Practice Management Tips, Tools & Techniques- Mary Toomey, PracticeManager.ie

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Mary Toomey, of PracticeManager.ie looks at how medical professionals can improve the efficiency of their practice, improve the level of care provided to patients and staff and generally increase productivity.

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Practice Management Tips, Tools & Techniques- Mary Toomey, PracticeManager.ie

  1. 1. 8th June 2013
  2. 2. PRACTICE MANAGEMENTTools, Tips & Techniques8th June 2013
  3. 3. Today’s TalkPractice Management - Patients FirstRisks in General PracticesMeasuring Practice PerformancePractical Problems : Debts, Well-Being8th June 2013
  4. 4. Our ResponsibilityTo enable our team toprovide timely, safe,effective and respectfulcare - and to ensurethis is consistently andcompassionately givento all our patients.8th June 2013
  5. 5. Stafford HospitalFrancis Report (Feb 2013)“put corporate self-interest and costcontrol ahead of patients and their safety”- Robert Francis QCFocus on systems - not outcomesFocus on data - not peopleLack of listening to patients and familiesLack of risk assessmentLack of leadership or urgency about decision makingLack of management and follow up8th June 2013
  6. 6. Patients “First And Foremost”8th June 2013 Put the patient’s needs first Working to agreed standards Working together Openness and transparency about matters of concern All those who provide care for patients – individuals andorganisations must be properly accountable Measure, understand and improve the performance ofindividuals, teams and your whole clinic
  7. 7. Primum non nocere“It may seem a strangeprinciple to enunciate as thevery first requirement in ahospital that it should do thesick no harm”– Florence Nightingale8th June 2013
  8. 8. Top Risks – MPS (UK, 2012)99.1% Communication95.7% Confidentiality95.7% Prescribing95.7% Record keeping94.0% Health and safety87.9% Test results84.5% Infection control8th June 2013
  9. 9. Communication - DifficultiesPatient / External• Unrealistic / differingexpectations• Rigid beliefs• Personality traits• Chaotic lifestyles• Multiple complaints• Chronic pain• AddictionsClinic / Internal• Previous experiences• Degree of training• Personality traits• Time pressures• Interruptions• Limited resources• Third party pressures8th June 2013
  10. 10. Dealing with Difficult InteractionsSupport• Active listening• Empathy• Open approach toproblem solving• Suggest the patientand you might find amutually acceptablesolutionTension• Summarise theinteraction so far• Acknowledge the realproblem• State the boundary• Encourage patient tocome up with solutionoptions8th June 2013
  11. 11. ConfidentialityOverhearing conversations especially at receptionViewing patient-identifiable information left out at receptionPatient-identifiable information left out on desks in thesurgery roomLost or misplaced post-its and pieces of paperInterruptions during consultationsUnsecure filing cabinets or unrestricted computer records8th June 2013
  12. 12. Prescribing• Have a robust repeat prescribing protocol• Make sure every staff member knows the protocol• Best practice is that only GPs should add medicationsto the prescription list• GPs should review medication lists regularly• Be especially vigilant about toxic medications• Ensure patients are uniquely identified to make surethey are not confused with similarly named others8th June 2013
  13. 13. Record Keeping• Ensure contemporaneous notes are kept of all contact includinghome visits and telephone contact• Scan all incoming letters / faxes / results• Use aide-memoirs to follow up test results• Ensure allergies are accurately recorded on patient files• Encourage patients to keep their details correct on your files• MPS recommends keeping files for a minimum 8 years afterlast treatment or death for adult and longer for maternityrecords, children’s records, or patients with mental disorders8th June 2013
  14. 14. Access to Medical RecordsFreedom of Information Act (Amendment) 2003 applies to records held by GPs inrelation to patients who are medical card holders. It does not apply to therecords of private patients. An application for a copy of the records is made tothe head of the public body. In the case of FOI, the request for access must bemade in writing to the head of the public body concerned which in the case of aGMS medical record is the HSE.The Data Protection Act, 1988 (Amendment Act, 2003) gives a person a right ofaccess and right to correct/delete errors. The current fee that a person can becharged for the provision of a copy of their medical records under the auspices ofthe Data Protection Act is €6.35. Such records should be provided within 40 days.No medical report or copy records should be provided by the doctor to any thirdparty other than with the consent of the patient or otherwise as required by law ordirected by an Order of the Court.8th June 2013
  15. 15. Health and Safety• Undertake risk assessments as needed, and prepare orupdate your practice’s Health and Safety statementannually or more often if needed (see www.hsa.ie andwww.besmart.ie for assistance).• Keep MSDS information, details of all safety checks, drills,and equipment services with the H&S statement.• Nominate staff safety representative(s).• Ensure sharps, chemicals, gases and clinical waste aresafely used, stored and disposed of.• Check your security – cctv, panic buttons8th June 2013
  16. 16. Measuring Practice PerformanceGood information is the best management tool.You can measure almost any aspect of yourpractice.Measurements need to be accurate and up to datein order to be most relevant and useful!8th June 2013
  17. 17. Financial MonitoringHave a proper recording and reporting system for all practiceincome and expenditure. Use regular, clear reporting to evaluate• Income• Expenditure• GMS claims• Cash flow / bank balance• DrawingsReview year to date & compare with target / last year’s figures
  18. 18. Capitation PaymentsPractice IT and PCRS patient listings (“Blue Books”) match (Use Importer)Newborn babies added to panel and deceased patients removed from panelPrivate residents in nursing homes (intending to stay periods of greater than5 weeks) registered and coded correctly (903/906) if over 70 yearsTemporary Visitors attending > 3 monthsVisitors with medical cards held by GPs elsewhere in your local areaCards expiring on 16th Birthday
  19. 19. STC / SS / VaccinationsEnsure claims are completed and claimed for:– Every special service consultation– Every out of hours consultation– Every emergency and temporary visitor– Every NHS / EHIC visitor– Flu and pneumococcal vaccinationsSubmit claims online to PCRS– Match claims to payments & follow up all queries
  20. 20. Practice SupportActual GMS Panel must be 100 or more to qualifyPayments increase pro rata in bands of 100 to max. panel size 1200 based on‘weighted panel’All patients over 70 are given a weighting of 3:1 when calculating practice supportsubsidy entitlementStaff grade (nurse, practice manager, secretary) and relevant years experience aretaken into considerationHours worked and employer PRSI may reduce practice support subsidy payments -top rate employer PRSI (10.75%) does not affect practice support.In group practices, practice support may be collectively assessedTo apply for practice support, complete form PSN/1 & submit with copies of relevantdocumentation to your local primary care office
  21. 21. Sick LeaveSick leave allowance is based on a four year rolling period.Panels of 100 – 700 : full capitation is paid for the first 6 monthsand half capitation for the next 6 months. Locum is paid based onthe GMS doctor’s capitation payment for the month divided by thenumber of days in the month (up to maximum €213.12 per day) andmultiplied by the number of days leave taken.Panels over 700 : as above, but locum payment is at the maximum€213.12 per day.
  22. 22. Annual Leave# days annual leave depends on the size of your GMS listMinimum 100 patients = 14 days annual leave200 patients = 16 days leave300 patients = 18 days leave400 patients = 20 days leave500 patients = 21 days leaveEvery subsequent 100 patients = +1 days leave up to 1400patients = 32 days leave1500 patients + = 35 days leave
  23. 23. Study Leave• Minimum panel size is 100• Study leave is calculated in half-daysessions up to a maximum of 10 days• Certificates of attendance must accompanyALF/1 form along with the name andsignature of the locum practitioner
  24. 24. Medical Indemnity RefundPanel must be over 100 to qualify for medical indemnity refundRefund is based on the size of the GPs panelRefund is calculated as a percentage of the net premium paid by thedoctor (gross premium less the benefit which the doctor receives as atax rebate). Forward medical indemnity certificate showing full timework to local primary care officeNo. Patients on Panel % Net Re-imbursement100 – 250 10%251 – 500 25%501 – 1,000 50%1,001 – 1,500 75%1,501 +and Rural Practice Allowance GPs 95%
  25. 25. Once-Off GMS GrantsNurse start up grant – to purchase equipment for first nurseemployed €3,809Fridge grant – one per practice €1,270Computer grant – one per GMS contract up to €2,539Submit receipts to local primary care office
  26. 26. Maternity FeesFirst visit & 6 week €41.53Subsequent visits (incl. special visits) €29.91Total for first pregnancy €262.52Total for subsequent pregnancy €292.43Emergency delivery €249.22_______________________________________Make sure all visits are entered on MSC reportClearly identify any special visitsCheck for past EDDs – miscarriages / movers
  27. 27. Childhood Vaccinations -Maximum Fees (per child)Registration € 37.78V1, V2, V3 + MMR €125.86PCV x 3 @ €18.82 € 56.46Hib Booster € 18.82Bonus (95% Uptake) € 60.00Total €298.92_____________________________________________Use software reporting to follow up missed / latevaccines & advise LHO of any patientsleaving your cohort
  28. 28. Other State ContractsPalliative care payments (GMS & Private)€212.48Cervical Check €49.10Social Welfare Certification Contract€8.25 per certificate and €44.44 for a detailedreport
  29. 29. Socrates : Keeping Tabs on ClaimsClaim Tracker• Child Immunizations• STCs (if printed)• Forms (cervical check)Ante Natal Reports• Check Boxes inMaternity Protocol8th June 2013
  30. 30. Tips for Getting Paid On TimeFee schedule and payment policy should be clearly displayed inthe surgery & on websiteBe consistent - minimise ‘discretionary reductions’Use practice software to generate invoices, receipts, debtors listsand account statementsFollow up any “left without payment” accounts with a phone call,ideally within 48 hoursConsider pay-on-arrival as an option if bad debts are a significantproblem for your practiceDon’t let debts spiral. Take a constructive approach support (e.g.help to apply for a medical card, direction toward MABS services)to patients in difficulty.
  31. 31. Debt Collection by Phone• Pre-call preparation: have the facts tohand.• Open strongly: be clear about why youare calling.• Work through objections and agree acommitment.• End the call with a clear agreement.• Follow up : check the agreement iskept, or if not, react quickly withanother call.8th June 2013
  32. 32. Problems with Staff Performance?Address it directly, objectively, honestlyMeet the employee to discuss it• Agree that the problem exists• Identify cause(s) of the issue• Agree a proposal to solve the problem• Agree how you will review performance and what willhappen if the problem is not resolved8th June 2013
  33. 33. Personal Well BeingStaying Safe - Crisis• Avoid escalating anger• It is safer to leave the roomthan insist somebody elseleaves• Call for help• Take time out• Debrief afterward with atrusted confidanteDaily Grind Stressors• Separate your emotions frompatients’• Recognise your own emotionalresponses• Set realistic expectations ofyourself• Share the load• Develop and use support systems8th June 2013
  34. 34. Thank YouQueries?info@practicemanager.ie087 178 4557 / 01 202 10708th June 2013

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