#12 How Do You Know When To Hire Your Next Physician? [Pediatric Practice Management MediaCast]

Recently, Chip and I saw a question posted on the SOAPM listserve that addressed this notion of when is it the right time to bring on a physician. We thought it was a great discussion topic so we decided to dedicate an entire episode surrounding some of things one ought to consider when bringing on a new doc. To give you a heads up, below you’ll find part of the email that was submitted to the listserve.

I recently interviewed a potential MD candidate. She looks fine on paper and was nice enough in the interview. But how do you know if someone is going to be right for your practice? My practice is small so bringing in a bad apple would cause a huge problem. Plus, she is the only person I have interviewed. I would love to have more choices from which to select. How does everyone else go about recruiting? I can’t exactly run a want ad in the local paper…

…since I have never done this before nor have I ever been solicited by a practice for employment, how do I structure a new MD package? Salary vs production? Salary for a while and then production? At what point? And how much? What benefits? How specific do I outline work hours, call duties, etc? What happens if I can’t stand the person I hire after 3 months?

Finally, how do I even know if my practice is ready to bring in another MD? What numbers do you look at? Perhaps I should just get a scribe and bust my butt for the next 6-12 months to see if I can absorb the patient load myself without adding someone else right away?

We hope you enjoy this episode and remember, give us feedback.  Positive or negative. We don’t care (well, actually we do care). We’d love to hear from you.

Here are ways you can catch the episode. Enjoy!

Pediatric Practice Management MediaCast

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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.

Part I: Ditching Your EMR For a New One? Here’s How To Prepare

As many of you know, EMRs have been around for some time. Although I wouldn’t go as far as to say they have matured as a product, there have been some progress in terms functionality (notice I didn’t say innovation).

The new word around the block is that apparently, practices are leaving their old EMR for new shinier ones. Now, some people say that moving from one EMR to another EMR is actually harder than moving from paper charts to an EMR. I find that hard to believe, but hey, what do I know.

Regardless, moving from one system to another is always a challenge and one that very few of us have actually gone through. So, let’s say you are planning to ditch your old EMR, what are the things you need to think about in order to start going down this huge transition?

Chip Hart from Physician Computer Company (my new vendor by the way), sat down with me recently and gave me the scoop on how, based on his experience of doing several conversions, is the best way to go about this monumental task.   It’s worth noting that they weren’t all conversions to PCC.  Chip tells me they’ve had plenty of people switch from one EHR to another and not PCC.

Chip, what is the biggest thing I need to be concerned about when taking on an EMR transition?

Data conversion. How will your data move from EHR1 to EHR2? This issue is, by far, the biggest obstacle in the process of transferring from one EHR to another.

Really? But it is all data isn’t it? Transfering 1s and 0s from one file to another should be easy and quick, is it not?

Any vendor who makes promises about what data can be transferred between the systems without analyzing your actual data is just guessing. Every EHR is different and often very different from practice to practice. Experience with a particular conversion is great, but not a guarantee. Many EHR vendors can’t even transfer data from one of their own systems!

OK, what is the second biggest concern that we need to consider?

You will likely need to manage a three-way balance of timing, cost, and quality for both vendors.

Whew, sound like a lot of work. OK, in your experience, what would an ideal EMR conversion look like?

In an ideal circumstance, an EHR conversion would work as follows:

  1. Comprehensive data from EHR1 is transferred to EHR2 well in advance of the transition to EHR2
  2. Over a matter of weeks the quality of the data transfer to EHR2 is reviewed by your office. Confirm everything from discrete data points like vitals to the transfer of scanned images to your narrative/notes.
  3. Then, on the last day actively putting data into EHR1, repeat the data transfer so that your database is as up-to-date as possible.

On paper this seems pretty smooth, but I know that in practice this isn’t always the case. What are some of the hurdles that come up during this process?

Sometimes, your relationship with EHR1 has deteriorated to the point that access to the database is limited. Additionally, many EHR companies restrict database access or export in their agreements with you. Their reasoning should be obvious, be prepared to fight for your data.

Let’s say my relationship with my old vendor is good. Anything I need to be aware of still?

If the relationship with EHR1 is good, and they are capable of delivering data to EHR2 in a timely and consistent manner, it is perfectly reasonable for them to charge for this service. The range of reasonable charges can be quite broad based on a variety of technical factors, but note that the amount of effort by EHR1 is not usually tied to the size of the practice or volume of the data…so a greater charge for a larger practice usually reflects EHR1’s expectation that a larger practice can afford to pay more.

Anything else?

As noted, make sure that TIMING is a part of any discussion you have relating to data conversions. Some vendors will take 2 to 3 to 6 weeks (or more!) to deliver data to you, the effective of which on a transfer can be devastating. Sometimes, it can take a few days to then convert the data – if you come with 800GB of images, you can’t transfer that in 15 minutes. [Future PediatricInc.com readers will laugh at that comment.]

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For my next post, I will posting Chip’s comments on how to leverage what we already know (as seasoned EMR users), to make the transition into the new EMR a successful one.

Chip Hart is Physician’s Computer Company Director of Pediatric Solutions at Physician’s Computer Company and he blogs at Confessions of a Pediatric Consultant. Chip also contributes from time to time to PediatricInc. To read Chip’s previous contributions, click here.

Lastly, I’d also like to point out that these are the types of discussions that we have on SOAPM, which is the Section of Administration and Practice Management at the AAP. As I’ve said before, if you are in private practice, and you are not  a member of SOAPM, you are missing out.

Is Social Media Bad for Physicians?

I read with great an article titled Facebook and Physicians: A prescriptions for Trouble.  In it, Lucas Mearia references a guy by the name of Crotty who advocates strongly on the notion that doctors should refrain from engaging patients and collegues online.

The article highlights several situations that could potentially lead doctors into trouble.

For example, a doctor who gave a patient a prescription for medicine that could have an adverse affect when mixed with alcohol might decide to check out the patient’s Facebook page to see if the individual is telling the truth about his drinking habits, Crotty said.

To me this is a little far fetched and an extreme example to make an ethical point. Let’s be realistic though, do doctors have time to check every single patient’s profile on Facebook? How long would that take? How would the doctor know if he/she was even on the medication?

The article also talks about sites like Doximity and Sermo which are social sites exclusively for doctors . Crotty equates these types of networks where doctors ask other doctors for advice as curbside consultations.

“What if the treatment they suggested was wrong and you chose the wrong one?” he said. “The thing is, when you get a second opinion, the doctor you’re getting the opinion from has no clinical context or clinical relationship with that patient.

How is this different than calling up a collegue and asking her for an opinion on a patient? Does Mr Crotty think that a physician is not smart enough to discern the fact that the consult physician isn’t seeing the patient, isn’t examing the patient and knows only what she is being told?

I think this Crotty guy is completely missing the boat with his assertions.

I think social media has giving us the tools to connect with our communities in ways we have never been able to do before. We can now broadcast, share, be published, connect, educate, curate, an collaborate thanks to social media tools.

And you know who are the ones in the best position to take advantage of these tools? Pediatricians. Why? Because peds’ demographic will always skew younger than other specialties. And guess who are the ones using all this new technology?

If we want to have any type of influence over generations to come, we will have to have a presence online. Simply put, this isn’t going away. This is the future, no doubt.

We can continue defending the status quo, like this Crotty guy, or we can find ways to leverage these wonderful tools the Internet has afforded us.

And as for Mr. Lucas Mearian of ComputerWorld, I think he should stick with writing on issues of storage, disaster recovery, business continuity, financial services and healthcare IT, because clearly he has no clear idea of how doctors could leverage this technology.

To read the entire Computerworld article, click here.

10 Ways to Find Ways to Improve Your Medical Practice

We often forget about improving things in our medical practices. We get comfortable and complacent. We often assume, we do a good job, no need to fix what isn’t broken.

But time and time again, I’m reminded that there is always areas of improvement. I’m also reminded that on occasion, we don’t do things as good as I see them in my mind.

The problem for many is that because we are so used to doing things the way we’ve always done them, it is hard to step back and look at things from a different perspective. It is like reading something you’ve written 20 times and then giving it to someone to proof read it for you and then they find 3 mistakes in the first line. C’mon, how could I have missed it? I READ IT SEVERAL TIMES! I often scream.

With that in mind, I’ve put together a few ideas or tips that will help you see things differently in an effort to show you ares of improvement.

  1. Send a message, as if you were a patient or prospective patient to the email on the website and see how long it takes to get an answer.
  2. Call the practice. Act as if you are a prospective patient/customer and see how the front desk or receptionist treats you.
  3. Call the billing department and ask them if they could explain all these things in your EOB. Decide if the billing staff is genuinely trying to inform the patient or being condescending, dismissive or simply not helpful.
  4. Pull a patient aside that just checked in, explain that you want to document how long an entire visit takes and ask if they agree to help you with your experiment. Have her write down how long each process takes, including how long it takes from the time she checks in to time she is called in; time it takes the doctor to step in after triage is done; how long does it take to get a refill on a Rx, etc.
  5. Print a patient’s statement and hand it to a relative that knows nothing about medical billing. Ask them if they know what is owed, how to pay the bill or if it is easy to identify where to call if they have a question.
  6. Search Google for each of your docs name as well as the practice’s name. See what comes up.
  7. In Google, type “pediatrics” or Pediatrician and your office’s zip code (or town). Hopefully, your practice will come up. If it doesn’t, you have work to do.
  8. Call several OBs in your area and ask if they know of any good pediatrician’s office in the area. If they don’t mention your name, call later and introduce yourself. You may want send them a pack of business cards too.
  9. Think about this question, If our practice relied solely on donations, what would you do different. Write at least 5 things down on a piece of paper and start working on the things on the list.
  10. Switch place for an entire day. If you are a biller, work the front desk. If you work the front desk, work as a biller. If you are a triage nurse, make appts for a day. Of course, this won’t work for everybody and I’m not suggesting for docs to answer the phones for the day. But the exercise will not only help appreciate others’ roles, but it will also allow people with different perspective take a look at what you do and perhaps find improvements. Much like the person that is reading your draft.

What else? Could you add to this list? What other things can we do to help us identify areas of improvement?

Service Tips From a Parent

Today, we are going to takle a few customer service tips. But these tips are a little different because they come from a mom. That is right. These tips are from a mom of two that has had her share of visits to the pediatricians office.  Her name is Deb Beaulieu. And with this post, she gives us some ideas from a parent’s perspective, on how we can improve our service. By the way, we are not Deb’s pediatrician’s office. If it was ours, she wouldn’t have these complaints. 🙂

 

Now that it’s more common for physicians to blog and use social media, some of the posts I find most intriguing list the top items that pediatricians wish parents understood. Today I’d like to offer a twist on that format. As a healthcare writer and a parent, here’s my list of what I look for in a pediatrician’s office, presented as simple “do’s” and don’ts”:

DO train all staff members who are going to interact with my child to introduce him- or herself to the patient by name.

I realize that if you’re about to jab my four-year old with several needles, it might be preferable to make a quick, untraceable getaway. But a brief, “Hi, Bobby, my name is Donna, and I’m going to give you a couple vaccines today” will buy you more trust upfront and help the process go smoother, both in the office and after we get home. Trust me, by the time we get to the car, “Donna with the green lollipops” will be a rock star in my child’s memory.

DON’T speak to me, the parent, as though I’m a child.

As a mom, I understand the force of habit to speak in a sing-songy manner and describe cause and effect at a three-year-old’s comprehension level. But my husband doesn’t like it when I talk to him like this, and I don’t appreciate it when a doctor or teacher (possibly worse offenders) does it to me.

However, DO, by all means, assume my memory and/or ability to concentrate is diminished compared to a nonparent.

If I have a baby, I’m likely sleep-deprived and may not retain the information perfectly. If my child is fussy or I’ve got more than one with me, much of my attention is focused on keeping them quiet, ironically enough, so that I can listen to you. Avoid my confused phone calls later by providing written take-home instructions whenever possible. To all of your materials, consider adding a “what if” section. “What if” my child throws up some or all of this medication? “What if” he still hasn’t pooped by New Year’s? “What if” my mother-in-law insists that the remedies of her generation are worth a try? (And, yes, I will show her the document if necessary.)

DO educate with sensitivity.

I’ve talked to a lot of moms about this: The first several appointments with a new baby feel more like an examination of our parenting than our baby’s health. Flat head? Mom isn’t doing enough tummy time. Still not sleeping through the night? Our bedtime routine isn’t soothing enough. Eating poorly? We must be doing something wrong. Now, I absolutely don’t believe pediatricians really insinuate any wrongdoing at all when educating us about how to do things better. But in our sleep-deprived, want-to-be-the-greatest-mom-ever, slightly paranoid/obsessed state, we’re already our own harshest critics. You may need to try harder than you think to reassure new parents you’re a partner, not a judge.

Therefore, DO compliment us on at least one thing we’re doing right at every visit.

It doesn’t have to be anything major to give a big boost to our day.

That said, DON’T be afraid to share a laugh.

The day my pediatrician won me over completely was the checkup when I was describing that my newborn daughter had a bowel movement only every two to three days, resulting in a blowout reaching her armpits. When I went on to describe that every time, it looked as though she had fallen, clothes and all, into a bucket of poop-colored paint, the doctor laughed out loud, even snorted a little. Standing there in her stethoscope and white coat, she took a second to compose herself before explaining that her pattern would even out and/or my little girl would “grow into” her poops. I wasn’t there trying to make jokes, but express an honest (albeit detailed) concern. The doctor’s very human reaction at that time was just what I needed, and certainly helped create rapport.

DO help me out when I have my hands full.

With two children just 13 months apart, I find it especially irksome for anyone (anywhere) to comment on how full my hands are—without doing anything about it. The receptionist at my pediatrician’s office was the first person to have the forethought to hold a credit card slip still for me so I could sign it while juggling two toddlers and all the stuff that travels with them. The medical assistant has pushed the stroller for me, and other staff have held open doors. For this, they’ve earned my undying appreciation.

So, you see, it doesn’t have to cost a lot of time or money to create a loyal patient who will recommend you eagerly to all of her friends. When we’re trusting you with the health of the people who matter to us most, a little common sense and compassion in return go a very long way.

Deb Beaulieu is a Boston-area freelance writer and editor who covers physician practice management topics for the Massachusetts Medical Society and FiercePracticeManagement. Learn more about Deb’s work or contact her at www.debbeaulieu.blogspot.com.