state medical society, etc.
23. Join Toastmasters and polish your “elevator speech” so you can effortlessly let others know who you are and where you’re heading.
24. Let me know what you plan to do, and how I can help.

Best wishes,

Mary Pat

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David Kirkup

Partner at B2B CFO® – Experienced CFO for Rent. Fast, Effective, Affordable.

Consider adding a part-time CFO to the mix. Many medical offices have very weak financial capability or understanding. Assistance can range from better financial reports, capital expenditure analysis, budgeting and exit plans.

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Bobby Jones

Eastern Region Sales Manager – Billing Tree

1) Build a relationship with the patient before he/she leaves the practice.
2) Make sure they know you are expecting payment on the portion they owe, and when you are expecting that payment.
3) Let them know what your process is for collecting, and when they will go to an outside agency.
4) Enable a web site to take payments 24 hours a day.
5) Set up an IVR system to take phone payments after hours.
6) Communicate your available payment acceptance methods in writing, on the phone and every time you speak with your patients.
7) Send the invoice or statement when you intend to send it.
Re-inforce the payment acceptance methods on the first and any subsequent invoices.
9) Adopt a plan for following up with any patients that don’t pay after 10 days.
10) Get email addresses from all of your patients and their permission to contact them in that manner.

***********************

Sukrit Tripathy

Sr. Product/Process Trainer and EDI Implementation Consultant

One suggestion would be to integrate the revenue cycle mangement function with your clearinghouse {for electronic billing} with integrated solutions like Coding database and Updates, Industry Broadcast, Performance and Audit reports for Claim Edits, Transmission and Rejects. Also, better training resources for billing staff actively into the practice management system.

***********************

Barbara Rotter

Consultant at Pacific Women’s Medical Group

I would add effective cash management (even if interest rates are so low).

***********************

Michael Glass

Medical and Business Consultant at Transworld Systems

Utilize a Flat Fee Collections Agency for Non-responsive Patient Pay concerns.

***********************

Randall Shulkin

Principal Consultant – Culbert Healthcare Solutions

- Do you collect co-payments on the way in rather than on the way out?
- Does your PM/Scheduling system show the patient co-payment and outstanding patient balance in the appointment screen? If not, then can you download a listing for your front desk staff?

***********************

Denise Price Thomas

DPT Healthcare Consulting & Training

I’d like to add “acknowledge the patient with eye contact” and offer “polished customer service” and they will WANT to return = return on your $ $

***********************

Stacy Mays

Managing Partner, Dynamic Grape Companies

One other thought… don’t be afraid to try new technology. For example, one of my clients has developed a kiosk that allows patients to take their own weight and bp and electronically feeds the data into their EMR. The whole set up costs about $3500 and can save a ton of staff time. Tele-health in general should also be considered.

***********************

Angela Short

VP at Operations

If you select a reasonably priced EMR and you implement enhancements then you more than save on staff cost. Keep in mind that my practice rolled out the EMR five years ago, so we have had time to get it right. Here are some of the savings/revenue opportunities:1. We utilize our electronic technology to send text messages and emails to our patients to remind them of their appointments. This function alone saves my practice one FTE. Not only do we save with staff time we improve patient satisfaction, as our Blackberry users loves the email or text that they can directly add to their calendars. The revenue enhancement to this function, we decrease no shows and lag time in our physician’s schedules.

2. The robust reporting within the EMR allows the organization to assemble important quality measures that we use in contract negotiations. Without the EMR this would be a labor intensive task.

3. We are able to push a secure message to our patients regarding their pathology results saving staff time on the telephone and increasing patient satisfaction by eliminating a visit just to obtain a normal result.

4. No more chasing charts for a phone message. My call center takes ALL clinical messages. This is attached to the patient’s electronic chart and routed to either a nurse to respond or a physician. This process greatly reduces staff time, decreases the time it takes to respond to the patient’s issue and provides a legal record of the telephone call which is often missed in a paper environment.

5. We receive a discount on our mal-practice insurance because in an electronic environment it is guarantee that your notes are legible.

6. The formulary function built into most EMR’s provides the physician will a real time snapshot if a prescription that he/she is about to write is covered by the patient’s health plan and provides alternatives if available.

I have just highlighted only a couple examples of the administrative benefits. There are many more. It is tough to imagine going back to a paper chart.

I have done the math and we could cover our current EMR with the incentives offered through the government initiative.

I will comment that physicians need to be trained on how to use the EMR. You can lose site of the patient and focus the entire visit on the computer versus the patient, however, we teach our physicians that the patient first and then chart completion. We conduct patient satisfaction surveys and I rarely receive a complaint regarding the physician’s time at the computer. I do however, receive praises from patients regarding the ePrescribe as it decreases their wait times when the arrive at the pharmacy, the prescription is ready.

********************

Okay Readers, it’s your turn – what’s your secret weapon for increasing revenue or decreasing expenses?

Mary Pat

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UPDATE: The poll is now closed and the webinar has passed, but you can still listen to the webinar here until April 2010:

You might have noticed that I’m a big fan of FREE.  I believe sharing information and experience builds relationships.  Giving information and experience away for free is my ideal.  My blog is free, although I must hint that my first eBook is about to be published and will be available here at Manage My Practice.  It will not be free.  But it will be a great deal and it will pay for itself in 31 days.

What do I get out of blogging?  You!  You freely share your information and your experience with me, and we both learn and become better.  We also get to know each other.  Through my blog I’ve met the most wonderful bloggers and authors and managers and vendors and people who have enriched my life.

I have a favor to ask of you.  I am participating in a webinar on October 14th – the details are at the bottom of this post.  The webinar, of course, is FREE.  I am exploring the future of traditional medical transcription and it would help me so much if you would answer one question.  I really, really want to know what you think.

Please click here to answer one question.

Thank you very much!

Mary Pat

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Evolving Medical Transcription: Technology’s Impact on Traditional Transcription’s Processes

What will happen to dictation and transcription in the coming age of electronic medical records? With the help of computers, doctors and nurses do more of the documentation themselves, and transcriptionists may find themselves becoming editors rather than typists.

When: October 14, 2009

Time: 2 pm ET/ 11 am PT

Duration: 1 hour

Register Here

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Related posts:

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1. Report to work on time daily. Be ready at your desk to begin work at the designated time.  Leave promptly for lunch and return to work when you should, unless you’ve made special arrangements with your supervisor.  Take breaks on the honor system and do not abuse the privilege.  Clock in and out faithfully.
Command respect from the physicians, managers and employees of (your practice name here) by demonstrating total professionalism in the workplace with your dress, your demeanor and conversation. Represent the practice in a way that would make your Mother and your boss proud of you.  Treat your co-workers as you would like to be treated.
Be economical by not wasting time or supplies or doing sloppy work that must be re-done.
Give every patient your total attention, patience and courtesy. Do not assume you know what the patient is going to say, but listen carefully to the patient (in-person or on the phone) so you can assist them to the best of your ability.  Remember how good it feels to be the center of someone’s attention and give that gift to every single patient.
Keep your supervisor aware of any problems in your workload, whether too much or too little.  Do not expect your supervisor to know if you are falling behind or caught up.
Document all interactions with patients and other medical facilities to assist your co-workers in knowing what you have done, and document your resolution of the situation to the customer’s satisfaction.
Strive for a positive attitude every single day. Don’t whine.
Be a team player. This means both covering for your co-workers and knowing that they will cover you.  This means supporting your co-workers to their faces and behind their backs.  This means having (your practice name here) goals for your goals, and knowing that your success will be your team’s success, and ultimately, the success of the practice.
Clean up your own messes and act as an adult acts in the workplace: responsibly, maturely, and with thought for others.  Accept blame for your own mistakes, knowing that everyone makes them, and that if no one is making any mistakes, nothing is improving.
Contribute to making (your practice name here) a good place to work. Only you can create a place where everyone enjoys working.  Only you can make this place a good place to be.

Photo credit: © Barbara Helgason | Dreamstime.com

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Here are Chris’s suggestions and my commentary:

• Start a blog – I can’t think of any simpler website technology to start and master, and there are cheap and free platforms readily available. Why a blog? Because they’re easy to create, because they’re easy to update, because they encourage repeat visits, and because you can use them in many flexible ways.

My comment: Most practices have websites and it is easy to add a blog to a website.   Some administrators and/or physicians would gladly take on a blog, and if not, there are some great writing professionals who can create and write a blog for you.  Professional bloggers get to know your practice and your patient demographic and create a voice for your practice that uniquely fits you.  A blog extends and enhances your relationship with existing and future patients. It’s all about the communication.

• Start listening – People are talking about you. Find out where they are and who they are.

My comment: It has been hard for physicians to come to terms with the fact that patients are publicly rating them. In some cases, physicians are requiring consumers to sign gag orders before becoming patients.  The truth is, patients will not be stifled and physicians need to monitor the bandwaves for commentary about them and take it seriously.

• Try Twitter OR Facebook – Let’s not rush things. Facebook has many more users, but it’s a bit harder to find customers, prospects, partners and colleagues. Twitter is easier to use and faster to connect with people, but there are far fewer users on there today. I’ll let you choose. If you go with Facebook, make a personal account under your own name, and then start a fan page for your business.

My comment: Does this seem too far out? It’s not! At the very least, practices should be learning about the technology and preparing for the time when they will need to jump in.  Businesses (who want customers) can no longer hold themselves aloof. You need to be part of the conversation, or at least know where/what the conversation is.

• Get the word out – If you’re going to spend time building these social sites, let’s presume that you want more people to contact you and interact with you through them. Print business cards with the company name, and/or the request for people to join your fan page or follow you on Twitter.

My comment: Your website and your social sites should be on everything you print that patients take home or receive from you, and can also be communicated to patients via automated communication: appointment reminders, messages on hold, emails, and electronic newsletters.

• Try moving the needle – now lets really get crazy. See if you can fill the place up with social-media minded folks. Okay, this won’t work for every business, but don’t be too quick to count out the idea. Let’s try inviting them to a store-only special event, or let’s give them a discount code. You know, the stuff you already know how to do. Any difference in the results? See if you can do some kind of really special one-day-only push, and what that brings to you.

My comment: This won’t work for every medical practice but it’s ideal for practices with elective services – plastic/cosmetic surgery, allergy, complementary & alternative medicine, sports performance, vision correction, cosmetic dental services, infertility treatment, etc.

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