Three Simple Questions To Help You Manage Disruptive Employee Behavior

Guest post by Brenda S. Campbell

One of the most challenging aspects of practice management is managing the people within the business. It can feel overwhelming to manage employee attitude, behavior and performance, especially if confrontation doesn’t come naturally.

Screen Shot 2016-06-05 at 9.56.40 AMI have had the privilege of working for an amazing pediatrician for the last fifteen years. He’s been in practice for decades and has taught me so much about practice management, especially the “people” part.

He has helped me understand that it is possible to manage any employee behavior and expectations using a simple strategy.

When confronted with unsatisfactory employee behavior and performance, it is important to focus on three questions:

You send a message to the rest of the staff no matter how you handle the issue.

What’s the message you want to send?

If you choose to overlook the behavior, the message to your staff is that it is okay to continue this behavior and that it is acceptable.

If you address a behavior, it sends a message to everyone that the behavior is NOT okay and will not be tolerated. Often times, even though they may not say it, the staff appreciate that you address negative behavior.

For example, we had a telephone triage nurse who had a lot of experience, worked for us for several years and was solid in the advice she would give.

Her customer service skills, however, were lacking. I had to make a decision about the message I wanted to send to the rest of the staff.

What you allow is what will continue. Are you going to allow it to continue?

Make the decision to address the behavior and do it. Don’t put it off. Ask, “May I give you some feedback?” Let them know the problem with their behavior, set expectations and move on. They’ll either choose to correct their behavior or they won’t.

We’ve found that employees generally receive feedback in one of two ways. Some are completely unaware that their behavior was being perceived in a negative manner and are quick to ask how they can fix it.

The others become defensive and refuse to take ownership of the behavior often blaming external factors.

With our triage nurse, I knew that I needed to address her customer service problem, particularly her tone which could be perceived as condescending and snarky at times.

Her response fell in the defensive category and she said “somehow I get all the nasty parents on the phone.” I explained to her that she was the common denominator in each complaint and that her tone was the problem.

“Ma’am” is not necessarily respectful if delivered in a sarcastic manner. It was her behavior that made the parents become, in her eyes, “nasty”.

Are you better off with them or without them? Is it time to let them go?

If, after you’ve given the feedback and they have not changed their behavior, it’s time to make the decision about the employee’s future.

As you may have guessed, it didn’t take long for another parent to complain about the triage nurse and, at that point, we decided that even though we’d be down a phone triage nurse in a busy sick season, it wasn’t worth allowing negative behavior to continue thereby sending the wrong message to the staff.

We have found that when it comes to working with someone who behaves poorly or working short-staffed most employees would rather work a little harder until we find someone who is a good fit for our practice.

It’s certainly easier in the short term to ignore problematic employee behavior but it’s always costly in the end.

Allowing negative employee behavior to continue can hurt your employee morale, productivity and retention as well as cause you to lose patients. When we reflect on the occasions where we’ve had to let someone go after asking these three questions, we have yet to regret a single one.


Brenda Campbell is a practice administrator for The Pediatric Center at Frederick. You can check out her practice by clicking, here. She is a member of AAP’s subcommittee Pediatric Practice Management Alliance (PPMA). This article originally appeared in SOAPM’s Quarterly Newsletter.


 

Learn How To Create A Budget For Your Medical Practice

In medicine, the mention of the word profit is often viewed or interpreted as a dirty word. It is as if the word does not belong in the lexicon when health care is addressed.
 Broke doctor
I argue (in the context of the private medical practice setting) that profitability is a medical practice’s responsibility for one simple reason. If the medical practice (also known as a business) doesn’t deliver profits, health care providers are unable to provide for those in need.

Why Profits?

Profits pay for infrastructure, technology, education and human resources, all of which translate to superior pediatric care when employed correctly.
Another way I like to put it is by saying,

 

…a broke doctor does do anybody any good.

 

Calling vs Profits

Indeed, our medical businesses differ from other companies in that we care for children. And the notion of withholding medical services or restricting access to a sick child merely by the patient’s parents inability to pay for health care services is simply not in a pediatrician’s DNA.
However, it is important to accept the reality that without a way for a doctor or the practice’s income to outpace expenses, health care providers are unable to provide services of any kind. At least not for the long term.

Is there a solution?

How do we reconcile these two competing issues? On one hand, it is necessary for a medical practice to deliver profits if it wants to remain sustainable. On the other, we have an intrinsic motivation to put the patient’s needs first.
I am glad you asked.
These two dichotomies can co-exist – and even flourish – alongside each other. There is indeed numerous tools and principles rooted in business that can help medical practices manage what otherwise appears to be opposing forces.

A Resource You Don’t Want to Miss

Today, I want to tell you about a resource I’ve been working on to help your office obtain financial success, while simultaneously providing unsurpassed pediatric care to your patients.

To help you succeed in your financial success, I’ve written a comprehensive eBook on budgeting that walks you through the process of creating a budget for your medical practice. The materials also cover basic principles necessary to put the exercise into perspective.

Budgeting is a major component of financial success. Moreover, financial success is essential to the continuity of care.

To read more about this offering, click on the image below.

Medical Practice Budgeting
Click on the image

I do hope that you buy the book, but more important, that you find the eBook helpful, useful and valuable.

Let’s Talk About What Happened In Vegas

My friends from the Pediatric Management Institute (PMI) put on another great practice management conference in Las Vegas last January.Screen Shot 2016-02-21 at 10.55.37 AM

The content was excellent, thanks to the fabulous faculty PMI brought in.

The topics varied from customer service principles to fundamental changes happening in the health insurance industry and how those changes are – or soon will be – affecting doctors’ financial bottom line.

Below are a few highlights and notable points that resonated with me.

ANCILLARY SERVICES | INCOME DIVERSIFICATION

Dr. Jeanne Marconi presented an account of how her practice diversifies income streams by incorporating ancillary services into her practice.

Admittedly Dr. Marconi’s comprehensive – almost overwhelming – plethora of services (they even offer in-house exercise training programs for children with high BMI) is probably too much for the standard practice to implement.

But for me, her talk wasn’t an invitation to follow her footsteps, but instead, provide insight into what is possible, what can be done and what is available to practices.

Dr. Marconi dished out several challenges to the physicians in the crowd. But the one that resonated with me the most was her call for pediatric practices to challenge the status quo, expand their minds, think creatively (or to use a cliche, think outside the box) and begin to think about ways to diversify practice’s revenue streams.

HOW HEALTH INSURANCE COMPANIES ARE PAYING DOCTORS

Susanne Madden arrived in Vegas with her extensive knowledge and expertise of the health insurance industry.

Screen Shot 2016-02-21 at 11.10.10 AM
Dr. Jeanne Marconi and Susanne Madden

She presented attendees the sobering reality of how health insurance companies are adjusting, changing – even experimenting in some cases – with their models to continue delivering value to “their” shareholders. And by value, she means lower cost and higher profits.

Susanne underscored the importance of implementing quality measures such as P4P, HEIDIS, PCMH into our medical practices. But not for the reasons you might think.

While many of these health insurance programs are currently in place as rewards (e.g., enhanced or incentive payments) for medical practices that achieve quality measures thresholds in patient care, Susanne highlighted that these programs will soon become a requirement for practices.

What does this mean exactly? Insurance companies will soon stop offering enhanced payments programs to practices for achieving PCMH level III certification (or other types of incentives). Instead, they will reduce payments to doctors don’t meet PCMH certification.

As if that wasn’t bad enough, she added that many payers are evaluating providers based on how much the provider costs the company in benefits payouts.

How is that different than what they do now?

The difference is that they are not looking at the practice as a whole, but rather evaluating each provider individually.

The implications are that if you have physicians in your practice that don’t adhere to designated quality standards, payors can potentially pay each doctor in the practice different amounts.

HOW MUCH CAN WE AFFORD TO PAY AN EMPLOYED PROVIDER?

PMI’s very own Paul Vanchiere gave two of his hallmark presentations. The first one focused on customer service using the acronym KIDS (Kindness, Integrity, Dignity & Service).

His second talk was my favorite. Why? Because Paul took a complicated, MBA, executive consulting level exercise (determining how much can your practice afford to pay an employed provider) and distilled it into an easy to follow, step-by-step, process, which only requires one to understand a few financial concepts and enter value sets into a spreadsheet.

BROADEN YOUR CODE REPERTUAR

Dr. Rich Lander went over the fundamentals of proper coding. In addition to reviewing the differences between coding Level 2, 3, 4 & 5 for a sick visit, Dr. Lander stressed the importance of documenting “time” correctly in a patient’s chart.

Screen Shot 2016-02-21 at 10.56.21 AM
Joanne Blanchard and Dr. Richard Lander

Dr. Lander shared multiple clinical scenarios that we often encounter with patients. But some of the codes he suggested I wasn’t all too familiar with. I couldn’t recall if we used them.

So I wrote down a reminder to myself to check how well (or not) providers at Salud Pediatrics were using the full scope of codes available.

NO PRESENCE, NO INFLUENCE

Dr. John Moore – a new PMI faculty member – brought us up to speed with some of the new social media trends (Are you familiar with SnapChat and how kids are using it?)

Screen Shot 2016-02-21 at 11.10.19 AM
Dr. John Moore and Paul Vanchiere

One of the points that Dr. Moore articulated that I appreciated the most was the importance for pediatricians to embrace social media.

He said something that I’ve been saying for a long time; which is, had pediatricians adopted social media at a faster clip, the pro-vaccine vs. anti-vaccine arguments would have been balanced. Moreover, there was the potential to stifle the anti-vax movement.

CHANGE IS THE NEW STATUS QUO

You can always count on Chip Hart to deliver great wisdom and insight. Chip also gave two talks.Screen Shot 2016-02-21 at 10.56.11 AM

I’ve heard Chip speak many times, but this time, I felt his talks were different. Chip’s talks had a subtle, tough-love tone to them.

While addressing the challenges practices are facing today, he stressed that pediatricians have faced similar challenges before. He mentioned that during all previous tectonic shifts (aka industry changes) naysayers shouted out the demise of private practices. Much like many are shouting today.

Chip eloquently argued that not only are the doomsayers wrong, but that pediatricians are actually in a better situation than most think.

Chip wasn’t disregarding the challenges or downplaying the potential threats. We are indeed going through tough times. But these tough times were an opportunity to transform and reinvent our practices, he argued.

My takeaway was: If the plan is to defend the status quo and hedge the long-term success of your business on account that you have the initials MD after your name, thus somehow inoculated from change, the end is certainly near for you.

MEETING, CONNECTING, NETWORKING, SOCIAL LEARNING

Attending a seminar like this to learn from the speakers is certainly worth the price and the time. But more often than not, the icing on the cake, at least for me, is the immeasurable, intangible value I glean from networking.

The people who attend these events are the smartest and brightest in my opinion (and I’m not talking about the faculty, although they are good too).

Whether attendees are veterans in managing practices or opened their first private practices last week and believe they have no clue what they are doing, the truth is, there is opportunity to learn from everybody.

The faculty makes the trip worthwhile. But I would say the attendees make the event special.

Next year I hope to see you there. Especially if you didn’t get a chance to attend this year.

Place: New Orleans
Dates: Jan 27-28th 2017

 

Simple Yet Effective Leadership Lesson You Must Learn If You Are A Practice Administrator

Medical practices don’t sell products, transport goods, develop software or produce widgets in a factory. Our businesses are all about people. Consequently, the only way to improve productivity or enhance performance is by getting better at managing people.

Screen Shot 2015-08-30 at 2.01.20 PM

One day, his wife complained that in their 25 years of marriage, he had never told her that he loved her.

“I told you when we got married. I’ll let you know if it changes,” he replied.

Acknowledging staff members or affirming employees for a job well done doesn’t come naturally to me. I’m the kind of person that believes recognition isn’t necessary when someone does as expected.

YOU’RE SUPPOSED TO WORK HARD

For example, I’ve heard employees say, I worked hard for this company. This comment doesn’t deserve affirmation.

Why? Because the expectations is not to barely do mediocre average work. The expectation is that people work hard. Pronouncing you work hard is like a father publicly declaring he takes care of his kids.

WHEN IS TOO MUCH, TOO MUCH?

I also feel that if you praise a person for their good job often, the praise eventually loses value. Like the word thanks. It’s polite, but is one thankful every time we say thanks? So when I acknowledge someone’s behavior, character, work ethic, etc. it is because it truly exceeded expectation.

WHAT IS THAT ABOUT?

Here is the thing. As a member of the team (as opposed to the boss) I like to receive positive feedback. I like to get recognition, have someone acknowledge my work and accomplishments.

WE ALL NEED TO HEAR IT

I’m sure the wife in the story knew the husband loved her, but she needed to hear it from him. And just like the wife, people too need to hear from the person in charge words of appreciation even though they heard it once before.

The affirmation, praise, recognition, pat on the back (how ever you want to describe it) isn’t only for those in charge to give to their reports. This also applies to colleagues and peers.

Furthermore, I’d challenge those of you that have bosses, supervisors or managers to share words of encouragement as well. They need it just as much as you need it too.

HAS BRANDON GONE SOFT?

You may be wondering what this has to do with practice management, business, revenue, CPT codes or ICD10? A lot!

Medical practices don’t sell products, transport goods, develop software or produce widgets in a factory. Our businesses are all about people. Consequently, the only way to improve productivity or enhance performance is by getting better at managing people. And frequent reminders that show appreciation is one of the best way to become a great practice manager.

As it turns out, people that are recognized, appreciated and affirmed are far more productive, far more efficient, and far more happy than those that are not.

 


Do you regularly provide positive feedback to your employees? Do you provide positive feedback to your boss, manager or supervisor? If so, how do you prefer to affirm or show appreciation to the staff? A note by email, a handwritten note, publicly? I’d love to hear ways your practice engages employee.


 

Seven Reasons Why You Don’t Want To Miss This Pediatrics Practice Management Seminar

My friends at the Pediatric Practice Management Institute (PMI) have an awesome seminar that you don’t want to miss.

Why should you not miss it?

Glad you asked.

I have lucky number 7 reasons why you should not miss this seminar.

OAK.0021 – YOU’LL BE AWESOMER

I know awesomer is not a word. But it gets’s the point across. Here is the deal, no matter how experienced you are at managing a practice, there is always something new you can learn.

2 – YOU’LL LEARN NEW IDEAS

Managing a private practice can be a lonely world. There aren’t that many of us. And most of the time we are locked up in a back room (used for both your office and storage) trying to figure out how to keep the ship afloat.

Without exposure to a variety of points of view, you will miss new ideas and trends that can impact future results.

3 – YOU’LL GAIN EXPOSURE

Paul and his team at PMI have put together a superb curriculum. The educational materials will certainly expose you to new ways of managing your business (e.g., private medical practice) and help you discover how to be more productive.

4 – YOU’LL MEET COOL & INTERESTING PEOPLE

Here is the way I see it. The practices that tend to go to practice management seminars are precisely the practices I want to learn from. And PMI’s seminar provides a great opportunity to network with the best practice in the country.

5 – TALK TO CONSULTANTS AND VENDORS

Not only will you have access to a community of like-minded people that have similar struggles, have similar challenges and practical, hands-on advice, suggestions, and solutions, you will also have access to the industries top consultants.

Don’t tell them I said this, but if you ask the right questions, to say… Chip Hart, I bet you, you’ll get thousands of dollars worth of practice management advice for <ahem> free.

Keep in mind that experts in the field are some of the best people for you to get to know if you want to learn more about the current health care business climate as it relates to small, private, independent, pediatric practices.

6 – YOU’LL DISCOVER

You will undoubtedly discover innovative ways to help your practice remain competitive in today’s fast-paced, hectic private-practice.

7 – IT’S VEGAS BABAY (NOT A TYPO)

Did I mention it was in Vegas?

All work and no play can get old fast. PMI’s conference can add a layer of enjoyment to managing your career growth by mixing a social aspect into your learning and industry branding efforts.

Never underestimate the power of a little fun mixed with some interesting people!

BUT THAT IS NOT ALL

Use the promo code “PediInc” and save $75 off your conference fee.

Conference Details:

  • WhenFriday, January 29, 2016 at 2:00 PM –  Saturday, January 30, 2016 at 5:00 PM (PST)
  • WhereTropicana- Las Vegas
  • Sign Up: Click on the Eventbrite logo below to sign up

https://www.eventbrite.com/e/pediatric-practice-management-conference-las-vegas-tickets-18689205918?ref=ecount

Don’t forget to use the promo code PediInc to get $75 off

Are You Following These 10-Steps Before Terminating A Physician- Patient Relationship?

This post was originally published on the Verden Group’s Blog. Written by Sumita Saxena, Senior Consultant, The Verden Group

It unfortunately can happen to anyone: You go above and beyond to provide your patients excellent care with uncompromising accessibility, and yet something somewhere goes wrong and the relationship quickly deteriorates.

Screen Shot 2015-08-29 at 12.13.02 PMAfter trying your best to mend the problem it becomes clear – the relationship has broken down beyond repair and for whatever reason you reach the tough decision to terminate the patient from the practice.

Before you act and send notice, please take a look at some helpful steps we have compiled for you to consider as you navigate this difficult subject.

Step One: Try to Work It Out With Your Patient.

Practically speaking, when faced with a difficult patient situation, the best course of action is to avoid a unilateral termination of the physician/patient relationship by addressing the problem quickly.

Communication is the key.

The patient should be advised of the situation and given a reasonable opportunity to correct the problem. You should make it clear that failure to correct the problem may result in the dismissal of the patient from the practice.

Step Two: Review the Applicable State Medical Licensing Rules.

State licensing boards govern the practice of medicine and the relationship between a physician licensed in that state and his or her patients. Accordingly, it is essential to review the medical board rules carefully before you terminate a patient from your practice.

Step Three: Consider AMA Guidance. 

The American Medical Association (the “AMA”) has provided guidance on terminating the physician/patient relationship. According to the AMA’s Code of Medical Ethics, physicians have the option of terminating the physician/patient relationship, but they must give sufficient notice of withdrawal to the patient, relatives, or responsible friends and guardians to allow another physician to be secured.

The AMA recognizes that there are times when a physician may no longer be able to provide care to a certain patient, including when the patient refuses to comply, is unreasonably demanding, threatens the physician or staff, or otherwise is contributing to a breakdown of the physician/patient relationship.

According to the AMA, terminating a physician/patient relationship is ethical as long as the proper procedures are followed.
The AMA has given the following advice for the termination process:

  • Giving the patient written notice, preferably by certified mail, return receipt requested;
    Providing the patient with a brief explanation for terminating the relationship (this should be a valid reason, for instance non-compliance, failure to keep appointments);
  • Agreeing to continue to provide treatment and access to services for a reasonable period of time, such as 30 days, to allow a patient to secure care from another person (a physician may want to extend the period for emergency services);
  • Providing resources and/or recommendations to help a patient locate another physician of like specialty; and
  • Offering to transfer records to a newly designated physician upon signed patient authorization to do so. American Medical Association (AMA), “Ending the Patient-Physician Relationship,” http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/ending-patient-physician-relationship.page

Step Four: Check Your Payer Contracts and Policies. 

A physician who is a participating provider (under contract) with the patient’s insurer (commercial or government payer) may be obligated to notify the payer and comply with additional requirements. You should review your provider contract(s) and policies in order to determine if the payer has a policy on patient termination.

For example, some insurance carriers require 60 or 90 days notice before dismissal (as compared to the 30 days notice required pursuant to certain state laws) and some require prior written notice to the carrier to enable the carrier to contact the patient.

There also may be specific requirements concerning pregnant or mental health patients. Medicare, Medicaid, and other government payers have strict policies on terminating a patient that should be reviewed before terminating a governmental plan beneficiary.

Step Five: Review Your Malpractice Carrier Requirements. 

Some medical malpractice insurance carriers have adopted rules or recommendations for terminating the physician/patient relationship. Accordingly, you should review your malpractice policy or contact the malpractice carrier when establishing the procedure for terminating the physician/patient relationship.

Step Six: Send Written Notification to Your Patient.

You should send written notification advising the patient that he or she is terminating the patient relationship. The notification should comply with the licensing board’s rules and the requirements of the applicable payer and the your malpractice carrier. Ideally the patient notification should be prepared or reviewed by experienced counsel before sending to the patient.

Step Seven: Provide Continuity of Care.

You should ensure that you provide the proper continuity of care when dismissing a patient from your practice, including any requirements under state licensing rules, their payer contracts and their malpractice policy. The AMA guidance recommends that the physician provide the patient with resources and referrals for other sources of care.
Step Eight: Do not Charge for Patient Records.

A physician who terminates his or her relationship with a patient should not charge the patient for copying the patient’s medical records.

Step Nine: Consider Risk Management.

Additionally, you should perform a risk management analysis before terminating the physician/patient relationship. You should consider the possibility (even if the patient’s position is without merit and you will ultimately be successful) of patient complaints, disciplinary investigations, litigation, or other action initiated by disgruntled patients.

Step Ten: Establish a Set Policy on Patient Terminations and Train Staff on the Policy.

In order to avoid any potential issues with former patients, the practice should have a set policy in place for the termination of the physician/patient relationship, including a sample termination letter. The policy should be applied to patients consistently and without discrimination. The staff should be trained on the policy and should document compliance with the policy.
By following the above steps you can be proactive and diligent in mitigating your risk if such a situation ever arises with a patient.

A Vital Aspect Of A Medical Practice That Practice Managers Cannot Afford To Overlook

A wise person once said, “a gentle answer deflects anger, but harsh words make tempers flair.” Therefore, the best way to dismantle anger, frustration, disorderly, disruptive or unruly people, is by employing respect, candor and kindness.

When we talk about managing our practices more efficiently, we think about negotiating with insurance companies, proper coding, practice financials, revenue per visit, E&M code distributions and a bunch of other objective things.

I find it interesting, however, that we put so much focus on maximizing revenue and minimizing cost, but ignore a topic that far consumes our time. And arguably is more important to the “health” of a pediatric practice than the things we consider “best-practices.”

Screen Shot 2014-07-10 at 11.59.51 AM

The topic I’m referring to is “people.” Specifically employee and parent/patient interactions.

Poorly managing how people interact with one another can have far-reaching consequences and be far more devastating than say, a bad payor contract. But how much time do we spend on honing interaction with people of our practices?

Medical practices revolve around people. We all know that we spend more time with co-workers than we do with our families. And due to the nature of our business we are engaging with people hundreds of times a day.

Most of these interactions go without notice, but many result in conflict. And the ones that result in a conflict (all it takes is just one) carry the potential to rip through the fabric of your practice.

LET’S TALK ABOUT A CONFLICT FREE WORKPLACE

The unhealthy tension in a workplace is disruptive and highly counterproductive. Unresolved conflict ruins a company culture. And a weak company culture is like a bad cough. You can’t hide it.

Consequently, addressing tension in the workplace is just as important if you want your practice environment to be a collaborative, mission-driven, high performing practice.

HERE IS WHY THIS MATTERS TO YOU AND YOUR PRACTICE

Happy employees enhance the company’s culture. Content, conflict free employees make for a better workplace, as well as create a pleasant experience for parents/patients visiting the practice.

All this translates to patient/parent satisfaction.

TIME TO EXAMINE

Now, think about how your practice employee treat unruly parents? Does you or staff become defensive or perhaps condescending? Do you unintentionally patronize them using tone, language or body language?

How about coworkers or your practice partners? During conflicts, do you push back as hard or harder as they push you? Are you passive aggressive? Do you have contempt for them? Are there harbored resentments, unaddressed conflicts, unsettled disputes?

THE FIRST STEP

Now, disagreements, arguments, tension, miscommunications, hurt feelings, etc. are unavoidable. The only way to eliminate those kinds of issues is to live by yourself (and even then you have to deal with yourself). We will always have issues with parents, co-workers, partners, and vendors. It’s just part of working with people.

But the key to a conflict-free workplace lies in how each of us reacts to the tension.

Our behavior during or after the conflict will ultimately determine if the issue perpetuates or is resolved.
Think about someone you don’t like. It could be a co-worker or even a relative. Now think about how your behavior is affecting the relationship. Is your behavior making things better or worse?

THE SECOND STEP

When things get emotional and, conversations go from casual to critical, the worst of us usually comes out. Pushing back starts us down a bad path that is often hard to recover from.

We know that being defensive, condescending -or my favorite, sarcastic- doesn’t lead to a path of resolution. But these three things do set us up on the right path:

Respect, Candor & Kindness

Sounds simple. Too simple in fact. But what is the alternative?

A wise person once said, “a gentle answer deflects anger, but harsh words make tempers flair.” Therefore, the best way to dismantle anger, frustration, disorderly, disruptive or unruly people, is by employing respect, candor and kindness.

I’m not suggesting this is easy. Some people get on our nerves. You may even feel the urge to provide too much candor. Other situations are unfair and responding with respect and kindness is difficult. And the truth is some don’t deserve your respect.

But even so, fighting fire with fire doesn’t make things better. But fighting fire with water gives us a chance to resolve.

So the next time things start to get heated with a parent or even a coworker remember, that how we approach a conflict will largely determine the outcome.

Extra, Extra – Now Offering Coaching Services

Screen Shot 2015-02-03 at 7.56.46 PMPeople always ask me if I do practice management consulting.There was a time when I did. But for the past two or so years, I’ve responded by saying no. I enjoy consulting and love to do it, but I had to stop because of the time commitment.

Recently, I was talking with a loyal reader of PediatricInc about this very topic and she suggested I do remote coaching.

My friend, who owns her practice, explained that she doesn’t necessarily need a comprehensive on-site consult. “I just want to ask a question about my practice or run things by someone familiar with practice management,” she said.

She went on to say, “…you know doctors don’t get training on business, management, marketing, collections…. having somebody to reach out to that has the business and practice management training would be valuable.”

“Like a practice management coach?” I asked. And she said, “ yeah, that is a good way to put it.”

We talked a little while longer. By the time we finished up, my loyal reader and friend had convinced me.

Today I’m announcing a new service on PediatricInc called PMB Coaching for those pediatricians and/or managers that want my perspective on practice management, discuss in detail a blog post, run something by me or provide another set of eyes.

Interested in learning about the PMB Coaching?

Click on this link.

 

Eligibility & Deductibles: Do You Verify Before Patient’s Appointment?

Recently, I caught up with my friend Lynn Cramer. Lynn is Chief Administrative Officer at Eden Park Pediatrics in Lancaster, PA. Lynn is one of the most – if not the most – experienced practice managers I know, so I always like to glean any insight I can whenever I get the chance by asking her questions on how she has resolved in her practice issues that are a challenge to many of us.

Screen Shot 2014-08-23 at 12.43.40 PMFor this post, I asked if she’d answer just a few questions that summarizes how she has structured the front desk to be accurate in the collection of important information (i.e. addresses, eligibility, telephone numbers, etc) and still remain efficient.

The question and answers are short, but there are valuable nuggets in them. Enjoy!

As far as your schedule goes, what percent is pre-scheduled and what percentage would you say you leave only for same day appointment?

We average about 75% pre scheduled visits and 25% same day scheduled visits.

The majority of your appointments are pre-scheduled, when does your staff check eligibility?

Two days prior to a scheduled appointments.

Is the front desk responsible to check the insurance information?

The billing staff (NOT front desk) verifies that the insurance information that is in our system is valid

What is the process? How does the billing staff goes about doing the checking?

The billing staff uses the eligibility check functionality in our practice Management System. If the patient is new to our office , we check [eligibility] using the payor’s website or Navinet.

Do they only check eligibility or do check other things like deductibles?

If  possible, they try to find out the dollar amount that will be owed at the time of service by the family when it shows that our services will mostly likely be paid to their deductible.

What do you mean by “paid to the deductible?”

That is an important term for your staff to learn  “paid to the deductible.”  When the family talks to your staff, they report that the insurance company told them that the service was “paid”.  The family interprets this as the insurance company paying the provider, however it is their amount to pay the practice because they have a deductible.

What happens if the patient is not eligible?

If their insurance is not valid, the staff messages (via secured electronic message on the portal ) the patient or call if needed.

Often, it is hard to reach a patient. What if they don’t respond to the secure message or your phone call?

If we get no answer, the staff will try to get a letter out in the mail so that the patient gets it the next day (day prior to their appointment). But this does not happen often. Most health insurance websites provide easy access and reliable insurance validity and deductibles.

Inevitability you’ll have a patient that is not eligible and missed all your attempts to reach them and show up for their appointment. What then?

For a prescheduled visit, if insurance is not valid and there is no proof of insurance coverage and they show up in the office we reschedule the visit or offer to allow the patient to pay up front.   There is no harm in delaying a preventive visit until payment is arranged.  The family may also want to choose a free clinic for the services.

What about same day sick visits?

We do NOT do this for sick visits

10 Question You Must Ask If You Want Your Project To Succeed

clarity.001When you observe large organizations, the kind that have MBAs, experienced managers and directors, a savvy CEO and a lot of resources, you would assume they succeed at every single project they do. They have the brain power, the money and the experience. Why would they not succeed?

But the reality is, projects fail all the time. They take longer than expected, are often over budget, conflicts emerge, sometimes people get fired, others quit and the project is doomed.

Why is that? Why do projects fail? Why do they fail despite the talent, experience and resources, etc?

Not long ago somebody explained it to me like this. The reason projects fail is because the people that are working on the project don’t know what it is they are doing. There isn’t a unity, a clear goal, a finish line that all involved are working together to reach. The fundamental issue is this:

In both large and small organizations projects fail, not because of lack of skills, resources, talent or experience, but rather because of lack of clarity.

If lack of clarity is the core reason projects fail, how do we make sure we have the clarity? The answer is somewhat underwhelming. It consist of asking the right questions. Questions that get to the essence of the project.

Here are a few you and your team can ask to get you started on the right path.

What is the project?

It is important to write down the project because writing it down actually means something. If you have it in your head, you don’t really have a project. You just have an idea. Furthermore, writing down what it is that you are trying to accomplish will be a solid reference for yourself as well as your team members.

When is it due?

This one seems obvious. But in my experience, we don’t set dates nearly enough. Putting a date down will provide a sense of urgency. It will also keep people focus while keeping procrastination at bay. The more specific you can be with the due date, the better.

Who is responsible for this project to succeed?

You may be tempted to add all the team members involved, but ultimately, it is better if there is somebody that is THE responsible person. Think about it in terms of a professional sports team. The coach is ultimately responsible for the team to win even though it is the players that are tasked with the execution.

Who is your customer?

List the names of people that you are trying to please. It could be your boss, your patients, your patient’s parents, voters, the board of directors or anybody else. It is important to list them because there is a good chance that you might lose sight of why you are doing this project. And when you do, it is helpful to know who you are doing this project for.

Who are the authorities, influencers and gatekeepers?

These are the people that actually matter to the project. These are the only people you need to pay attention to. Define who they are. Everybody else, you can ignore.

Who is essential to the success of your project?

In every project, there are key people that must embrace the project for it to succeed. This group of individual are not the same as the authorities, influencers and gatekeepers. These can be committees, specialized groups, financial backers, that without their involvement you are dead in the water.

What does perfect look like?

Often times, we start out a project without really thinking about what the end results is supposed to look like. Consequently, we lose direction. For this question, it is important to be as specific as possible. Much of the clarity comes from answering this questions appropriately. Take your time with this one. It is an important questions and should not be taken lightly.

What does failure look like?

Failure is an important aspect of a project one must consider. For starters, failure is almost a sure thing. Thus, understanding what it looks like helps one steer away from it.

How would you plus it?

Here is the stuff you put down when one says, “you know what would be cool?” List 5 or 10 things that would make your project that much better. But make sure addition to the projects become distractions that can delay the timeline or take away from the final product.

How would you minus it?

Just like adding little things to make your project a little better, there are other things that you ought to consider that don’t add anything to the project. These are the things that if you take away from your project, you will actually improve it. Steve Jobs asked a version of this question frequently. I don’t remember the quote exactly, but I remember somewhere reading Jobs saying something like, you know when you are done, not when you can’t add anything else but when you can’t take anything else away.

Of course, this isn’t a comprehensive list. Notice, for example, budgeting isn’t addressed. It’s absence doesn’t mean it isn’t important. However the purpose of these questions is to help you and the team begin defining the project in a way that is clear and concise for the benefit of all.

What would you add to this list of questions?

 

Editorial Note: These questions were inspired and others borrowed from Seth Godin’s book Ship It.