A Quarterly Publication of Florida Medical Group Management Association

Florida MGMA NewsFlorida MGMA News

Vol. XIII Issue III

Summer 2015

Florida MGMA Annual Conference PicturesApril 22-24, 2015 - Omni Orlando Resort at Championsgate

Sherry Mills presentsMarynell Lubinski with aplaque for her service asPresident of FloridaMGMA.

2014 ­ 2015

BOARD OF DIRECTORS

President

Marynell Lubinski, FACMPEMiami Jewish Health Systems

President Elect, Conference Chair

Sherry Mills North Florida Surgeons

Treasurer

Ilene Gilbert­Droge, FACMPESMH Physician Services, Inc.

Past President

Michael A. Franks, MPA, CMPE Premier Dermatology

Florida Collaborative Chair

Kevin LockettMayo Clinic

ACMPE Representative North

Tom Menichino, FACMPEThe Villages Health

ACMPE Representative South

Lori­Ann Martell, LPN, CMPE

Advanced Medical Center, Inc.

Vice President ­ North East

Thomas BalestrieriNoPark Avenue Dermatology

Vice President ­ North West

Chip Geitz, CPA, CMPEMedical Center Clinic

Vice President ­ Central

Gerry Bessette

Medical Associates of Brevard

Vice President ­ Central West

Tracey MitchellUSF Physicians Group

Vice President ­ South East

Mario SalcedaMemorial Healthcare System

Past President at Large

Henry Del Riego

FIU HealthCare Network ­ FIU Health

Member At Large

Kevin Pizzuti, CMPE

Executive Director

Lisa Beard(561) 452­6702 ~ flmgma@yahoo.com

Dear Colleagues,

Florida MGMA’s Annual Conference in

Orlando in April was a tremendous

success. I want to thank our confer­

ence chair and president elect, Sherry

Mills, and Executive Director, Lisa

Beard, for their hard work on our fan­

tastic conference filled with practical

information and networking opportuni­

ties with colleagues. The conference

committee is already working on

another great conference for your next

June in Orlando.

In our practices we’re all in the final

countdown to ICD­10. Soon we’ll

enter the next phase as we find out

the impact of ICD10 on our actual pay­

ments. Our Florida Collaborative

Committee is a great resource for

information on ICD­10 and other

administrative simplification initiatives.

All Florida MGMA members are wel­

come to participate. Look for informa­

tion on the FMGMA website or reach

out to us at flmgma@yahoo.com.

Florida MGMA, in partnership with

other state chapters, continues to offer

webinars throughout the year to pro­

vide you tools to effectively manage

your group practice and stay ahead of

the curve. Our webinars are present­

ed by nationally known speakers on a

variety of current topics. They are free

to FMGMA members and the value of

one of these webinars alone out­

weighs the cost of your annual

FMGMA membership. I encourage

you to take advantage of as many of

these webinars as possible. As an

added bonus, these live webinars

qualify for ACMPE credits for those

members in the certification and fel­

lowship programs.

Remember to participate with a local

chapter in your area to complement

your FMGMA membership. Most local

chapters offer monthly meetings, pro­

viding both the opportunity for educa­

tion, and for valuable networking.

Specific information on the local chap­

ters can be found in the FMGMA web­

site at www.flmgma.com.

As my tenure as Florida MGMA

President comes to a close this fall, I

want to thank my fellow board mem­

bers for their dedication and efforts to

you, our members, our industry, and

our association.

Sincerely,

Marynell Lubinski, FACMPE

Florida MGMA President

A Message from the President

Marynell Lubinski, FACMPE

Florida MGMA President

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Why You Should Be Interviewing Your Existing Employees

All leaders understand the need for “performancemanagement” meetings. Having that crucial con­versation with an underperforming person on yourteam will often be the difference in whether theystay or go. Leaders who don’t have these kinds oftalks miss the opportunity to help their peoplegrow.

Another crucial conversation that exceptional lead­ers conduct is called the “Stay Interview”. It is amanaged conversation that can make a huge dif­ference in your team, your relationships, yourretention of talented people, and your long­termteam performance.

As it’s name implies, the “Stay Interview” is theconversation you have with a proven and valuedteam member that you don’t want to lose. Do youwant to surprise and impress your team with trulyprogressive leadership? Learn how to conduct theStay Interview.

When You Should Schedule a Stay Interview

Add “stay interviews” to your calendar on a quar­terly basis. Each quarter, consider who is reallyperforming? Who might be being overlooked? Whois in a role that may have less recognition attachedto it compared to other roles? Who seems to havea lot of upside? Who do you need to connect with?Who seems to be under utilized? Over utilized?You aren’t necessarily reacting to a certain accom­plishment… you are paying close attention to sus­tained performance.

Important: Don’t use the phrase “stay interview”with the candidate. That is an internal descriptor tohelp you remember what you are doing and why.As far as they are concerned, you are scheduling atime for a conversation with them about them. Also,don’t schedule a series of stay interviews. Theseare occasional and important one­off conversa­tions. Doing too many or doing them too often willerase the positive effects.

How to Conduct a Stay Interview

The meeting should be set casually, and not as apart of a formal performance review. Ask the teammember to set aside some time for you on a cer­tain day and not more than a day or two into the

future. Make sure your tone isupbeat and positive. Youdon’t want this valuable per­son worrying for a weekabout a pending conversationwith the Boss.

When the day comes, keepthings very casual. The onlyformal part of the meeting willbe your preparation. Startthings off by thanking the per­son for taking the time tomeet. Next, tell them youhave been consistently impressed by their per­formance. Be specific here… be certain to noteaspects of the candidates work that are excellent.Tell them you want to ask them some questionsabout themselves and their job, and that you wouldappreciate candid responses. Make sure theyknow it is because you value their opinion. Youtone and body language will make it clear that theyare in a safe environment with a leader that reallyvalues them.

Recommended Questions for Your Stay

Interviews

Here is a series of questions for Stay Interviews.This is not meant to be a complete end all list butrather, to give you an idea of the rhythm of a suc­cessful stay interview. Start of with general ques­tions and then move to more specific topics.

• How are things going for you?

• Are you enjoying your work?

• What is the best part of your job?

• What is the part you enjoy least?

• If you could change something about your current responsibilities, what would it be?

• Do you ever have tasks to do that feel like awaste of time?

Tracy Spears

4

• Where do you see yourself in five years?

• Is there a task or process that is done outside ofyour responsibility that you think we could improveon?

• Is there something that you think we may befocusing on too much?

• Do you see any growth opportunities that youthink we may be missing?

• How do you feel about our working relationship?

• Do you have any coaching tips for me?

• Do you know how valuable you are to this organ­ization?

These questions, along with the additional ques­tions you add to the list, will guarantee a positivedialog with your candidate. You will have opportu­nities to ask for more detail and possibly hearsome great ideas… maybe even do a little brain­

storming. The last question will give you an oppor­tunity to tell the candidate how much you appreci­ate them and their great work.

Your Stay Interviews should take around 30­45minutes. Any shorter and it wasn’t a substantiveconversation. Any longer and you probably startingtalking about other people or went off topic. 30­45minutes is your sweet spot.

It would be hard to list all of the positive benefits ofStay Interviews. Many of the best outcomes will beinvisible, but still powerful. You can strongly influ­ence retention, culture, job satisfaction, expecta­tions, working relationships, and much more.Adding the Stay Interview to your repertoire ofleadership skills will let you people know you arepaying attention. It will help you better connect toyour people….before they decide to go some­where else.

­Tracy Spears

ww.tracyspears.com

Why You Should Be Interviewing Your Existing Employees, continued

Join us at the national MGMA15 AnnualConference in Nashville, Oct 11­14, and help ourMGMA state association win the MGMA15 StateReception Contest. Each state in our section iscompeting to bring the most attendees to the con­ference. Winners will enjoy an exclusive receptionparty on the first night of the conference.

Besides the party, you’ll join healthcare executives,administrators, physicians, vendors, industryexperts and dynamic speakers to discover the rightbenchmarking data, strategies and operationaltechniques to improve your practice.

Learn more about MGMA15 at:

www.mgma.org/mgma15

5

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the practice of good medicine.

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Active Members

Roxanna AmorelliBayCare Medical GroupTampa

Ginger BibiloniBayCare Medical GroupTampa

Alan BowenFlorida Sports Injury and OrthopedicInstituteClermont

Stacey BowenHCA Physicians Service GroupBrooksville

Kevin BullerSt. Vincent’s HealthcareJacksonville

Patricia CampbellFlorida Hospital Physician GroupTampa

Tracy ChildressCFHALeesburg

Diane CochranWest Orange Physician GroupOrlando Health Central HospitalOcoee

Julie DavisPonte Vedra Plastic SurgeryPonte Vedra Beach

Jerrald DeLoachCitrus Cardiology Consultants, PAInverness

Wendy Wriggins ErnstFemwell Group HealthMiami

Florida MGMA Welcomes New Members

Shannon DelpFlorida Retinal InstituteJascksonville

Victor FerreiraSt. Vincent’s HealthcareJacksonville

Candice GonzalezFlorida Hospital Physician GroupWesley Chapel

Diana GonzalezFlorida Skin CentrFort Myers

Susan HughesRobert A. Sylvester, MD, PAMiami

Sonia JamesMedical Management ServicesPensacola

Tiffany KrampotaUF Pediatric Integrated CareSystem (Ped­I­Care)Tallahassee

Ranjanbala PatelHeartland Cardiology GroupSebring

Natalie PettySt. Vincent’s Medical CenterMiddleburg

Critaina PlacykD. Baldolato, PAMelbourne

Laura PorterRehabilitation &ElectrodiagnosticsTampa

Elizabeth QueletVascular Associates LLCPanama City

Bo RazzanoBartow Regional Medical CenterWinter Haven

John RegenfussUniversity of Florida, Dept. of NeurosurgeryGainesville

Debbie  W. Saltiel, RN, MPH, MSNFountainhead Practice ManagementSolutionsSt. Petersburg

Elizabeth StrombomMedical Specialists of the Palm BeachesLake Worth

Laura WilsonUniversity of FloridaGainesville

Affiliate Members

Jessica CalinaoCenterstate BankJacksonville

John OliverHearing Health, Inc.Nashville, TN

Joseph PaoliniGlobal Network Systems, Inc.Exter, NH

Adam RyzenmanWells Fargo BankNaples

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ACMPE...The Road to Certification

Finding your way through anything is so much easierwhen you have a map to follow. As a result this year weare giving you the map quest version of how to succeedin your travel to certification and the budget that you willneed to get there. When available I have included thecosts so that you can budget for what you will need. Ifyou are just curious, a little bit scared, planning on it, orheadlong into it, we hope these steps will help you alongthe way!

Phase 1: Totally FREE! Dip your toes in the water

See if you are ready: If you are not a member of nation­al MGMA, go to mgma.org and join for free for 45 daytrial. Then proceed to education andcertification/process requirements and do the “are youready” quiz and personal inventory assessment. Thiswill allow you to identify your strengths and weakness­es. From there you can go to body of knowledge and gointo each of the 5 areas and take a mini exam on eacharea

Phase 2: Make the commitment

MGMA National Membership $380.00 With Board Certification $250.00 (waives $95.00 application fee)

Log into your account/education andcertification/process requirements/application. Fill outyour application and submit it with a copy of yourresume and wait for MGMA to verify your informationand accept you into the ACMPE certification process.

While you wait, it is a great time to explore opportunitiesfor CEU credit hours as you will need 50 as part of yourcertification. With your MGMA membership comes themagazine Connection each one has an article worth oneCEU credit, you can get back copies on MGMA website.You can count anything you do, up to one month beforeyour application/acceptance. There are many backissues that once you are accepted you can read/answerthe questions and apply for the credit.

Connection articles 11 CEUFlorida State MGMA 2015 12 CEUBody of Knowledge Quiz 2 CEUFlorida MGMA Webinars 1 CEU

Wow with your Florida and national membership you arejust over half way there before you start!!!

Phase 3: Do the work/Toolbox

Now you are on your way. It is time to considerresources to help you along your journey and there areso many more than the ones that I am listing!

Certification Exam work book $89.00 and 4 more CEUcredits.

Get it, live it, study it and do all the work.

Online Courses are great ways to strengthen weak­nesses and earn credits, here are a few:Essentials of Group Practice covering all domains$375.00/ 15 CEU credit

There are also individual domain reviews for any areathat you have weakness

Any individual is about $75.00 / 3 CEU creditsIf financials are a weakness for you then look atFinancial Management Boot camp All 4 areas $500.00 /15 CEUAny one area $125.00/5 CEUPhase 4/ Freak out before exam

Are you ready, do you know, what will it be like, will Ipass? Hey, you run a medical practice, you can doanything!!! However, when you need a hand or some­one to walk it through with or to bounce a question off,we are your local Florida ACMPE reps and we will helpyou anyway we can!­ Lori­Ann Martell, LPN, CMPE 239.216.1252 or

lmartell@advancedmedicalcenter.com­ Tom Menichino, FACMPE 352.674.8905 or

tom.menichino@thevillageshealth.com

Finish Line:

Get online and register all your CEU credits in youraccount also review all the ways that you can receivecredits through out the year and get to your 50.Go to the online store and register for your exam.

175 question exam in 3.25 hours $165.003 essay questions in 1.5 hours $165.00Read the cancellation notice and costs associated, andkeep your appointment!!!

I wish you every success, call or email me if you needanything and I will be watching to see who is steppingup. I met so many of you at the state conference and Ifully anticipate each and every one of you joining me inthe ACMPE!!

­Lori­Ann Martell, LPN, CMPE

Florida MGMA ACMPE Forum Rep. South

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Leadership Development: Are You A Visionary Leader?

What makes a medical practice unique is the directionthat practice leaders set for it. As a leader, successdepends on your ability to understand and deliver whatyour patients and their families, the marketplace andregulators expect. But that’s not enough. Understandingthe necessary capacity and capability of your workforce,business partners, and the suppliers of critical goodsand services are key to visionary leadership.

When practice leaders do not clearly set direction,define performance expectations, create a patientfocus, and demonstrate clear and visible practice val­ues and ethics, physicians and other employees arelikely to invent their own ideas as to what needs to bedone and how to accomplish it. Imagine the inefficien­cies and inconsistent clinical, financial and patient expe­rience results if your practice staff is working at crosspurposes!

The following are 7.5 specific skills and attributes need­ed to be a systems thinker and visionary leader. As youread each section, give yourself a score between 1(needs serious help / improvement or someone else onyour team to take that role) and 10 (outstanding, would­n’t change a thing).

1 – I understand the difference between being a

leader and being a boss.

A boss says, “GO Staff!” A leader says, “Let us go,Team!” and leads the charge. The CEO or managingphysician needs to clearly articulate the vision and mis­sion of your practice. The practice administrator, withinput from other key organizational stakeholders, cre­ates the strategy to meet the practice vision and mis­sion and, along with the rest of the team, execute thatplan. A leader is able to help each team member under­stand the valuable part they play in achieving the orga­nization’s goals and, ultimately, its vision and mission.

Your practice’s values, those guiding principles andbehaviors that embody how your organization and staffare expected to operate, support and guide the deci­sions made by every workforce member and pave theright path to achieving the practice’s mission and vision.The example a leader sets will drive the action of theirstaff far better than words. Is this how you lead?

2 – I am a key part of a leadership system.

As a leader of a medical practice, HOW do you lead?We’re not talking about the behaviors you exhibit that“show” you are a leader. We’re talking about theprocess you follow to ensure you have the right planand the right people and the right tools to have anexceptional practice.

Although leadership systems can vary, most have somecommon steps. First, exceptional leaders set the direc­tion for the organization. With the input of all of theirstakeholders, exceptional leaders develop the strate­gies and plans to move the organization in that direc­tion. They make sure they have the right people andprocesses to carry out their plans. They make sure theirentire workforce and other key stakeholders (vendors,volunteers, the community, etc.) know the plan and therole they must play in its success. And exceptional lead­ers evaluate the achievement of the plan and the effec­tiveness of their leadership.

What systematic steps do you take throughout the yearto lead your practice? How are decisions made andcommunicated? How do you develop your workforce?How do you reinforce values, ethical behavior, strategicplans and performance expectations?

3 – I manage for innovation and leading edge think­

ing in my practice.

You know the saying, “Think outside the box”? NidoQuebein, who has transformed North Carolina’s HighPoint University in the last few years, says to “throw thebox outside of the window.” Are you asking your teamfor their input on improvements or is your own voice theloudest in the room? Are you reconnecting to sharewhat will work, what won’t work and what’s missing?Often your front line team will be the best go­to peoplefor insight on positive change that will impact businessperformance. How do you promote innovation, initiativeand appropriate risk taking? Encourage your staff tochallenge the status quo. Be agile and avoid longchains of command that require long decision paths.

4 – I have a focus on the future of my medical practice.

Changes are rapidly occurring in how we deliver care,what resources are available, the expectations of ourpatients, new technology, new partnering opportunities,the economy, the needs of our workforce, evolving reg­ulatory requirements, strategic moves by competi­tors…the list goes on and on. Change is inevitable, butyou can plan for it.

How do you rate yourself in your ability to focus on thefuture and deal with change? As you strategically plan,are you considering the key external and internal fac­tors that will affect your practice and your market? Areyou agile enough to modify your plans when circum­stances warrant? Are you developing the future leadersin your practice?

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Leadership Development: Are You A Visionary Leader?, continued

Have you seen the TedMed video of Dr. ZubinDamania? The National Society of Certified HealthcareBusiness Consultants (www.NSCHBC.org) sent thisover the wire recently and it was mesmerizing. Not justbecause of Dr. Damania’s ability to deliver meaningfulinformation in an exciting, humorous and educationalway, but because of his willingness to lean in, to focuson the future, to be open to new ideas and change.Click here to see his TedMed talk “Zubin Damania: AreZombie Doctors Taking Over America?”

5 – I manage by fact.

Sales managers for Dale Carnegie Training often asktheir instructors to share statements about the companythat distinguish Dale Carnegie Training from its com­petitors. As instructors state what they believe to be dis­tinguishing factors, the manager asks the group “Is thisa fact or is it a claim?” Now apply that same way ofthinking to your practice. If you say your practice deliv­ers exceptional patient care on all of your advertising,yet your patient experience survey ratings or your clini­cal outcomes are in the tank, then your message is aclaim, not a fact.

The monitoring and use of key performance data is crit­ical to the success of any business. The operative wordis “key”, meaning the essential few measures that arecritical to achieving your practice’s intended outcomes.The amount of data available to every practice manag­er can be overwhelming. Find the measures that bestrepresent improved health care outcomes, improvedpatient experience, improved financial performance,and other factors important to your practice. That datashould then be analyzed to extract meaning to supportthe decisions you make, to drive improvement and inno­vation, and to plan for the future.

6 – I know the importance of taking intelligent risk.

Do you tolerate failure in your practice? You should. Aslong as taking a risk does not cause personal harm orirreversible loss to the organization, encouraging theexploration of different avenues of improvement canultimately lead to finding ways to make your practiceexceptional. Not all actions are going to achieve thedesired outcomes. But if your practice is risk­averse,the ability to improve may be limited.

7 – I have a “systems perspective” in managing my

practice.

The Malcolm Baldrige Health Care Criteria for

Performance Excellence defines systems perspectiveas “managing your whole organization, as well as itscomponents, to achieve sustainability.” (BaldrigePerformance Excellence Program. 2013­2014 HealthCare Criteria for Performance Excellence.Gaithersburg, MD: U.S. Department of Commerce,National Institute of Standards and Technology.http://www.nist.gov/baldrige.)

The work of a visionary leader is complex. You mustdrive exceptional results by building strategies based onkey business environment factors, including the veryimportant voice of your patients and their families. Youmust make certain you have the right people with theright training in the right roles. You must be a motiva­tional leader to ensure your staff is inspired to show upevery day and do their best work. You must measurethe right things and use this data to drive improvement.You must make sure all of your key processes are func­tioning smoothly and producing exceptional results. Asystems thinker wraps their arms around all of thesecomponents and clearly sees their linkage.

7.5 – I show our patients and their families that I

care about them as a person.

Smile, make eye contact, use the person’s name, don’tinterrupt, be genuinely interested in them as a person,sit down next to them if possible, address everyone inthe room, not just the patient, be willing to say, “I’msorry” and remember, these are people, not just “thegallbladder in room 12.”

Want to take an intelligent risk? Give them a hug, whenappropriate, and follow a Mary Kay Ash principle –make them feel like the most important person in theworld. These foundational skills can set you apart as aprovider. People are much more forgiving and under­standing when they feel you are being kind, patient, andcaring.

Want to take another intelligent risk? Make a commit­ment to put more CARE into health care by using theseprinciples daily. These will enhance your leadershipskills and ability to connect with your team in a mean­ingful way while making an impact in patient­ and fami­ly­centered care.

­ Merikay Tillman, MS

www.coachmkay.com

­Sue Cumpston, MHA

sue.cumpston1@gmail.com

Florida MGMA Annual Conference PicturesApril 22-24, 2015 - Omni Orlando Resort at Championsgate

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Large physician practices and hospitals already havea portion of their payments linked to patient satisfac­tion. Over the next few years, it will be an integralportion of physician payment, including penaltiespossibly dwarfing those under meaningful use. Moreabout this program, known as the Clinician & GroupConsumer Assessment of Health Providers andSystems (CG­CAHPS) can be found on the Agencyfor Healthcare Research and Quality's website.

Here's the government's hypothesis in a nutshell:

• Patients who like their doctors are more likely to becompliant patients;

• Compliant patients are healthier patients;

• Healthier patients are less expensive; so

• Physicians with satisfied patients should be paidmore than physicians with dissatisfied patients.

The Affordable Care Act introduced a different set ofquality metrics than used by the Institute of Medicine(IOM): quality, patient satisfaction, and payment.

Quality is a key element with both programs, butthere's an important difference with the reform law:your patients are the arbiters of quality. Quality moreor less equals patient satisfaction.

What's being measured?

CG­CAHPS measures the patient experience, anexpansive proxy for quality that takes into accountthe following:

• Timely appointments

• Timely care (refills, callbacks, etc.)

• Your communication skills

• What your patient thinks about you

• What your patient thinks about your staff

• Your office running on schedule

I have been in enough medical practices — both asa patient and as an administrator — to know there'sa method to this madness. It's less about the careand more about the caring. Here's what I suggest forimproving your quality measures via these proxies.

Six Ways to Improve Patient Satisfaction Scores

Florida MGMA Annual Conference Pictures

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1. Hire sunshine

I can train anyone* to do anything in our office, but Ican't train sunshine. Look to hire positive and happypeople, particularly for roles with lots of patient inter­action. Your patient satisfaction — and thus, your"quality" — will improve. You'll also find a cost­savingbenefit to this hiring tactic: employee turnover willshrink.2. Start on time

CG­CAHPS asks patients whether they were seenwithin 15 minutes of their appointment times; it's evenunderlined for emphasis. Physicians who start ontime are more likely to run on time, so have your feetset before you start running.

3. Set patient expectations

It's helpful to share with patients the FAQs about yourpractice so that they know what to do for refills, after­hour needs, appointment scheduling, etc. By makingthese answers available on your website, on yourpatient portal, and in your print materials, you'll betteralign patient expectations with patient experiencesand thereby score better on quality surveys.

Some patients gauge quality by whether or not theyget the antibiotic they think they need. It's helpful forprimary­care physicians to include education onantibiotic overuse in their patient education materials.

Along these lines, it is important for your patient toknow what to expect after their visit in terms of testresults, follow­up visits, etc. I receive more com­plaints about the back end of our patients' experi­ences than anything else. Make sure you and yourstaff do not drop the ball as you near the goal line.

4. Listen with your eyes

Nothing says "I don't care" like having your physicianfocus on a computer screen rather than on thepatient. This is particularly true in the first couple ofminutes of each visit, and especially important withnew patients. One virtue of using medical scribes isthat you can listen with your eyes a whole lot more.

5. Put your staff in their place

Your staff has an important bearing on the patientexperience. I'm a big fan of letting them know theiractions influence quality. It's pretty cool, for me as a

Six Ways to Improve Patient Satisfaction Scores, continued

mere bureaucrat, to know that I can improve qualitysimply by being friendly and helpful to our patients.Make sure your staff knows that making a patient'sday is a beautiful act.

6. Monkey see, monkey do

Staff will follow your lead. If your thoughts and actionsemphasize running on schedule, being kind topatients and their families, and not dropping balls,they'll be stronger teammates for you.

Patient satisfaction has always been a gauge of qual­ity, just as patient referrals remain the lifeblood ofmost practices. Treat this next wave as an opportuni­ty to show off the caring that has always been a bigpart of the medical care you offer your patients.

* The Wonderlic Personnel Test is my tried­and­truetool for measuring cognitive acumen. Anyone whoscores 20 or more on this test can be trained to domost any non­clinical task in your office. A score of 25or more suggests an innate ability to juggle tasksunder stress, a great quality in today's medical prac­tice.

­ Lucien W. Roberts, III, MHA, FACMPE

Mr. Roberts is administrator of GastrointestinalSpecialists, Inc., a 22­provider practice in CentralVirginia. For the past 20 years, he has worked in andconsulted with physician practices in areas such ascompliance, physician compensation, negotiations,strategic planning, and billing/collections. He can bereached at muletick@gmail.com.

http://www.physicianspractice.com

Leveraging the Front Office, Strategies to Increase Your Practice’s Cash Flow

One of the biggest changes in the healthcare systemrecently has been the growth of consumer­directedhealth plans (CDHP), a trend which has led to greaterpatient responsibility for the cost of their care.

According to a June 2014 survey from the NationalBusiness Group on Health, a nonprofit association oflarge U.S. employers, 57% of employers are imple­menting or expanding CDHPs. The percentage ofemployers offering only CDHPs continues to grow aswell. In 2015, 32% of employers surveyed plan to haveCDHPs as their only offering, up from 22% in 2014.With this shift, practices have to anticipate that a sub­stantial portion of their income is no longer comingfrom an insurer.

Without processes in place to collect payment for serv­ices during a patient’s visit, some physician practicesmay find themselves struggling to collect from patientsin full, or even at all. Cash flow can be especially lowin the first and second quarters of the year, as patientshave not yet met their deductible and many patientshave 100% responsibility for their healthcare costsuntil they do. According to a September 2014 reportfrom the Kaiser Family Foundation, the average gen­eral annual deductible for a single person enrolled in ahigh­deductible plan is more than $2,200 and $4,000or more for families.

Related: How physicians can improve cash flow

with accounts receivable financing

No physician or practice manager is alone in thisstruggle. According to a healthcare patient paymenttrend report from JP Morgan, practice managers havebeen focused on clinical applications such as elec­tronic health records and scheduling rather than rev­enue cycle management and payment processingsolutions. While their attention has been diverted, theirbad debt has skyrocketed.

If you’re one of the independent practices —especial­ly those with fewer than 10 staff members—dealingwith this issue, here are three simple tips to implementin your practice today.

Detailed eligibility verification is a must

While for some it is standard practice to verify apatient’s insurance status either at or prior to anappointment, due to increased workloads and compli­

cations with obtaining benefit information, some prac­tices are skipping this important step.

Related: How to evaluate revenue cycle manage­

ment vendors

Not knowing if a patient is covered can be costly. Anddon’t stop at just confirming if the patient has cover­age. Find out if the patient has a deductible and if ithas been met. If you are able to ascertain thedeductible balance, even better, because dependingon your services, a patient may hit his or herdeductible mid­visit.

Your staff should also gather information on benefitdetails tied to the services you offer and confirm if youare in­network for the patient. The more informationyou have, the more you can prepare your patients forwhat their responsibility likely will be.

Collect at time of service

Your front desk staff is your most important resourcefor collecting payments up front for new patients andon any outstanding bills for returning patients. Are yourfront desk staff members equipped to have these con­versations with patients?

If benefits and deductible information is understoodbefore a patient walks in the door, your staff is alreadyin a better position for the conversation. The goal is notto turn your staff into collection agents, but it’s alsoimportant to try and collect whatever the patient owesbefore he or she leaves.

A 2009 McKinsey Quarterly consumer survey foundthat 52% of patients are willing to pay from $200 to$500 or more by credit or debit card at the time of adoctor visit, if they received an estimate at the point ofcare. The same study also found that 74% of insuredconsumers would be willing to pay out­of­pocket med­ical expenses of up to $1,000 per year.Without proper systems in place to help managepatients and collect this money, independent physi­cians will struggle with cash flow. That’s because aftera patient walks out the door, the chances of thatpatient paying drops considerably. According to a 2010McKinsey report on healthcare payments, providercollection rates are 50% to 70% for small­dollar pay­ments from insured patients. For self­pay patients, therate is only 10%.

continued on page 1514

responsibility is growing.

Make it easy for your patients to understand what theyowe and pay it in whatever valid form they want to giveyou. Accept credit or debit cards, payments over thephone, online through a portal, via a monthly billingplan or by check. Think of your front desk as a­point­of­sale terminal and help your staff members shift theirmindset to work with patients to collect those fundsany way a patient will pay.

Related: Lines of credit: A tool to boost reserves

and sustain cash flow at your practice

Help your front desk staff stay informed so theybecome a trusted resource for your patients. Toencourage patients to pay on the spot, offer an incen­tive such as a prompt­pay discount. For larger bills,offer payment plans that include a down paymentbefore the patient leaves. The few dollars a patientsaves can create motivation and save your staff time,money, paperwork and headaches chasing down thesame payment months later.

If your staff is trained to collect the necessary informa­tion immediately and to remind patients of theirresponsibility, you’re more than halfway there. Makingit part of your practice’s expected process eliminatesthe wiggle room or the excuses your patients mightoffer.

Conclusion

All of these ideas can be implemented without invest­ing in much more than staff time. Your cash flowshould increase and your bad debt decrease, whichcan help shorten your revenue cycle.

Enrollment in CDHPs is only going to grow. Practicesthat put simple systems into place today will benefitnow and long into the future.

Hanny Freiwat is the co­founder and president ofWellero, developer of a mobile healthcare payment

app based in Portland, Oregon.

Leveraging the Front Office, Strategies to Increase Your Practice’s Cash Flow

Related: Using your office lease to manage cash

flow

Establish a process and expectation for your staff toprovide estimates to patients and collect at check­infor previous bills and at check­out for that day’s visit.From there it is all about scripting and training to helpstaff members know what to say, how to ask for pay­ment and how to answer questions. Doing this forevery patient can help increase your chances of get­ting paid. Make it part of your practice’s routine andyou will change your business.

Make it easy for patients to pay

When McKinsey surveyed consumers to ask why theywould not to pay a medical bill, respondents cited alack of options for payment plans, poor timing of billsand difficulties coping with confusing statements orpolicies. Electronic statements, online bill pay and sim­plification are commonplace nowadays. Healthcarepractices need to embrace these methods as well.

The shift to a retail­centric approach in healthcare iswell under way. Smartphones have one­touch pay­ment capabilities and major retail chains are includinghealthcare among their services. Patients want both toknow what they owe up front and to have multipleoptions for paying, especially when their financial

15

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