4 Simple Questions That Will Make You A Better Manager To Your Employees

As practice managers and administrators of both large and small practices, we are wired not to see our failures but instead see the shortfall of our employees and attempt to correct them. Nothing wrong with that. It’s part of management.

But let me challenge you on this one. The next time you have difficulties with an employee, take a moment and reflect how you are interpreting the issue using the questions above. Consider where you are placing the blame. On people’s character or the circumstances?

As humans, we have an uncanny ability to justify and explain situations in ways that benefit us.  For example…

When we observe a father shouting, tugging or being overpowering towards their child, we raise an eyebrow and pass judgement on that parent’s poor parenting skills.

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If we lose our temper with our kids, we justify it by blaming the circumstances. We’ll say, “if you knew how challenging my children are, you would understand.”

In a medical practice environment, it may go something like this.

Julie: Nancy is late again.
Michelle: That’s the way she is. She’s so disorganized.
Julie: I know. And she doesn’t take her job seriously.
Michelle: Bill has given her so many opportunities, but she seems not to get the message in that thick head of hers.

Let’s look at it from another viewpoint.

Julie: I’m sorry I’m late. It’s just that my car has been acting up. And with my husband being out of town, I have to get the 3-kids ready, drop them off at my mother-in-law’s house – you know she is still upset about that thing – and just as my luck will have it, there was a fender bender on Route 95 and traffic was backed up all the way to the freeway.

CHARACTER VS CIRCUMSTANCES

Medical practice managers and administrators tend to make similar judgements.

When we have an under-performing staff member, we question their work ethic, make claims about their lack of motivation, engagement or lack of interest. Simply put, we tend to judge their character.

When we fall short, we don’t dare blame our work ethic, lack of motivation or lack of interest. Instead we blame the circumstances.

For example, we’ll blame our underperforming employees, unreasonable parents, the healthcare system, insurance companies, the printer, the network, being overworked and our boss. She’s too demanding and has unrealistic expectations.

REVERSE

What if we reverse the tendency to blame circumstances when we fall short and blame people’s character faults when they make a mistake or underperform? What would it look like if you looked at your character when employees in your practice fall short?

To help you put all of this into perspective, think about a time in the practice when an employee was underperforming. Using that situation in mind, read and think about the four questions I’ve listed below.

1.- Am I measuring a fish by its ability to walk?

Everybody has their strengths, but if you place someone in an environment that is counter to their strengths, they will undoubtedly fail.

Before rushing to judgement, ask this question first. Have I done a disservice to the employee by placing them in a position that they are not naturally good at doing?

2.- Am I telling them instead of leading them?

The best leaders are not the best because of their title. The best leaders are remarkable because they have distinctive character traits. Thus, asking employees to think and see the way you think and see things is often unfair.

Instead of saying, why can’t they just… (they being employees) ask, have I led them?

Consider putting more efforts towards helping them understand – leading them – rather than expecting them to know.

3. – Am I assuming employees remember?

Just because you said it once, doesn’t mean it was heard or retained.

If an employee keeps overlooking necessary task for example, take pause and consider if the reason is that you have not made clear the importance of the tasks.

One important distinction to have present when reminding employees. It is more important to tell employees why their jobs matter than remind them how to do their jobs.

4. – What am I doing about it?

Some hires simply are not a good fit. Others don’t work out. You know that. The entire staff also knows that.

Keeping an employee around that doesn’t fit well into the culture, is disruptive, consistently underperforms, and makes mistakes despite coaching, is a failure of leadership.

In other words, an employee that is out of line is not necessarily your fault, but it is on you if they remain an employee of the practice.

As practice managers and administrators of both large and small practices, we are wired not to see our failures but instead see the shortfall of our employees and attempt to correct them. Nothing wrong with that. It’s part of management.

But let me challenge you on this one. The next time you have difficulties with an employee, take a moment and reflect how you are interpreting the issue using the questions above. Consider where you are placing the blame. On people’s character or the circumstances?

 

Can Your Medical Practice Afford To Drop An Insurance Carrier?

I worked with a practice that was in a similar situation. The partners wanted to drop an insurance plan, but they had questions they wanted to answer before pulling the trigger, so to speak.

For example, one of the questions was how many patients would they potentially lose and how significant would be the financial impact if they dropped the insurance plan?

Screen Shot 2016-01-05 at 11.09.13 AMI received a letter from the University of Chicago Medical Center explaining that effective Jan 2016; they will no longer accept BCBS.

The announcement took me by surprise. Not because the hospital was dropping an insurance plan- but because they were dropping a major plan, BCBS.

BCBS has a significant market share in Chicago; which translates to a lot of patients having BCBS as their insurance carrier.

I can only imagine why the hospital decided to drop BCBS, but I think I can say with a fair amount of certainty that the decision must have been difficult for stakeholders of the hospital. Undoubtedly dropping such a large plan would affect a lot of patients, but also, shake up the hospital’s income.

CAN A PRACTICE AFFORD TO DROP A PLAN?

I worked with a practice that was in a similar situation. The partners wanted to drop an insurance plan, but they had questions they wanted to answer before pulling the trigger, so to speak.

For example, one of the questions was how many patients would they potentially lose and how significant would be the financial impact if they dropped the insurance plan?

INSURANCE DISTRIBUTION

To help them answer their questions, I worked with the practice manager to create a simple spreadsheet that I call an insurance distribution sheet. Below is a version of the spreadsheet already completed.

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To build the spreadsheet, we needed 3-data sets from the practice’s practice management system. Those three data sets were:

  1. Number of Patient Seen by Insurance Plan
  2. Gross Charges by Insurance Plan
  3. Net Receivables by Insurance Plan

The practice management system we were working with did not provide these data sets in one clean report. We had to run individual reports and enter the values into the spreadsheet.

Once the data was aggregated, we added a simple formula to translate the results into percentages. And the results is what the example above shows.


For those that are unfamiliar with Excel, click HERE to see a brief overview of how to calculate the percent of the total.


WHAT DO THE COLUMNS MEAN?

The first column is the insurance company patients had at the time of service. Percent of patients represents the ratio between all the patients seen, versus the patients seen with the corresponding insurance company. For example, let’s say the practice saw 1000 patients and of those, 300 had BCBS.

300 / 1000 = .3*

(*) BCBS represented 30% of the patients seen

Like percent of patients, percent of charges is the ratio of the practices gross charges divided by the gross charges corresponding to each insurance company. Example. Let’s say the practice billed $1,000,000. Of that million, BCBS represented $250,000.

250,000 / 1,000,000 = .25*

(*) Percent of charges for BCBS is 25%

The percent of receivables column follows the same math as percent of patient as well as percent of charges. And the cents/$ column calculates how many cents on the dollar the practice is collecting from the payor.

INTERPRETING THE GRAPH

Let’s look at BCBS and read across from left to right.

We see BCBS has 40% in the percent of patient column. Meaning, of all the patients seen, 40% had BCBS as their primary insurance. The next column is percent of charges. We see the BCBS represented 45%. This indicates that 45% of gross charges for the practice was billed to BCBS.

Percent of receivables is the next column over. It indicates that the revenue from BCBS accounted for 50% of the practice’s total income. And the revenue averaged 73 cents on the dollar. Another way to read it is, for every $1 billed to BCBS, the practice received 73 cents.

In contrast, let’s look at UHC. Only 8% of all the patients the practice saw for the period were UHC patients. UHC represented 9% of the practice’s revenue, and they averaged 60 cents on the dollar.

WHAT CAN WE GLEAN?

With an analysis like this, the practice can begin to find concrete answers to their pressing questions. For example, if UHC was the plan they were planning to drop, the sheet is able to show them what the impact would be from both a patient standpoint and financial standpoint.

UHC represents 10% of their patient panel. Which would have to leave the practice if they drop the plan, taking with them 9% of the practice’s revenue.

If the plan in question is BCBS, the numbers tell a different story. Fifty percent of the practice’s revenue would walk away with 40% of their patient panel.

Another observation is that Medicaid accounted for 37% of patients seen; but the State’s insurance plan accounted for 24% of the practice’s revenue. Something worth pondering.

HOW MUCH IS THE SHORTFALL?

For the sake of argument, let’s say UHC is the plan the practice was considering dropping. Doing so they would lose 9% of their revenue. This is not insignificant. If practice revenue is 1-million dollars, 9% represents $90,000. If practice revenue is 5-million, 9% is near $500,000. It’s less money no matter how you look at it.

PREPARING FOR THE SHORTFALL

When the doctors I was working with realized how much they’d lose, they got cold feet.

Here is what I explained to them…. the practice doesn’t have to see the same amount of patients to recuperate the 9% revenue shortfall. In fact, the practice can see fewer patients and still make up the revenue shortfall. How so?

Because of the cents on the dollar.

BCBS pays .73cents for every dollar billed. That’s 13cents more than UHC. By filling the schedule with better paying plans, like BCBS, Aetna or HFN, the practice will recuperate the 9% revenue loss faster because they are making more per patient than they would treating a UHC customer.

NOT ALWAYS SO CLEAR

Admittedly this graph does not give you a comprehensive picture. There are potentially other variables that a practice may consider. However, in the case of the practice that I worked with, this analysis was all they needed to answer their questions and move forward.

One last thing before you move one… don’t focus on the numbers you see on the graph and use them to compare with your practice numbers. Focus instead on the method, the process and the math with your numbers. Deal?


EDITORIAL UPDATE
The practice reached out to the payer to negotiate better rates. Armed with the data, they felt empowered (not at the mercy of the payor) and firmly request payment increases. The payer agreed. And they signed a contract that was competitive.

 

Simple Formula To Calculate How Much Of What You Can Collect, Do You Collect

Today’s post by guest blogger Mary Pat Whaley – Managemypractice.com. Mary clarifies a few misunderstandings managers often have regarding the term collection percentage. She also defines the term “funny money.” Read to find out what she is talking about.


 

COLLECTION PERCENTAGE

Screen Shot 2015-11-20 at 12.10.44 PMOne of the most talked about and least understood metrics is the collection %. There are two reasons it is misunderstood. One is because most people talk about a monthly collection percentage, as if the money you collect this month relates to the charges you billed this month.

Some of it does – the co-pays, deductibles, and co-insurance definitely applies to this month’s services, but the insurance payments most often do not.

This is how you can collect more than 100% in a month – by having lower charges and higher collections, you can achieve more than 100% collections! Not a real metric!

THE PROPER WAY TO MEASURE

Over the course of 12 months, it tends to even out, so you can use your annual collection % with a degree of confidence, but the very best way to know what you are collecting is to use a report that applies the payments (regardless of when they arrive) to the services in the month they were rendered. If your PM system doesn’t have this report, ask for it.

GROSS CHARGES, REAL OR NOT?

The second is because gross charges are not necessarily “real” numbers. Most practices set a retail fee schedule at a point to capture the most any payer will reimburse them. So, a practice could set its fees anywhere and never really expect to charge or to collect what I call “funny money.”

How to calculate:

Collection % = Net collections / Net charges.


Net Collections = Gross Collections – (Refunds).


Net Charges = Charges – (Contractually Obligated Write-offs).


 

Contractual write-offs are the difference between the practice fee schedule and the fee schedule you’ve agreed to accept.

PROPER COLLECTION RATE

A 98% or better collection rate is considered excellent, depending on what, if any, other write-offs you include with your contractual adjustments.

If you have only one category of write-offs (sometimes called adjustments) in your PM system, you are going to find it hard to calculate this percentage.

You may want to introduce new write-off categories and have your staff post-contractual adjustments to one category and other types of adjustments to several other new categories.

See my article here for in-depth information on creating write-off categories and managing write-offs.

If you have your contracted adjustments separated, follow the formula above to get your collection percentage.

Some practices will use a rolling 12-month figure for their collection percentage (i.e. ignoring the most recent month, use the last 12 month’s cumulative total net collections divided by the total net charges.)

 


If you found this article helpful, so will somebody else. Consider sharing it. Remember, sharing is caring.
Also, Make sure to check out Mary Pat’s blog for a treasure trove of practice management related articles.

 

What Do Patient Lab Reports Have To Do With A Medical Practice’s Financial Statements?

An important aspect of managing a business is learning how to read financial statements.

It’s no secret, however, that most doctors don’t have formal business training. So reading financial statements to some is like reading in a language you don’t speak.

Screen Shot 2016-01-05 at 10.05.35 AMBut that is not an excuse for physicians that own or have a stake in their medical practices not to learn fundamental business principals such as reading financial statements.

Learning how to read just a few financial reports will give you a good idea of the financial health of your practice.

THEY’RE LAB RESULTS

If the financial report talk sounds complicated, think of them as a patient’s lab reports. Imagine your practice is a sensitive patient with an illness.

Just like labs results tell you want’s going on with a patient’s health, financials reports let you know what is going on with the medical practice’s financial condition.

And when you know what’s going on, you can instantly spot potential problems before they get out of control.

FINANCIAL STATEMENTS

Below are four financial reports. Familiarize yourself with them as well as get in the habit of checking/reading them each month.

Keep in mind that I’m not saying these are the only reports you should review. I am suggesting, however, that these are among the most significant and valuable reports for a business/private medical practice.

PROFIT & LOSS STATEMENT (P&L)

Also called the income statement, the P&L shows revenue minus expenses and either your practice’s net profits or loss.

The income statement gives you a snapshot of how different areas of the business is performing. For example, did the practice match revenue projections? Is the practice staying within budget?

BALANCE SHEET

The balance sheet is a simple document that shows what your business is worth. It list all of your assets and liabilities.

The report provides a quick and simple way to see what you own, who you owe, and revenues owed to you.

RECEIVABLES REPORT

This report – also referred to accounts receivables (AR) – shows you who owes you money, how much they owe, and the age of the debt.

In a perfect world, you would avoid extending credit to anyone. But in the business of private practice, we provide credit to virtually every single patron. Therefore, this report is critical to understand and review frequently.

CASH FLOW REPORT

If you’ve balanced your checkbook before, the cash flow report is a supped up version of that. The report shows you the number of checks you’ve written, your deposits, and your account balance.

This report is the best way to verify that your bank account balance is correct, and there are no unusual charged or errors.

GOOD HEALTH = STRONG PROFITS

 

You wouldn’t neglect to review a delicate patient’s lab results. So don’t neglect to familiarize yourself with these important financial reports and review them regularly.

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.

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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.

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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?)

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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

 

Does Your Pediatric Practice Need A Vision Statement?

A compelling vision strikes a chord in people, motivates them by tapping their competitive drive, arouses desire for greatness and hopefully appeal to their need to make a difference in the world.

Most vision statements I’ve read, are a bunch of fancy words put together in a somewhat coherent matter with the intent to demonstrate that the company or the business stands for something.

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As a result, nobody pays attention to them.

WHY YOU NEED A VISION STATEMENT

When crafted correctly, a vision statement is enduring and inspirational. It’s a guiding, transformational initiative, that removes the clutter and sets a defined direction for the practice’s growth.

A proper vision statement illustrates the organization’s purpose… why the organization exists.

And that is why your medical practice should focus on writing a vision statement.

WHAT IS A VISION STATEMENT?

A vision statement is a desire for your private independent pediatric practice. Another way to look at it is what you want the practice to become. Some refer to it as the desired end-state. In other words, how things could be instead of what they are.

VISION STATEMENT EXAMPLES

The best visions are clear, concise, memorable and inspirational. Some of the best vision statements are from organizations in the non-profit sector.

Below I’ve brought along some of the best (IMHO) vision statements from non-profit organizations to help you visualize what one may look like for your practice. But also I think they provide insight into how just a few words can bring people together towards a common goal.

Feeding America: A hunger-free America
National Multiple Sclerosis Society: A World Free of MS
Alzheimer’s Association: Our vision is a world without Alzheimer’s
Habitat for Humanity: A world where everyone has a decent place to live.
Make-A-Wish: Our vision is that people everywhere will share the power of a wish.
San Diego Zoo: To become a world leader at connecting people to wildlife and conservation.
World Vision: For every child, life in all its fullness; Our prayer for every heart, the will to make it so.
Cleveland Clinic: Striving to be the world’s leader in patient experience, clinical outcomes, research, and education.
Leukemia & Lymphoma Society: Cure leukemia, lymphoma, Hodgkin’s disease and myeloma, and improve the quality of life of patients and their families.
Boy Scouts of America: To prepare every eligible youth in America to become a responsible, participating citizen and leader who is guided by the Scout Oath and Law.
Charity Water: believes that we can end the water crisis in our lifetime by ensuring that every person on the planet has access to life’s most basic need — clean drinking water.
Amnesty International: Amnesty International’s vision is of a world in which every person enjoys all of the human rights enshrined in the Universal Declaration of Human Rights and other international human rights instruments.

WHAT IS IN IT FOR THE PRACTICE?

When a practice’s vision is strong, it is easier for employees and stakeholders to absorb and commit themselves to the goals and the values of the practice.

A compelling vision strikes a chord in people, motivates them by tapping their competitive drive, arouses desire for greatness and hopefully appeal to their need to make a difference in the world.

Simply put, without a clear vision, strategic plans are plain marching orders on a piece of paper with no guiding principle or ideal to plan.

Benchmarking Evaluation & Management Codes

With the advent of EMRs, doctors are now able to track, monitor and visualize data that was not as easy to obtain as before.

One data set that EMR systems feature, are E/M codes. E/M codes, if you are not familiar with the term, stand for Evaluation and Management. E/Ms are represented by CPT codes 99211-99215.

Evaluating your practice’s CPT data is highly beneficial because the data reveals insights into the practice. For example, gathering E/M codes allows you to analyze each code’s distribution (e.g., how many 99213 is the practice ‘or a provider’ coding in comparison to 99214).

But how does one know if the distribution is a proper distribution? In other words, if a practice’s 99213 is two times greater than 99214s, is that good or bad?

My go-to guy for this sort of questions is Chip Hart. Chip has access to large data sets over the span of many years thanks to his company’s customers. And when it comes to this sort practice management analysis stuff, Chip is the biggest nerd I know.

Coincidentally, Chip posted on SOAPM a response that addressed this very question of E/M code distribution and what is an appropriate benchmark for pediatric practices.

I took Chip’s response (with his permission) and adapted it for the blog post. Enjoy:

 

B: You’ve done some work on E/M distribution, have you not?

C: I’ve done a lot of work on the semi-mythical E/M distribution topic.

B: OK, let’s get to it. What is the E/M distribution benchmark practices should use?

C: I want to mention a few things first.

  1. We are talking about Pediatrics data specifically. What Family Practice does, for example, is interesting or helpful in an argument, but really doesn’t pertain to pediatrics.
  2. I’m assuming that you really want to know what practices are DOING, not in fact what they SHOULD be doing. There is a difference.

B: Anything else we should know before you share the data?

C: Yes, let me remind you that what other people are doing should only act as a mild guidepost…just because a practice’s distribution is different doesn’t mean the practice is safer or losing money or whatever.

B: This sounds like an important point to highlight.

C: I know practices who do a great job with 60% 99214s and I know practices who should be in jail for their 15%.

B: Give me the bottom line then.

C: The bottom line is this, providers should chart what they did [in an exam] and code what they chart. Nothing more, nothing less.

B: Noted. Now, let’s get to the data.

C: Here’s some real pediatric data from millions of pediatric visits.

Screen Shot 2015-11-08 at 4.36.35 PM
2010 – 24% | 2011 – 25% | 2012 – 27% | 2013 – 29% | 2014 – 30% | 2015 – 31%

 

B: I’m confused by the numbers… I thought you were going to share with us a bell curve. What did you do here?

C: To provide a single, simple number, I just add the 99214s+99215s and divide it by the total 99212-99215 set.

B: What about the 99211?

C: In this benchmark, I am only looking at 99212s through 99215s.

B: Why is that? The 99211 are part of the EM codes.

C: Pediatricians shouldn’t be doing 99211s, and the “normal” curve does imply that pediatricians do as many 99214s as 99213s, for example.

B: Your “simple” single number changes the bell curve.

C: The peak [of the bell curve] is between the 99213 and 99214, not the 99213.

B: Let me see if I understand. To calculate my practice’s E/M distribution, I add all the 99214s and 99215; then I add all the 99212 thru 99215; and finally, I divide the total of 99214 and 99215 by the total of 99212-99215. Correct?

C: Yes.

B: Walk us through the interpretation of the result.

C: Looking at the chart above, for 2015, our clients bill a 99214 or 99215 31% of the time they do an E/M.

B: This way of calculating and benchmarking E/M distribution is different. E/M distribution charts traditionally show the percent for each code for a specific time.

C: I think this data is a lot better than the MGMA data for a variety of reasons (namely sample distribution).

B: What about wellness codes that were billed with an E/M code, do you factor them in?

C: This [data] does not include 9921X codes done during a well visit (i.e., 99213-25).

B: Are we talking new and established E/M coded or just established?

C: The data I shared above does not include NEW 9920X codes;

It is important to reiterate that while Chip’s data represents millions of pediatric claims, you should use Chip’s data as a reference among many.

In other words, just like a sailor uses multiple navigation tools and visual aids to determine its position, speed, and course – instead of a single reference point – you should use additional data points to determine how well your practice is doing.

Don’t forget to visit Chip’s blog Confessions of a Pediatric Practice Management Consultant

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.


 

10 Questions You Need To Ask Before Starting A Project To Ensure Success

The best strategy one can embrace before beginning a project is to gain clarity on the task at hand. And with these 10-questions, you’ll gain the perspective required to ensure your project gets off to the right start.

Imagine all of the sudden you decide to go on a camping trip. So you round up your spouse and the kids, jump in the car and head out. No supplies, no route, camping equipment, site, food or proper clothes. When asked about all these things, you respond by saying, “We’ll figure it out as we go along.”

I’m no camping expert, but I know that this is a silly way to go about camping. Talk about a recipe for disaster.

Screen Shot 2015-08-30 at 4.17.50 PMBut here is the thing… even though most people would never go on a camping trip without determining a site beforehand, planning out the best route, deciding how much food they’ll we need to take and how many days they will stay, I’ve seen first-hand many practices that have embarked on more than one project with the same carelessness.

“What is the plan for the transition?” 

“Too busy right now. We’ll figure it out as we go.” 

I’m no project management expert, but that is a silly way to about conducting a project at one’s practice. No wonder many projects end up taking longer, are more expensive and cause more headaches than expected.

To get a better understanding of the project, we should ask ourselves these questions:

1 – 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.

2 – When is it due?

The more specific, the better.

3 – Who is responsible for this project to succeed?

You can add all the team members, but ultimately, there has to be somebody that is THE responsible person.
Who is your customer?

4 – List the names of people that you are trying to please.

It could be your boss, your patients, your 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.

5 – Who are the authorities, influencers and gatekeepers?

List all those names under this question. These are the people that actually matter. Everybody else, you can ignore.

6 – Who is essential to the success of your project?

In every project, there are always key people that must embrace the project for it to succeed. List the individuals or committees or groups of people.

7 – 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.

8 – What does failure look like?

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

9 – 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.

10 – 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.

The best strategy one can embrace before beginning a project is to gain clarity on the task at hand. And with these 10-questions, you’ll gain the perspective required to ensure your project gets off to the right start.