Reed Tinsley, CPA

What can you learn from Benjamin Franklin?

I don't know about you but I really like to read blogs. I subscribe to numerous blogs and it seems I always walk way learning something new after I read them. One post I recently ran across discussed 14 action lessons that could be learned from Benjamin Franklin. It was posted at Dumb Little Man (http://www.dumblittleman.com/).

Benjamin Franklin was clearly a man who knew how to get things done. Here are some lessons we can learn from him, whether you are a physician or a practice administrator:

Less Talk, More Action
“Well done is better than well said.”

Talk is cheap. Talking about a project won't get it completed. We all know people who constantly talk about the things they are going to do but rarely ever take that first step. Eventually people begin to question their credibility. Taking action and seeing the task through to completion is the only way to get the job done.

Don’t Procrastinate
“Never leave that till tomorrow which you can do today.”

This is probably one of the first quotes I remember hearing as a teenager. With an impressive list of achievements to his credit, Benjamin Franklin was not a man hung up on procrastination. He was a man with clear measurable goals who worked hard to turn his vision into reality. What are you putting off till tomorrow that could make a difference in your life today?

Be Prepared
“By failing to prepare, you are preparing to fail.”

You need a plan to accomplish your goals. Charging in without giving any thought to the end result and how to achieve it, is a sure way to fall flat on your face. Think like a boy scout. Have a realistic plan of attack and a systematic approach for getting where you need to be.

Don’t Fight Change
“When you're finished changing, you're finished.”

Whilst many of us don’t like change, others thrive on it. Either way change is inevitable. The stronger we fight against it, the more time and energy it consumes. Give up the fight. Focus on proactively making positive changes, instead of having change merely thrust upon you. Wherever possible, try to view change as a positive instead of a negative.

Get Moving
“All mankind is divided into three classes: those that are immovable, those that are movable, and those that move.”

There’s a reason we use the expression, movers and shakers. Movers are the ones who take action, the people who get things done, while the immovable are sitting around scratching their heads wondering how others could possibly be so successful. Which group do you want to belong to?

Avoid Busywork
“Never confuse motion with action.”

We are always running around doing things. We rush from one meeting or event to the next, sometimes without achieving a great deal. At the end of the day, how much of our busywork are we proud of? How much of that running around improves anyone’s life (including ours) for the better? Make your motion mean something.

Give Yourself Permission to Make Mistakes
“Do not fear mistakes. You will know failure. Continue to reach out.”

If we fear making mistakes, we become scared to try new things. Fear leaves us nestled in our comfort zone. Staying in your comfort zone rarely leads to greatness. Taking risks and giving yourself permission to make mistakes, will ultimately lead you to whatever your version of success may be.

Act Quickly on Opportunities
“To succeed, jump as quickly at opportunities as you do at conclusions.”

Opportunities are everywhere. The trick is being quick enough and smart enough to seize them when they arise. Instead of jumping to the conclusion that something won’t work or can’t be done, allow yourself the freedom to ask what if?

Continue to Grow
“Be at war with your vices, at peace with your neighbors, and let every new year find you a better man.”

We all have vices of some description. The key is to keep them under control or preferably eradicate them entirely. Be kind to those around you, whether they are neighbors, family, co-workers or friends. Never accept that you have finished growing as a person.

Keep Going
“Diligence is the mother of good luck.”

Have you ever looked at a successful entrepreneur or business person and thought how lucky they are? Most of the time, luck has nothing to do with it. Hard work and sacrifice on the other hand have everything to do with it. Successful people deal with failure. They tackle their demons head on. They pick themselves up and keep going.

Know Yourself
“There are three things extremely hard: steel, a diamond, and to know one's self.”

Understanding ourselves is not easy. Sometimes we just don’t want to see ourselves for who we really are. It’s much easier to hold onto a romanticized version of ourselves or to simply view ourselves through other people’s eyes. Start by being brutally honest with yourself. Follow through with understanding, compassion and acceptance.

Don’t Self-Sabotage
“Who had deceived thee so often as thyself?”

We spend so much time worrying about other people hurting us, yet fail to comprehend the damage we inflict on ourselves. If you are using negative self-talk, lying to yourself or indulging in addictive behavior you are self-sabotaging. Life can dish up enough challenges without us adding to the mix. Be kind to yourself. Treat yourself like you would a best friend.

Don’t Give Up
“Energy and persistence conquer all things.”

Achieving our goals can be downright exhausting. There will be days when you want to give up. There will be times when your energy levels flatline and you wonder why you bother getting out of bed. Yet you push forward, day after day because you believe in yourself and you have the determination and strength to back up that belief.

Wise Up
“Life's tragedy is that we get old too soon and wise too late.”

Benjamin was definitely onto something with this one. Who hasn’t had the thought - I wish I could know then, what I know now? Unfortunately there is no time machine; there is no going back. The key is to wise up as early as you can to start forging a life of purpose, achievement and happiness.

Looking for a little light reading this weekend?

I’ve got nothing to do, so let’s read the healthcare reform bill. Enjoy.

 

http://www.mediregs.com/files/1007-1/FINAL-PPACA-VOL1.pdf

 

http://www.mediregs.com/files/1007-1/FINAL-PPACA-VOL2.pdf

 

Will physician practices be required to implement a compliance plan under new healthcare reform?

The section in question amends 42 U.S.C. 1395cc(j) to include a requirement that all providers and suppliers establish a compliance program.  The definition of "supplier" in 42 U.S.C. 1395x(d) includes physicians.  So far, I haven't found a provision that exempts physicians from the requirement to have a compliance program. 

This is the language at issue (Section 6401 of H.R. 3590):

(7) COMPLIANCE PROGRAMS.—

‘‘(A) IN GENERAL.—On or after the date of implementation determined by the Secretary under subparagraph (C), a provider of medical or other items or services or supplier within a particular industry sector or category shall, as a condition of enrollment in the program under this title, title XIX, or title XXI, establish a compliance program that contains the core elements established under subparagraph (B) with respect to that provider or supplier and
industry or category.

‘‘(B) ESTABLISHMENT OF CORE ELEMENTS.—The Secretary, in consultation with the Inspector General of the Department of Health and Human Services, shall establish core elements for a compliance program under subparagraph (A) for providers or suppliers within a particular industry or category.

‘‘(C) TIMELINE FOR IMPLEMENTATION.—The Secretary shall determine the timeline for the establishment of the core elements under subparagraph (B) and the date of the implementation of subparagraph (A) for providers or suppliers within a particular industry or category. The Secretary shall, in determining such date of implementation, consider the extent to which the adoption of compliance programs by a provider of medical or other items or services or supplier is widespread in a particular industry sector or with respect to a particular provider or supplier category.’’.

If you hear of anything let me know. Obviously stay tuned for further details.

What is the purpose of a deposition?

The deposition is not a time for you to present your malpractice case. Rather, it is a chance for opposing attorneys to ask you whatever they wish to know, to fill in some blanks, and finish preparing. It also gives attorneys a chance to evaluate your testifying style and determine how they will approach you at trial.

Therefore, simply answer the questions that you have been asked. Although the situation can and should be cordial, do not get involved in a lot of general conversation with opposing attorneys. They can be your friends some other time, but right now they are the opposition, and the approach and demeanor you present is important. Every attorney approaches depositions differently, so go into these sessions feeling flexible and comfortable. Also be prepared to move easily from one subject to another.

 

New Lean Six Sigma Book Takes Medical Practices 20 Years Ahead in Profitability

To help medical practices increase profitability without cutting costs or boosting revenues, Greenbranch Publishing announces a new book by two of my good friends, Lean Six Sigma Master Black Belt Frank Cohen and Practice Management Expert Owen Dahl. The book, Lean Six Sigma for the Medical Practice - Improving Profitability by Improving Processes is priced at $89 plus $9.95 S&H. It can be purchased at:

 

http://shopmpm.com/Mastering_Lean_Six_Sigma_for_the_Medical_Practice.asp

 

For the first time, this new book translates Lean Six Sigma principles and tools specifically for the real-world medical practice environment. Drawing on his involvement with thousands of medical practices, author and Lean Six Sigma Master Black Belt Frank Cohen empowers practices - and their advisors - to use 20 process improvement tools to boost efficiency so more of the revenues that come in go directly to the bottom line.

 

What types of improvements can practices make? For starters, says Frank Cohen, "They can use analytics to identify inconsistent behavior by payers - that means practices can hold payers' feet to the fire. Plus, process improvement can help practices reduce denials by upwards of 50%." In addition to optimizing reimbursement, the Lean Six Sigma approach that Cohen maps out in this book can be used to improve everything from patient visit cycle time to , A/R to staff and patient satisfaction and morale to compliance.

 

Health care providers have focused intently on improving quality of care. The recession and reimbursement issues demand that health providers and their advisors focus that same attention on the business side of the practice. This exciting book gives them the process improvement tools to do it successfully. Over the past 20 years, Lean and Six Sigma approaches have created profit breakthroughs for other types of businesses. Cohen and Dahl have brought this methodology to health care providers, whittling down the myriad of traditional Lean Six Sigma tools to only those that matter most to their practices.

 

The following is a selected Table of Contents:

 

Chapter 1: What's In It for Me? Lean Six Sigma benefits for healthcare providers, administrators, frontline staff, attorneys, consultants and payers.

 

Chapter 2: Why Process improvement? Understanding why process improvement will become the key driver for efficiency and profitability.

 

Chapter 3: Team Building How process improvement (PI) teams differ from other teams since they require step by step project management including an end date- and how to create and use them.

 

Chapter 4: Project Management How to streamline, eliminate bottlenecks, and use data and metrics for making PI decisions.

 

Chapter 5: TPI Toolbox A compilation of the most applicable Lean Six Sigma tools tailored specifically for medical practices.

 

Chapter 6: Deployment Platforms Understanding and differentiating between the different deployment platforms, including PDSA, A3, DMAIC, FOCUS and others.

 

Chapter 7: What's Next? A look into the possible future of healthcare and why process improvement transcends any possible health reform model.

 

This is a book every practice administrator and physician manager should read in addition to any consultant or CPA working with physician clients:

 

http://shopmpm.com/Mastering_Lean_Six_Sigma_for_the_Medical_Practice.asp

J-1 & HI-B Visas - Use by Physicians

From Lathrop Gage law firm (www.lathropgage.com):

Immigrant visas are for people who intend to live permanently in the U.S. Nonimmigrant visas are for people with permanent residence outside the U.S. but who wish to be in the U.S. on a temporary basis – for tourism, medical treatment, business, temporary work, or study.

The J-1 visa is for study. The J-1 visa recipient must return to his or her own country unless a waiver is obtained.

The H1-B visa is for work.

J-1 Visa.

The J-1 visa holder is supposed to return to home country for specific period of time, absent a government waiver. If the J-1 visa holder is subject to the two-year foreign residence requirement, absent a waiver, the holder may not change status to that of H, L, or K, or to immigrant or legal permanent status until you have fulfilled the two-year foreign residence requirement by going back to the holder's home country or receiving a waiver of this requirement.

A J-1 Visa Waiver eliminates the two year home residency requirement, allowing the physician to remain and practice in the United States. State government agencies may also sponsor a J-1 Physician waiver requests, which are called Conrad State 30 programs.

The J-1 Visa Waiver program has been instrumental in maintaining access to healthcare in many rural communities when other recruitment efforts have failed. The J-1 Visa Waiver is contingent on the physician working in a HPSA or MUA, the program produces a win-win situation for the doctor and the community. The physician is able to stay in the United States to practice and an underserved community gets a much-needed doctor.

There are five statutory alternatives upon which to apply for a waiver of the two-year foreign residence requirement:

• a no objection statement from exchange visitor’s country, issued through its embassy, referred to as a No Objection Letter - takes an average of four months;
• a request from an interested U.S. Government agency on your behalf, referred to as an International Government Agency Waiver - takes an average of four months (For IGA applications on behalf of foreign physicians, who agree to serve in medically under-served areas, please refer to Federal Register Volume 62, No. 102 of May 28, 1997.); 
• a claim that you will be persecuted if you return to your country of residence, referred to as an Asylum Waiver - takes an average of nine months; 
• a claim of exceptional hardship to a U.S. citizen or permanent resident spouse or child if you are required to return to your country of residence, referred to as a Hardship Waiver - takes an average of nine months; and 
• a request by a designated State health agency or its equivalent - takes an average of five months.

H-1B Visa.

An employer must agree to hire and sponsor the immigrant. (Most medical fellowship programs will not sponsor H1B visas.) The H1B visa is that it is a 'dual intent' visa which means that the recipient can apply for a Green Card (Legal Permanent Residency).

The Process to obtain an H1B Visa is as follows:

Step 1 - Find an H1B Sponsorship Job with a US sponsoring employer.

Step 2 – A US H1B employer files the H1B Visa Application with the US Immigration Bureau. An H1B visa is typically valid for up to six (6) years (3 years with 3 year renewal) and entitles a spouse (husband/wife) and children (under 21) to accompany H1B visa holder and live in the USA on an H4 visa. The H4 dependent visa does not allow your spouse/children to work but they to can get their own H1B visa.

The H1-B visa is a non-immigrant visa, which allows a U.S. company to employ a foreign individual in a specialty occupation. A specialty occupation requires theoretical and practical application of a body of specialized knowledge along with at least a bachelor's degree or its equivalent. For example, architecture, engineering, mathematics, physical sciences, social sciences, medicine and health, professional nurses entering the U.S. to perform complex job duties or supervise nursing operations education, business specialties, accounting, law, theology, and the arts are specialty occupations.

Upon expiration, the alien must have become a citizen or remain outside the United States for one year before another H1-B petition can be approved.

Get Up and Think

This is a little off the cuff but did you know that instead of sitting at your desk trying to solve a complicated problem you might actually be better off getting out of your chair and moving around.  In this study, researchers found that, "a person's ability to solve a problem can be influenced by how he or she moves."  In other words, our minds and bodies can work together to help us solve problems:

 

The new findings offer new insight into what researchers call "embodied cognition," which describes the link between body and mind, Lleras said. "People tend to think that their mind lives in their brain, dealing in conceptual abstractions, very much disconnected from the body," he said.

 

"This emerging research is fascinating because it is demonstrating how your body is a part of your mind in a powerful way. The way you think is affected by your body and, in fact, we can use our bodies to help us think."

 

Next time you've got a problem to solve, get up off your butt, move around a bit, and you might find that your body helps your brain find the answer.

Current Physician Recruiting Trends

The following comes from Jeffrey Sisk, President/CEO of PhysicianWork.com

I have had the opportunity to talk with a large number of physician recruiters over the last few weeks about the state of the physician recruiting industry as a whole. These recruiters are from hospitals, health systems, medical practices, permanent placement firms and locum tenens companies, and some of their feedback has been very insightful. I thought I’d share some of this information with you because it is thought provoking and gives each of us a clearer picture of the current physician recruiting environment. I think it is important to share this type of information with the physician recruiters in our network.

If you are recruiting permanent physicians, this is one of the more difficult recruiting environments we have ever seen. Many physicians are afraid to consider changing jobs for a variety of reasons that are all related to the current economic state of our country. Some of the specific reasons mentioned to me recently are: It is very difficult to sell your home in the current real estate market at a fair price. Home values are way down and it’s a buyer’s market. If you are lucky and can sell your home you will have difficulties getting a new home loan because banks aren’t lending money; especially for jumbo home loans on larger homes and physicians typically purchase a home in this category. Also, physicians, just like many Americans, have seen their savings and retirement accounts shrink considerably because of the drop in stock prices so they feel that their financial “safety net” is no longer there. Overall, there is a lot of uncertainty about the future, so even if a physician isn’t happy in his or her current job, they are more likely to stick it out in their present position until things get better.

Additionally, many physicians (especially primary care and non hospital based specialties) are reporting drops in the number of patients scheduling office visits and elective procedures. Consumers have slowed down routine medical care and are seeking treatment only when they are sick. Consequently, many medical practices have stopped growing and therefore do not need to recruit additional physicians. In some cases, practices already have “one physician too many” in the practice. There is apparently a stable demand for hospital based specialties at the present time because hospitals treat sick patients, so recruiting needs in these areas should continue to be strong.

The shining star in the current market would be for the locum tenens physician, and locum tenens companies. Facilities that are desperate to recruit a permanent physician are turning to locums to fill the gaps in their recruiting needs until they can find a more permanent solution. My advice to any physician who loses his or her job in this economic climate would be to work locums for a while until things improve. These jobs will be easier to find, you don’t have to sell your home to work locums (they will put you up in a hotel and provide a rental car in most cases), and the locum tenens company is picking up your malpractice costs.  If you are a medical practice, hospital or health system with critical recruiting needs, you may want to consider utilizing locum tenens physicians to fill your needs for the near future. In some cases you may find a permanent hire and this is a good way to find out if a physician is “a good fit” with your practice because you get to see them in action before you hire them permanently. Keep in mind though that many locums physicians are working locums because they are not interested in a permanent job, so they may only be a temporary solution for you until the economy recovers.

This is the bottom line for physician recruiters based on the information coming in to us here at PhysicianWork: The current candidate pool of physicians is greatly reduced as compared to previous years. In this economic climate you’re not going to be covered up with stacks of CV’s from any recruitment advertising resource you are using. Candidate response rates will be low or moderate for most specialties and you will have to be patient with your advertising programs. The key here would be to use as many recruiting resources as possible, and do not have unreal expectations of these resources. In other words, if you are using a known national physician recruiting resource, you shouldn’t terminate these ad programs because you aren’t getting the large number of candidate responses that you have in the past. Stay diligent with these programs because they are the ones most likely to produce viable candidates for your company. If you stop using good national resources that you know have traditionally produced results, then you will further isolate your company’s visibility to an already reduced candidate pool. Most of the good national physician recruiting resources will produce results, but it takes more time and you have to be patient.

So, where is the market headed? At the present time, not even “the experts” can tell us when things will turn around with our economy, the real estate and financial markets. So, physician recruitment will continue to be more difficult in the near term than it has been in the past.

 

Getting creative on the job

I found this great list of 100 Simple, Low-Cost, Soulful Ways to Be More Creative on the Job and wanted to share it with you.  Next time you're stuck, pick a few off the list at random and give them a shot.

Some physicians cutting fees and offering payment plans during economic downturn

The Washington Post/Kaiser Health News (6/2, Boodman) reports that "doctors are encountering more patients struggling to pay for care," and as a result, some physicians are now "selectively cutting their fees or devising novel payment arrangements." These physicians "say they feel a responsibility to help strapped patients," and "some say assisting patients pays dividends in the form of loyalty, which will benefit them once the economy recovers." Meanwhile, "others have taken a harder line on billing and are sending more overdue accounts to bill collectors" as they face "rising overhead and static reimbursements." But, "whether the downturn will lower physicians' incomes this year remains to be seen." According to "a survey by Sullivan, Cotter, and Associates...doctors' incomes increased an average of four percent last year, despite the souring economy."