As the years go by, we hear that more and more doctors are feeling defeated and overwhelmed in practice. Costs are going up. Reimbursements are down for certain services. Not to mention, there are challenges with billing, coding, and compliance. There is more confusion and there are fewer answers on how to step off this hamster wheel. Just breathe. I have been where you are, and I can tell you that the sooner you make the decision to stop working in your practice and start working on your practice, the sooner things will get better.
Setting aside time every day, or a minimum of once a week, to work on your business will allow you to see a much bigger picture. When I was on staff at the VA Medical Center, we had mandatory “admin” time built into every week. When I made the leap to my own practice and forced myself to take a step back, I realized that many of the little problems I was dealing with were the result of much bigger problems. I had wasted time and resources by plugging holes and not addressing the cause of the leak. By not facing the bigger problem, I was exposing my practice to unnecessary risk. There’s nothing like putting out fires all the time, especially if you realize you may be the arsonist, or that by not dealing with little things they turn into raging fires!
PEOPLE
Staffing issues can make or break a business. Getting your people issues under control starts with defining what type of person best fits your practice. To do this, you need job descriptions. I will be honest and say I have written and rewritten many job descriptions in my career. In retrospect, they stunk. Your team needs to know their responsibilities and the results that are expected in your office. Don’t write an endless task list. Instead, identify the five major responsibilities of that role. While interviewing potential candidates, you need to determine if they “get it,” “want it,” and have the ability to do the job.
When I interview for front desk C As, I look for specific criteria. Asking questions related to that criteria narrows the candidate pool. Do they “get it”? Do they understand the benefits of chiropractic? Do they want it? If this person is not a people person, he or she is not likely a good candidate for the front-line position in the office. Do they have the ability to do the job? You can always train employees to leam new skills, but there are some basic skills required
“If this person is not a people person, he or she is not likely a good candidate for the front-line position in the office. JJ
for this position, such as being organized, well spoken, comfortable requesting payments for service, and possessing the ability to multitask, to name a few. I also think it is imperative to run a background check on every employee. Why? Because if your new front desk staff member is in personal financial chaos, has a history of job-hopping, and is unable to pay or manage his or her own financial life, then how well do you think that person will manage your finances at the front desk? There are companies that specialize in running these checks, so don't do it alone. Use a professional service because there are, as always, legal ramifications if you do it the wrong way.
DATA
My EHR software generates reports that track every statistic and number associated with my practice. Data can tell you the health of your business on a weekly basis. A common problem in practice is that many owners do not review that information often enough to identify issues and effectively act before a much larger problem occurs. In each job description, my staff has individual measurables that correlate to the data we track. This helps each person understand his or her responsibilities, allows me to see what they have accomplished, and keeps the business on track. This includes every team member, from the front desk to therapy, and each associate doctor.
Making each person responsible gives him or her a sense of ownership. As a result, when a measurable is missed, that person has a solution in mind to correct the problem in the future. My front desk C A reports weekly on the number of missed appointments, collections, conversion of shopper calls, and new patient visits. My insurance and billing C A reports on claims submitted, claims denied, corrected claims, records requests that have been received and sent, and the number of patients who received a financial report of findings.
PROCESSES
Like many provider offices, I have a binder of standard operating procedures. It outlines everything from how we open the clinic each morning to how we close out credit cards at the end of the day.
The problem with these operating procedures is that they are very rarely updated, if ever. Over time, staff will take shortcuts to accomplish tasks when they are running out of time.
Before you know it, you have five staff members doing the same task in five different ways, or worse, you have no one doing the task at all or tracking information. Then you have a major problem on your hands.
For example, one of my close friends utilizes a DMPO to legally offer discounts on noncovered services. This is especially beneficial since 90% of his Medicare patients receive therapy and rehab in his office. When he experienced turnover in his office, his new staff was not properly trained using the DMPO.
This discounting policy had been left out of the binder. One morning, his billing and insurance CA looked into a Medicare patient’s account and realized that the DMPO membership had expired, but the patient was still receiving discounts on his or her noncovered services.
After pulling more patient files and reviewing patient accounts, they discovered that charges to patient accounts were not being checked at the end of each day; patient memberships in the DMPO were not being renewed; and that they had continued to offer discounts that could be considered an inducement violation to their federally insured patients, which exposed them to potential high fines and penalties.
With a potential $10,000 fine per discount, one patient file alone could have resulted in $150,000 in fines.
He has since revamped his policies and procedures manual. His clinic has step-by-step instructions for every predictable and redundant task in the practice. As a result, team members are consistently completing tasks, thereby minimizing the risk of something falling through the cracks. He also has a clear outline for training new team members, something that had been left up to his staff and was inconsistent. Now his team functions more consistently and efficiently.
TRACTION
Every practice has projects and new initiatives that
they need to implement. In my own practice, when I transitioned to a new EHR system a few years ago, I signed on the dotted line, wrote a check, and then continued to use my existing software for another 18 months. I just couldn’t get it off the ground and kept putting it off, all while paying for two practice software systems. Now, we assign a team member to manage special projects such as software upgrades. He or she is responsible for managing deadlines, handling and addressing issues, and making sure that everyone is trained.
Another great example is our compliance officer who manages our compliance program in the office. She is responsible for regularly scheduling team training during staff meetings, updating compliance manuals, completing internal audits, etc. I no longer have to manage every project, and my team no longer has to wait for me to get them done. If you are like me (and many other doctors I know), the surest way to bog down a project is to have it land on my desk. I still receive regular updates and address project concerns, but I no longer waste money by purchasing new products or services that we can’t seem to implement in the practice.
Since we have started this new process, our office has seen more improvement in the past year than I have seen in the 32 years that I have been in practice. Everyone is on the same page, clearly understands their responsibilities, communicates more effectively, and we’ve become more productive. We are prioritizing the things that matter and no longer wasting time on things that don’t. My business is more profitable. My team is happier and more engaged. My patients are getting a better quality of care. What could be better than that? I can’t take credit for coming up with this on my own. Our practice, thanks to some dear friends (thank you, Dr. Jay and Kathy), implemented EOS, a system for running any business. It not only has been a game changer, but also a life changer for our team. You can learn about it at www.EOSworldwide.com. EOS is the acronym for Entrepreneurial Operating System, based on the book Traction by Gino Wickman. I have no vested interest in you using the system; I am just passing along what has worked for us. Remember, there will be fewer fires to put out when you put down the matches and transition “arsonist time” to “administrative time.”
Dr Ray Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicChiropractor, he remains “in the trenches ’’facing challenges with billing, coding, documentation, and compliance. He has served as president of the Mississippi Chiropractic Association, former Staff Chiropractor at the G. V. Sonny Montgomery VA Medical Center, and is a Fellow of the International College of Chiropractic. To request a free one-page financial policy, send an email to infofichirohealthusa.com.
