Diagnosing and Treating Critical Practice Management Systems<br />Sponsored by:<br />Northern Colorado IPA<br />June 17, 2...
www.karenzupko.com<br />2<br />
What’s Going On Now?<br />Operational Roadblocks?<br />3<br />
How Can You Improve the Patient Experience?<br />4<br />
Physician Efficiency?<br />5<br />
What Business Processes Have the Most Steps?<br />6<br />
Barriers to Implementing Technology?<br />7<br />
Average Tech Literacy?<br />8<br />Dr. Need Tech<br />KZA<br />Technology<br />C<br />
Governance, Management and Leadership<br />9<br />
Criticisms<br />No respect for organizational systems.<br />Meetings start late.<br />Evening meetings.<br />Poor agenda, ...
“Dr. Sanders thinks he’s part of the solution.That’s part of the problem.”<br />11<br />
Shortages will make recruitment of new partners challenging.<br />“We don’t have enough doctors in primary care or in any ...
The urge to merge among independent practices will continue to accelerate.<br />13<br />
Flawed Decision-Making:Ready! Fire! Aim!<br />Examples:<br />“We’re quitting all health plans!”<br />“Spending money on ma...
Confusing Control, Deligationand Abdication<br />15<br />I’m in control!<br />How do you know?<br />Of what?<br />
Confusing Control, Deligationand Abdication<br />Examples:<br />“I can’t let anyone else do ________, I have to maintain c...
How Do You Measure Up?<br />Our Practice Management Reporting<br />Visits<br />Procedures, Surgeries, Treatments<br />Coll...
Taking Your Eyes of the Ball(s)<br />Strike!<br />“We stopped looking at the:”<br /><ul><li>Surgery deposits
Daily deposits
Monthly P&L
AR reports
Patient monthly statements
Point of service collection
Inventory (supplies)
Audit controls
Appeals</li></ul>18<br />
19<br />Read Reports!<br />
Non-Physician Expenses As a % of Net Revenue (Overhead)<br />20<br />Source: AOA 2009<br />
Open Your Eyes To Risks<br />21<br />Blinders off!<br />
The Fraud Buster’s are out in force. Expect an audit.<br />60 <br />Minute Rule<br />Careless Coders Beware!<br />22<br />
2011 OIG Work Plan Excerpt<br />Coding or Evaluation and Management Services<br />Medicare paid $25 billion for E&M servic...
What Does This Look Like?<br />24<br />2008 National<br />2008 NE State<br />Dr. C<br />
“There! Is that enough bullets for you?”<br />25<br />
Risk Areas<br />26<br />
Supervision and Scope of Practice:<br />State and Payor Variations Matter<br />Tech<br />MD<br />NP<br />RN<br />PA<br />2...
“This board has to implement a compliance program. Please … we don’t need the visual aid.”<br />28<br />
Trusting and Not Verifying<br />“Background checks – nope we don’t do that unless, well you know, they look like we should...
Right people?<br />Right jobs?<br />Right time?<br />Right tools?<br />Right training?<br />30<br />
“Are they as good as they look?”<br />31<br />
32<br />
Audit Controls <br />Specific steps that ensure the integrity of the accounting system.<br />Payables<br />Receivables<br ...
Who Will It Be?<br />34<br />
35<br />
36<br />Receipt  #102<br />For: 		John Patient<br />On:		July 28th, 2010<br />Paid:	$40.00<br />Rona at Reception<br />
Audit Controls in Action<br />37<br />Numbered superbills<br />Daily Close<br />Fidelity bonds<br />Regular inventory reco...
Money Handling<br />38<br />Screen candidates<br />Limit cash<br />Watch patient complaints<br />Safeguard credit card<br />
Unallocated Cash<br />39<br />
Suppressed Statements<br />40<br />
41<br />Insurance Coverage<br />Check Today!<br />
Personnel<br />42<br />Investment or Overhead?<br />
43<br />“It would be easier to massage a squid than to hold my staff accountable.”<br />
Staffing Costs as a Percentage of Total Medical Revenue<br />24%<br />on average in practices<br />Salary + Retirement Ben...
45<br />Finding qualified clinical support and business staff are a growing challenge.<br />
46<br />Do you test applicants?<br />
Example of Total Test Results<br />47<br />
48<br />“Instead of my resume, I’ve printed out my daily horoscope for the past year.  You’ll see that I’m a special perso...
Staff Gap Analysis<br />49<br />What are my staffing needs?<br />
Technology<br />50<br />
Litmus Test for New Technologies<br />Save Time<br />Boost Efficiency<br />Reduce Costs<br />Improve Patient Experience<br...
More Common Than You Think<br />52<br />You Bought This…<br />You Drive It Like This...<br />
Race Car vs. Station Wagon<br />Appointment Schedule<br />Integrated with encounter form generator?<br />Set-up templates ...
Reimbursement Process<br />54<br />
Business Solutions<br />Online/real-time claims submission<br />Electronic claims remittance<br />Batch eligibility<br />O...
Pre-Registration <br />56<br />Done the RIGHT way in 2010<br />Gather detailed insurance information prior to  the visit.<...
57<br />Source: philly.com, August 13, 2010<br />
Real Time Claims Adjudication<br />58<br />
Remote Deposit<br />Saves Time, Reduces Risk<br />Example<br />$150 set up fee<br />$100 per month service fee<br />.10 pe...
SmileReminder.com <br />60<br />
Understand.com<br />61<br />
Solveras.com<br />62<br />
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Diagnosing & treating practice mgmt 6.17.11 karen zupko

  1. 1. Diagnosing and Treating Critical Practice Management Systems<br />Sponsored by:<br />Northern Colorado IPA<br />June 17, 2011<br />Presented by:<br />Karen Zupko, President<br />
  2. 2. www.karenzupko.com<br />2<br />
  3. 3. What’s Going On Now?<br />Operational Roadblocks?<br />3<br />
  4. 4. How Can You Improve the Patient Experience?<br />4<br />
  5. 5. Physician Efficiency?<br />5<br />
  6. 6. What Business Processes Have the Most Steps?<br />6<br />
  7. 7. Barriers to Implementing Technology?<br />7<br />
  8. 8. Average Tech Literacy?<br />8<br />Dr. Need Tech<br />KZA<br />Technology<br />C<br />
  9. 9. Governance, Management and Leadership<br />9<br />
  10. 10. Criticisms<br />No respect for organizational systems.<br />Meetings start late.<br />Evening meetings.<br />Poor agenda, poor minutes.<br />“Bomb throwers” reign.<br />Deficient preparation.<br />10<br />
  11. 11. “Dr. Sanders thinks he’s part of the solution.That’s part of the problem.”<br />11<br />
  12. 12. Shortages will make recruitment of new partners challenging.<br />“We don’t have enough doctors in primary care or in any specialty.” <br />Rep. Shelley Berkley <br />(D-Nevada)<br />To cope with the growing shortage, suggested proposals include:<br />“One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants.” <br />“The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional doctors each year.”<br />Source: Shortage of Doctors an Obstacle to Obama Goals, by Robert Pear; The New York Times, April 27, 2009<br />12<br />
  13. 13. The urge to merge among independent practices will continue to accelerate.<br />13<br />
  14. 14. Flawed Decision-Making:Ready! Fire! Aim!<br />Examples:<br />“We’re quitting all health plans!”<br />“Spending money on marketing with no predictable ROI or ROE”<br />“Hire her! Fire him!”<br />“Buy the laser!”<br />“Install the EMR – next week!”“We need an aesthetician.”<br />14<br />
  15. 15. Confusing Control, Deligationand Abdication<br />15<br />I’m in control!<br />How do you know?<br />Of what?<br />
  16. 16. Confusing Control, Deligationand Abdication<br />Examples:<br />“I can’t let anyone else do ________, I have to maintain control.”<br />“Here you do this even though you don’t have the skills or training”<br />“We told the nurse/manager to do it.”<br />16<br />
  17. 17. How Do You Measure Up?<br />Our Practice Management Reporting<br />Visits<br />Procedures, Surgeries, Treatments<br />Collections<br />Staff to Revenue Ration<br />17<br />
  18. 18. Taking Your Eyes of the Ball(s)<br />Strike!<br />“We stopped looking at the:”<br /><ul><li>Surgery deposits
  19. 19. Daily deposits
  20. 20. Monthly P&L
  21. 21. AR reports
  22. 22. Patient monthly statements
  23. 23. Point of service collection
  24. 24. Inventory (supplies)
  25. 25. Audit controls
  26. 26. Appeals</li></ul>18<br />
  27. 27. 19<br />Read Reports!<br />
  28. 28. Non-Physician Expenses As a % of Net Revenue (Overhead)<br />20<br />Source: AOA 2009<br />
  29. 29. Open Your Eyes To Risks<br />21<br />Blinders off!<br />
  30. 30. The Fraud Buster’s are out in force. Expect an audit.<br />60 <br />Minute Rule<br />Careless Coders Beware!<br />22<br />
  31. 31. 2011 OIG Work Plan Excerpt<br />Coding or Evaluation and Management Services<br />Medicare paid $25 billion for E&M services<br />Payments for Evaluation and Management Services<br />Medical records with identical documentation across services<br />Evaluation and Management Services During Global Surgery Periods<br />The number of E&M services provided by physicians and reimbursed as part of the global surgery fee<br />23<br />
  32. 32. What Does This Look Like?<br />24<br />2008 National<br />2008 NE State<br />Dr. C<br />
  33. 33. “There! Is that enough bullets for you?”<br />25<br />
  34. 34. Risk Areas<br />26<br />
  35. 35. Supervision and Scope of Practice:<br />State and Payor Variations Matter<br />Tech<br />MD<br />NP<br />RN<br />PA<br />27<br />27<br />
  36. 36. “This board has to implement a compliance program. Please … we don’t need the visual aid.”<br />28<br />
  37. 37. Trusting and Not Verifying<br />“Background checks – nope we don’t do that unless, well you know, they look like we should.”<br />“Sure I cleaned up the AR.”<br />“Yep, we are appealing accounts.”<br />“How would I know they weren’t sending patients statements?”<br />“Well, I though we were _______.”<br />“She told me we were ______.”<br />29<br />
  38. 38. Right people?<br />Right jobs?<br />Right time?<br />Right tools?<br />Right training?<br />30<br />
  39. 39. “Are they as good as they look?”<br />31<br />
  40. 40. 32<br />
  41. 41. Audit Controls <br />Specific steps that ensure the integrity of the accounting system.<br />Payables<br />Receivables<br />Inventory<br />33<br />
  42. 42. Who Will It Be?<br />34<br />
  43. 43. 35<br />
  44. 44. 36<br />Receipt #102<br />For: John Patient<br />On: July 28th, 2010<br />Paid: $40.00<br />Rona at Reception<br />
  45. 45. Audit Controls in Action<br />37<br />Numbered superbills<br />Daily Close<br />Fidelity bonds<br />Regular inventory reconciliation<br />Background checks<br />Computer passwords<br />
  46. 46. Money Handling<br />38<br />Screen candidates<br />Limit cash<br />Watch patient complaints<br />Safeguard credit card<br />
  47. 47. Unallocated Cash<br />39<br />
  48. 48. Suppressed Statements<br />40<br />
  49. 49. 41<br />Insurance Coverage<br />Check Today!<br />
  50. 50. Personnel<br />42<br />Investment or Overhead?<br />
  51. 51. 43<br />“It would be easier to massage a squid than to hold my staff accountable.”<br />
  52. 52. Staffing Costs as a Percentage of Total Medical Revenue<br />24%<br />on average in practices<br />Salary + Retirement Benefits + Health Insurance + Training<br />44<br />
  53. 53. 45<br />Finding qualified clinical support and business staff are a growing challenge.<br />
  54. 54. 46<br />Do you test applicants?<br />
  55. 55. Example of Total Test Results<br />47<br />
  56. 56. 48<br />“Instead of my resume, I’ve printed out my daily horoscope for the past year. You’ll see that I’m a special person who is destined for great things!”<br />
  57. 57. Staff Gap Analysis<br />49<br />What are my staffing needs?<br />
  58. 58. Technology<br />50<br />
  59. 59. Litmus Test for New Technologies<br />Save Time<br />Boost Efficiency<br />Reduce Costs<br />Improve Patient Experience<br />Leverage Knowledge<br />51<br />If it doesn’t, don’t buy it!<br />
  60. 60. More Common Than You Think<br />52<br />You Bought This…<br />You Drive It Like This...<br />
  61. 61. Race Car vs. Station Wagon<br />Appointment Schedule<br />Integrated with encounter form generator?<br />Set-up templates by condition, MD?<br />Integrated with batch eligibility processing?<br />Billing & Collections <br />Are you leveraging custom message on statements?<br />Do staff use work queue features?<br />Is anyone using the payment plan follow up tool?<br />Flags & Account Alerts<br />Reporting! <br />53<br />
  62. 62. Reimbursement Process<br />54<br />
  63. 63. Business Solutions<br />Online/real-time claims submission<br />Electronic claims remittance<br />Batch eligibility<br />Online eligibility look up – faster than phone!<br />Remote deposit<br />Auto collection<br />Online banking<br />55<br />
  64. 64. Pre-Registration <br />56<br />Done the RIGHT way in 2010<br />Gather detailed insurance information prior to the visit.<br />
  65. 65. 57<br />Source: philly.com, August 13, 2010<br />
  66. 66. Real Time Claims Adjudication<br />58<br />
  67. 67. Remote Deposit<br />Saves Time, Reduces Risk<br />Example<br />$150 set up fee<br />$100 per month service fee<br />.10 per item<br />59<br />
  68. 68. SmileReminder.com <br />60<br />
  69. 69. Understand.com<br />61<br />
  70. 70. Solveras.com<br />62<br />
  71. 71. Social Media<br />63<br />
  72. 72. The Rise of Networks and Social Media<br />35% of online adults have social network profiles.<br />Facebook reports ‘several million’ accounts of users older than 65.<br />Source: Pew Internet and American Life<br />64<br />
  73. 73. MGMA Survey Results<br />Do you currently have a group practice web site? Yes - 81%<br />Do you see the internet as an effective communication medium for basic information between you and your patients (office information, insurance information, downloadable forms etc)? Yes - 93%<br />Assuming security is not an issue, do you see the internet as an effective communication medium for personal information between you and your patients for:<br />65<br />
  74. 74. 66<br />
  75. 75. Does Your Website Do This?<br />New patient packet/pre-registration<br />Referring physician section<br />Digital forms and policies<br />Appointment scheduling options<br />Post-op instructions <br />Patient stories<br />Videos of surgeons and what to expect in the office<br />Email staff and surgeons<br />67<br />See KZA’s Minimum Website Requirements–2009<br />
  76. 76. Patient Portal<br />68<br />What: An online application that allows practices and patients to communicate and interact with physicians.<br /><ul><li>Prescription Renewal
  77. 77. Secure Patient Messaging
  78. 78. Ask a Clinician
  79. 79. VOV / Symptom Assessment
  80. 80. Referral Portal
  81. 81. PHR
  82. 82. Online Bill Payment
  83. 83. Auto-draft payment plans
  84. 84. Virtual Card Swiper
  85. 85. Ask a Biller
  86. 86. Pre-registration / Health forms
  87. 87. Appointment Requests
  88. 88. Patient Messaging</li></ul>Source: Medfusion<br />Practice website, patient education, patient satisfaction surveys …<br />
  89. 89. Use Key Features<br />69<br />Out of Office Reply<br />Greetings! I am out of the office returning on August 24th. My phone access is limited and none to email. Call my office at 312.642.5616 x. 15 and ask for Mary if you need something or to schedule an appointment.<br />Karen<br />Custom<br />Signature<br />
  90. 90. 70<br />I don’t skate to where the puck is; I skate to where I think the puck is going to be.”<br />-Wayne Gretzky<br />

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