ICT role in 21st century education and it's challenges.
Motivation
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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
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Best Practices:The Front Office
• Define Reality
• Identify the bottlenecks
• Increase efficiency
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The Right Questions
– What is a “best practice?”
– What are the functions of the “front
office?”
– Definitions of some key principles
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Defining Reality
• Max DuPree – Leadership Is An Art
• “The first responsibility of a leader is
to define reality. . .”
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Wrong Jungle
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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.)
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Defining Reality - Similarities
• Provide medical services
• Face increasing costs
• Struggle with reduction in payment
• Patients
• Staff
• Physicians
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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
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What are the functions of the
front office?
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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 Flow
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Touches Revenue Cycle at
Multiple Intervals
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Removing Roadblocks to Efficiency
• Throughput = Money coming in (profit)
• Operating Expense = money going
out to make throughput
• Inventory = Money stuck inside
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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
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Bottlenecks or Roadblocks
• Crowded reception area
• Irritable patients
• Financial underperformance
• Burnt out staff
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Causes of Bottlenecks
• Too much paperwork
• Poorly planned processes
• Inefficient office design
• Miscommunication between staff
• Poor scheduling
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Productivity
• Accomplishing something in terms of
goals
• Meaningless if you don’t know the
goals
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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
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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
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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 . . .
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“You cannot manage what you
cannot measure and
what gets measured gets done!”
Bill Hewlett
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Dynamic Relationship of
Staffing Levels With
Accounting Functions
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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
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Waiting Room Time
“Yes, I have
an
appointment.
Should I
also have
made a
reservation?”
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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
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The Peasant and The King
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Management’s job is not to see
the company as it is . . .
But as it can become.
John W. Teets
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RE-ENGINEERING THE FRONT
OFFICE
• R eliable
• E fficient
• S ervice
• P atient-Focused
• E nergy
• C ustomization
• T rust
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Put the Cookies on the Lower
Shelf
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S N A P
• Smile
• Name
• Ask “May I help you?”
• Parting comment
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The Five Whys
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Best Practices:The Front Office
• Define Reality
• Identify the bottlenecks
• Increase efficiency
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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
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Our Role As Leaders . . .
Finding the gifts people have to give
Inviting them to give them, and
Honoring the result when they do
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DON’T GIVE UP . .
.
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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
Editor's Notes
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