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21 posts from May 2009

May 15, 2009

Practice interaction with insurers costs $21B-$31B per year

This certainly doesn’t surprise me! A recent study has found that medical practices spend between $21 billion  and $31 billion annually dealing with insurers - or more than $68,000 per physician per year.  The study -- "The Costs to Physician Practices of Interactions with Health Insurance Plans" -- found that physicians spend three hours per week - or 43 minutes on average per workday - interacting with health insurance plans.

The research found that primary care physicians spend more time on these interactions than medical or surgical specialists. Nursing staff spend nearly four hours per physician per day interacting with plans, while clerical staff spends 7.2 hours per day. Solo practitioners and their staffs spend up to 50 percent more time interacting with health plans than physicians in larger practices. Non-physicians' staff time did not vary significantly by specialty.  For more, see Healthcare Finance News.

This is just further evidence on why smaller medical practices need to consider a merger – an opportunity to decrease administrative time and costs.

May 14, 2009

First impressions are lasting impressions at the front desk

Your front desk personnel are the first contact a patient has with your office. How they are dealing with “people” every day gives off a lasting impression about your office. Here are a few observations made from recent visits to client offices:

The Best: It’s great when I go into an office and hear something like, “Hi, Ms. York. How are you today? You know, we need to get a copy of your insurance card because it’s been a while since you’ve been in and we need for you to go over this information to make sure it’s all correct.” A kind voice makes a big difference, and body language says a whole lot. So remember, first impressions are lasting impressions.

The Worst: From a patient’s point of view, the thing I appreciate most seeing in a client’s office is a friendly face and an inviting feeling. I want to see that the person who greets a patient appears happy to have them there. When I walk into an office, I can always tell if the person at the front desk has a positive or negative attitude. You can just see and hear it. In fact, on a recent client visit, I observed the same receptionist always has the same negative attitude. Whenever I observe the front desk, she does not greet a patient with a pleasant hello or other pleasant chatter; she simply says, “I need a copy of your insurance card.” This is not a very friendly greeting and does not make the patient feel happy to be there. Needless to say, I wonder how many patients have been lost simply due to how the front desk handles patient activity every day.

May 13, 2009

A positive attitude improves productivity

You don't have to re-invent the wheel when it comes to practice development. Rather, make it a goal to imitate identified management patterns in top-producing practices. Based on my own consulting experiences, here are five key personal traits common among most high-performing physicians:

  1. Actively seek advice. Physicians in best-of-class practices show a willingness to entertain new ideas and concepts.
  2. Be bold. With this same mindset, top performers unhesitatingly try new approaches. Even if changes don't work out as expected, the most productive groups avoid blaming the planner. Rather, they learn from their mistakes and move on.
  3. Know what you do best. While open to new ideas, high-producing physicians don't follow every new fad. Instead, they constantly reassess themselves and their strengths.
  4. Learn how to work smarter. While not afraid of hard work, high earners actively pursue new ways to maximize efficiency and productivity.
  5. Understand-and exploit-all the ways you can generate revenue. See if daily practice patterns and interactions really demonstrate open thinking and a willingness to embrace progress. As long as your group culture continues to reflect core values, be willing to change anything else to reach your vision.

May 12, 2009

What if employee wants more FIT withheld

Occasionally, an employee will submit a W-4 with a certain number of exemptions and ask you to have additional FIT withheld. You may withhold an additional fixed dollar amount, provided that the minimum required tax on the federal wage bracket or percentage method withholding tables has already been withheld.


You may not withhold a flat dollar amount, such as $100 per paycheck, or a flat percentage of tax, such as 10% of wages per paycheck. There are exceptions for supplemental wages. Flat amounts of withholding are not an option, regardless of the employee’s reason for requesting them. However, employees who want a specific amount withheld can review the graduated tables and adjust their withholding allowances and, if necessary, request an additional amount of FIT to obtain the total FITW that they want.


Problem: Peggy in your office is married, has one child and earns $25,000 a year. Because she will have mortgage interest of $5,000 this year, she wants to reduce his FIT far below the amount normally withheld from someone earning $25,000. What should you do?

Solution: Tell Peggy to complete the worksheet included with her IRS Form W-4 and to take as few allowances as she needs to bring his withholding in line with her estimated FIT liability for the year.

May 11, 2009

The Heart of Business Strategy:48 Things That Matter

Here is something a little different that I thought any reader of this blog might be interested in. It's from Tom Peters and it makes sense for any person or business, including physicians, administrators, and their medical practices:

We usually think of business strategy as some sort of aspirational market positioning statement. Doubtless that's part of it. But I believe that the number one "strategic strength" is excellence in execution and systemic relationships (i.e., with everyone we come in contact with). Hence I offer the following 48 pieces of advice for creating a winning strategy that is inherently sustainable:

• "Thank you." Minimum several times a day. Measure it.
• "Thank you" to everyone even peripherally involved in some activity—especially those "deep in the hierarchy."
• Smile. Work on it.
• Apologize. Even if "they" are "mostly" to blame.
• Jump all over those who play the "blame game."
• Hire enthusiasm.
• Low enthusiasm. No hire. Any job.
• Hire optimists. Everywhere. ("Positive outlook on life," not mindless optimism.)
• Hiring: Would you like to go to lunch with him-her. 100% of jobs.
• Hire for good manners.
• Do not reject "trouble makers"—that is those who are uncomfortable with the status quo.
• Expose all would-be hires to something unexpected-weird. Observe their reaction.
• Overwhelm response to even the smallest screw-ups.
• Become a student of all you will meet with. Big time.
• Hang out with interesting new people. Measure it.
• Lunch with folks in other functions. Measure it.
• Listen. Hear. Become a serious student of listening-hearing.
• Work on everyone's listening skills. Practice.
• Become a student of information extraction-interviewing.
• Become a student of presentation giving. Formal. Short and spontaneous.
• Incredible care in 1st line supervisor selection.
• World's best training for 1st line supervisors.
• Construct small leadership opportunities for junior people within days of starting on the job.
• Insane care in all promotion decisions.
• Promote "people people" for all managerial jobs. Finance-logistics-R&D as much as, say, sales.
• Hire-promote for demonstrated curiosity. Check their past commitment to continuous learning.
• Small "d" diversity. Rich mixes for any and all teams.
• Hire women. Roughly 50% women on exec team.
• Exec team "looks like" customer population, actual and desired.
• Focus on creating products for and selling to women.
• Focus on creating products for and selling to boomers-geezers.
• Work on first and last impressions.
• Walls display tomorrow's aspirations, not yesterday's accomplishments.
• Simplify systems. Constantly.
• Insist that almost all material be covered by a 1-page summary. Absolutely no longer.
• Practice decency.
• Add "We are thoughtful in all we do" to corporate values list. Number 1 force for customer loyalty, employee satisfaction.
• Make some form of employee growth (for all) a formal part of values set. Above customer satisfaction. Steal from RE/MAX: "We are a life success company."
• Flowers.
• Celebrate "small wins." Often. Perhaps a "small win of the day."
• Manage your calendar religiously: Does it accurately reflect your espoused priorities?
• Use a "calendar friend" who's not very friendly to help you with this.
• Review your calendar: Work assiduously on your "To don'ts"—stuff that distracts.
• Bosses, especially near the top: Formally cultivate one advisor whose role is to tell you the truth. Regularly!
• Commit to Excellence.
Talk up Excellence.
• Put "Excellence in all we do" in the values set.
• Measure everyone on demonstrated commitment to Excellence.

You'll find a longer version of this as a PDF—it includes two Appendices.

May 08, 2009

10 Steps to a Better Practice

Deceptively simple  - think about these: 

  1. Get control of your space.
  2. Get control of your schedule.
  3. Get control of the phones.
  4. Get control of the paperwork.
  5. Streamline relentlessly.
  6. Make it a team effort.
  7. Train your staff well.
  8. Reward exceptional effort.
  9. Find your own ways to do things.
  10. Never stop changing

May 07, 2009

Social Security benefits

Ever wonder about when social security benefits start? Here is your list:


Age 50. Benefits start for a disabled surviving spouse.


Age 60. Benefits start for a nondisabled surviving spouse.


Age 62. Benefits start based on the employee’s, spouse’s or former spouse’s earnings (if the former spouse is still alive).


Full Retirement age reached in 2009. Employees born in 1937 or earlier receive full benefits at age 65. There is no limit on earnings and no reduction in benefits for those at FR age.


Full Retirement age reached before 2009. Employees born in 1940 or earlier receive full benefits at age 65. There is no limit on earnings and no reduction in benefits.


Full Retirement age reached after 2009.  Recipients can earn $14,160 in 2009 before losing $1 in benefits for each $2 earned.


Important: Just earning 40 credits (formerly “quarters of coverage”) does not make individuals eligible for the maximum Social Security benefit. It simply makes them eligible for retirement benefits at a certain age. Credits are unrelated to the amount of the benefits.


Social Security benefits are based on average earnings over 35 years of work—not just on the last 5 years, as many people think. An adjustment is made to account for changes in average wages since the year the earnings were received. SSA then calculates average monthly adjusted earnings over the 35 years when the worker earned the most money. 

Employees can obtain their Social Security earnings by calling 800-772-1213, by visiting an SSA office, or by visiting www.socialsecurity.gov/mystatement.


Reminder: Withhold Social Security taxes on all wages regardless of age or Social Security benefits status.


May 06, 2009

Remember OSHA?

Everybody talks about HIPAA lately but it seems OSHA has been forgotten topic of interest. So do you know that the Occupational Health and Safety Administration (OSHA) imposes guidelines and rules designed to protect you on the job?

For example, OSHA has rules to protect medical office staff against getting certain infectious diseases, such as hepatitis B. So ask yourself: Do I ever help out in the clinical area by cleaning the lab or taking patients back? Even if the answer is that you only do such things rarely, you should consider getting the hepatitis B vaccination series. While OSHA doesn’t require receptionists who don’t have patient care contact or duties to get the hepatitis B vaccination, some offices are offering it to these personnel.

Front desk staff who have direct patient contact (rooming patients or working in the lab) must follow their office’s policies and procedures for wearing gloves and protective equipment, such as goggles, gowns, masks and, in some cases, even respirators. OSHA requires offices to provide this equipment for staff to protect themselves against communicable diseases.

Your office should have an eyewash station for staff who might splash or rub something hazardous into their eyes. In your case, that might include ink or liquid paper or a cleaning solvent. So make sure you know where the eye wash station is and how to use it.

In addition, you and your office should pay attention to ergonomics, which can prevent back and neck injuries and what’s known as “repetitive motion” injuries. The latter usually only occur when someone does intensive data entry or types on the keyboard many hours every day. To prevent such problems, make sure your workstation is comfortable and doesn’t strain your back, neck or arms unnecessarily. For example, you don’t want a chair that requires you to hunch over the keyboard or a keyboard that’s too high or low.

You can also help prevent injuries by taking mini stretch breaks throughout the day. OSHA has information on ergonomic solutions for computer workstations available at:http://www.osha.gov/SLTC/etools/computerworkstations/checklist.html.

May 05, 2009

Mandatory Disclosure of Physician Ownership in ASCs Required by the Medicare Conditions for Coverage Effective May 18, 2009

The final Medicare Conditions for Coverage were published October 30, 2008 and will become effective May 18, 2009. One of the most significant changes in the Conditions for Coverage is the requirement for ASCs to provide patients with certain verbal and written notification of rights and of ownership in advance of the date of the service. The notice must be provided in a language in any manner that the patient or the patient's representative understands. ASCs specifically must:

  1. Post the written notice of patient rights set forth in the Conditions for Coverage in a place or places within the ASC likely to be noticed by patients (or their representative, if applicable) waiting for treatment. The ASC's notice of rights must include the name, address, and telephone number of a representative in the State agency to whom patients can report complaints, as well as the Web site for the Office of the Medicare Beneficiary Ombudsman.
  2. Disclose physician financial interests in the ASC. Disclosure of information must be in writing and furnished to the patient. This disclosure, which had previously been a safe harbor requirement, is now a requirement for all centers. Further, disclosure must be provided in advance of the procedure - i.e., generally made prior to the date the patient has the procedure.
  3. Provide the patient or, as appropriate, the patient's representative, in advance of the date of the procedure, with information concerning its policies on advance directives, including a description of applicable State health and safety laws and, if requested, official State advance directive forms. The ASC must also inform the patient or patient's representative of the patient's right to make informed decisions regarding the patient's care and must also document in a prominent part of the patient's current medical record whether or not the individual has executed an advance directive.
  4. Establish a grievance procedure for documenting the existence, submission, investigation, and disposition of a patient's written or verbal grievance to the ASC and notify the patient of the same.

The requirement that such notice be provided "in advance" is generally considered to be at least the day before the procedure is scheduled for all of the above notifications. If the patient is not scheduled for an initial appointment at the ASC before the date of surgery, the ASC may be able to meet the advance requirement by (a) providing verbal notice over the telephone and (b) mailing the written materials to the patient (or instructing the patient to download the materials from the ASC website) and, on the date of the procedure, having the patient bring the notice materials with a signed acknowledgement that they were provided in advance of that day. There is no requirement that all of the above notices be included in the same documentation, but it will be critical for the ASC to ensure that the above verbal and written notices are provided and properly documented in patient records. 

May 03, 2009

FTC Suspends Enforcement of Red Flags Rule Until August 1

On April 30, 2009, the Federal Trade Commission (FTC) announced that it will delay enforcement of the "Red Flags Rule" (Rule) until August 1, 2009, to give affected institutions, including some health care providers, additional time to develop and implement written identity theft prevention programs.

The Rule requires "creditors" who maintain "covered accounts" to implement a written identity theft prevention program. Health care providers that bill insurance companies before requesting payment from the patient or offer alternative payment plans to a patient will be considered a creditor under the Rule.

A health care provider offers or maintains covered accounts if the provider establishes a continuing relationship with a patient and creates or maintains an account for such patient that allows for multiple payments or transactions. Covered accounts also include any accounts that the health care provider creates or maintains for which there is a reasonably foreseeable risk to patients of identity theft, including patient billing or payment accounts.

Health care providers should review the requirements of the Rule and, if affected, work with legal counsel to implement a compliant program before August 1, 2009.

For more information, please visit the FTC Web site.