8 Tips To Help You Publish Better Post To Your Medical Practice’s Facebook Page

Are you looking to improve your practice’ Facebook Page? Want to give it a little boost? Perhaps engage parents more, get more fans or add value to your community?

Well, you are in luck if you answered yes to any of those questions.

Below are eight suggestions you can implement today to leverage your practice’s Facebook page.

Salud Pediatrics Facebook Page Screen Shot1. Keep it short.

First things first. People like to scan on Facebook. Keep your writing short for better responses.

2. Use Images. Preferably big and beautiful images

According to Facebook, posts with eye-catching photos and videos stand out in the News Feed, which makes it more likely that people that follow your practice’s Facebook page, like, comment and share.

But don’t get too hung up with the quality of the pictures. Your images do not have to be shot by a professional photographer or a fancy camera.

Dr. Betancourt with Dr. AUsing your phone or a point shoot camera is usually good enough to create a compelling picture.

Examples of photos you can take to go along with your post are pictures of your staff working. O perhaps pictures of one of your docs doing something goofy (shouldn’t be hard to catch a pediatrician doing something goofy). You can also consider featuring a services your practice offers (i.e. mother support groups, parenting classes, etc).

Something as simple as a snail chart with a brief description of why vision screens are an essential part of the preventive wellness visit can not only draw engagement, but also serve as a less formal educational post.

3. Share exclusive content and info with Facebook Ads

The intent of Facebook ads is to offer special deals to customers to keep them interested and drive sales. I know…

Medical practices are not in the business of offering 2for1 deals. However, you can use Facebook Ads to promote the practice’s Facebook page or drive Facebook users to the practice’s website.

The idea is to expose your medical office to a larger audience. And Facebook ads is a great way to go beyond your group of fans.

4. Respond to customers in a timely manner

There is nothing worse than sending an email to a customer service email address and never hearing back from the company. Simply put, people like when you listen to them.

Facebook offers a unique opportunity in that one can engage with patients outside our practice’s four walls.

When you reply to posts and comments quickly, you will notice customers are more responsive, too.

5. Keep a calendar

When special events and holidays are on everyone’s mind, mention them in your posts. Planning and scheduling posts around important dates—like Valentine’s Day, Christmas, Halloween, Back-to-School season and more—means you will be more likely to get people talking.

6. Post for the right audience

Posts are more effective when the people who care see them.

If you have customers who live in different areas or speak different languages, you can create posts just for them.

Facebook Demographic ChartWrite a post and choose the locations and languages you want. When you publish your post, it will show up in just the locations or languages you picked.

7. Link them directly to your website

When you add a link to your post, it automatically creates an image from the website and a large clickable area that makes it easy for people to go to your site.

You can also customize the headline and description to give your customers more reasons to click.

8. Post more of what customers want

When you learn how and when your parents respond, you will be able to post more of what they love.

Keep in mind that posting on your Facebook Page is about quality—not quantity.

From there, you can post more of what they like, and avoid posting what they do not.

Lastly, to learn more about  “your audience,” make sure to check out your Facebook Practice Page Insights page. To Learn more about Page Insights, click on this link.


This post was adapted from a Facebook For Business article titled, Make Post More Effective


 

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.

Q/A With Dr. Kristen Stuppy: Mother, Wife, Practicing Pediatrician, and Social Media Maven

Screen Shot 2014-02-24 at 11.46.47 AMLast year, Dr. Kristen Stuppy and I had an opportunity to do a webinar together for the AAP about social media.

While preparing for the webinar and deciding on the content we were going to address, Dr. Stuppy and I exchanged several emails. Below, I’ve compiled our email and phone conversation along with the questions I asked Dr. Stuppy in preparation for the webinar.

Dr. Stuppy’s answers provide a lot of insight in to the value of social media; not only personally, but also professionally. She shares how she manages her online presence, where she finds content and patient’s reactions to her online efforts.

Dr. Stuppy, could you share with us a little bit about your how long you’ve been practicing, where your practice is located, and how many docs?

14 years, practice in Overland Park, a south west suburb of KC. 4 docs and several midlevels

So, you are the SM champion of your practice, I know this because I follow you closely. But before we get into how you manage a strong online presence, work in a busy practice while balancing work and home life, share with us how long have you been on social media?

Some time in 2009-10 a senior partner suggested I start our office FB page. He suggested me because I had done our website’s articles. At the time I had a personal FB account that I rarely used, so I first played around on it for a bit to see how it worked, then opened a business page.

Did you first dive in as most people do with Facebook as a way to connect with family and old high school friends?

I don’t know that “dive in” is accurate. I have a personal page, but it is not used as frequently as my business page. It can be very addictive to spend time looking for good updates. Big time waster. When I find an old friend, I look at pictures of their kids. That is always fun. I will sometimes see updates, but I don’t post very often to my personal page. No one needs to know what I eat and everything I do. Those posts I find annoying. Business pages are much more informational and suit my needs more, so I spend my time there.

At one point, you started hearing about the potential of social media in medicine, walk us through how this idea of using social media as a pediatrician started to form.

As I mentioned, a Sr partner suggested it. He was good at coming up with ideas and giving the work to someone else. While I could have declined, I thought it was a good idea that suited me. I enjoyed being on the high school newspaper/yearbook staff and even my medical school yearbook staff. This seemed like a new way to share that type of information. I wasn’t afraid of computers, so thought I’d try it out.

Did you have an epiphany of sorts or did your interest grow as you learned more about SM?

My interest grew as I did more online. I originally planned on posting several times a week and more about our office itself. I still post our flu shot clinics, weather closings, reminders to schedule PEs, and other office business, but I have found that another great purpose is to share information.

The more I followed various pages on FB, the more pages I found to follow from their shared posts. I soon found that I had to register for email newsletters from my favorites because I missed great posts on their FB pages. It has become really important to me to share reliable medical information, something I don’t think I considered much when first starting out. The information out there has grown too. My original goal was to post 2-4 times/ week. I currently post 3-4 times/day on average.

Can you describe what is so cool about it? As a practicing pediatrician, what is it that you see in these internet tools?

Very little in medicine gets immediate positive rewards. Telling a parent that their child has a cough and it will take a couple weeks to get better, watch for these complications… it can get old.

Parents never give thanks for that. But with social media, you get instant “likes” or comments. I found that I can share solid reliable information with many people in a short time. Safety, illness treatments, insurance tips, and more.

We can communicate with followers in a way that fosters learning in both directions. Comments might drive me to find more articles to post that show it in another way because parents are still questioning, or comments might even initiate a discussion in my office on how we can improve based on a negative comment.

Do you view your SM media efforts as a hobby, or do you view this new way of communicating with people part of your job as an advocate for children?

Some people watch TV. Others golf. I surf the web. It is a hobby to me. I enjoy my time reading and sharing the right articles. It is also an advocacy position. That makes the hobby more rewarding.

You manage more than just your practice’s Facebook page. You have a presence in other social media sites, like Pinterest. Run down for us all SM platforms you engage.

In addition to my office FB page, I am one of the administrators on the unofficial AAP SOAPM “We Are Pediatrician’s” page. You mentioned Pinterest– that page is personal, but linked to my office website so I can share websites with patients. I also use Twitter and have an account at LinkedIn but don’t use it. I have a GooglePlus account, but use it mostly to share my own blog updates. I probably need to work more with Google, since more people are joining it.

Share with us your philosophy or your purpose. Do you do this as a marketing strategy for your practice? Do you view this as just a more efficient way to advocate for children in a broader capacity?

The original purpose of SM for our office was of course marketing. I’m sure it does draw new patients, but we’ve never measured that number. I personally feel the biggest benefit is educating my current patients. I love it when I start to do the car seat talk and mom says, “Oh, we’ll be rear facing for a long time… saw that on your FB page.” I then can stop that discussion short and spend more time on something else. I know the people who frequently interact on FB and I do change my well visit discussions with them. I can spend more time on things I don’t post regularly. It makes the time in the office better spent.

How about the tools you use and the difference in each one of them?

I rely heavily on HootSuite to manage my accounts. It is one of several scheduling tools that allows me to pre-post articles. I can choose post to my 2 FB accounts and Twitter at the same time, different times but the same information, or select which SM site I want it to go to. It doesn’t take any more time to post to all 3 than it does one – except that Twitter limits characters, so I often change my intro statement for Tweets.

Often times, people think of SM as Facebook and Twitter, but SM is more. For example, blogging. You also blog, could you tell us why blogging matters?

Blogging allows me to talk about what’s on my mind. We all get tired of giving the fever talk a million times a day, but I can write about it and share with hundreds within a week. It can slow the phone calls in my office or when I’m on call to blog about the current illness going around.

I have also used it to answer common questions that I couldn’t find good information to post, such as “will standing hurt baby’s legs?” I also hope to educate families about children’s healthcare on a bigger scale.

I find great satisfaction knowing that thousand’s have read my article on generic Concerta substitutions. I am worried that going back and forth between brands will cause overdosing due to the difference in time release of the different formulations. If I can save one child from the effects of an overdose, it will be worth while.

How do you find topics for your blogs?

I tend to write about what is on my mind. Most are illness related or parenting topics. This time of year complaints start coming in from parents who get billed for summer PE components. I really hate those phone calls, so I wrote about why they get a bill.

I can refer to that when I talk to parents, but my hope is that people start reading this information before the next PE, so they won’t have the surprise bill in the first place.

 How often do you post?

I schedule 3-4 posts per day. Sometimes something comes up, such as recall notices or a fun community event that I learn about too late to pre-post. Occasionally our office administrator will share things, such as a fun picture taken at the office (with parental written consent if applicable), phone problem notices, etc.

Where do you find content to share?

I follow many FB business pages, such as other pediatric offices, parenting sites, AAP section and State pages, poison control, pro-vaccine sites, CDC pages, sleep consultant pages… so many!

FB rotates which pages I see on any given day, so I can choose to go specifically to a page to see it. I also manage the pages by adding them to interest lists, so I can choose from Nutrition, behavior, fun kid stuff, etc. (whatever I have grouped together).

My favorite blogs I don’t want to miss I subscribe to their newsletters so their posts come by email. Twitter is another great source that I don’t use as much as I should.

How do you decide what content goes where or do you post the same message all across the board?

I differentiate posts based on the audience. My office posts are geared toward patient families. I watch the Insights statistics to see what posts people are actually reading.

Highest numbers tend to be funny cartoons, quotes, or other quick information. Another trend I’ve noticed is when I post something with a warning (such as “don’t read if you get offended with bad language”), people tend to read those more.

I guess parents are like kids, they want to see what’s of questionable nature. I do restrict those types of articles to only those with a very strong good point, but sometimes it is too good of an article to not post.

When I first started, I decided to steer away from funny cartoons and things, but when I posted one and got such a response, I started to post more. I still try to mostly post information I want people to read, but we have fun on the page too! It is good to try to get people to comment or at least Like a post so it shares on their wall– that’s how posts go viral!

The We Are Pediatricians (WAP) page has a completely different audience. I see this as a blend between personal and professional. The followers should be my peers, not patients, though it is an open page and anyone can follow it.

I do post the same patient directed articles there, but also business management articles. I do post more liberally the questionable or controversial articles on that page, since I want pediatricians to be aware of those issues. I hope people read articles before they share on their office FB pages!

My Twitter followers also tend to be more professionals, so I post some business things there as well as patient information. I keep it pretty non-controversial too since the feed displays on my office website.

My blog automatically posts to Google+, but unless I hit the G+ on an article I really like or comment on a Google blog, I don’t post to Google specifically.

What are your thoughts on hiring somebody to drive a practice’s SM effort?

While I can see how starting a FB page seems like a time consuming and daunting task, I try to make it easy with the WAP page. If someone follows it and a couple other pages they can find plenty to post every day. The benefit to doing it yourself is that you can add your own thoughts in the introductory statement. This is a great opportunity to let your patients know your thoughts.

If you hire someone to do this for you, you will need to know how that person will choose content, what they will say about it, and how they will respond to comments.

Be sure they understand how to pick articles that have reliable healthcare information. There’s a lot of misinformation out there. I will sometimes love an article but one part of it is not what I agree with. I can use the intro statement to add my 2 cents about what I would do or say differently with an overall endorsement of the remaining article. How would a non-medical marketing person handle that?

As long as you have the ground rules for them, it can be done. But in my opinion that is money not well spent. It is not hard to do it yourself.

How much time would you say you spend on SM a day or a week?

This is hard, because I spend about two hours weekdays doing computer work, all before my kids get up or after they go to bed. This is all my personal and professional email, scheduling posts, checking FB for comments, and more. I do spend a little more time on weekends, but mostly because I use that time for blogging and reading articles I didn’t get to during the week.

 Is it necessary to spend that much time? Could you spend less time and still have a presence?

Remember that I probably do a lot more than someone who just wants to post a few articles per day. This is my hobby too! I make it easy for others to just share articles by posting to WAP. If all you do is share some of those articles, you could do this in a few minutes a day.

What do your patients think about all this?

I hear so many positive comments, which makes it very rewarding. I’ve even been stopped in the hall by my partner’s patients who thank me. They love the information and have given many specific examples over the years on how it helped them.

How do you think social media has benefited your practice, your patients or your parents?

As I mentioned before, sharing information has allowed fewer phone calls due to improved education of parents. It can decrease time during visits discussing common issues, saving time for more specific concerns of a family.

It has also allowed sharing of important office events, such as late openings due to bad weather, phone line problems, and vaccine clinics. Patients have had fun seeing their pictures at times.

Do you separate your personal digital presence and your professional presence? If so, how do you?

I think since I must be professional on my social sites, I don’t really separate them much. I tend to be a bit more careful online- especially with my office page, since in the office I can be a little more free of speech if I know who I’m talking to. That’s the same with all social media. I would advise anyone to be careful what they post since it can be misunderstood and it is forever discoverable.

To visit or follow Dr. Stuppy’s online presence, click on the links below.

Do Your Patients Expect Something for Nothing?

iStock_000000385270SmallI would say yes.

However, I would submit that the reason our patient’s expect something for nothing is our fault, not theirs.

The truth is, we’ve given away so much over the years. And now that we want to charge for things (that have always cost us) like forms, after hour phone calls, and other things, people think we are now wanting to collect for things that they were lead to believe had no value.

Not to mention they often think we are nickle-and-diming them now.

But some practices have been very careful about not falling into this trap of giving away their time and their resources.

Take Village Pediatrics for example. Dr. Gruen and Dr. Gorman charge parents between $150 and $325 (depending on how many children) for a plan they call the added benefits plan. Here is what their website says about the plan:

This modest per-child administrative fee includes services that may be non-covered or non-reimbursed by your insurance company and are typically billed for at other medical offices. Such services include: e-prescribing, unlimited school/camp forms, as well as 24/7/365 access to the doctors without the use of a phone triage service. This fee has allowed Village Pediatrics to offer prompt and personalized care without dramatically increasing our practice volume, dropping insurance plans, or significantly raising our cash fees.

Why would parents pay above and beyond their health insurance premium every year to visit Village Peds?

Because Village Peds from the beginning decided to take a stance and tell parents, what they do has immense value. The time they spend with patients/parents in and out of the examining room is of great value. And if patient/parents want access to Dr. Gruen’s and Dr. Gorman’s valuable time and expertise, parents are going to have to pay for it.

I say, Good for them!! I applaud Dr. Gruen and Dr. Gorman’s efforts in establishing a practice that focuses on providing value worth paying for.

And my guess is that nearly 100% of Village Peds families pay the fee. Because all the other families that didn’t see the value, don’t have their children seen at Village Peds.

Here is the hurdle for me.

When I first read  the things Village Peds  offers  as a part of their added benefits plan, I said to myself, we can’t start charging like they do.  Why? Because all the things on that list our practice already provides without getting anything  for it.

Who’s fault is that? The patients/parents?

No. This is our mistake.

For those of us in the private health care world, we need to get over the fact that people are going to complain about paying for something they used to get for free. Heck, I don’t like to pay for something I used to get for free either. So we can’t hang that over our parents.

Furthermore, I’d emphasize that it is our responsibility to educate our parents that there is HUGE value in everything we do (both inside and outside the examining room).

If we don’t educate them, parents will continue to expect what they’ve always gotten. Which is something for nothing.

This is something I’m gonna start thinking about more. Especially if the plan is to remain an independent private practice.

Is Your Company’s Culture Hindering Your Profitability?

1-IMG_0089I come from a non-medical business world where most conversation centers around profit, revenue, budgets, marketing, sales and things like that.

In the private  practice world, mentioning profit or revenue is almost prohibited as if it was a kind of taboo.

I remember being a little taken aback when people in the healthcare business would talk about “profit” and they would lower their voices and look around and whisper the words “making money” to ensure nobody outside of our conversation heard the money reference.

In our practice, we take a completely different approach. In our practice, we don’t apologize for our pursuit of profitability.

We are very upfront with both patients and our staff about the need to be profitable.

We view “profitability” as a responsibility.

Why? Because a broke doctor doesn’t do anybody any good.

Profitability allows the practice to hire the best docs, hire the best staff, buy the best equipment, send staff to training, pay for docs’ CME’s and all the other things that go along with ensuring patients receive the best medical care possible.

Top notch medical care is expensive.

We believe so strong in this, that in our practice, we discuss profitability in practice’s core values document. Here is an excerpt from our company’s charter:

In order to carry out our mission, we recognize that every staff member must take every opportunity to decrease cost, to increase efficiency, and earn revenues that support our team, our practice and our patients.

In today’s health care climate,  practice employee must be comfortable with talking about money. They need to know that not only is it okay, but a necessity.

Thus, I suggest it is important to “bake” revenue into the culture of the practice.

Fundamentally, this approach sets the expectation. Employees understand that collecting copayments and balances at the time of service is vital to the practice’s mission.

By openly talking about money,  employees understand that the money that comes in to the practice isn’t the doctor’s money, but it is everybody’s money. Collecting from both insurance companies and parents is where the practice gets the money to pay everybody’s salary.

In primary care, this is even more critical because we are in a low margin, high volume business.

And it isn’t just collections. Keeping down cost an unnecessary expenses is just as important. In pediatrics, for example, drawing up vaccines incorrectly, dropping a dose on the floor or simply keeping poor inventory can make the difference between profitability and loss.

Want to avoid revenue leaks an increase profitability? Start talking about money.

Embed it into the practice’s culture.

Please don’t misunderstand me with this point. I’m not suggesting that we only think about money. That is not what I’m suggesting. After all, we are still healthcare providers and things like empathy, caring, understanding, healing, compassion and sacrifice are all part of what we do day to day.

But what I am saying is that if there isn’t enough “margin” docs and their staff won’t be around to be empathetic, caring, compassionate and heal patients. In other words, we can’t help people in need if the practice is also in need.

How Many Billers Should A Medical Practice Employ?

med-billing-and-codingWe’ve talked about in-house billing vs outside billing before. I even teamed up with my friend Chip Hart and devoted a full podcast to the topic. But we’ve never talked about billing staff ratios. How many billing staff should we have? How do we know if we are understaffed or overstaff?

Should we calculate the ratio based on charges and collections or should we base it on physician count?

Dr. Suzanne Berman, one of the many outstanding contributors to the SOAPM list serve and an avid supporter of the Survivor Pediatrics Blogs, jumped in to the discussion with excellent insight on how she staffs her office. Here is what she had to say.

One full-time biller could probably do 65% of our 5-provider practice. This would essentially involve simple in-and-out: convert all the superbills to claims, send ’em out, then post whatever she gets back, and send a bunch of statements, then deposit whatever we get.

A colleague of mine (who probably thinks I’m overstaffed) does just this very thing with a single part-time biller.

This physician is happy to collect 65% of his claims with hardly any effort and write off the rest — which also gives him hardly any days in AR (“oops, they didn’t pay for imms with an EPSDT? OK, I guess we’re writing that off. Next claim!”)

65% is the easy low-hanging fruit. Another FTE might do another 20% — but it’s the next hardest 20% (appeals, corrected claims, etc.) which require more skill. Another FTE will do the very hardest 10%. This gets us to 95% of collections, or so.

Then I have to decide if another FTE could get me 2-3% more collections, and is it worth it, and (perhaps most importantly) does that newly-added FTE have the skill set to squeeze out that very-difficult-to-get 2-3%? If I add another FTE, it needs to be a Claims Commando, not a “worker bee” whose main skill is being fast and accurate entering data on a 10-key

I’d like to jump in here and add that I think there needs to be a person in charge of working the patient balances. This is the person that is calling patients informing them of their balance, explaining to them why they have a balance, writing and sending collection letters and setting patients up on payment plans.

Dr. Berman brought up another very important point that one must consider when deciding how many “billers” an office should have. She writes:

The other related question is: who’s a biller? I know this sounds dumb, but a lot of the important billing functions revolve heavily on the front desk doing their job (at least, that’s how the work is divided up in my office):

  • validating insurance for each and every visit
  • collecting copays
  • getting correct addresses, phone numbers, email addresses, etc.
  • updating VFC status
  • figuring out which of the divorced parents is supposed to be paying

If you have receptionists who are not doing these jobs consistently, more work is going to devolve to the billing office to track down this information when the patient isn’t in the office. On the other hand, if you have an extra receptionist up front who does all the insurance validation the day before and runs a list of people coming in who need to be squeezed for $$, you can get by with fewer billing people. Or should I say, “billing” people. I think billing + reception = a constant (when it comes to total collections effectiveness, that is.)

Dr. Berman doesn’t answer the question, but with her approach, she is teaching us how to fish, as opposed to simply giving us the fish. I like this approach better.

But for those of you that don’t have the patiences, time or interest, I have something for you too. My friend Chip Hart also chimed in and he summarized it like this:

I usually expect at least 2:1.

Professionally I know Chip enough to know that with this statement, he isn’t saying this is a set in stone, hard-rule type statement. So don’t misinterpret his simple statement. He acknowledges that every office is different, different factors affect different things in an office. But if you want a hard rule of thumb, then the 2:1 (2 docs for every 1 biller), is a good start.

How many billers do you have in your office? What do you think is the right number? How many is too many? Does more billers equal better collections for your office? Drop a line. I’d love to learn from you too.

Keeping Credit Cards On File Is The Only Option

Image: Swiping a credit cardIf you’ve read this blog long enough, and you’ve heard me speak at conferences, you know I’m a huge proponent of practices implementing a credit card on file policy.

If you don’t know what I’m talking about, I’m referring to the practice of asking patients to leave a credit card on file (with the practice) to cover balances that the health insurance companies deem patient responsibility.

Much like a car rental company or a hotel requires a credit card on file for incidental.

Our practice has been doing this since 2009 and we’ve never looked back. It has been one of the best decisions we’ve ever made. Not only was it not as difficult to implement as we thought, but we’ve been able to improve our accounts receivables.

As it turns out, I found a practice that has been doing the credit card on file thing  longer than we have. I wanted to learn more about their experience so I asked Melanie, the manager of this practice, if she could answer a few questions about their experience in implementing this policy.

She agreed. Enjoy!

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 How long have you had the credit card policy in place? 

We have had this mandatory since 2008.

What do you use to store the cards and process the payments?

We’ve partnered with a vendor name Instamed that helps us with this process.

Do you give patients options or is the policy you have in your office rigid?

Our patients have the option of cc/hsa/debit card and also any copay amount they wish to leave in their credit account on the day of service or if they have coinsurance/deductible etc & don’t want the patient responsibility portion to go on their card.

What if a patient is completely against leaving the card on file?

If they are completely against the card on account, the only other option is to leave deposit of full network allowable at time of service & wait for me to refund by check any difference from what their insurance pays.

Do you have any patients that take this option?

We have maybe 2 that actually do this.

Are there exception to this policy?

This policy is across the board, even medicaid patients. We check daily for eligibility so no one with active medicaid is charged anyway.

Do you bend the rules for some patients?

You need to be consistent with your policy.

Surely there have been a few bends here and there?

For first time patients we do not bend. They are made aware by phone or mail of this [policy] before coming in. It’s also on our website under forms to bring to first visit as well. Some but extremely few have decided not to continue with the visit.

How about established patients, do you bend the rules for them?

For established patients we gave them a pass if they “didn’t bring one” for one visit & sometimes two, but if it went a third, I would go talk with them.

What would you tell them?

I explained it’s not personal, but necessary to keep consistent for all patients.

 If they don’t agree with the policy, then what?

Unfortunately, they would have to find another provider if they didn’t want to follow the policy.

 Your policy sounds fool proof, is it?

Keep in mind even having the card on account doesn’t guarantee that it will actually work by the time the era/eob comes back, though for the most part it does.

Eligibility I understand, but I think checking for benefits is a hassle. Do you check eligibility and benefits beforehand?

We are also on top of making sure we do our best to know everyone’s coverage, so patients are not surprised by what they may owe (front desk has a spreadsheet of payer allowable as only 20 fit in our EMR). This includes immunizations and we always let them know the health department is an option for those with coinsurance/deductibles. We are a vfc provider so medicaid or no-insurance is not a barrier.

Let’s say a practice is thinking about instituting this policy. What would be your advice to them?

Everyone needs to be on board and stand behind it. For established patients maybe you want to give them a pass on one visit but have them sign updated policy & let them know it’s required by next visit.

Anything else?

Be consistent with your policy.

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I wish more docs would get over their fear of asking patients for a credit card company. It is the only way to shift the risk and responsibility back to the patient.

Just like patients are getting more savvy about the cost of healthcare and looking for ways to save, doctors also need to look at ways to operate with the understanding that financing patient’s medical services is not a very good long term strategy.

Reasonable patients will understand why you are doing it. Those that don’t understand ought to find another sucker then…

If you’ve implemented this policy, let me know. I’d love to hear about it.

Want To Wow Patients? Here is How To Do It

EmpathyOne of our core values in our practice, is empathy. It is so important to us, that we include it in our practice charter. Here is a little summary of our Empathy and Compassion section of our charter.

Central to our core values is treating our patients with compassion and respect. Understanding how our patients may be feeling and being sympathetic about that is essential to how we provide care. We are committed to maintaining a deep awareness for our patients and each family’s needs. And we embrace the fact that having compassion for our patients and their families is a cornerstone of what pediatricians do.

Here is the thing though, despite having empathy as part of core value, we fall off the wagon from time to time. Why? Well, I think we get comfortable with our everyday task and the day-to-day patient loads that we forget to put ourselves in our patients’ shoes.

For us, after giving 100s of shots in a day, it stops being a big deal. But for parents, it isn’t as easy to handle. Many parents, when they see their kid’s eye shut and goo coming out, they freak out. The only time they’ve seen an eye closed by swelling is when they see a UFC fight. Pink eye for us is, well, pink eye. That’s all.

But we need to remind ourselves to understand and share the feelings of our patients.

Why?

Because keeping our empathy will always be one of the greatest tools we have to WOW parents.

11 Questions to Ask A Potential EMR Vendor About Their Software

Software demos are notoriously biased. EMR representative will generally show you the stuff that works really well. They will show you the stuff that will make you say, ooh, aaah.

Nothing wrong with that. When I’m showing something off, I want to share the best of what I have too.

But one of our main jobs as leaders of our medical practices, is to shift through the nonsense and get to the nitty gritty.

So how do we know, from a practical stand point, that the software we are evaluating can handle real world examples?

The best way to understand if a piece of software will work for you is to see it in action. Not from a representative’s point of view, but from a practice point of view.

I know what you are thinking… but I don’t know what questions to ask the EMR rep that will help me get a practical sense of how the EMR works.

Wonder no more. Suzanne Berman, MD, SOAPM member extraordinaire, wrote down 11 Questions that I think will really put an EMR through a ringer. As you will see from her questions, she emphasizes the importance of seeing  how the system performs extracting data.

Take a look at these questions and have them ready the next time you meet with an EMR vendor.

  1. “Show me how I recall all asthmatics who haven’t had a spirometry in >6 months.”
  2. “The next time this family calls or comes in, SOMEONE needs to get a correct mailing address. Please mark the chart on all the siblings so it will alert the next time someone opens the chart.”
  3. “Show me all patients who are behind on their checkups.”
  4. “Which of our patients don’t have a current Framitz Flopulitz form on file?”
  5. “I need to pre-order my flu vaccine for next year. I need a breakdown of how many VFC vs payable kids, 6 to 36 months vs big kids we had last year and how many shots/mist we gave; then I need this year’s numbers to extrapolate.”
  6. “I saw a kid with something like this last year — the specialist recommended a great treatment regimen, that I’d like to try again. Nuts, can’t remember that kid’s name. I do remember charting “Spoke with Dr. Matheson” — the specialist. How can I look through all the charts for a teenage girl seen in 2011 where the phrase “Spoke with Dr. Matheson” appears?
  7. Me, Dr. Speedy, and Dr. Talksalot are all vying for a limited number of shared exam rooms. Which of us a) has the most visits; b) runs on time vs. behind; c) has the most patients in the office at once [i.e. does the most double/triple sib appts]?”
  8. “How many active patients do I have? Exclude cross-cover patients, patients who’ve transferred, patients who we discharged, and patients we haven’t seen in X months. Oh yeah, and please show age distribution.”
  9. “How do I mark this kid’s chart as “African-American child adopted by Caucasian couple — do not ask “are you mom?” when family comes in — sensitive issue” so my receptionists stop putting their foot in their mouths?
  10. “I’m doing a sick and a well visit on the same day. Where do I chart the different bits?”
  11. “How can I find all kids who got vaccinated with Lot X? The mfr is recalling that lot.”

Of course you are free to add your own questions based on situations you’ve encountered. Oh, and don’t assume this is all the due diligence you have to do. Search the web. There are tons of articles that can help you with this process as well.

Lastly, I’d like to mention that data input is also important. The program ought to feel intuitive and easy to input data into. But don’t forget the data output. This is often an overlooked aspect of the EMR evaluation.

What question or request would you add to this list?

Dr. Suzanne Berman is a general pediatrician in private practice in Crossville, Tennessee.   Her family works, lives, goes to school, worships, and buys stuff from Walmart all within the 38555 zip code. Dr. Berman is a regular contributor to the Survivor Pediatrics blog. To read all her post, click here.

How to Leverage Our Voices, Our Patients and Social Media

Fed up with learning that many kids in her community were getting the measles, Dr. Natasha Burgert decided to take the vaccine epidemic in her city head on.

Over the 12 weeks of summer, she partnered with her patient’s families to support ShotAtLife. This vaccine advocacy group allowed her to have a way to actively respond to the measles epidemic that affected her Kansas City community.

In just a few weeks, she collected $6,740. That is enough to protect 1,348 children against measles.

Click on the video below and you’ll see her story.

I think there are so many lessons for those of us that work in pediatrics.

I can’t think of a better public display of advocacy for the pediatric community. I also appreciate how she is leveraging her social media platform (ie blogging, Twitter, YoutTube, etc), to get her message out.

But more important to me, is how she is wisely using her status as a trusted source of medical information to reach out to her community in an effort to bring awareness to a cause she feels deeply about.

What I love the most about Dr. Burgert’s initiative  is that she didn’t wait for the AAP to initiate the campaign or any other large entity. She took matters into her own hands with the resources she has; which includes her voice, her relationships with parents, and her social media platform.

Almost all pediatricians have a voice. Something they feel passionate about. And all pediatricians have strong relationships with their patients. But most pediatricians do not have a strong online presence that will give them the opportunity to be heard or to influence more than a few patients at a time.

Think about this… the AAP has 60,000 members. Let’s say only 10% of those 60,000 members had a strong online presence. That is 6000 pediatricians. Right?

Now, Dr. Burgert raised $6740 in just a few weeks. Let’s say each of those 6000 pediatrician raised half of what Dr. Burgert raised ($3370). That would be over $20,000,000 when one multiplies $3370 x 6000.

Just imagine what kind of an impact 6000 pediatricians (only 10% of the AAP membership) would have if that scenario played out.

Think about what type of a message pediatricians would be sending to their patients and their community. Think about how the media would react.

By the way, I’m not suggesting that we all get behind Dr. Burgert’s measles initiative (although I believe it is a great one to support). Everybody is free to support what they want, of course.

What I’m trying to point out is that with social media, a cause, and our position of influence with our families and patients, pediatricians could cause a lot of disruption, in the good sense.

My last point is this… movements rarely start within the establishment. It has to come from the fringe, from the unconventional, and sometimes the extreme.

Dr. Burgert has an awesome blog. She also Tweets. And apparently she is an avid texter. She was recently featured in a NYT article where she talked about how she uses text with her teenage patients. Dr. Burgert is also a regular contributor to Survivor Pediatrics.