Reed Tinsley, CPA

Pay that motivates your physician medical practice staff

Physicians know who their best employees are — hardworking, competent, loyal and emotionally invested in the practice and its patients. They're essential to the quality care doctors provide each day and increasingly vital to ensuring a financially healthy practice that can withstand ongoing changes in health care expectations, technology and regulations.

So how can physicians continue to ensure that their practice is a place where valuable employees want to work and give their best effort every day? How do physicians know which benefits and pay increases are most likely to attract and retain quality staff and motivate other employees who may need an incentive to work harder, all while working within the financial realities of the practice?

Read the following article written by Sheryl Cash for which I was interviewed:

http://www.amednews.com/article/20130520/business/130529997/4/

Handling an impaired physician situation

From a reader:

I could use some feedback on a very sticky situation in my practice.　 We have a physician that is in the middle of a mid-life crisis.　 This once "top doc" has become incresaing dysfunctional and disruptive to our practice.　 He is constantly running 2 to 2 1/2 hours behind schedule resulting in disgruntled patients.　 Production has dropped due to patients leaving without being seen.　 We can not put same-day appointments on his schedule due to how far behind he is constantly running.　 Daily work such as dictation, lab review, and correspondence is not being completed.　 At this time he is 3 months behind in ditation.　 Lab results are not reviewed for many, many weeks whereas we used to call his patients the very next day with results.　 The staff is frustrated because he has upset the apple cart and our daily work routines have been disrupted.　 His once happy-go-lucky demeanor has been replaced by anger and a mean spirit.　 Staff avoid interacting with him as much as possible.　 We have had a meeting with him which has resulted in no change.　 He clearly has a lack of insight into how much his behavior has effected the practice, staff, and patients.　 He has placed blame on everyone and everything else, not taking any responsibility.　 There have been a few times he has come in for work several hours late due to over sleeping because he had been up all night.　 Rumor has it that his home life is strained.　 The other doctors in the practice feel that he is profoundly depressed.　 We have asked him to be evaluated for depression and other medical conditions and he has refused.　 I believe that there is nothing good at the end of this road we are on.　 Something bad is bound to happen to him, a patient, or the practice eventually.　 The other partner in the practice (there are only two partners) feels that she is too close to the situation to deal with it.　 They have been in practice together for 20 years.　 Ignoring the situation is not the answer.　 What would you do?

So I ask my readers, "What  would you do in this situation?" I would suggest seeking the advice of counsel.　 Particularly since this doctor has an affect on the business partnership. The attorney may suggest help from the practice's malpractice carrier, its state medical board, etc. Most State Medical Societies or State licensing boards have an section to aid with physician health issues. They are designed to be the physician advocate. Sometimes this may involve "forced" entry into treatment to maintain licensing. The hospital that you maintain priviledges with should also have an program for physician health.

I-9 FORM UPDATED—NEW VERSION EFFECTIVE IMMEDIATELY

The Immigration Reform and Control Act of 1986 and amendments imposes penalties on employers who knowingly hire or continue to employ persons who are not authorized to work in the United States. IRCA generally requires employers to have all employees hired after November 6, 1986 complete Section 1 (Employee Information and Verification) of Form I-9 no later than the first day of employment (i.e., the first day of paid work); review documents that establishes an employee's identity and work eligibility within three business days of the first day of employment; and to complete Section 2 (Employer Review and Verification) of Form I-9 within three business days of the first day of employment. Employers must maintain a properly and fully completed Form I-9 on file for all current employees, and for the duration of a required retention period for all separated or departed employees.2 The failure to properly and fully complete and maintain a Form I-9 on file may result in significant civil penalties, including fines ranging from $110 to $1,100 per Form I-9.

http://www.uscis.gov/files/form/i-9.pdf

 

Top 10 tips for employers (physician medical practices)

These are excellent tips to employers provided by the Texas Workforce Commission; I think these practical tips apply to any physician medical practice no matter what state you practice in:

1. Hire for fit - train for skills - promote, transfer, discipline, or fire for documented cause.

2. Do yourself a favor - do not try to avoid payroll taxes, new hire paperwork, or unemployment claims by classifying temporary workers as "contract labor". That will only be a tax audit waiting to happen. Instead, consider hiring such workers through temporary staffing firms - that way, those firms get the unemployment claims.

3. Get as many company documents and required forms signed by employees at the time of hire as you can (it only gets harder after that), and report all new hires and rehires to the Attorney General’s New Hire Reporting office within 20 days of hiring.

4. Maintain a safe and healthy workplace in compliance with OSHA rules, and whether hiring, evaluating, promoting, transferring, disciplining, or discharging an employee, keep everything as job-related and consistent as possible, and never retaliate against an employee for reporting safety hazards, workplace discrimination, or other potential employment law compliance issues.

5. Have specific, written wage agreements with each employee, and get specific written authorization for any wage deductions that are not ordered by a court or required or specifically authorized by a law.

6. Unless an employee is clearly, absolutely, and undoubtedly in an overtime exemption category, do not pay on a salary basis, but rather pay an hourly or performance-based rate.

7. Never loan or advance money to an employee without getting a signed, written receipt and repayment agreement from the employee.

8. Give as much advance written notice as possible of pay and benefit changes.

9. In order to minimize the shock and disappointment factor that so often leads to unnecessary claims and lawsuits, treat employees fairly and consistently according to known, job-related rules and standards, follow stated policies as closely as possible, and avoid exceptions whenever possible.

10. In handling unemployment claims, file timely claim responses and appeals, present testimony from firsthand witnesses, and present clear documentation of warnings, policies, and other relevant facts.

Tips for hiring a biller for your physician medical practice

Know where to look. Staff can help recruit, too, so ask them for suggestions. A current staff member may have a friend who would fit in well with your operation. More employers are offering small incentives – for example, a $200 gas card – to employees who suggest a job candidate who turns into a hire. Managers and employees alike can network with colleagues at local medical billers’ associations. Many of these groups can also circulate the job posting. Turn to local training programs and community colleges when posting a position, as well as using advertisements in the local newspaper. Local community colleges and technical schools that train billing and office staff may be able to place interns. Internships can give you a view of how a potential candidate would fit with your team well before you ever need a replacement.
 
Get online. Online job listings like monster.com and careerbuilder.com can be expensive, but they will get the word out to a lot of people. Post the opening on your organization’s website and don’t forget about social networking. If your organization uses Facebook or Twitter, use them to spread the word about an opening. Staff might mention the opening to their online “friends” and “followers”, too.

Be patient. Yes, medical billing requires daily attention, but that doesn’t mean that you should hire the first candidate who walks in the door. Take your time, and find the right person. Consider employment like a marriage – the cost of a failed one comes at a very high price. Plan how to handle work on a short-term basis because you may need to wait to get the right candidate. If you’re hiring from another medical practice or billing service, the candidate may need to give two weeks’ notice. Don’t be put off by a top candidate’s desire to leave their previous employer on good terms – it’s a sign of respect. You’ll appreciate the same consideration when your employees leave.

Don’t overlook references. Research shows that Americans have a propensity to stretch the truth on their resumes. Check all references. Be on the lookout for anything appears sketchy (for example, all of the reference phone numbers are cell phones, or the voice of the “reference” sounds the same on every call). Look carefully at the company name of the reference, then call the main number directly and ask for that individual. If they’ve never heard of that person, you know the job candidate is trying to scam you. Speaking of scams, don’t skip the background check – essential in today’s recruiting world – particularly for someone hired to handle significant sums of money. Finally, verify credentials directly with the accrediting body – the American Academy of Professional Coders, for example, offers an on-line confirmation process to determine if a candidate actually is a certified professional coder (CPC).

Large medical practices and The Family Medical Leave Act

The Department of Labor posted a new publication called The Employee's Guide to the Family and Medical Leave Act on its website (www.dol.gov/whd/fmla/employeeguide.htm). The Family Medical Leave Act (FMLA) requires employers with at least 50 employees to provide up to 12 weeks of unpaid leave to an employee for births, adoption, foster care placement, or serious health conditions involving the employee, employee's spouse, child or parent. The new guide helps employees understand (1) who can use FMLA leave, (2) medical certification, (3) when the leave can be used, (4) FMLA benefits, (5) requesting leave, and (6) returning to work. Employees must have worked for the employer for at least 12 months, but it does not have to be 12 months in a row. Airline flight attendants and flight crew members are subject to special eligibility requirements.

When Was The Last Time You Reviewed Your Personnel Manual From A Legal Standpoint?

While not intended as a legal document, did you know your personnel manual may have the force of an employment contract? If you haven’t done so in a while, or not at all, review it to be sure it won't cause unintended problems. Like many other physician contracts, personnel manuals often do not get an annual review; they get stuck in a drawer never to be looked at again until an employee leaves the practice and a problem arises.

Perhaps you think your personnel manual as some sort of low-key presentation booklet that describes policies and benefits for your staff. Unfortunately, it's often loaded with dynamite. A variety of court decisions have made this apparent.

If you haven’t reviewed your manual recently, I strongly suggest having it reviewed by your legal counsel - make sure it’s legally correct, comprehensive, clear and relatively bulletproof. As I mentioned before, many manuals in existence today are ticking time bombs waiting to go off. You certainly don’t want to create any undue problems for yourself and your medical practice. This issue not only applies to medical practices, but any healthcare organization that issues an employee manual to its workforce.

Retaining Key Employees in Your Medical Practice

Many medical practices are you tired of losing good employees to the competition? They are looking for ways to stop the revolving door of hiring one good employee only to have two others resign? As health care organizations strive to deliver quality health care, retaining key employees is an ongoing concern. Employers can begin to address the growing concern of how to retain good employees by asking employees, “What makes for a good place to work?”

A study conducted by the Gallop Corporation found the top responses to be:

 Having the opportunity to do what I do best.
 Having the sense that someone cares about me.
 Knowing what’s expected of me.
 Getting recognition for what I do.
 Having opportunities to learn and grow.
 Being productive.

A common thread runs through these responses — effective performance management. Physician practice managers do not intentionally ignore employees’ needs for recognition and professional development. Usually absent are both a system and accountability for ensuring employees understand expectations, receive feedback about their performance, receive recognition for good performance, and have a plan for professional growth and development.

10 requirements of the perfect (physician practice) manager

Jamie over at (e)merge (http://emergewithus.com/) turned me on to this list at TechRepublic - review it - how many of these traits do you or your practice admininstrator possess?

1. Be a “people person”

2. Be visionary

3. Be a good communicator

4. Be technically proficient

5. Put your employees’ needs first

6. Encourage teamwork

7. Lead by example

8. Treat your staff like professionals

9. Encourage professional growth

10. Do something special

Satisfying all the above criteria is not enough. You are also required to do something special for your employees that:

Will be remembered fondly decades from now.
Can be shared by the entire group.
Won’t break the budget.

To read commentary to each of these traits, go to

http://m.techrepublic.com/blog/10things/10-requirements-of-the-perfect-manager/3157

Turnover is Costly

I have heard that there is a study by the United States Department of Labor that confirmed that costs to replace an employee could equal 200% of salary. Regardless of survey, we all know the actual and hidden costs to replace an employee. Some costs of unplanned turnover include:

• Departing employees costs (vacation pay and other benefits);
• Advertising for the new position;
• Management interviewing time for the new employee;
• Conducting background checks (driving, criminal, etc.);
• The time it takes to train the new employee;
• The new employee's initial low productivity;
• Unbudgeted overtime for staff covering the empty position while it is being replaced;
• Possible low morale of remaining staff and its related impact on productivity – staff becomes overworked and stressed during this time.

So my question for you is: How is the turnover in your physician practice? If high, what is the problem and how are you going to fix it?