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."

Employed or Independent - What direction is in store for you?

The trend of hospitals acquiring physician practices is back. Approached physicians are thinking should I stay put or should I sell out. My friend and colleague Mike DeVries (Mike@vmde.com) has written an excellent blog post on the subject…..check it out:

http://www.mdmanagement.blogspot.com/

 p.s. Don’t forget to follow me on Twitter: www.twitter.com/rtacpa

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.

Doctor Liable for Sleeping With Patient, but Fault Shared

It’s not funny but sometimes a good reminder of stupid things that can you one in trouble…………..A New York judge has upheld a $416,500 jury award in a malpractice action against a doctor accused of sleeping with a patient he treated for depression. However, the judge declined to strike the jury's 25 percent apportionment of responsibility to the plaintiff under the doctrine of comparative negligence. Plaintiff Kristin Kahkonen Dupree, a former model, visited family medicine practitioner James E. Giugliano for anxiety and depression after her infant daughter was diagnosed with cerebral palsy.

http://www.law.com/jsp/article.jsp?id=1202430009273

Let’s get down and tweet

Okay, I’ve finally succumbed to all of those “pundits” that say you need a twitter account to further your communications with clients, colleagues, friends, etc………..like any gives a ^&*# what I’m up to. Really don’t know yet what my tweet “strategy” is going to be but I hope you’ll drop by and check out my postings from time to time.

The New York Times calls Twitter "one of the fastest-growing phenomena on the Internet." TIME Magazine says, "Twitter is on its way to becoming the next killer app," and Newsweek noted that "Suddenly, it seems as though all the world's a-twitter." What will you think? http://twitter.com