Increase Your Revenue without a Change in Patient Volume

Jessica Johnson, CPA, Health Care Consultant 

We all probably think that increasing the number of patients walking through the practice doors is the surest way to see an increase in revenue.  While this is our first thought regarding desired profit growth, there are several actions your office can do to increase revenue before the patient is seen. 

Under most circumstances, the initial contact an office has with the patient is over the phone while scheduling an appointment.  Developing telephone scripts for office staff is essential to ensure that all necessary information is collected at this time.  Also, be sure to develop scripts that follow the sequence of the practice management system so information can easily be entered.  Collecting all required information enables your practice to perform patient eligibility verification, receive appropriate referrals if necessary, inform patients of their financial responsibility such as deductibles, co-payments, and coinsurance, prior to the office visit. 

Another factor impacting the bottom line that should be evaluated is your hours of operation.  Is your first appointment at nine in the morning and your last appointment at three in the afternoon?  If so, you might be limiting yourself to a smaller patient population, one with the ability to schedule an appointment during those times.  Consider implementing extended office hours one evening a week to accommodate those patients unable to schedule a visit during the day. 

Although all office visits for the day are complete, the revenue cycle still continues. Another element impacting revenue includes charge entry and claims submission.  Best practice is for office charges to be entered within one day and for hospital charges to be entered within two days of receiving all necessary information, such as, operative notes and demographics.  This is typically an area where lost charges can occur, and by preparing a monthly reconciliation, these lost charges can be decreased or eliminated. 

It is essential to evaluate your key indicators to determine which areas are in need of additional attention and concentration.  The beginning process of obtaining demographic information, eligibility verification, pre-certifications, authorizations, referrals, and entering of charges can either accelerate or postpone the speed at which the practice receives its earned money. With effective internal processes, you can definitely impact your revenue without increasing the number of individuals entering the practice.

Professional Healthcare Organizations, which is right for you?

Many times we run across the question of whether our clients should participate in one or more of the many professional organizations that are available to medical executives today.  If so, is there one better than the other?  

To help you make the decision, here is a list of several organizations and a brief description of their purpose: 

MGMA - Medical Group Management Association
www.mgma.org
MGMA is national, state, and local, although separate dues are required for each level.  The primary focus is management of medical practices.
The organization offers educational programming, support and resources to practice management professionals, with an opportunity to become certified. 

HFMA - Healthcare Financial Management Association
www.hfma.org
HFMA is a national, state and local organization.  The primary focus is healthcare executives engaged in financial leadership within the hospital and healthcare environment.                       

ACHE - American College of Healthcare Executives
www.ache.org
ACHE is national and local.  ACHE is an international organization with a focus on executives in hospital and other healthcare systems. 

AHIMA - American Health Information Management Association
www.ahima.org
AHIMA is national, state, and local.  AHIMA’s primary focus is EHR, coding and Health Information Management.                               

AAHAM - American Association of Healthcare Administrative Management
www.aaham.org
AAHAM has local and national membership.  The organizations primary focus is on patient accounts management in the hospital environment 

Professional organizations hold their weight in gold if they are active, structured organizations with seasoned members involved in the planning of meetings and content.  Observably, an organization can be an invaluable resource in one area of the country and a waste of energy in another.  So do your research.  Go to a couple of meetings as a nonmember before committing to a membership.  At the meeting(s), ask yourself:

• Do you mesh well with the other members?
• Will this organization help you and your facility grow?
• How often does the organization meet?  Do the meeting times work with my schedule?

Does the organization provide resources primarily in the areas you need?

First Impressions in a Physician Office

Chastity Werner, Health Care Consultant

We have to remember every new patient is a first impression.  As we know “first impressions” last forever.  These impressions can become one of your strongest marketing tools or one of your worst nightmares.  Depending on their condition or reason for visiting your office, more than likely your office will become one of the hot topics during a family get together and other social event in the next several weeks.  Here are a few pointers to ensure the patient leaves with the best first impression: 

• Make sure to be observant of your tone and dialogue while scheduling the appointment.  Make sure your tone is upbeat and your dialogue reflects the fact that you are “glad they chose your practice”.
• After you finish recording the patient demographics, give the patient a briefing on what will happen at the appointment and make sure they know where your office is located.
• When the patient arrives, greet them as if they were coming to your house for dinner.  “Hello, Mrs. Smith!  Do you have your paperwork with you today?  Great!  Please have a seat and we will be with you momentarily.”
• Make eye contact and smile, smile, smile! If the patient is talking to you make sure to look them in the eye while they are doing so.  If they are talking, stop and listen!
• When putting them in the room, if they are going to have a bit of a wait then let them know. 
• After their appointment, as they check out make sure to tell them “thank you for choosing our practice.  Have a Good Day”.
• Send them a thank you card. 

The best compliment you can receive is a referral!  Appreciate your patients and they will appreciate you!

Bridging the Physician-Patient Communication Gap

Brian D. Meyers, CPA, Tax Supervisor

After a recent trip to the Mayo Clinic in Rochester, Minnesota, I understand the communication gap in a very real way.  My father was diagnosed with small cell lung cancer a few years ago and was at Mayo for a checkup when a scan showed a small blotch.  This blotch was later determined to be a different type of cancer and the course of action was surgery.  My father is now resting comfortably at home during his recovery, but my family’s unfamiliarity with the procedures led to many questions.

Luckily, the doctor was gracious with his time and answered every question my mother, brothers, and I had regarding the diagnosis, the surgery, and the recovery.  It is a well-known fact that today’s medical practices are busy and medical professionals are pressed for time.  However, patients and their families must remember to ask questions and get clarity before leaving.  This is the most effective way to close the communications gap.

Here is an article from Physicians Practice which talks about the ways in which patients and providers can misunderstand each other.  The author provides good insight about how to close the gap.

The Communication Gap

By Sue Jacques | August 3, 2011

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“But the doctor told us last week that dad would live to be 100!” If I had a nickel for every time I heard that phrase when I was a medical investigator at the medical examiner’s office I’d be sailing on a private yacht by now.

On countless occasions when investigating a sudden death it would become painfully apparent that the person’s demise wasn’t that unpredictable after all. Yet, despite the evidence of a medicine cabinet full of cardiac meds and coronary arteries full of plaque, the families I dealt with would often be flabbergasted to hear that the cause of death was heart-related.

The same confusion can apply to a patient’s understanding of a simple lab test or surgical procedure. Why? Because what’s commonplace for medical professionals usually isn’t as straightforward for patients.

You and your staff are fluent in the language of medicine, but the majority of your patients are not. They take your word as gospel, and even when they have no idea what you’re talking about, most people won’t question you for fear of appearing to be naïve. Plus, they know you’re in a hurry.

The results of medical misunderstandings can be inconvenient at best, disastrous at worst. Every morning, in hospitals around the world, people show up for surgery after eating a full breakfast because they didn’t understand the NPO order. That’s a costly inconvenience. But more expensive is a life lost over situational semantics.

A misinterpretation that leads a patient to insert a suppository in the wrong orifice is one thing, but one that leads them to repeatedly inject a double-dose of heparin(Drug information on heparin) is quite another. That’s what happened to my uncle when he had a DVT. He thought it was okay to play catch-up with his anticoagulant after somehow forgetting a few doses. Though his INR was all over the map, thankfully he suffered no serious consequences. The fact that his thrombus was even diagnosed in the first place was a miracle, because he didn’t want to “bother” his physician. He only mentioned his swollen, warm, red calf as an afterthought when he went to get a prescription for a completely unrelated ailment.

The biggest opponent of clinical clarity is time. A busy medical practice simply doesn’t provide practitioners with the luxury of explaining every last detail of a diagnosis, test result, or prescription.

How can you efficiently communicate your medical messages with clarity?

Here are five CLEAR tips for making sure that your patients really hear what you’re saying:

C ― Clarify your messages by using lay terms as much as necessary to ensure comprehension
L ― Listen carefully to questions and concerns voiced by patients
E ― Explain things in a different way if patients are confused by what you’ve told them
A ― Ascertain that patients understand what you’ve said by asking them to repeat it
R ― Recap the conversation in a single “bottom line” sentence

The next time you’re tempted to tell someone that they have the heart of a 20-year-old or they’re as healthy as a horse, think twice. Patients and their loved ones will take you at your word. Make sure it’s accurate.

Sue Jacques is The Civility CEO™, a veteran forensic death investigator turned corporate civility consultant who helps individuals and businesses gain confidence, earn respect and create courteous corporate cultures. She can be reached at editor@physicianspractice.com or www.TheCivilityCEO.com.

It is the time for giving…

Chastity Werner, Health Care Consultant

…are you and your staff giving your patients the treatment and services they deserve? 

It is so easy to get caught up in the hustle and bustle of the holidays.  The question really is “how is your staff handling the emotional roller coaster of the holiday season?”  Do your patients feel welcome and wanted or do they feel they are obstacles interfering with the staff’s holiday shopping and scheduling of events?  

It takes one bad patient experience to explode over the internet reaching thousands of people within minutes.  The evolution of social media can make or break a business today.  While the patient is in the office they can be sending Yelp or FaceBook reviews on how they feel about your practice – good or bad! 

Your best course of action to avoid bad reviews is to be proactive.  Consistently train your staff on the importance of good customer service.  

Here are a few tips to review: 

• Smile and greet patients when they enter the facility.  If you are on the phone – multitask (smile and talk at the same time!).
• Make eye contact
• If the patient is talking, stop what you are doing and listen.  Even better act interested!
• Remember details about the patients and they will love you forever.
• Remember to not take it personally.  You never know why a patient is in a bad mood and with the exception of extreme situations, it is just part of being involved in a service environment.

 Have you googled your practice today?

First Time at NextGen User Group 2011 in Las Vegas?

Chastity Werner, Senior Health Care Consultant

This is a great conference; here are some tips for first time (and returning) attendees:

1. Determine whether the pre-conference is of value.  Remember you will already be sitting through two and half days of sessions.  If it is not a topic of interest, it will be better to save your energy and brain space for the other days.
2. Ask veteran attendees which presenters are the best or most knowledgeable of NextGen.   NextGen UGM is like any other event in that there are interesting speakers who are great at presenting and some that are not.  This is especially important on day two and three.
3. Focus on the “Track” and the “Level” that fits you when determining which session you would like to attend remember to always  If this is your first year using NextGen ideally you should attend a 100 level session. 
4. Visit the vendor area.  Talk to them about their services and how it might fit your organization.  Some of the vendors are NextGen specific.  Write notes on their business cards so when you return you will remember why they were of interest.
5. Visit the NextGen booths in the Vendor area.  NextGen has all of the different products on display and available to demo.
6. Visit the Hands on Area as much as possible.   The Hands on Area allows you to work with an experienced NextGen Representative (commonly trainers).  So the question(s) that you have had as to why the system will or will not do something or better yet you know it will but cannot figure out how…you have them right there and they cannot put you on hold!
7. Network- this is a prime time to get contacts from across the country of other users.  Make sure to reach out afterwards by sending a card or giving them a call after UGM.  If you have an issue it is always nice to be able to call someone that also uses the software to see if they have had the same situation. 
8. Bring your laptop or iPad to take notes. This makes it easier to organize notes from all the sessions.
9. Pack so that you can dress in layers.  Wear comfortable shoes-you will be doing a lot of walking! 
10. Allow yourself time each morning to grab something to drink and eat.  There are typically stands throughout the facility that are provided.
11. If in doubt about anything, ask. There will usually be 2000-3000 people at the event, so you won’t be the first.
12. Don’t miss the “client event” it’s always a great time! 

Questions for Your EHR Vendor

Brian D. Meyers, CPA, Tax Supervisor

Buying an EHR system can be a daunting task.  This is not only because of the price tag associated with the software, but because of the complex nature of the implementation project.  Many practices probably do not know where to even start, which is where connections come in quite handy.  If one of your staff members knows of another practice which has implemented an EHR, then you have an easy place to begin gaining an understanding of the questions you should ask.

If you and none of your staff know anyone, then it can be a challenge to know the right questions to ask.  This list provides 20 questions to ask potential vendors to gain a better understanding of their product.  I hope this list helps you in your information gathering process.

20 Questions to Ask Your EHR Vendor

By Marisa Torrieri | July 6, 2011

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Whether your practice is shopping around for an EHR or waiting for upgrades, it’s good to know what you’re in for, technology- and time-wise. That’s why we asked our readers, practice consultants, IT experts, and members of our Physicians Practice Group on LinkedIn to submit their thoughts for the most crucial questions you should be asking your vendor. Here are our favorites:

1. Do you have an implementation team that will make an assessment of the readiness of your practice and staff?

2. Do you have a user group that meets annually and that has a listserv for sharing information online?

3. Do you have a dashboard report to track phone message turnaround time by nurses and providers?

4. How often do you update your software; what updates are you planning for your next two releases?

5. Have your clients been more successful with a “big bang” implementation approach or a phase-in approach?

6. What happens when your office is hit by a disaster; are the records safe?

7. How many providers in our specialty use this system? Can you refer our practice to at least three who have set up this current version to see how it went?

8. Which systems failed implementation or were replaced within 24 months of implementation?

9. How many clients can demonstrate they have achieved their ROI?

10. Can we load our insurance contracts and see apples-to-apples performance comparisons?

11. Do you carry cyber and privacy liability insurance coverage?

12. Will an EHR migration absorb all of the patient demographics through a reverse migration from the billing data?

13. How often are coding updates incorporated (if the vendor provides this component)?

14. Do you, the vendor, have a complete inventory of drug, allergy, food interactions and their respective alerts incorporated into the system and again, how often is the database updated?

15. What is the pricing structure, by practitioner? By location? Are there different prices for varying types of practitioners?

16. Is the specific system version you are proposing: the same system that won the awards you tout; the same one that’s CCHIT/ONC certified; and the same one that is certified as interoperable with our regional health information exchange or health information organization?

17. You say your system is template-driven and completely customizable. For my specific specialty, how much time do I need to devote to populate and customize the templates to become functional in my practice?

18. What reporting capabilities are natively embedded in your system? Is it a separate module? How easy is it to generate my own custom reports?

19. To achieve meaningful use qualification, do you have dashboards and other tools to allow me to evaluate how our providers are doing in the specific areas needed to qualify for ARRA/HITECH funds?

20. Do you have a money-back guarantee for Stage 2 and Stage 3 of meaningful use qualification?

Contributors: Ronald Cline, manager, Physician Consulting Services at QHR; Robert Evans, healthcare consultant; Gayle Gottlich, owner, Pathfinder Consulting; Ken Groff, executive, Beacon Insurance Group; Marion Jenkins, CEO, QSE Technologies; Bruce Miller, owner, M&M Practice Consulting; and Rosemarie Nelson, healthcare consultant, MGMA.

Marisa Torrieri is associate editor for Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

FASB Approves EITF-100H as Final Standard

Jon Waitukaitis, CPA, Audit Manager

The Financial Accounting Standards Board (“FASB”) has approved EITF-100H, Other Expenses (Topic 720):  Fees Paid to the Federal Government by Health Insurers as a final standard.  

When Will This Apply?

The changes to Other Expenses (Topic 720) are effective for calendar years beginning after December 31, 2013 (the fees become effective beginning in 2014). 

What Changes Will Be Required?

The amendments specify that the liability for the fees mandated by the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act (the “Acts”) should be estimated and recorded in full once the entity provides qualifying health insurance in the applicable calendar year in which the fee is payable with a corresponding deferred cost that is amortized to expense using a straight-line method of allocation unless another method better allocates the fee over the calendar year that it is payable.

Why the Changes?

The FASB believed it was unclear how existing GAAP would be applied to the fee that is the subject of the amendment to Other Expenses (Topic 720).  As a result, the amendment is simply a clarification of the application of existing GAAP to a specific situation.

FASB Approves EITF090H2 as Final Standard

Jon Waitukaitis, CPA, Audit Manager

The Financial Accounting Standards Board (“FASB”) has approved EITF090H2, Health Care Entities (Topic 954):  Presentation and Disclosure of Net Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts, as a final standard.  

When Will These Apply?

Private companies won’t have to apply the changes to Health Care Entities (Topic 954) until 2013, although earlier adoption is permitted.

What Changes Will Be Required?

The amendments to Health Care Entities (Topic 954) would require a health care entity to change the presentation of its statement of operations by reclassifying the provision for bad debts from an operating expense to a reduction from revenue (net of contractual allowances and discounts).  Additionally, a health care entity would be required to provide enhanced disclosures about how it considers collectibility in determining the amount and timing of revenue and bad-debt expense.  The amendments also would require disclosures of revenue (net of contractual allowances and discounts) as well as a reconciliation of the activity in the allowance for doubtful accounts by major payor type.

Why the Changes?

The amendments change the presentation of the statement of operations and add new disclosures that are not required under current GAAP. FASB believes the change in the presentation of the statement of operations would be an improvement from current GAAP because it would result in the presentation of an amount of net revenue (after any provision for bad debts) that is closer to the amount that the health care entity ultimately expects to collect.  The provision for bad debts still would be required to be disclosed on a separate line as a reduction from revenue (net of contractual allowances and discounts) in the statement of operations.  The new disclosures would assist users of financial statements to better understand how a health care entity has considered collectibility and customer credit risk in applying its revenue recognition policies.

Keys to an Outstanding Patient Experience

Brian D. Meyers, CPA, Health Care Consultant

A physician’s primary responsibility is the well-being of his patients.  They strive to provide high quality care to their patients, thus demonstrating excellent skills to diagnose and treat patients effectively.   They are so engrossed in the care of their patients that they often forget about the element of patient service. 

Physicians have a direct influence on their work environment.  Behaviors adopted by them that create an atmosphere of teamwork, collaboration and support, leads to the ability of all health care team members to provide patients with high quality care experiences and patient satisfaction.

Below are a few practical examples to implement within your practice:

• Hire the best and friendliest receptionist
• Train employees on patient relations
• Conduct patient satisfaction surveys
• Include patient relation skills as a significant and highly weighted component of the performance appraisal
• Terminate employees who are unkind, rude and do not adhere to patient service policies and training
• Require employees to keep their social conversations among themselves to a minimum during the patient flow in the office
• Make patient service and patient relations a regular agenda item at your office staff meetings

Understanding patients’ experiences outside your exam room, leveraging staff to work as a team, serving as a role model for service behavior, and sharing your knowledge are keys to comprehensive quality care.  Small changes in behavior can reap big rewards.