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Best Practices:
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Best Practices:The Front Offi...
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The Right Questions
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Defining Reality
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Wrong Jungle
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Defining Reality - Difference...
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Defining Reality - Similariti...
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MGMA Best Performers
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What are the functions of the...
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Front Office Multi-Functional
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Director of First Impressions
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Can Help or Impede Patient Fl...
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Touches Revenue Cycle at
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Removing Roadblocks to Effici...
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Bottleneck
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Bottlenecks or Roadblocks
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Causes of Bottlenecks
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Productivity
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The Goal
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What is Our Goal?
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The Goal Defined
by Jim Colli...
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“You cannot manage what you
c...
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Dynamic Relationship of
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Physician Time
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Waiting Room Time
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Standard Production Measures
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The Peasant and The King
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Management’s job is not to se...
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RE-ENGINEERING THE FRONT
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Put the Cookies on the Lower
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S N A P
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The Five Whys
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Best Practices:The Front Offi...
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You are NOT Alone . . .
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Our Role As Leaders . . .
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DON’T GIVE UP . .
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DESINGED BY
Sunil Kumar
Resea...
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Motivation

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  • Introduce Tiffany – A “star” –
    Introduce Sallie – Some things haven’t changed in healthcare. Good leaders in healthcare have always invested in others. Back in the 1970’s when I first began in healthcare . . . Knew nothing at all about the function of a physician’s office from any viewpoint except a patient – my obstetrician was needing help in his office.
  • WHAT DO WE WANT TO TRY TO ACCOMPLISH TODAY?
    I am not an expert. I certainly do NOT have all the answers. I am experienced in just about every role in physician’s office. I am passionate about finding answers – workable solutions. SO BEFORE WE CAN FIND SOLUTIONS, WE HAVE TO ASK THE RIGHT QUESTIONS
  • The Right Questions – My first question is “WHAT DO YOU HOPE TO TAKE AWAY FROM THIS MEETING TODAY?”
  • Whose reality are operating with? Office closed for lunch. Mail still being put on doctor’s desk.
  • DEFINE REALITY
    Pros and Cons of Benchmarking
    It is a good starting place
    See “Key Indicators” – some formulas to get you started if this is new to you.
  • Cost of locating a missing chart or pulling the wrong chart for a doctor
  • Basic Terms of Operations Management
  • It would be different if we could obtain reimbursement for looking for that lab result that the nurse “just saw a minute ago.”
    What if physicians were paid for authorizing refills so that the patient could obtain their prescription at a “better” price.
  • Goal is to reduce cost per procedure. Fixed costs cannot be altered. The largest percentage of variable costs (non physician comp) is staff comp and benefits. Need to increase volume. Sometimes it is easy – office closed during lunch because they always have.
  • Staffing as a function of Productivity – Revenue – Expenses - Profit
  • Refer to Benchmarking in Handouts
    Direct correlation between this data and the most valuable resource in our office (or in the case of a surgeon – keeping him/her OUT of the office and IN OR)
  • Pre-visit functions – test results, Rx, chart prep, correspondence and forms
  • A king had a boulder placed on the roadway and hid himself to see if anyone would remove the huge rock. Some of the king’s wealthiest merchants and courtiers came by and simply walked around it. Many loudly blamed the king for not keeping the roads clear but noone did anything to clear the path. A peasant came by carrying a load of vegetables. Upon approach the boulder, the peasant laid down his burden and began to work diligently to move the boulder. After working for some time, he finally succeeded. As he turned to pick up his load of vegetables, he noticed a purse lying on the road where the boulder had been. The purse contained many gold coins and a note from the king indicating that the gold was for the person who removed the boulder from the roadway. Many never learn that EVERY OBSTACLE PRESENTS AN OPPORTUNITY TO IMPROVE OUR LIFE.
    Maybe there are boulders you are walking around.
    Now we are not the king. And we don’t put boulders in the path. But there are many roadblocks to efficiency. Blessed be the employee that takes the initiative to convince us that something needs to change. Most will not . . . Therefore we must put the cookies on the lower shelf.
  • Article in your handouts
    Re-engineering starts with you asking questions and seeing “reality” from the eyes of your staff, your patients, etc.
    Photo mapping
    Are you telling your receptionist to copy every insurance card and making her stand up to make the copy?
    Wireless telephone headset because of observation.
    The other day at doctor’s office
  • Tell story about Dad who was talking with daughter about college. Five years? That’s fine, honey, Dad will pay for the first four. Put it in terms they can understand and relate to.
    Woodcock recommends having approved abbreviations lists – not just the obvious bid, q d, etc. but what about office terms. Also have a list of initials of everyone in your office. Recently I was working on some appointment stats and did not remember the initials of an employee. Had to ask. We’re talking about increasing efficiency. What questions do you, your staff, your physicians have to ask or look for answers to frequently? Make it easy for them. Put the cookies on the lower shelf so the most vertically challenged can reach them.
    A couple years ago the nurses were continuously complaining about their overloaded nurse’s schedule when they were short staffed. Template? Tell the front office where you want them to be scheduled. Make boundaries for others to help them know how to do what you want them to do.
  • My experience at the doctor’s office the other day.
    Friend recently related how they were looking for another internist because of customer service. Taking Mom and Dad with her.
  • NO PROCESS STANDS ALONE. THERE ARE ASSUMPTIONS HELD AS REALITY BY EVERY PERSON THAT INTERACTS WITH YOUR OFFICE – THE PATIENT, THE PHYSICIAN AND EVERYONE IN BETWEEN.
    So I’m a foreman walking through a plant with a friend who is a systems thinker.
    I see a pool of oil on the floor and do what I always do – grab the nearest member of the assembly crew and say “Hey! There’s oil on the floor
  • WHAT DO WE WANT TO TRY TO ACCOMPLISH TODAY?
    I am not an expert. I certainly do NOT have all the answers. I am experienced in just about every role in physician’s office. I am passionate about finding answers – workable solutions. SO BEFORE WE CAN FIND SOLUTIONS, WE HAVE TO ASK THE RIGHT QUESTIONS
  • Motivation

    1. 1. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Best Practices: The Front Office Removing the Roadblocks to Efficiency DESINGED BY Sunil Kumar Research Scholar/ Food Production Faculty Institute of Hotel and Tourism Management, MAHARSHI DAYANAND UNIVERSITY, ROHTAK Haryana- 124001 INDIA Ph. No. 09996000499 email: skihm86@yahoo.com , balhara86@gmail.com linkedin:- in.linkedin.com/in/ihmsunilkumar facebook: www.facebook.com/ihmsunilkumar webpage: chefsunilkumar.tripod.com
    2. 2. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Best Practices:The Front Office • Define Reality • Identify the bottlenecks • Increase efficiency
    3. 3. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level The Right Questions – What is a “best practice?” – What are the functions of the “front office?” – Definitions of some key principles
    4. 4. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Defining Reality • Max DuPree – Leadership Is An Art • “The first responsibility of a leader is to define reality. . .”
    5. 5. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Wrong Jungle
    6. 6. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Defining Reality - Differences • Primary Care versus Specialist • Single Specialty versus Multi-specialty • Number of sites • Ancillary service offerings • Use of midlevels • Cost or accrual based accounting • Physician compensation • Payor mix • Many other variables (triage, billing, etc.)
    7. 7. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Defining Reality - Similarities • Provide medical services • Face increasing costs • Struggle with reduction in payment • Patients • Staff • Physicians
    8. 8. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level MGMA Best Performers In Three Critical Areas • Profitability and operating costs • Productivity, capacity and staffing • Accounts receivables and collections See “Key Indicators” Handout – Expanded Quantifiers of Better Performing Practices
    9. 9. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level What are the functions of the front office?
    10. 10. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Front Office Multi-Functional
    11. 11. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Director of First Impressions
    12. 12. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Can Help or Impede Patient Flow
    13. 13. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Touches Revenue Cycle at Multiple Intervals
    14. 14. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Removing Roadblocks to Efficiency • Throughput = Money coming in (profit) • Operating Expense = money going out to make throughput • Inventory = Money stuck inside
    15. 15. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Bottleneck • A resource whose capacity is equal to or less than the demand placed upon it. • The flow through the bottleneck must equal the demand from the market. • Capacity of a process is the capacity of its slowest resource
    16. 16. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Bottlenecks or Roadblocks • Crowded reception area • Irritable patients • Financial underperformance • Burnt out staff
    17. 17. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Causes of Bottlenecks • Too much paperwork • Poorly planned processes • Inefficient office design • Miscommunication between staff • Poor scheduling
    18. 18. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Productivity • Accomplishing something in terms of goals • Meaningless if you don’t know the goals
    19. 19. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level The Goal • Reduce operational expense • Reduce inventory • Increase throughput – More important to increase volume – Expand hours with providers with no increase in fixed costs – Incorporate efficiencies to increase patient volume
    20. 20. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level What is Our Goal? • The Right Number of Staff • In the Right Place • With the Right Skills • At the Right Cost • With the Right Behavior • With the Right Rewards • With the Right Outcomes • No More – No Less Deborah L. Walker 2003
    21. 21. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level The Goal Defined by Jim Collins • Get the wrong people off the bus • Get the right people on the bus • Get the right people in the right seat on the bus In “Good to Great” the bus doesn’t leave until . . .
    22. 22. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level “You cannot manage what you cannot measure and what gets measured gets done!” Bill Hewlett
    23. 23. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level
    24. 24. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Dynamic Relationship of Staffing Levels With Accounting Functions
    25. 25. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Physician Time • Data suggests that most critical resource in a medical group is physician time • Profit is a function of productivity and the cost of the resources that enable productivity
    26. 26. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Waiting Room Time “Yes, I have an appointment. Should I also have made a reservation?”
    27. 27. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Standard Production Measures • Telephone calls w/messaging 180-200 • Appointment scheduling 75 – 125 • Check-In with registration Verification and copay collection 75 – 100 • Check-Out with schedule of return appointment and charge entry 70 - 90
    28. 28. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level The Peasant and The King
    29. 29. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Management’s job is not to see the company as it is . . . But as it can become. John W. Teets
    30. 30. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level RE-ENGINEERING THE FRONT OFFICE • R eliable • E fficient • S ervice • P atient-Focused • E nergy • C ustomization • T rust
    31. 31. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Put the Cookies on the Lower Shelf
    32. 32. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level S N A P • Smile • Name • Ask “May I help you?” • Parting comment
    33. 33. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level The Five Whys
    34. 34. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Best Practices:The Front Office • Define Reality • Identify the bottlenecks • Increase efficiency
    35. 35. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level You are NOT Alone . . . • Books – The Total Service Medical Practice by Vicky Bradford, PhD – Mastering Patient Flow by Elizabeth Woodcock, MBA, FACMPE – Good to Great by Jim Collins – The Goal by Eliyahu M. Goldratt – The Fifth Discipline by Peter Senge – All books by John Maxwell • Medical Group Management Association – Local www.mgma-sl.org – State www.mgma-mo.org – National www.mgma.com • Other Organizations – American Academy of Family Practice www.aafp.org – Organization of your specialty – The Journal of Medical Practice Management
    36. 36. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Our Role As Leaders . . . Finding the gifts people have to give Inviting them to give them, and Honoring the result when they do
    37. 37. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level DON’T GIVE UP . . .
    38. 38. • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level DESINGED BY Sunil Kumar Research Scholar/ Food Production Faculty Institute of Hotel and Tourism Management, MAHARSHI DAYANAND UNIVERSITY, ROHTAK Haryana- 124001 INDIA Ph. No. 09996000499 email: skihm86@yahoo.com , balhara86@gmail.com linkedin:- in.linkedin.com/in/ihmsunilkumar facebook: www.facebook.com/ihmsunilkumar webpage: chefsunilkumar.tripod.com
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