diagnosing & treating practice mgmt 6.17.11 karen zupko

2011 KarenZupko & Associates, Inc.

Sponsored by:

Northern Colorado IPA

June 17, 2011

Presented by:

Karen Zupko, President


www.karenzupko.com

2


What’s Going On Now?

Operational Roadblocks?

3


How Can You Improve

the Patient

Experience?

4


Physician Efficiency?

5


What Business Processes Have

the Most Steps?

6


Barriers to Implementing

Technology?

7


Average Tech Literacy?

8

Technology C

Dr. Need Tech KZA


Governance, Management

and Leadership

9


Criticisms

1. No respect for organizational systems.

2. Meetings start late.

3. Evening meetings.

4. Poor agenda, poor minutes.

5. “Bomb throwers” reign.

6. Deficient preparation.

10


“Dr. Sanders thinks he’s part of the solution.That’s part of the problem.”

11


Shortages will make recruitment of

new partners challenging.

Source: Shortage of Doctors an Obstacle to Obama Goals, by Robert Pear; The New York Times, April 27, 2009

“We don’t have enough

doctors in primary care or

in any specialty.”

Rep. Shelley Berkley

(D-Nevada)

To cope with the growing

shortage, suggested proposals

include:“One would increase enrollment

in medical schools and residency

training programs. Another would

encourage greater use of nurse

practitioners and physician

assistants.”

“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.”

12


The urge to merge among

independent practices will

continue to accelerate.13


Flawed Decision-Making:

Ready! Fire! Aim!Examples:

“We’re quitting all health plans!”

“Spending money on marketing with no predictable ROI or ROE”

“Hire her! Fire him!”

“Buy the laser!”

“Install the EMR – next week!”“We need an aesthetician.”

14


Confusing Control, Deligation

and Abdication

15

How do

you know?

I’m in

control!

Of what?


Confusing Control, Deligation

and AbdicationExamples:

“I can’t let anyone else do

________, I have to

maintain control.”

“Here you do this even

though you don’t have

the skills or training”

“We told the

nurse/manager to do it.”16


How Do You Measure Up?

Our Practice Management Reporting

Visits

Procedures, Surgeries, Treatments

Collections

Staff to Revenue Ration

17


Taking Your Eyes of the Ball(s)Strike!“We stopped looking at the:”

Surgery deposits

Daily deposits

Monthly P&L

AR reports

Patient monthly statements

Point of service collection

Inventory (supplies)

Audit controls

Appeals 18


19

Read Reports!


Non-Physician Expenses As a

% of Net Revenue (Overhead)

20

Overhead # Respondents % Amount

Overall Practice 54 60.7%

Allergy Services 29 55.4%

Audiology Services 40 74.3%

In-Office Imaging

Services

13 52.1%

Source: AOA 2009


Open Your Eyes To Risks

21Blinders off!

http://www.inmagine.com/rbv001/rbv001366-photo


The Fraud Buster’s are out in

force. Expect an audit.

60

Minute

Rule

Careless Coders Beware!

22


2011 OIG Work Plan Excerpt

Coding or Evaluation and Management Services

Medicare paid $25 billion for E&M services

Payments for Evaluation and Management Services

Medical records with identical documentation across services

Evaluation and Management Services During Global Surgery Periods

The number of E&M services provided by physicians and reimbursed as part of the global surgery fee

23


What Does This Look Like?

24

Office or Outpatient Consultation

0%

20%

40%

60%

80%

100%

99241 99242 99243 99244 99245

2007 National

2007 Midwest State

Dr. C

2008 National

2008 NE State

Dr. C


“There! Is that enough bullets for you?”

25


Risk Areas

26

CERT

OIG

Hiring

PracticesIdentity

Issues

Red Flag

Rules

Commercial

Plans

State

Authorities

RAC


27

Tech

NP RN

MD

PA

Supervision and Scope of

Practice:

State and Payor Variations Matter

27


“This board has to implement a compliance

program. Please … we don’t need the visual aid.”

28

http://www.hcmarketplace.com/?source=EHUMOR


Trusting and Not Verifying

“Background checks – nope we don’t do that unless, well you know, they look like we should.”

“Sure I cleaned up the AR.”

“Yep, we are appealing accounts.”

“How would I know they weren’t sending patients statements?”

“Well, I though we were _______.”

“She told me we were ______.”

29


Right people?

Right jobs?

Right time?

Right tools?

Right training?

30


“Are they as good as they look?”

31


32


Audit Controls

Specific steps that ensure the integrity of

the accounting system.

Payables

Receivables

Inventory

33


Who Will It Be?

34


35


36

Receipt #102

For: John Patient

On: July 28th, 2010

Paid: $40.00

Rona at Reception


Audit Controls in Action

37

Daily Close

Fidelity bonds

Background checks

Numbered superbills

Regular inventory

reconciliation

Computer

passwords


Money Handling

38

Limit cash

Safeguard credit card

Screen candidates

Watch patient

complaints


Unallocated Cash

39


Suppressed Statements

40


41

Insurance Coverage

Check Today!


Personnel

42

Investment or

Overhead?


43

“It would be easier to

massage a squid than

to hold my staff

accountable.”


Staffing Costs as a Percentage of

Total Medical Revenue

24%on average in practices

Salary + Retirement Benefits + Health

Insurance + Training

44


45

Finding qualified

clinical support

and business staff

are a growing

challenge.


46

Do you test applicants?


Example of Total Test Results

47


48

“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!”


Staff Gap Analysis

49

What are my

staffing

needs?


Technology

50


Litmus Test for New Technologies

Save Time

Boost Efficiency

Reduce Costs

Improve Patient Experience

Leverage Knowledge

51


More Common Than You Think

52

You Bought This…

You Drive It

Like This...


Race Car vs. Station Wagon

Appointment Schedule Integrated with encounter form generator?

Set-up templates by condition, MD?

Integrated with batch eligibility processing?

Billing & Collections Are you leveraging custom message on

statements?

Do staff use work queue features?

Is anyone using the payment plan follow up tool?

Flags & Account Alerts

Reporting! 53


Reimbursement Process

54

Reimbursement

Proper Claim

Submission Accurate Coding CPT

ICD-9

Payment Posting,

EOB Analysis, &

Appeals

Insurance

Verification Appointment Scheduling

Supportive

Documentation

Pre-Surgical Financial

Counseling

Pre-Certification Written Prior

Authorization

Pre- Registration


Business Solutions

Online/real-time claims submission

Electronic claims remittance

Batch eligibility

Online eligibility look up – faster than

phone!

Remote deposit

Auto collection

Online banking

55


Pre-Registration

56

Done the RIGHT way in 2010

Gather detailed insurance information

prior to the visit.


57Source: philly.com, August 13, 2010


Real Time Claims Adjudication

58


Remote Deposit

Example

$150 set up fee

$100 per month

service fee

.10 per item

59


SmileReminder.com

60


Understand.com

61


Solveras.com

62


Social Media

63


The Rise of Networks

and Social Media

35% of online adults

have social network

profiles.

Facebook reports

‘several million’

accounts of users

older than 65.

Source: Pew Internet and American Life64

http://images.google.com/imgres?imgurl=http://www.breakitdownblog.com/wp-content/uploads/2008/03/apple-iphone-keyboard.jpg&imgrefurl=http://www.breakitdownblog.com/iphone-review-part-1-of-3/&h=400&w=375&sz=52&hl=en&start=3&sig2=s7ePXcwSOLDkyRtx8iE4DQ&usg=__tKCItHSvQFxon4l32uxvnO2Rq6w=&tbnid=SukbEgisMDRoYM:&tbnh=124&tbnw=116&ei=qNbSSJjBJoqEpATpvJTjCA&prev=/images?q=iphone&gbv=2&hl=en

http://secondlife.com/


MGMA Survey Results Do you currently have a group practice web site?

Yes - 81%

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%

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:

65

Pre-registration Yes - 89%

Appointment Requests Yes - 79%

Prescription Requests Yes - 74%

Lab Results Reporting Yes - 79%

Online Bill Payment Yes - 79%


66


Does Your Website Do This?

New patient packet/pre-registration

Referring physician section

Digital forms and policies

Appointment scheduling options

Post-op instructions

Patient stories

Videos of surgeons and what to expect

in the office

Email staff and surgeons

67

See KZA’s

Minimum Website

Requirements–2009


Patient Portal

68Source: Medfusion

• Pre-

registration /

Health forms

• Appointment

Requests

• Patient

Messaging

• Online Bill

Payment

• Auto-draft

payment

plans

• Virtual Card

Swiper

• Ask a Biller

• Prescription

Renewal

• Secure Patient

Messaging

• Ask a Clinician

• VOV /

Symptom

Assessment

• Referral Portal

• PHR

Practice website, patient education, patient satisfaction surveys …

What: An online application that allows practices and patients to

communicate and interact with physicians.


Use Key Features

69

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.

Karen

Out of Office

Reply

Custom

Signature


70

I don’t skate to

where the puck

is; I skate to

where I think the

puck is going to

be.”

-Wayne Gretzky

diagnosing & treating practice mgmt 6.17.11 karen zupko

Health & Medicine