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.

11 Straightforward And Practical Tips To Improve Your Practice’s Bottom Line

It is our responsibility as captains of our ships, however, to equip our practices and our staff members with the necessary tools and information if we want to have any chance of overcoming these real threats.

You do not have to be a marine captain to know that there are countless potential dangers navigating waters.

With a little imagination you know there are many risks. Some hidden, like currents, while others are painfully apparent (i.e. howling winds, waves and torrential storms).

 

Compass Direction GuideWe know there isn’t anything the captain can do to eliminate weather conditions or enforce her will on ocean currents.

However, we can all agree the captain has control over the vessel. We can also agree that the captain has the responsibility to equip the ship and its crew member to its maximum potential if they have any intention of overcoming environmental threats.

Running a “profitable” practice is indeed becoming more of a challenge. For many, it is uncharted territory. And while there are many extrinsic reasons – like decreasing insurance payments, high deductible plans, and the increased cost of providing care – that are contributing towards the “remaining profitable” challenge, the truth is, there is little – if anything – we can do to eliminate those threats.

It is our responsibility as captains of our ships, however, to equip our practices and our staff members with the necessary tools and information if we want to have any chance of overcoming these real threats.

Below are 11 STRAIGHTFORWARD and practical tips you can implement immediately to help you navigate these rough waters.

  1. Review fee schedules regularly to ensure your fees reflect market conditions in your region.
  2. Adjust fee schedules for certain procedures to improve providers’ competitiveness.
  3. Review all E&M charges by a certified coder before submitting claims.
  4. Hire coding consultants for annual chart reviews to ensure accurate coding.
  5. Monitor and report payments of your top insurance-payers.
  6. Run reports to understand payments by different networks or other contract types.
  7. Renegotiating (or consider dropping) contracts with payers who have low payments.
  8. Monitor how long it takes for charges to be entered and claims to be submitted to make sure claims are being filed timely.
  9. Consider provider training or implement random audits to ensure billing slips are completed clearly and accurately.
  10. Review your practice’s policies for routing super-bills to ensure claim submissions are sent as soon as possible.
  11. Implement processes so your billing staff works missing super-bills, claims, denials, consistently.

Imagine for a moment navigating open waters without navigation tools. Now, imagine what would happen if conditions were less than excellent?

If your boat ran off course or worse, capsized, would you blame the environmental conditions? Or would you take responsibility because you didn’t have the proper equipment and tools to navigate in challenging conditions?

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.

What A Top Management Guru Can Teach Us About Managing Our Medical Practice Better

Jim Collins affirms that accumulated progress is what drives greatness in companies. He adds that focusing and being disciplined about progress in small increments is the only way to become a great organization. Greatness, in other words, is not a silver bullet. It is a work in progress. And we get there not mile-by-mile, but rather inch-by-inch.

Screen Shot 2014-08-20 at 1.05.17 PM

We often talk about making things better. We often challenge the staff to think about how to improve a process; for example the check-in or check-out or improving the process of drawing up the vaccines.

When we challenge the staff to find ways to make it better, faster, stronger, more efficient, we don’t imply incremental changes. We are, in essence, asking for an overhaul. We are asking for a re-invented, transformational, innovating change.

But Collins tells us that high performing companies don’t work like that. Great companies are disciplined in their progress, which in turn, results in incremental improvements; which over time creates drastic change.

For me, this is important. It reminds me that when challenging staff to improve, I need to be clear about not asking for a complete overhaul or make a request to dismantle a process, but rather emphasize that the purpose is to make incremental improvements.

This frame of mind also helps me set my expectations too. I often devise plans with the expectation to improve an area of the practice and make it 10x better. When in fact, small additions an increases accumulate over time are not only a more realistic approach, but it is also easier to manage.

How about you? How do you approach changes in your practice? When you and your team are trying to make changes, improve or make progress with something in the office, you expect a complete overhaul? When you come back from a seminar, do you want to implement everything you learned at once but end up not doing most of it because it was just too much?

If so, perhaps adopting this notion may help.

What Does Taking Patient Vital Signs Have To Do With A Medial Practice’s Financial Health?

Screen Shot 2014-08-20 at 9.56.10 AM

I don’t know about you, but when I first started managing our practice, it took me a while to understand what part of the business I needed to measure. In other words, what were the best performance indicators I needed to keep tabs on to ensure the practice was doing well. Of course things like cash flow and account receivables were obvious to me due to by background.  But it was apparent that the medical business world is different than, let’s say, a law firm or an accounting firm.

In some respects, there are overlapping metrics, but in the private practice business world, there are other KPIs (that is what the cool kids call it) that are crucial to measure.

If you are in the same boat I was a few years ago, then this post is going to help you out.

But first, in order to get into the right frame of mind, think of KPIs or Key Performance Indicators as patient vitals. Just like recording body temperature, pulse rate (or heart rate), blood pressure and respiratory rate among other things are an important part of what clinical staff do to assess a patient’s well-being, good practice managers also check their practice’s “vitals” in order to determine the practice’s financial wellbeing.

Our friends at Pediatric Management Institute were kind enough to let me re-post an article they published that highlights Four key performance indicators. As if that wasn’t helpful enough, PMI also took the time to write a brief description for each metric as well as illustrate how to calculate the metric.

Enjoy!

Accounts Receivable Turnover

Description:
ART shows your practice’s collections for a given period compared to your total accounts receivable balance.

Why Is This Important?
This KPI is important because it is a barometer of how well you are bringing in the money owed to you. In the example below, you can see that every 1.52 months, you are essentially collecting or adjusting all the money owed for services rendered. In a perfect world, the A/R will turn rapidly. During times of increasing charges such as flu season, this amount will be much different than during the spring. That is why comparing the month of January to the month of May is very misleading. Practices should compare same months when running this analysis.

Formula:
Provider or Practice AR / Provider or Practice Average Monthly Collections

Show the Math:
$87,500 / $57,500 = 1.52

Clean Claim Rate

Description:
This shows the number of “clean” claims submitted compared to all claims filed with managed care plans.

Why Is This Important?
A “dirty” claim is a claim that will have payment delays. More billing systems attempt to catch claims that may be missing important pieces of information before sending to the managed care company for payment. These “dirty” claims should be routed back to the person responsible for the claim not being clean so that they can learn why their actions could have caused a delay in payment. This feedback is a learning process to ensure that your staff and providers seize the opportunity to avoid similar mistakes going forward.

Formula:
Clean Claims / Total Claims Submitted

Show the Math:
950 / 1,000 = 95%

Cost per Encounter

Description:
CpE shows your practice cost per encounter.

Why Is This Important?
This KPI is important because it helps you ascertain the cost to provide care for each patient you see. This becomes a valuable statistic when you are negotiating with managed care companies so you know what it cost you to provide care to a child- especially in capitated contracts!

Formula:
Total Operating Expense / Office Encounters

Show the Math:
$450,000 / 5,000 = $90.00

Net Collection Ratio

Description:
NCR shows total collections as it relates to expected contracted reimbursement rates from payors.

Why Is This Important?
While a practice may charge $300 for a series of CPT codes, the managed care company may have a contract to pay you $210 when you add up the combined allowables for the billed CPT codes. As such, many practices use the Net Collection Ratio to examine the amount of payments compared to the negotiated rates.

Formula:
Total Payments / (Total Charges – Contractual Adjustments)

Show the Math:
$800,000 / ($900,000 – $75,000) = 96.97%

Keep in mind that these are not ALL the KPIs a practice should monitor. There are actually quite a few more. Don’t worry. I knew you’d ask yourself, what are the other KPIs Brandon? 

Head on over to the Pediatric Management Institute for 15 Key Performance Indicators.

Do You Have We Employees or They Employees?

Screen Shot 2014-02-23 at 2.10.13 PM

Next time you are in a meeting with your staff, or you are conversing with them, try to determine which employee say “we” and which employees say “they” when they are referring to the company, the management or the leadership of the practice.

What is the difference between the ones that use “we” and the ones that use “they,” and why does it matter?

The “we” are high performing employees. The employees that use the word “they” are the ones that are alienated.

Understanding where each employee stands goes a long way in helping you lead better. That is why I think there is great value is working with the “they” to convert them in to “we” employees.

But don’t neglect the “we.” Our jobs with them is to empower them.

Brandon, What Is Your Policy On Keeping Credit Numbers on File? [Pediatric Practice Management AwesomeCast]

I continue to get a lot of questions about our practice’s policy of collecting credit information from all of our patients. So Chip and I thought we’d dig into what is a recognized growing trend.

In this episode, I describe my thoughts going into this decision, some of my concerns, and why we decided to collect them. Chip also asked me how do we go about collecting cards, how did I/we present the idea to parents, where I store the cards and what benefits did it bring to our practice and our families.

I also give out a shou-tout to Mary Pat Whaley from Managementmypractice.com. Mary Pat hosts a monthly webinar on how to implement a credit card on file.

I addition to this recording, I’ve written quite extensively about the issue. If you click on this “link“, you’ll be directed to all things collections from the PediatricInc perspective.

Enjoy!

 

 

Listen 

iTunes link

10 Time Management Axioms For The Dedicated Medical Practice Manager

At the end of last year I went to a leadership conference. Among the session, there was one on time management. This, of course is an area that many of us struggle with.

Show of hands, how many of you have uttered these words? there just isn’t enough time in the day.

That is what I thought!

I’ve had to think a lot about time management in recent years due to life circumstances. Life has gotten more hectic with a growing practice, and growing kids. So I was eager to hear what Craig Groeschel had to say.

Craig is the head of a large organization. He is behind one of the most downloaded smartphone app of all time; he writes books, is a well known speaker, and as if that wasn’t enough, he’s a father to 6 children.

I think he may have a thing or two to say about how to manage time.

So what did Craig say? Well, lucky for you, I wrote notes. But instead of writing them here on the blog, I created a pretty slide show that highlights Craig’s main lessons from his time management session.

Of course, it isn’t going to be the same without Craig’s insight, context, and gifted speaking ability. But at least you will get enough to incite a few thoughts and tailor your own approach towards time management.

Hope you enjoy the axioms and the slide show. (By the way, I’m aware of the typo on the last slide. I’ll fix it soon.)

If you are interested in learning about the leadership conference I referenced, check out this link to learn more about it.

#20 Key Performance Indicators Smart Practice Managers Measure [Pediatric Practice Management AwesomeCast]

Screen Shot 2013-11-07 at 7.42.08 PMFor today’s AwesomeCast, I invited my friend Paul Vanchiere from the Pediatric Management Institute. Apparently, Chip had more important things to do… Pfff. Family. So he was MIA for this recording.

If you don’t know about the Pediatric Management Institute, make a note to visit. Paul and his team are doing some really cool things to help pediatric practices manage their business better.

Paul knows a few things about key performance indicators, why they are important, and most important, how to calculate them. So I sat down with him and asked him a few questions regarding the topic.

On the AwesomeCast, Paul shares with us an area on his website where you can find explanations, formulas, examples and descriptions for all the key performance indicators.

For details check out this link: Calculators – KPI 

And if you want to learn about the seminars Paul and his crew is doing around the country, visit: PMI Seminars

Here are other ways you can check out the AwesomeCast: