Reed Tinsley, CPA

Starting physician salary information

Reed Tinsley — 2009-11-11T09:25:52-05:00

The HealthCare Group’s Physician Starting Salary Survey for 200 is an excellent source of starting salary information. It also includes information on issues like covenants not to compete. You can find the survey here:

https://www.thehealthcaregroup.com/Productdownloads/2009PSSSreport.pdf

Job description for a managing physician/director in a group practice

Reed Tinsley — 2009-11-10T09:33:46-05:00

GENERAL SUMMARY OF DUTIES: The Managing Director is the elected representative of the Board of Directors. This representation is both external and internal to the organization, especially with regard to managing, supervising and directing the professional clinical staff of the organization, including all employed physicians, and employed or contracted allied health professionals (physician assistants (PAs), and nurse practitioners (NPs)). He/she will serve as the Chair for all meetings of the organization, including Executive Committee and Board of Directors meetings.

A primary responsibility of the Managing Director is the implementation of the organization’s strategic plan. The Managing Director and the Administrator work together to attain the goals and objectives of the organization in accordance the approved actions of the Executive Committee and the Board of Directors, and accepted business practices.

SUPERVISION RECEIVED: Day to day supervision and accountability will be to the Executive Committee, with ultimate accountability to the Board of Directors.

SUPERVISION EXERCISED: Supervises the clinical support staff through the Nursing Supervisor and the Research Supervisor; and the physician assistants through the Senior Physician Assistant.

Responsible for the day to day supervision of the Administrator, the XXXX Clinic, Director, the Medical Directors of the XXXXXX, and The XXXXX Medical Director. As required, may assume the role of Medical Director for one or more of the office-based services or one or more of the surgery centers.

TYPICAL PHYSICAL DEMANDS: Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. May require lifting up to 40 pounds.

TYPICAL WORKING CONDITIONS: Normal medical practice environment, including both office, ambulatory surgery center and hospital settings. Frequent evening or weekend work. Some business travel is required. Position is very demanding and stressful.

DUTIES: (This list may not include all the duties assigned.)

1. Works with the Board of Directors and the Administrator to chart and implement the group’s strategic vision in response to the changing needs of the community.

2. Develops, recommends, and updates strategic long-range plans to support the group's mission, vision, and values. Has primary responsibility for implementing the organization’s strategic plan as approved by the Board of Directors.

3. Informs the Executive Committee and the Board of Directors about current trends, problems, and activities in the medical field both locally and nationally to facilitate policy making.

4. Chairs all Executive Committee and Board of Directors meetings.

5. Approves unbudgeted expenses or purchases in accordance with the organizations purchasing guidelines, as established by the Board of Directors. Unbudgeted expenses or purchases in excess of the established maximum must be approved as outlined in the organization’s purchasing guidelines.

6. As provided by the policies and procedures of the organization the Managing Partner will act in concert with the Executive Committee and/or the Board of Directors; however, he/she may act independently in areas reserved for Executive Committee or Board of Directors action when convening a meeting of the Executive Committee or Board of Directors is not possible or feasible. When taking such independent action the Managing Director will coordinate decision making with members of the Executive Committee. Should the Managing Partner take such independent action without consulting either the Executive Committee or the Board of Directors the Managing Director is required to report such action to the Executive Committee or the Board of Directors as soon as possible..

7. In accordance with company policy, the Managing Director is responsible for the development of monthly and annual work schedules for all employed physicians, PAs and NPs, and is authorized and responsible for posting all final monthly clinical work schedules in a timely manner. The Managing Director is also responsible for resolving scheduling issues, including short-notice requests for physician time-off, schedule changes, and/or schedule conflicts.

8. Supervises the group’s Administrator. Initiates regular contact by phone, email, and in person to maintain a high level of coordination and focus with the Administrator, reinforcing the physician/administrator team management philosophy.

9. Helps set work priorities for the Administrator and clinical supervisors as identified above, monitors delegated duties, and reviews and acts on leave requests,.

9. Works with the Administrator to recommend policy positions regarding administrative and legislative matters.

10. Works with the Administrator and Assistant Administrator to develop and present an annual budget to the Board of Directors. Reports monthly financial data to the Executive Committee and the Board of Directors.

11. Directs and participates in the training of new members of the Executive Committee and the Board of Directors.

12. Works with the Board of Directors, professional staff and other members of the organization to monitor medical activities to ensure that the community's needs for quality health care are met.

13. Directs and coordinates the efforts of the Executive Committee, the Board of Directors, and the Administrator to recruit, develop, evaluate, and retain physicians and allied health professionals.

14. Participates in and supports the development and administration of clinical research trials, including the evaluation and reporting of results and outcomes of care.

15. Works with the Administrator to encourage the integration of the practice with the community through effective communication and public relations programs.

16. Represents the organization in its relationships with other health care organizations and government agencies. As appropriate, participates in negotiations with third party payers.

17. Approves recommendations regarding the employment or termination of all clinical support staff, including the Nursing Supervisor, the Research Supervisor, allied health professional staff, and all Laboratory Technical Directors. As appropriate, participates in decisions regarding the employment of non-physician clinical staff.

18. Provides assistance to the Nursing Supervisor, the Research Supervisor, allied health professional staff, and all Laboratory Technical Directors in establishing department philosophies and objectives.

19. Maintains professional affiliations and enhances professional growth and development to keep abreast of trends and advancements in group practice leadership.

20. Maintains strictest confidentiality regarding the organization’s business affairs and strategic plans.

21. Performs related work as directed by the Board of Directors.

PERFORMANCE REQUIREMENTS:

Knowledge, Skills and Abilities:

Knowledge of the purposes, organization and policies of the community's health systems sufficient to interact with other health care providers at a senior leadership level. Knowledge of the policies and procedures of a medical group practice sufficient lead the organization to achieve its goals and objectives. Knowledge of the principles and practices of a medical group practice sufficient to ensure clinical staff productivity and retention. Knowledge of effective personnel practices, including how to supervise physician staff. Skill in exercising a high degree of initiative, judgment, discretion and decision-making to achieve organizational objectives. Skill in analyzing situations accurately and taking effective action. Skill in organizing work, making assignments, and achieving goals and objectives. Skill in organizing and conducting internal and external meetings. Ability to assume responsibility and exercise authority over assigned work functions. Ability to establish and maintain clinical quality control standards. Ability to organize and integrate organizational priorities and deadlines. Ability to represent the best interests of the organization without prejudice. Ability to make decisions and act objectively and without partisanship. Ability to bring a long-term vision to the strategic planning process. Ability to provide leadership in all areas of group practice governance.

QUALIFICATIONS:

Must hold a valid license to practice medicine and surgery in the State of XXXX; be a member of the Board of Directors of XXXXX Medical Practice; and be elected by the Board to the position of Managing Director.

Experience:

At least five (5) years of prior service as an active member of the organization’s Board of Directors is required. At least three (3) years tenure as a member of the organization’s Executive Committee is preferred. Prior experience as a manager with training in management and supervisory techniques is desirable.

Exit interviews

Reed Tinsley — 2009-11-09T08:39:43-05:00

The value of exit interviews is directly correlated to what you will do with the information, and the number of interviews you do. If you have a low number of folks you want to do these on, the value of the information will be less valuable and more influenced by individual bias. If you don’t do anything with the information, or don’t trust the reliability of the interviewee, why bother???

I have seen these used in the past by clients to focus on areas where they suspect problems - the usual ones of training, supervision issues, orientation. The biggest help they have gained is in revising the orientation and training processes. The most helpful questions have been "How would you change the training/orientation process? What did we not teach you that you now realize would have been incredibly helpful?"

Believe it or not, many clients don’t ask questions about the departing employee’s new wages, hours, and benefits provided by their new employer; these clients utilize other methods to ensure a competitive place in the marketplace.

Promote cultural competency

Reed Tinsley — 2009-11-06T09:29:48-05:00

Cultural differences between patients, staff, and physicians pose barriers to true patient involvement. Such differences can occur in thoughts, communications, customs, beliefs, and values. Cultural competence, therefore, is integrating the knowledge of cultural differences into your standards, policies, and practices to increase the quality of services and thereby improve patient outcomes. It promotes inclusiveness, respect, and value with regard to cultural differences.

Examining and improving cultural competence can have a positive impact on prevention, identification, and treatment of your patients. Failing to do so can affect what information you are able to gather for a patient history and about patient symptoms, which you use to diagnose illness and provide quality treatment. Handle these issues from an organizational standpoint, including incorporating them into your policies and procedures.

Deceased patients with unpaid balances

Reed Tinsley — 2009-11-05T08:36:51-05:00

How are you managing the accounts of deceased patients when they have a balance? If you were told there is no estate, are you confirming this with the courts? Do you get involved in probate?

In case of unfortunate death of a patient who has a balance, it is best to first bill the patient’s estate. Most of time someone from the family will call and offer to settle the bill and ask for some discount (You should probably be offering some kind of a discount anyway in most of these circumstances). Since the cost of collecting by collection agency is at leaset 25%, offer a discount from 10% to 25% if they pay right away with a credit card or mail a check within a week.

If there is no response or no offer to settle by the family because they say the person did not have any estate, turn the account to collection agency.

Advantages to hospital employment?

Reed Tinsley — 2009-11-04T08:07:48-05:00

Here are a few of the most common advantages I hear out there for a physician’s employment by a hospital:

§ A stable financial circumstance, including, but not limited to guaranteed or fixed competitive base compensation and benefits;

§ Access to continuing and reliable malpractice coverage and, in many cases, tail insurance;

§ A practice environment free from the day-to-day burden and administrative tasks of operating and managing an independent practice; and

§ More regular work hours and shared call responsibility.

Oh really? What about THE major disadvantage – the hospital controls your compensation now and in to the future. I just hope hospitals have learned from their mistakes in the past but from what I see so far, that is doubtful. Are physicians really better off employed by a hospital rather than go at it as an independent practice? It’s going to be interested to see how all of this is going to shake out.

Unauthorized prescription call in

Reed Tinsley — 2009-11-02T09:06:19-05:00

Suppose a clinical employee comes to you and says that she overheard one of your RN’s calling in a prescription yesterday for her daughter. As best the employee could tell, she was calling it in under the name of your nurse practitioner (who was not even at work that day). She also heard a conversation regarding “my nursing license allows me to do this” “the nurse practitioner would call this in if she were here”. Let’s say the prescription was for Zithromax and there is no paper documentation that you can find. To make matters more interesting, this RN has actually resigned from your practice and her last day is Friday this week.

Do you confirm this has happened by calling the pharmacy and finding out if the RX was actually called in, who called in and under what name the prescription was authorized? Do you confront the employee? If it is true, do you report it to the Nursing board?, what else do I need to do?

As far as confirming the information, I would recommend checking with the pharmacy first to verify the script was called in but I would not notify the nursing board. It isn't that you don't want to allow employees to utilize your services to help them or their families. What you do want to be sure of, is that she is not circumventing appropriate medical care for her child and taking short cuts that could, in the end, cause her child harm.

If she wasn't already leaving I would have given her a formal warning about abusing her position. A second time and I would have let her go. All she had to do was ask and I’m sure someone would have ok'd the prescription but someone like this could become untrustworthy.

Do you have a written policy about employees seeking medical attention from one of your doctors? We have all run across cases where one of your very kind doctors is being taken advantage of by employees by going to him for all their aches and pains. Consider writing and adopting a policy that would allow an employee to seek out one of your doctors with their managers permission. That doctor would complete a very short form stating what their findings were and any scripts they wrote for the employee. The form should state that the employee is expected to contact their PCP for follow up. In the end, you may have less time missed at work to see the PCP or for illness.

Employee policy handling lax work effort that may lead to internal theft

Reed Tinsley — 2009-10-30T09:13:49-04:00

A medical practice recently had two instances of what appears to be cash theft by an employee. The staff in the reception area that handles the cash boxes had been quite lax for some time now when it comes to the security of their cash. The practice wants to have zero tolerance but was unable to determine who is taking the missing cash. The practice recently adopted the following changes:

1. The safe combination has been changed.

2. New cash boxes and keys have been purchased.

3. New locks have been put on reception area draws where the cash boxes are kept during the day.

So what is a good policy regarding theft/missing cash? Obviously if a theft can be proven, immediate termination must occur. But what about sloppiness or carelessness that could lead to a theft? How do you handle that?

I like how one physician office handles it – a policy called automatic Corrective Action - Decision Making Leave – used when employees don't lock draws; leave cash unsecured, can't identify where cash has gone due to sloppy work, etc. Under this policy, employee is sent home for a day without pay. It sounds much better than “Suspended Without Pay.”

Registration evaluation

Reed Tinsley — 2009-10-29T09:46:29-04:00

Does the staff make it a priority to accurately gather and enter the necessary registration information for each patient? ___Yes ___No

Do they know what information is necessary to prevent claim delays or rejections? ___Yes ___No

Do they clearly understand the importance of recording information accurately? ___Yes ___No

Is there a clear understanding of what information is essential? ___Yes ___No

Is staff aware of what information is needed to do appropriate follow-up? ____Yes ___No

Does the staff discuss and obtain preauthorizations and referral information from patients? ___Yes ___No

Is there a clear understanding of when and how to obtain preauthorizations and referrals? ___Yes ___No

Does the staff understand and effectively communicate the financial expectations to patients? ___Yes ___No

Are copays collected at registration? ___Yes ___No

Does the staff discuss the payment options that are available to patients (credit cards, debit cards, cash, checks)? ___Yes ___No

Does the staff try to identify credit risks? ___Yes ___No

Does the staff recognize their potential to reduce patient statements? ___Yes ___No

Reducing payment denials

Reed Tinsley — 2009-10-28T09:10:27-04:00

So what advice do I have for ways to reduce payment denials? Start simply – but right away – by implementing a system such as the following:

1. Flag all denied charges, making a copy of the related EOBs and placing them in a folder.

2. Hold staff meetings of the billing and collection personnel twice a month if possible or, at a minimum, once a month. In the meetings review and discuss the denials; why they occurred, and what corrective action needs to be taken to prevent them in the future.

3. Implement the corrective action by communicating with the individuals who are involved with the process. In most cases this will be the people in attendance at these meetings – but not always. It could also include anyone from front desk personnel to even the physicians. For example, a denial pattern might be identified as stemming from the fact that a particular physician is filling out the patient charge ticket incorrectly.