Tuesday, September 25, 2018

Good Documentation and a “Clean” Firing can Help Protect your Practice

Without being mean and cold-hearted, a manager needs to keep communications with the terminated employee short and simple. The more you talk, the more trouble you can stir up. Firing an employee is never easy. You have to be careful and thorough to make sure you haven’t said or done something that could be used against the practice in a wrongful-termination lawsuit. It’s important that you clearly document the history that led up to the termination, and it’s critical that the record shows that you have treated the terminated employee the same as you treat everyone. Lawyers look for evidence of discrimination—especially if the worker is part of a “protected” class. 

In trying to make a firing easier on the employee, many managers and physicians trip themselves up with legally clumsy mistakes. Here are five pointers for avoiding some of the common errors:

1. Keep the discussion short and direct. It’s tempting to unload on the failing staffer with a history of underperformance and mistakes. Each problem you raise gives the employee a chance to argue each point. If the worker tries to draw out the conversation, tell him or her that “there’s nothing left to talk about.”

2. Be clear that this is a termination. Trying to soften the blow can relay a mixed message—a firing sounds more like a last-chance warning. Leave no room for misinterpretation.

3. Tell the truth about your reason to fire the employee. If you’re firing the staffer “for cause,” don’t call it a layoff. Calling it a layoff (or eliminating a position) can affect unemployment claims. Worse, you can get in legal hot water if you then turn around and hire a replacement. Similarly, don’t call an economic elimination a performance-based firing. You likely won’t have the records to back up your claim.

4. Calm the remaining employees afterward. Don’t lie, but don’t divulge too much information either. Tell remaining staffers only what they need to know to assure them that the decision was fair and that their own jobs are not necessarily in jeopardy.

5. Take the former employee to the door immediately. Don’t let a terminated employee talk with other staff members. Have someone (probably yourself) accompany the worker back to his or her desk to collect personal items. While this can feel like you don’t trust the employee, it also protects him or her from being wrongfully accused of unprofessional conduct or theft.

Once you’ve made the decision, though, make sure the employee understands that there’s no room for discussion or negotiation. If you allow him or her to talk you into allowing one more chance, you will only extend the process and delay the inevitable firing. You’ll lose credibility with the under-performer and with other members of your staff.

Good documentation, fair practices, and a “clean” firing will help protect your practice and will remind the rest of your staff that you mean what you say about performing up to standard.

www.greenbranch.com   The Journal of Medical Practice Management   Fast Practice 

Thursday, September 20, 2018

Nothing in Your Revenue Cycle Takes Care of Itself. Five Mistakes Providers Make.

Healthcare providers with sub-performing accounts receivable will do well to take a close look at these five broad areas. This advice is especially important to high-volume billing offices affiliated with hospitals and healthcare systems. It’s not uncommon for institutional departments to falter in any of these five areas.

1. Not staying current with payer requirements. Payers often develop new tools and processes that can help you avoid slow payments and rejected claims. 
Make sure you have the latest technology (system updates), manuals, and contact information in place.

2. Failure to monitor the entire claims process: Without thorough monitoring of each step, staffers will waste countless hours analyzing denials and delays. The bottleneck that’s choking your cash flow may hide in a process you’ve inadvertently ignored.

3. Not resubmitting rejected claims: If you don’t feel you have access to data to support your claim, you might be reluctant to resubmit the rejects.

4. Failure to verify patient eligibility: Fully one quarter of practices never verify patient eligibility and copayment amounts. With constantly rising copayments, this can cost a practice dearly.

5. Not recognizing trends: Focusing on one claim at a time without stepping back to look at the
bigger picture will prevent you from seeing correctible errors in your processes.

Without a specific assignment, no one has time to analyze charges going out to make sure billing requirements have been met, and no one has time to analyze payments and adjustments coming in the door. The problems described in this article require analyzing trends and identifying where you’re missing out on revenue opportunities. 

The take-home lesson: Nothing in your revenue cycle “takes care of itself.” You must deliberately plan to analyze and evaluate your processes so that it becomes part of your routine. Otherwise, you could have a significant “leak” draining potential income from your practice.

Visit us at www.greenbranch.com for The Journal of Medical Practice Management or our Abstracts and Commentary Newsletter, Fast Practice. 

Friday, September 14, 2018

Optimizing Your Reception Area (Waiting Room) – Time for a Reality Check

Patient satisfaction depends on more than how well you perform as a physician. The entire “patient experience” affects how patients feel about your practice. What they see, feel, hear, and even smell in the reception area has a significant impact on how they evaluate your practice’s performance. Often referred to as “the waiting room,” patients can spend a good deal of time there. We prefer to use the term, “reception area.” A well designed area can actually shorten patients’ perceptions of passing time—and the opposite of that is likewise true.

There are several weak points in reception area environments that could be improved. Areas needing attention include:

• Waiting times. Patients who experience long waiting times have a greater tendency to be dissatisfied with the actual doctor consultation. Practice operations must be streamlined to minimize wait times, but every effort must also be made to help patients feel that time passes quickly, too. A comfortable environment is key, as is an attentive, compassionate staff.

 • Welcome companions. When calculating seating requirements, be generous enough to
accommodate patients’ companions comfortably. Companions affect patient perceptions as well, so various amenities, decorative details, and a pleasant atmosphere elevate everyone’s impressions. The he presence of anatomic pictures, illness information, and medical “educational” materials in the reception area has a tendency to elevate anxiety levels.

 • Patient confidentiality and respect. Patients have been sensitized to their right to privacy. Make every effort not only to guard personal health information, but to make sure patients feel protected. Details such as bathrooms that do not open directly into the reception area help patients feel more comfortable on a personal level. 

Regardless of your best efforts on the phone or in the exam room, patients are deeply affected by their impression of your reception area. Conducting an objective investigation at your own practice is an excellent first step to elevate patient satisfaction. Just about every medical management professional already knows this: An optimized waiting area raises patient satisfaction and can even boost practice efficiency. But sometimes we can be blinded by common wisdom. 

It’s very difficult to step back and take a fresh look at the things with which we are most familiar. We don’t even notice the worn furniture in the reception area, but new patients scowl at the “dingy décor.” Patients stare at the water-stained ceiling, the cracked bathroom tile, and the scuff marks on the reception counter. We walk right past them. The conversation between a nurse and patient at the clinic entrance bounces off our ears—but patients in the waiting room squirm to hear about Mrs. Jones’ urinary tract infection. Familiarity really does breed contempt. 

So how do we gain the objectivity we need? We suggest a three-pronged approach:

 • Ask. Forget about what you “already know” for a moment. Find out what patients really want in a reception area. Google “patient reception area” for a couple million hits with general advice and design tips. Better yet, design your own patient survey with specific questions about their impressions and preferences. Consider forming a focus group of several patients to meet one evening and discuss their impressions and experiences in your reception area. Ask them how you can improve.
 • Assign. Hire someone from outside the industry to assess your reception area. Provide an evaluation guide that directs them to look at everything from décor to cleanliness and maintenance, from staff attitudes and performance to patient confidentiality. 
• Assume the patients’ point of view. Spend some time in your reception area. Take some simple work—and go sit with your patients for about an hour. Be aware of what’s going on. Look around at the furniture, the artwork, the floor, and the windows. Listen to conversations—especially at the reception desk. You can learn a lot. 

Until you make a conscious effort to overcome familiarity, your practice will not likely make the improvements your patients want.

Thursday, September 6, 2018

Before You Invite Colleagues to a Staff Meeting, Ask This One Question

No matter how many times we read management articles suggesting that we cut down on meetings, they still seem to, well, happen before we know it. That’s in part because there’s something reassuring about seeing the faces of your colleagues and reading their body language and tone when discussing key issues. That doesn’t make holding needless gatherings a good idea, though.

It’s worth bearing in mind the maxim cited in one of our favorite articles in The Economist, to wit: “80% of the time of 80% of the people in meetings is wasted.” Very few organizations can afford to waste that much of their staff and management time.

The question is, it’s time to have a face-to-face discussion on an issue, how do you decide who should participate? Are the people that must be included as a matter of course? Is it possible that by leaving a lower status person out, you’re missing a vital perspective?

One way to process this is to start by asking yourself “who has the best understanding of this issue?” rather than “who needs to be in the meeting?” When you ask who needs to be there you may be obeying unwritten rules that don’t really serve your organization. But if you ask yourself who understands the issue you might draw on knowledge sources that are otherwise neglected.
Another way to think your meeting strategy through is to ask yourself whether the key issue to be discussed is related to company policy or company operations. While the two overlap, as well the people who should be present to address them, it helps figure who has the biggest stake in the matter.
For example, if you make a major policy decision it’s likely that all of the executives or leadership members should attend. On the other extreme, if you’re deciding how to organize your sales team, that’s a purely operational issue.
You may even want to mix it up to some degree, holding one meeting to solicit feedback from your executive team and another to learn what your staff has to say on an issue. Then, everyone is in synch with little time wasted.

Few office workers like to attend meetings. Reasons for this include their inefficiency, the tendency to run to groupthink and the likelihood that many who attend public have little to contribute. These meetings can drag on for hours.

In some cases, involving people in a meeting can be important, including when significant events such as a change of leadership or strategy, or with the announcement of job losses. Also, it may be beneficial to hold a very brief team meeting each morning to share progress updates. However, if a meeting is meandering and ineffective it’s probably not worth holding.
To improve meetings, experts say, it’s important to see that everyone involved as well prepared and has seen the agenda. People can react badly if they don’t know what to expect and get caught off guard. A good agenda will put the most difficult items at the beginning of the meeting and tackle them right away.  It also helps to decide whether the meeting is designed to gain buy-in for a management decision to collect feedback from workers.

Meetings that push a management objective should be rare in a well-run firm, but if such a meeting must be held it’s best if allies of the meeting leader speak first and drive the agenda.
Meanwhile, the meeting’s goal is to learn what people think, it’s best to start with low status employees and encourage them to speak. For best results, enforce a “no interruption rule” to be sure they are not intimidated. It’s also an option to let people submit their views anonymously in advance.
Once a meeting has been held and decisions made, it’s important that everyone else finds out what has been decided. Sometimes even people who are present leave the room without being sure what has been agreed upon.

Finally, if you can avoid a meeting avoid it. When possible, use electronic messaging groups or private message exchange tools to keep management and employees in touch. These venues allow everyone to impart messages in succinct form. They also make it easy for those who aren’t involved to ignore the messages and keep working.