Deductible, co-pay, reimbursement, certification - Besides caring for patients, physicians with smaller practices spend a great deal of time tunneling through fiscal and organizational protocols. The lucky ones have managerial support to untangle gnarly issues; others rely on receptionists, nurses or willing spouses.
Of course, larger groups, sometimes employing dozens of health care workers, typically have practice management down to a science, with personnel overseeing every operation outside of direct patient services. For small- to mid-size offices, though, one or two people may have to juggle financial, staffing and administrative chores along with their medical responsibilities.
This predicament is not uncommon, because a significant number of medical practices now operating in the United States are relatively small. The latest data from the Centers for Disease Control National Center for Health Statistics shows that an average of 311,200 office-based physicians were working in an estimated 161,200 medical practices in the United States, earning a whopping $200 billion in revenues. Of these, 69.2 percent consist of solo practitioners. On the other hand, one-fifth of medical practices with three or more doctors (19.5 percent) contained only one-half of all office-based physicians.
The upshot of this welter of facts and figures is this: A significant number of physicians head up small operations, but the fact remains that each and every practice is a business, requiring deft, comprehensive management to stay profitable. Solid systems based on good management practices should drive every function - from software and hardware utilization, patient relations and marketing, to staffing and training, accounting and billing, and vendor relations and purchasing.
Software and Hardware: Tech Talk for Paperless Practices
Every year, more than 908 million patients pass through doctors' waiting rooms nationwide. Each person walking through a practice's doors generates reams of paperwork, including charts, invoices, insurance filings and other related records.
Fortunately, industry analysts say an increasing number of medical practices are opting for high-tech management methods to keep matters straight. In a 2008 survey from the Centers for Disease Control, 38.4 percent of participating physicians reported using full or partial electronic management record (EMR) systems, compared to only 29.2 percent in 2006. Prescription tracking, test orders and results, and clinical notes were the chief applications.
As hardware goes, some experts maintain that health care practitioners are quick to realize the benefits of high-tech instruments. In-house network servers are appearing in practice groups of every size, while mobile technologies have proven invaluable to physicians requiring off-site access to patient information.
A software primer
Health care providers would do well to conduct a bit of research before selecting EMR or other practice management software systems - simply because the choices out there are mind-boggling. Here are key points to keep in mind:
- Before shopping for software, pin down the needs of the practice by talking with coworkers. Experts also suggest consulting colleagues with similar-sized operations and in similar disciplines to ascertain what works effectively for them. Many programs target individual specialties, so a family practitioner may well go in a different direction than a surgeon. When possible, it's always a good idea to request demonstrations of several products in order to compare. For online subscription services, vendors often will allow trial memberships.
When making a purchase, consider these points, among others:
-Who will be using the software?
- Does the program allow for practice expansion (e.g. addition of another health care provider or office)?
- Will the software allow access from off-site locations?
- Can the system field scheduling changes and adjustments?
- Does the program recognize all applicable diagnosis and procedure codes utilized in the practice?
- With software, go for products that multi-task across systems and are compatible with existing programs and hardware. Some packages offer productivity features across the board, including patient and insurance billing, patient information management, multi-provider scheduling, electronic faxing and electronic prescriptions. Document management, off-site software synchronization capabilities, custom report templates and document imaging components come with better products.
Other programs provide online access to patients, pharmacies and vendors; reimbursable online consultations; electronic care management tools; and revenue cycle outsourcing. Many suppliers will provide demo CDs or time-limited service trials - good ways to test-drive a program.
Licenses for EMR or medical practice management software can carry a hefty price tag, starting at several thousand dollars and soaring into the five-digit range. Leases and payment schedules typically are options, coming in at monthly figures that are easier to live with, especially for new practices.
- Weigh online services against in-house systems. Some industry analysts agree that Internet practice management applications may be the best choice for smaller operations lacking IT staff - simply because they provide round-the-clock support. Setup fees generally run under $1,000 to free with some providers. Monthly payments can run under $100, but additional fees for data transfer, exit and support beyond the basic plan are typical. What's more, relying on the Web can cause real problems when the Internet goes down.
To conduct a cost/service comparison among providers anywhere in the world, check out The List of ISPs (www.thelist.com), a detailed rundown of thousands of Internet companies. The searchable database includes contact information, product summaries, prices and links to individual corporate Web sites. Many of those represented offer free trials.
Locally-hosted software, with data stored on an in-house system's network server or a computer's hard drive, allows for complete control of practice management software. On the flip side, HIPAA's data security standards are so tight that software needed to meet these requirements - firewalls, SSL (Secure Sockets Layer), access control - can get expensive. In addition, frequent updates are a must, as is a reliable backup system in the event of a crash.
- Invest in antivirus solutions suitable to a corporate network. Given issues of patient confidentiality, sensitive medical files and e-mail's vulnerability, standard consumer products likely will not suffice. Most experts stress that antiviral software for medical practices must include three elements: the basic program, a detection/removal engine and a signature virus-recognition file. Consistent monitoring and updates to insure complete protection are critical, and major programs usually include these services.
Hard facts on hardware
Desktop computers are just part of the scenery in most medical practices; but in the case of smaller facilities, network servers likely aren't in the hardware inventory. That said, pundits suggest that product diversity, easy access to technical support, the notion of full data control and manageable purchase/service costs seem to be making in-house network systems a lot more doable.
Nonetheless, servers and server software can be tricky. It's always wise to consult with an expert before investing in a new system. Considerations should include practice size, as well as the type of functions the server will handle. In other words, big, complicated jobs require a more complex technology.
Keep in mind, too, that server operating systems, as well as server software, require client access licenses. A reputable vendor will be able to assist with the obtaining the proper authorizations.
Outside office walls, small laptop computers, such as notebooks and mini-notebooks still top the list of preferred MCDs (mobile clinical devices) as patient care tools. Even so, some researchers consider Smartphones and other PDAs (portable digital assistants) the up-and-coming hardware gadgets for health care providers on the go - with more than 70 percent of hospitals and medical practices owning them. Not surprisingly, physicians are the most frequent users, employing PDAs in particular for schedule management, database access, e-mail, e-prescribing and research.
Consider the following tips when shopping for a personal digital assistant:
- Decide how high-tech to go. For simple tasks, such as accessing calendars and contact lists away from the office, an inexpensive handheld model costing under $200 may suffice. For more complex tasks - reading and editing documents or patient records, for instance - opt for higher-end models ($1,000-plus) with expanded functions.
- Make sure the PDA screen is readable by testing it both inside and outdoors.
- For very expensive systems, consider purchasing insurance.
- Products employing Bluetooth and other wireless technology allow e-mail/Internet access from hotspots in coffee shops, airports and Internet cafes all over the world.
- A PDA keyboard is a must for editing files and composing e-mail. Pen-based interfaces work well when writing tasks are minimal.
- If the PDA has an expansion slot (allowing additional applications), purchase an extra card for data backup.
- Consider a PDA/phone (smartphone, for instance) instead of a simple handheld PDA. This will allow synchronization of schedules and contact lists with the office PC system.
- Look into PDAs (e.g. Blackberry) with embedded Internet capabilities, a growing tech trend. Embedded devices can handle transmission of large e-mails with attachments; receipt of real-time data away from the office; instant access to business applications and databases; and shortened response time to staff and patients while away from the practice.
Patient Relations [top]
As vital as patients are to medical practices, surprisingly little quantifiable data is available regarding the impact of good patient/doctor relations. What is interesting, though, is that articles, editorials and advice columns on the subject abound. Aside from a very appropriate emphasis on the practice's medical and technical excellence, most of the literature boils down to one basic principle: Treat every patient as a valued individual.
The following "patient relation pointers" represent a compilation and summary of excellent suggestions from leading physicians, health care providers and industry analysts. While clearly the doctor/patient relationship transcends a standard business transaction, some aspects of good customer service can apply to medical disciplines, too.
- Solid business practices lay the groundwork for good patient relations. Though glitches happen in the most efficient practices, savvy professionals make every effort not to give patients cause to complain. Accurate scheduling; clear, reliable telephone and e-mail messaging; prompt feedback on procedures and tests; and coordinated communication between physicians, nurses, patients and desk personnel build patient confidence and satisfaction.
Research suggests that poor billing procedures can particularly strain patient relations. Given this, staff persons responsible for invoicing and other financial matters must take particular care to be sensitive and equitable in dealing with patients. In addition, all bills should be concise, complete and easy to understand.
If inferior practice management software or outdated record-keeping systems are causing snafus, look into new programs, or seek the advice of a qualified IT professional. A relatively small investment can make the difference between losing - and holding on to - a significant number of patients.
- Create a pleasant ambience in the reception area. Lengthy sojourns in the waiting room don't do much to increase patient satisfaction, but delays sometimes are unavoidable. If patients cannot be seen promptly, the receptionist should inform them of the situation upon their arrival, and then provide a projected time.
To further ease the situation, stock the place with current general interest magazines; books and toys for children; and a television tuned to a news channel or talk show.
Indirect lighting (lamps rather than overheads), large windows and clean, comfortable furniture likewise work well to soothe and relax tense patients.
- Allow time for patient education. Be generous with information concerning a patient's particular issues and invite questions. Keep answers clear, understandable and light on medical jargon.
- Treat patients as individuals. A medical practitioner may have performed thousands of biopsies and minor in-office surgeries, but for their patients, these procedures may be new territory. Take time to address their fears during treatment, and follow up with phone calls or e-mails.
- Add a "human" touch. Include notes about the patient's job, family, school, hobbies and other personal circumstance in their files; then bring up one of these topics during the appointment. People feel nurtured when they believe their health care providers care about them
- Don't just talk. Listen. Observe. By allowing patients to speak freely, by taking note of body language, astute medical professionals can gain insight on how best to approach treatment on an individualized basis. Being a good listener also invites the patient's trust.
- Use specific language when taking patient histories. Too often, unclear or imprecise questions elicit incomplete information, leading to miscommunication and misunderstanding between the physician and patient.
- Keep tabs on current patients, even when they have not been to the office for a while. Checking in via e-mail, an occasional phone call or an annual "state-of-the-patient" appointment are strategies that can warm up the most tepid practitioner/patient relationship.
- Train support staff to value all patients. While medical reception areas can be hotbeds of activity, this is never an excuse for brusqueness or rude disregard of patients waiting to see their physicians. Recognize and reward personnel who interact with patients in a warm, respectful manner.
- Treat office staff with consideration. In the long run, being fair and courteous to personnel impacts patients positively as well. After all, a happy employee is more likely to be pleasant to others.
- Understand personal limitations. No matter how service-focused a practitioner may be, everyone has his or her weak spot. Unreasonable, irritable or complaining patients can trigger impatience, distress - even anger - in their physicians and other care providers. Make a concerted effort to keep emotions under control, a technique that, admittedly, requires a healthy dose of patience.
Marketing and Advertising [top]
Aside from topnotch patient care, many analysts concur that an organized marketing strategy serves as a powerful business builder. In addition to tried-and-true methods, such as referrals and the patient grapevine, today's practitioners have a range of high tech tools to spread the word about their practices - and with a landmark 1982 U.S. Supreme Court ruling, unlike their predecessors, doctors of the 21st century can take full advantage of advertising opportunities.
Though necessarily multi-pronged, a good marketing plan need not be complicated or costly. For the most part, positive publicity starts within the practice walls, so getting started is simple. After that, print and electronic media provide excellent promotional tools.
Keep in mind that a public relations consultant can do all the legwork for a fee - a godsend for busy professionals, and well worth the money. Those who specialize in health care marketing - and practitioners who've used their techniques - make the following recommendations:
In the office
- Provide a clean, cheerful waiting area. Stained carpeting and a film of dust on the furniture can send the wrong message about practice standards.
- Keep tabs on waiting-room reading materials. In offices where children may accompany their parents (e.g. pediatrician, family practice), make sure all publications are G-rated. Survey magazine covers for content - an article talking about the pros and cons of chemotherapy, for instance, could cause a lot of anxiety in a patient whose oncologist is treating him for lung cancer.
- Train staff to be positive, professional and friendly. No news spreads faster than tales of a rude receptionist or cold-mannered nurse. This brand of advertising results in lost revenue and a tarnished public image. To this end, address inappropriate behavior in staff members directly and without delay.
- Strive to provide accessible office hours. Given that many patients have full-time jobs, physicians who operate strictly on a 9 to 5 basis may be at a distinct disadvantage. Solo practitioners, for example, might consider starting office hours at noon one or two days a week and staying open until 7 p.m. Group practices might alternate rotations with colleagues to offer extended coverage.
Make the news
- Create a media kit. A media or press kit is a collection of print and/or audiovisual material promoting a particular product, service or individual. Target sectors include newspapers, television, radio, periodicals, community groups and any other business, group or organization that might generate business.
A media kit for a medical practice might include: the health care provider's biography, highlighting education, credentials, awards and professional experience; brochures or fact sheets on the practice; information pertaining to the specialty (e.g. an FAQ on breast health; screening tests for prostate cancer; prevention of gum disease); news articles featuring the practice, physician or patient; business cards, contact numbers, and Web and e-mail addresses; and CDs presenting the practice's history, services and accomplishments.
- Contact local newspapers. Any positive development in the life of a practice - office relocation or expansion, new hires, awards or recognitions, free screenings, special events (e.g. an open house) - merits area press coverage. A public relations professional will know the standard procedures, but do-it-yourselfers should get in touch with the appropriate department editors for guidance; health/science, features, local/regional and life-style editors typically are the best bets.
Paid ads, particularly useful for new practices and relocation, also are an option. In this case, someone in the newspaper's sales division can help with the process.
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Write a press release. Submitting a well-written announcement or news story, particularly via e-mail, often works more effectively than a telephone call. Busy editors appreciate not having to dig for story details, and a solid press release does half their job for them. When putting a release together, observe the following guidelines:
- Find an angle. A story about a new piece of medical equipment, for instance, is more interesting when it leads off with an unusual detail. Is the machine the only one in the area? Does it incorporate cutting-edge technology? Does it represent a huge cost savings for patients? In short, turn a humdrum announcement into real news.
- Grab the reader's interest. Provide important details in the headline and first couple sentences, with supplemental details following the hard information.
- Write in a "media" style. Announcements slated for a particular newspaper, for instance, should follow that publication's format. Use published articles in the same vein as your story for models.
- Use direct quotes. The words of a real person lend both human interest and credibility to a press release.
- Be truthful and objective. Go with the facts and avoid injecting personal opinion. Remember, this is a news story, not an op ed piece. Avoid exaggeration, overstatement and emotional language.
- Use active voice. Passive voice makes for monotony, while active voice engages the reader. For instance, "Dr. Jones promoted her to assistant office manager," is much stronger than, "She was promoted to assistant office manager by Dr. Jones."
- Use words sparingly. Go light on adjectives and repeated phrases in favor of a tight story in concise language. Avoid using exclamation points in general, and never more than one at a time.
- Shun medical jargon. Unless the press release is headed for a scholarly journal, use laymen's terms to describe equipment, procedures, job functions, etc. Otherwise, readers may give up before they finish the story.
- End with a boilerplate. This is simply a short paragraph with information about services, staff and corporate/personal history.
- Never submit a release in all upper case letters. A busy editor won't even read it.
- Use proper grammar. Stay away from slang and most importantly, run a spelling check. Before submission, have someone do a thorough proofreading.
- Follow a standard format. Here is a sample template:
Headline (80 characters or less). All words are capitalized except prepositions and modifiers consisting of fewer than three characters.
City, State, Month, Day, Year -- Lead sentence or sentences. The reader should get most of the information in the first paragraph.
Detail paragraphs (who, what, when, where, why, how). Two or three short paragraphs can include direct quotes and specifics. Keep it brief; the entire release should be 300-600 words.
Final paragraph. Additional information such as deadlines, telephone numbers, e-mail addresses, etc.
Boilerplate. Practice/personal information
Contact Name
Practice Name
Phone
E-mail
Web site
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Use the telephone book. Don't underestimate the power of the Yellow Pages. Experts suggest that phone book ads allow medical professionals to target market segmentation - or the division of the market into demographic groups. A recent study by the Yellow Pages Association reveals that the telephone-book heading entitled "Physicians & Surgeons," ranked second highest in access of all available topics, with roughly 1.2 billion referrals. Online, the heading garnered 99.1 million hits.
What's more, researchers also suggest that, on average, advertisers earn $27 on every dollar they invest, primarily because they're reaching potential clients just when they're looking for those particular products and services.
Electronic media and the Internet
- Consider a television or radio PR campaign. While fees for local commercial production vary widely according to the market, experts say running well placed advertisements (e.g. on television, around news broadcasts or in prime time; on radio, during morning and evening peak drive times) targets a broader range of demographic groups than do print ads.
If the marketing budget is tight, think about pitching a news story - for instance, a piece about specialized or expanded services, a professional award or the addition of cutting edge equipment may well warrant some air time. Again, a marketing firm can make access to the right people a whole lot easier.
- Invest in the Internet. Any medical professional trying to grow a practice must own a Web site to effectively market their services. With more and more people using the Internet to research products and services (and to read their newspapers), overlooking this cyber-tool is foolhardy indeed.
The fees for using a Web host - a company that operates the site - can run as little as a couple dollars a month. Web designer services, however, cost more, from a few hundred dollars at the low end, up into the thousands. The more capabilities the site possesses, the higher the price. Remember the old adage - "You get what you pay for."
In addition to providing general information about a medical practice, a Web site allows the use of press releases, e-zine articles, news updates, medical information, blogs, e-mail, digital video features, sound bytes, links to other sites and much more.
- Get into the social networking scene. Not so long ago, online networking was a territory reserved for teens and lonely singles, but these days, venues such as Facebook and LinkedIn are drawing thousands of visitors every day - with businesses of every type putting up pages. Given their tight schedules, however, physicians owning small practices might find that networks geared toward the medical community are the best option.
As a marketing tool, social networking is inexpensive, convenient and personalized. On sites such as Sermo.com, DoctorsHangout.com, Student Doctor Network (www.studentdoctor.net), MedicSpeak (http://medicalnetwork.medicspeak.com) and DoctorNetworking.com, physicians can:
- Establish personal branding through logos, pictures and videos
- Examine marketing possibilities in the U.S. and abroad
- Share news about services, practice changes, staff additions, etc.
- Connect with fellow practitioners
- Exchange professional knowledge and information
- Conduct staff searches
Get help from the Pros
The strategies listed above represent only a fraction of the methods available to promote health care practices. Still, those who find the prospect of any marketing intimidating may want to hire a professional marketing/PR consultant. Their job is to provide as much positive exposure for their clients as possible - from ad placement and media opportunities, to publicity (such as speaking engagements) in the community at large.
Quality marketing firms or consultants should possess:
- A solid performance history in health care disciplines
- An extensive network of electronic-media relationships
- A good relationship with area journalists and news personnel
- Professional-level materials, including media kits, brochures, press releases, digital products, etc. Always ask to see samples.
Employment and Training [top]
What type of medically related small business do you have? Medical Supplies, Home Health Aides, a specialty Medical Practice like dermatology, oncology, anesthesiology, pediatrics, or are you a Family Practice, a Pediatric Practice, or something completely new like a medical software design company to assist doctors’ offices and specialty practices to integrate all the record keeping, billing, insurance claims, etc., in one electronic data base? Almost all of these medically related small businesses have common business/human resource issues that you will need to address as you move your business forward.
Or, are you starting a new practice/business in a new location or purchasing an existing business/medical practice, complete with existing customers/patients, an established location/reputation, and existing staff, a physical location complete with equipment, etc.? If you are purchasing an existing business, you can probably stop reading and get busy being a doctor/small business owner as you have already done your due diligence and “own” an enterprise that is purportedly functioning well. If you are starting your medical business/practice from scratch in a new location, hopefully you have done your homework on the geographical population demographics, competition, etc., and the time it takes to establish a practice as well as the cost/payback ratio’s you can probably expect for the first 5 years. This “make” vs. “buy” decision is probably one of the biggest decisions you face as you begin to use the doctoring/business skills. Don’t forget that you are also a business owner and you are faced with economic, budget, marketing, human resource, etc., roles that you must now also successfully perform, too.
As a relatively “small” business owner/operator, in today’s environment you probably already know that it is best to minimize the number of full-time “employees” on your payroll. Not only do you have a number of tax obligations (social security, Medicare, unemployment, etc.), but legislation requiring paid benefits continues to place the burden of things like medical insurance, paid days off for sick leave, paid holidays, etc., squarely on the backs every small business owner. And, the trends that have developed don’t portend for a “turnaround” view of an employer’s inherent obligation to “provide” for employees. If you think the part-time employee model is fits for your business needs, you might target segments of the population that could be interested in continuing to work but a lifestyle change has taken them out of the every day, “9 to 5” work world and they have a spouse/significant other whose full-time job provides necessary benefits. Job sharing sometimes works really well for new parents who must provide their own child care and are looking for flexible, part-time employment. So might the person who has just retired but who doesn’t want to get out of the game completely.
The flip side of this suggestion is that some research shows that the success of medical practices is determined in part by how well the customers/patients are treated by the staff/personnel in the office —how friendly they are and how “cared for” your patients feel. So, part-time employment may not get you the staff that will achieve high levels of “pleased patients.”
Assuming you own a medical practice and depending on the size of your practice, (including number of existing patients and the attrition/new patient acquisition rates in your on-going business assumptions {or projected if you are a new start-up office} the square footage of your office, number of projected appointments, and the number of different treatment venues available in your space for the different stages of an appointment/treatment), you will have to employ staff which will likely be comprised of Medical Assistants, LVN, LPN, RN, and possibly a Physician’s Assistant, and certainly a patient friendly/empathetic receptionist who will be the primary contact point for your patients over the phone or when they enter your office. It is also a good idea to pay well for a receptionist who can also handle all of the billing for the insurance claims that your office will file on behalf of your patients —problems with insurance claims not only will render poor patient satisfaction, but will retard your cash flow. If your practice is large enough, you may need a full-time claims processor —a good “problem” to have.
In today’s world, it is also a “must” to make certain that every person you are hiring (or engaging) is fully fluent, functional, trained, and adept at using today’s tools to perform work in a virtual world. This training should include knowing how to maintain the integrity of e-files, systems, e-storage, and all forms of communication medium so that, as required by HIPPA, the integrity of your clients’ information/data/medical histories is uncompromised. It is also a good idea to “test” their comfort and expertise levels using a fully automated and integrated medical information system before you make any offer of employment. Medical records, perforce, must be timely, complete and accurate for all the obvious reasons.
If you need to hire (or replace) people who have the skills, certification, training, and experience noted above, where do you find them? A quick internet search will give you the contact information for schools which provide training in your State or geography (and they usually have a referral service for alumni). Also, with today’s social media reach, using your private list of key contacts by simply letting them know you have a specific need for an employee will probably satisfy your talent needs faster than you can imagine. If you use your search engine to query “employment agencies near {zip code}” not only will you get names of a variety of hiring agencies (aka “headhunters”) who can relatively quickly provide you with suitable candidates at a cost, but you will also see a number of boards on which you may post your “opening” at virtually no cost. If you use this tool, be prepared for an avalanche of candidates —the point being, be selective in the modalities you use to find talent.
For more ideas on how to find the people you need, please refer to the Human Resource for additional suggestions.
Billing & Accounts Receivable [top]
With excellence of patient care the top priority in today's medical practices, a number of industry analysts point out that invoicing and accounts receivable practices just don't get enough attention. That the health care disciplines pump billions of dollars into the economy lends particular irony to the situation.
Billing and accounts receivable functions work hand in hand. To keep the receivable column lean, billing systems must be consistent and on the mark. The literature on this subject abounds, and the following strategies represent some of the best the experts have to offer.
Tame the receivable column
- Ascertain why patients are behind on payments. In some cases, they may have been unable to cover expensive one-time procedures, such as services rendered during hospital stays. A second factor is confusion around who owes what money. When insurance companies reject claims, for instance, staff sometimes transfers balances to patient accounts rather than deal with the insurance firm.
- Be scrupulous in posting receipts. Record all transactions immediately, even if this means daily attention to the task. Check with responsible personnel frequently to insure all receivables are posted, including those that fall outside of patient revenues. If staffing is too tight to do this consistently, consider hiring someone to devote full time to the process.
- Conduct regular in-depth reviews with accounting personnel. For example, it's smart to compare the practice's collection percentage and average collection period to established benchmarks, as well as to review ending A/R reports. This practice allows identification of positive and negative trends.
- Purchase or update accounting software. Having the right programs to effectively track billing and receivables can make a world of difference in the bottom line. Investigate the many products on today's market that allow virtually any employee to keep accurate records. When implementing a new system, take advantage of any training or support the manufacturer offers.
Collect what's owed
- Communicate invoice procedures and expectations. Instruct personnel who man the check-out desk to explain payment terms to the patients before they leave the office.
- Require immediate payment for services. This practice has become almost universal, for good reason. With the complexities of insurance reimbursement, co-pays and deductibles, delayed collection can spawn errors throughout the billing system.
- Establish a consistent invoicing protocol. Bills should be complete, with all services dated and itemized. The format should be simple to understand, with clear due dates and payment terms. Include contact information so the patient can seek more information. Most important, send invoices the same day each month to keep the receivable flow steady.
- When accounts are delinquent, attempt to work out solutions with the patients first. Because providing patient care is the mission of any practice, the majority of physicians prefer to arrange some sort of payment plan for delinquent accounts.
One strategy consists of asking patients to sign a payment agreement, with for instance, a monthly payment of 10 or 15 percent of the original amount owed. All written and verbal communication concerning this sort of situation should be clear, friendly and non-threatening.
Fully document, track and back up telephone calls, correspondence and e-mails attempting to arrange payment on delinquent accounts. This includes a patient's promise - or refusal to pay.
- After all else fails, get tough. Here's the scenario: A patient behind in payments has ignored telephone calls, polite letters and all attempts at a solution for three, maybe four months. Unfortunately, the practice may have no other alternative than to turn matters over to a collection agency.
The procedure for this unpleasant chore typically involves flagging offenders as "cash only" patients for subsequent visits, thus allowing them to continue care without further risk to the practice. If delinquency continues, the practice may give a notice period (10 days, for example) before discontinuing services. If the outstanding sum is significant, small claims court can be an option.
If an individual is truly in need, however, practitioners may want to consider extending payment terms, especially when the patient is trying to meet demands.
Vendor Relations & Purchasing [top]
In the realm of medical practice, the purchase of provisions and equipment happens on nearly a daily basis. The high price of everything - from office and exam room supplies, to furniture, pharmaceuticals, computers, x-ray machines, imaging tools and kitchen gadgets - can drain a smaller operation's resources, especially in start-up practices.
Even so, there's an upside. Industry pundits say several practical strategies derived from corporate models go a long way toward expediting purchasing tasks. Chief among these are an efficient inventory management system and effective communication with vendors.
Get a grip on inventory
Unplanned and last-minute purchasing habits can nickel-and-dime a practice to insolvency. To avoid cash leaks, or deluges in some cases, set up a few universal protocols.
- Devise a standard inventory management system. A large number of software packages feature inventory tracking components, which personnel can master with a bit of training. Many small- to mid-size practices report saving hundreds to thousands of dollars a year just from keeping tabs on supplies.
- Appoint one staff person to research all purchases prior to buying. With so much information available via the Internet, price comparisons on software systems, computers and medical appliances are simpler than ever. Some vendor Web sites can pinpoint estimated costs almost to the penny, and many offer free product demonstrations.
- Assess current stock. It's not unusual for a practice owner to discover that support staff is ordering 20-pound copy paper for routine jobs when the 15-pound counterpart would do just as well; or that the office pens cost $6 apiece, when multi-packs of a cheaper brand would suffice.
- Join a purchasing group for greater discount opportunity. Some professional groups, such as the American Association of Family Practitioners, provide this service, which allows considerable savings on routine purchases.
- Buy online. Internet "stores" frequently offer products at lower costs than their bricks-and-mortar cousins, primarily because online operations carry minimal overhead.
- Demand product back-up. Repair service and warranty coverage are musts when purchasing items such as machinery or network hardware. Research the vendor's services regarding product guarantees, ongoing tech support and the availability of repair.
- Maintain meticulous vendor files and review them regularly. Include full contact information, invoice/payment dates and product particulars. Every six months or so, compare the data with new market prices for the same product or services. If current costs are too high, seek several competitive bids.
Vendor relations: Upfront works
A variation of the Golden Rule works nicely here: "Communicate with vendors as you would want them to communicate with you." The revised adage implies many criteria - honesty, clarity and negotiation, to name a few, that will benefit both vendor and purchaser.
- When dealing with several pharmaceutical representatives, consider hosting a single lunch or reception, with time set aside to speak with each sales rep individually. This method, rather than separate appointments, saves both vendor and practitioner a lot of time and energy.
- Ask vendors for consideration based on anticipated future purchases. To be competitive, major suppliers offer significant discounts if they expect clients to add or upgrade products in the next year or two. The best results come from assertive negotiation, with the buyer clearly communicating long-term goals around the purchase. This strategy likewise applies to large-volume or repeat orders.
- Approach negotiations with a written list of pertinent questions. Examples are:
- What support comes with the initial purchase?
- Will the vendor's staff install equipment (e.g. network hardware, copy centers)?
- Will the vendor provide training services for the practice's staff? When, where and for how many personnel?
- Will new personnel receive training on equipment or software programs, if needed?
- For new office management or ERM systems, will the vendor provide data-transfer assistance from the existing system?
- What types of benefits are available with future purchases (e.g. additional training, discounted fees, etc)? - Be assertive about payment terms. Do not hesitate to request a larger payment window, or lower monthly fees. As businesspersons, vendors understand the value of flexibility.
Medical Insurance [top]
The Hippocratic Oath said nothing about huge cash outlays for professional insurance. Nonetheless, newly-minted physicians often find that malpractice coverage takes a hefty bite out of annual income.
Then, there's all the other coverage. Physicians who own practices must consider employee benefits, as well as protection of property, equipment, data and earnings. Given the significant costs involved, it follows that systematic research should precede all purchases, whether the product is malpractice or business insurance.
For the most part, using an experienced agent specializing in policies for medical practitioners is the best way to go. Even so, insurance experts have published numerous guidelines and in-depth articles on the subject for those want to learn more. What follows is a primer of sorts, with information culled from scores of government and industry sectors.
Malpractice Insurance: Painful but Necessary
Without adequate protection against lawsuits, medical professionals with small- or mid-size practices might well face financial ruin. Medical malpractice insurance can avert this disaster, covering doctors and other personnel from liability claims related to patient treatment. Although now a federal legislative issue under individual state regulation, the three general product categories under the malpractice umbrella are:
- Claims-Made Coverage: These policies cover alleged acts of malpractice that take place and are reported to the provider only while the policy is in effect. Premiums tend to rise annually until peaking at five to seven coverage years. A physician with a clean record may enjoy lower premiums because costs are predicated on history, as well as on current experience. Policy owners also may increase liability limits when the need arises.
A word of caution, though: Claims-made products cover incidents occurring and reported only during the policy's effective period. When changing providers, a tail policy - a separate purchase from the old carrier - will cover mishaps taking place during the coverage period, but that go unreported until after the policy lapses. Retroactive (prior-acts) coverage, which the new carrier can provide, serves the same purpose.
- Occurrence Coverage: This policy type protects the insured against any incident, no matter when it's reported. In turn, liability limits are based on those effective at the time of the event. Premiums ride on future projections, rather than on current experience, which leads to widely varying rates. On the upside, neither retroactive nor tail coverage is necessary when terminating this type of policy.
Business Coverage: Protection is a MUST
With the focus on malpractice insurance, health care entrepreneurs may pay less attention to insurance programs covering business operations. This is not a good idea. Even solo practices involve equipment, patient files and office space - add an employee or two, and other coverage comes into play. Many industry experts deem the following products as critical protection.
- Employment practices liability insurance offers general coverage for employment-related claims (sexual harassment, discrimination, wrongful termination, etc.). According to the Insurance Information Institute, a nonprofit organization with the mission to increase the general public's understanding of insurance issues, premium rates depend on practice type, number of staff and risk factors such as prior law suits.
- A business owner's policy (BOP), preferably one tailored to medical practices, typically covers equipment and property (including electronic data), liability (slips, falls and other accidents) and company vehicles. A number of riders providing for a practice's unique needs are available with most plans, so it's critical to speak with a business insurance specialist before making a final decision. Workers compensation, which provides financial coverage when an employee cannot work due to injuries sustained on the job, also falls under this umbrella; but individual state rules vary insofar as the employer's obligation to offer this benefit to employees.
- The Insurance Information Institute points out that adding business interruption insurance to a BOP makes a lot of sense. This type of protection covers ongoing costs when a practice cannot function after a loss, as well as making up for lost revenues.
- Life, disability and long-term-care insurance protect assets, income and family members when the insured practice owner cannot work. The range of products in this category is extensive (e.g. whole life, term, universal, annuities), allowing considerable flexibility in selection and premium costs.
Medical Communication [top]
Medical professionals who wish they could take their practices with them when they're away from their offices can pretty much have things their way. Communication technology continues to spawn mobile gadgets with capabilities that range from simple telephone connection to e-mail, instant messaging, word processing and record keeping.
What's more, many of these devices allow practitioners to review and maneuver office-based patient files from virtually anywhere on the road, as long as Internet access is available. Industry pundits agree that this level of connectivity can't help but facilitate and enhance patient care.
Hardware, Software To-Go
Although a 2006 long-range study by Chalmers Research Group places usage of portable digital tools at between 45 to 85 percent among physicians, researchers did observe an ongoing upward trend in their popularity. To this end, engineers and manufacturers are scrambling to accommodate the growing medical market with an almost dizzying array of hardware, software and online support.
The following products are particularly suited to the needs of health care professionals.
- Personal Digital Assistant. Typically referred to as PDAs, the granddaddies of today's more sophisticated lines have been around since the early 1990s. At their most basic level, these handheld computers manage contact and to-do lists, as well as appointment calendars. Some models accommodate additional software, such as medical dictionaries, reference manuals, coders, drug databases and medical calculators - add-ons that allow on-the-spot research. Wireless PDAs may also feature e-mail, Web browsing and cellular phone service (see smartphone).
Data synchronization takes place between PDAs and desktop computers via cable or wireless connection, thus allowing continual data transfer and update. Costs for these devices range from less than $100 for basic versions to upwards of $500 for those with wireless connectivity.
Software prices run the gamut, too, though it's possible to find real bargains. One major manufacturer even offers a full mobile clinical practice suite - including a medical dictionary, coder and a drug/disease/diagnostic program - for under $500. On the other hand, individual products (e.g. mobile drug reference) can run less than $100.
Smartphone. A recent survey by Manhattan Research found that 64 percent of doctors, more than double the number eight years ago, are using products such as iPhones, BlackBerrys and other hand-held devices. A smartphone is a cell phone with information access, offering digital voice service and various combinations of touch screen, e-mail, pager, text messaging, Internet, voice recognition, organizer, camera (still and/or video), MP3, television and video player. The most promising medical applications for this technology, say some pundits, are functions such as e-prescribing and point-of-care charge capture.The first model, hitting the market in 1994, combined a telephone with a PDA, a marriage that made the gadget both pricey and cumbersome. By contrast, at around $100 to $800, the 21st century version is lightweight, versatile and fairly cheap, considering its capabilities.
Like their PDA cousins, smartphones can accommodate a multitude of software products geared to the health-care professions. The difference is the level of support. Because smartphones have Internet capabilities (as do wireless PDAs) a bounty of online resources is always on hand. For this reason, the range of mobile programs specifically geared to smartphones is expanding at a dizzying speed.
A case in point: A leading medical software provider offers a subscription service supplementing several of their flagship products. Among these are regulatory and scientific updates, patient education materials, association guidelines and reference tables, clinical criteria and more - all for less than $100 a year. Other products worth looking into include:- Mobile medical reference guides. Among the most popular apps for the BlackBerry/smartphone genre, these provide access to information on specific drug/narcotic products, interactions, dosage particulars, pricing and more. Leading manufacturers such as QxMD and Epocrates Rx have designed the software to provide on-the-spot, continuously updated search capabilities - the main advantage over print guides.
Because of this flexibility, mobile guides also allow physicians to maximize efficiency regarding diagnosis and prescription at the point of care. This capability can greatly reduce medical error, according to some experts.
- Patient data management and charge capture.These mobile software productspermit doctors and other medical professionals to access patient information and backend data from the hospital, home, during rounds or anywhere in the field.
- Mobile telemetry and results viewing.According to many medical technology experts, products in this category are particularly useful in the fields of cardiology, critical care and obstetrics. By bringing sensitive patient information directly to the smartphone user, telemetry apps assist in accurate, efficient decision-making. EKGs, DICOM images, x-rays, CT scans and MRIs are among the many types of data these products accommodate.
- Dictation programs. This type of mobile application allows healthcare providers to record patient encounters in any location. Besides facilitating treatment processes, this function can reduce potential medical errors and improve workflow.
As costs go, smartphone mobile communications programs start at under $10, ranging upwards of $100. Even so, a quick Internet search will turn up scores of medical libraries, hospitals, medical schools, government agencies and private corporations that offer free downloadable medical software covering hundreds of subject areas.
- Mobile medical reference guides. Among the most popular apps for the BlackBerry/smartphone genre, these provide access to information on specific drug/narcotic products, interactions, dosage particulars, pricing and more. Leading manufacturers such as QxMD and Epocrates Rx have designed the software to provide on-the-spot, continuously updated search capabilities - the main advantage over print guides.
- Tablet PC. Also a wireless mobile device, a tablet PC enables physicians to take notes via keyboard or by using digital pens or styluses directly on the screen. They then can download the information written at their patients' bedsides into the hospital units' main computers and ultimately into practice databases.
While they do not have the broad application potential of smartphones and PDA appliances, tablet PCs do have larger screens, about the size of a standard sheet of paper. As such, physicians accustomed to jotting notes on charts find it easier to record and view information on tablet computers.
Even more important is the tablet's potential for patient communication and education. Practitioners, for example, can use these devices to share results, such as x-ray images, when discussing treatment options at their patients' bedsides. Because they are completely functional laptops, tablets also accommodate full keyboards, allowing users to install and utilize practice-management programs, electronic record keeping, word processing or any other type of software.
Some models even include voice recognition software, which translates spoken remarks into text notes on the screen, or digitally records voice dictation for wireless transfer to a transcription service.
Like PDAs and smartphones, tablet PCs allow secure, seamless, wireless connection to desktops, EMR systems, private practice servers and other devices.
Security: Keeping patient info safe
With so much sensitive information stored in PDAs, smartphones and tablet PCs, it's not surprising that the HIPAA (Health Insurance Portability and Accountability Act) has raised concerns around patient privacy and security. In response, the National Institute of Standards and Technology has established guidelines regarding the use of mobile devices in the work place. Practitioners should:
- Purchase software programs users themselves can install (this avoids third-party snooping).
- Provide proper storage facilities for devices and accessories.
- Monitor password selection, encryption and use.
- Establish procedures for reporting lost or stolen PDAs, smartphones and other devices.
- Enforce all rules regarding proper use of these appliances.
Striking a Work/Life Balance [top]
By definition, burnout is a sense of emotional and physical exhaustion contributable to work-related stressors such as staff difficulties, heavy workloads and other demanding situations. Burnout can lead to chronic fatigue, volatile emotions, chronic depression and susceptibility to ailments such as colds, fevers and headache.
Unfortunately, research suggests that physicians with small practices and little back-up are particularly prone to burnout. While the "cure" requires a degree of self-discipline, most mental health professionals and career counselors insist that a few simple measures, applied consistently, can take care of the problem - preferably before it becomes too much to manage. In truth, the process starts with basic common sense.
- Take care of physical needs. This means getting adequate sleep, eating well, exercising and resting when ill. It's also important to go through regular screening for conditions inherent to various life stages (e.g. mammogram, prostate screenings).
- Pursue outside interests. Tempting though it may be to spend down time catching up with professional reading - or sprawled in an easy chair watching television - avoid this form of inertia. Instead, take up a hobby or sports activity, preferably with friends and family. The idea is to completely forget about the practice, even for a couple hours.
- Communicate. When nerves are tight or emotions are raging, share these feelings with someone trustworthy. Sometimes a confidante is the answer - a former mentor, medical school classmate or older physician, for instance. Persons of faith may prefer to turn to their pastor or rabbi.
- Consult a professional. Career and life coaches, attorneys and financial planners will help alleviate business stressors, but a mental help professional can be a valuable ally against depression or anxiety.
- Consider a physician support group. Professional facilitators typically run these highly-confidential groups, which are structured to help participants honestly share professional and personal matters. Keep in mind, though, that different dynamics make up individual groups, so sampling two or three may be necessary to find the right fit.
- Establish professional boundaries. Explore strategies for time and workload management. Hiring a P.A. or experienced nurse can help, as does capping patient enrollment.
- Go with the flow. Turbulent economic times can set anyone's teeth on edge. To this end, it's important to keep the situation in perspective, no matter its severity. Things will get better.
Temporary Practice Coverage [top]
Regardless of work ethic, every doctor needs time away from the office. Unfortunately, physicians in small practices find real vacations - let alone sick days - are out of the question, because no one is available to cover patient care.
To this end, medical staffing agencies have become a godsend to the private medical community. Specializing in locum tenens placements - or temporary practice coverage - agencies such as Onyx M.D. screen and provide medical professionals qualified to work in many disciplines.
While staffing companies virtually walk clients through the contract process, certain measures can make the experience more successful for both the hiring doctor and the substitute. The following tips will help:
- Arrange coverage at least two to three months prior to a planned absence.
- Thoroughly review the substituting physician's qualifications and experience, as well as all employment contracts, before signing the dotted line.
- Inform patients of the temporary reassignment of their care, providing the physician's name and background information.
- If money is an issue, limit hiring and staffing costs by cutting back office hours during planned absences.
- Make sure the substitute physician has all pertinent contact information, including phone numbers for weekend coverage staff, specialists for referrals, local hospital emergency departments and patients.
- Leave detailed instructions on coding policies.
- Keep the fill-in doctor busy. This is a good time for the appointment nurse to schedule routine exams and screening tests.
- Make up a checklist for the temporary physician. Items might include lab protocols, prescription policies, patient communication, etc.
- Provide review forms for studies, consults and labs, and require initials or a signature.
- Provide patient follow-up forms to be completed by the subbing doctor. This measure ensures continuity of care and reduces the likelihood of errors.
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