All posts by Nicola Hawkinson, DNP, RN, RNFA


Reviewing an Orthopedic Practice’s Ancillaries

An Orthopedic Practice should like about reviewing ancillary services by looking at which procedures and tests your practice is referring out. Building practice profitability require sufficient time and effort. Having a marketing plan in place and considering the amount of time, staffing and space needed will help create a new form of revenue for the practice.

For some physicians, the decision to add ancillary services is a matter of survival rather than a choice. Before this becomes the case, carefully assess where the market potential is. Does you practice contract out to physical therapists and ambulatory surgery centers? Design a marketing plan for adding ancillary services and market to your patients accordingly. Marketing to the public might take more time but convenience and patient health will help add revenue. Understand the location of your practice and what medical procedures might be underserved in that area in order to better serve patients.

Five Steps for Changing Medical Practice Patterns

The initial startup for a practice can be overwhelming and hectic. The staff needs to be hired and trained; but, what happens down the line when your practice starts to grow but there are many inefficiencies? Changing bad habits is time consuming but not impossible. Here are five steps for creating a more productive work environment for you and your staff.

1) Don’t Overlook the Small Stuff
All too often medical practices make the mistake of hiring people who don’t fit the job description. For instance, hiring a nurse for a private practice when he/ she wants OR time and prefers a hospital environment. At first, it may not seem like a huge deal but eventually this will become a problem. Taking the extra time to recruit the right person will save more money in the long run and boost revenue. Patients want to feel like they are the priority; hiring the right medical staff is one key to a successful practice.

2) Changing Behavior and Attitudes
A competent practice manager can help diffuse disagreements between doctors and staff. If one doctor refuses to work evening or Saturday hours, forcing the other doctors to pick up the slack, this can impact a practice negatively. Weekly meetings should be held in order to ensure all staff is on the same page. If issues arise, the medical staff should feel secure that any problem will be handled professionally and in a timely manner.

3) Understanding Different Physician Personalities
Every physician has a different ways of working and connecting with patients. Some Physicians are task oriented and enjoy seeing as many patients as possible. Other physicians might be research oriented and enjoy having the time to write journal articles or attend continuing education seminars. Every doctor serves a purpose in the practice. It’s important to understand that even though every doctor is different there is no reason why they can’t work together. Having different personalities in the workplace can be have a positive impact if they are managed properly.

4) Apply the Framework
Incentivizing medical staff from the beginning of employment will help keep bad habits at bay. Remember, even though incentivizing is important, making sure there are consequences for poor behavior is just as important. Make sure the medical staff has the correct guidelines to follow from the start of their employment. In order to increase revenue, the medical staff must work efficiently.

5) Look Ahead
Don’t just focus on the current day or month, focus on the future as well. Plan ahead for your practice, but be flexible enough to make changes when they are necessary. There will be less surprises down the road and less chances for your practice to fall short.

Best Practices when Conducting Pre-Employment Screening of Medical Staff

After interviews have been completed with potential future employee(s), there comes pre-employment screening. Pre-employment screenings are a necessity. Pre-employment screening is the type of checks that employers conduct during the hiring process when an offer has been made to the candidate(s). The types of screenings companies include are criminal background check, credit checks, employment history verification, education verification, and driving record checks. This step in the hiring process is critical to making a final decision and, if all goes well, then the next stop is to think about how best to manage the candidate’s transition into the organization.

Employment history and education verification as well as reference checks can reveal information that causes you to eliminate a candidate. For example, you may find that the candidate exaggerated information about employment history or education on his or her resume.

Contacting references provided by the candidate is an easy way to determine whether or not he or she is suited for the company.
5 Tips to Remember When Checking References:
1) Ask candidate to sign a waiver: the waiver will grant you permission to contact references.
2) Ask candidate for at least 5 professional references. You will need to contact all 5 and most likely only 3-4 will contact you back. You want to be able to get as much information as possible to see if the candidate has the right attitude and personality for your organization. Professional references should be at least a manager/supervisor from a past job, or a co-worker.
3) Ask candidate for references within the last five years. A reference check should cover the most recent five years of employment. Most people will be hard pressed to remember the specifics of an individual’s past job performance outside of five years.
4) Verify all degrees and licenses. It is unfortunate that people misrepresent themselves on their resume. You should always call the state licensing board and school registrar’s office for confirmation and verification.
5) Ask open ended questions during the reference: the goal of references is to learn as much about the person as much as possible. Refrain from asking questions about age, race, sex, religion, marital status, or national origin. These are the categories protected by law, and have no bearing on the person’s ability to do the job.

Criminal background checks are mainly performed for security purpose. In other words, they target to protect companies from potentially risky candidates. Some companies like to perform the background checks themselves or some may have third party agencies complete the background checks. There are several things you should know about the candidate when conducting a proper criminal background check.

1) Full name (preferably what appears on the candidate’s driver’s license or another government-issued document) including any nickname and maiden name.
2) Date of birth from an official source (e.g., driver’s license, passport, birth certificate, etc.)
3) Current Address where the candidate is resides.
4) A social security number.

In regards to healthcare sanctions background check, it searches a U.S. Federal Government list to detect individuals and organizations that have been excluded from participating in Medicare, Medicaid, or any federally funded healthcare programs due to fraud and/or abuse. In conclusions, it is important to promote quality, safety, and value to your organization and conducting pre-employment screenings on medical staff can secure the future for your establishment.

Utilization of Medical Scribes

Hospitals and private practices are utilizing medical scribes in order to fill the gap left by EMR systems. With EMR systems becoming more prevalent, there is now a way for physicians to effectively treat patients and document their visit in real time. Emergency physicians are finding that scribes are becoming an asset in healthcare rather than a cost. However, the use of scribes has not caught on with private practice physicians, and since EMR systems are still on shaky ground with physicians and there has become an increasing need for medical scribes in hospitals as well as private practices.

Physicians are still unsure about how to properly use EMR systems. In some cases the interest level may not be particularly high, but in other cases, there may be lack of trust with a system and inclusive amount of training time needed. Doctors run on busy schedules and are often rushing from patient to patient. They frequently get stuck doing after hours dictation, and this increases the doctor’s stress level, exhaustion and could lead to burnout. Scribes are able to take on the clerical aspects of patient care. The average pay for a scribe could be anywhere from $9-$25/hour, but a lot of the benefits of having scribes on staff are non-monetary; Medical scribes are able to cut a lot of the stress felt by physicians and increase patient satisfaction.

Becoming a medical scribe can be a great move for students who are interested in attending medical school. Working as a scribe looks great on a resume, and scribes learn important terminology and training that will ultimately help them in medical school. Scribes also build up a professional network of doctors and nurses that could lead to great letters of recommendation; the extra experience prior to residency can be invaluable to any med student or anyone who is looking for a long term career in healthcare. However, scribes usually have a high turnover rate because students that are in medical school cannot commit to being a scribe for more than a year or two; but usually scribes are highly motivated and willing to go through the training process so there is little to no problem finding a replacement. Scribes are able to have a first-hand account of what it’s like working in a fast paced setting with a preview for how physicians think. Medical scribes are nonclinical or clinical employees that work under a doctor’s supervision. Some medical students choose to work as a scribe in order to gain a better understanding of the healthcare field; other non-clinical medical scribes generally have an interest in medicine but are not licensed to provide healthcare. Since the scribe in the room with the doctor and patient, the doctor does not have to do after hour’s dictation.

Scribes are able to boost the EMR productivity since offices and hospitals are in a period of transition where the learning curve is high. The daily responsibilities of a scribe include: taking patient histories, transcribing details of the physical exam and patient orders, documenting procedures performed by the physician, recording physician-dictated diagnoses, prescriptions and instructions. Some patients fear that scribes are not adept enough to pick up on drug interaction warnings. However, this can be avoided with proper training and routine performance evaluation. In order to make EMR’s more successful in hospitals and private practices there needs to be proper training for physicians, nurses and nonclinical staff and utilizing medical scribes is one way to help reinforce and stay on top of quality patient care.

How to Manage Physician Staff Performance

Effectively managing clinical staff, for a medical practice, takes a lot of work and can be stressful at times. However, taking the proper steps to manage physicians and medical staff will boost revenue and decrease your turn-over rate. There are six steps that every practice should employ in order to create a productive and stress free work environment:

1) Shared GoalsPhysicians and staff should all share the same goal which is providing quality care for all patients. This is an overall goal for your practice as well as an individual goal for each physician and member of the nonclinical staff. In order to create shared goals amongst doctors and staff, there has to be guidelines and mission statement for staff. Creating a specific office culture that encourages growth and hard work will ultimately benefit how your practice operates. Connect with members of the staff during meetings in order to form cohesive goals that will have measurable outcomes.

2) Clearly Defined Roles
For any practice to function, and function well, roles need be to be clearly defined prior to an employees’ start date. A lot of the issues that arise between healthcare professionals have to do with confusion about job responsibilities. However, cross-training staff to learn your current EMR system may be a good idea; if someone is out sick then you won’t have to worry about jobs not getting done. It’s easy to say that doctors treat the patients and the staff controls the filing and scheduling, that’s true, but there is a lot more to the daily operations than just patient flow. When hiring an employee there needs to be a clear set of job skills and responsibilities that need to be met not just so they can understand their role, but the employer can organize daily operations of the practice better.

3) Effective CommunicationCommunicating effectively may seem like the easiest part about managing clinical staff, this is not the case; you’d be surprised to hear that many practices flounder because of poor communication. Communication needs to start with the practice manager and trickle down from there. If the practice manager does not communicate well with staff, then other aspects of the practice will suffer; revenue might decrease and the turnover rate will be high. Employees do not want to work in a setting where they are not given proper direction; the environment becomes chaotic and no practice can afford that.

4) Physician Productivity
How the physician is able to conduct his/her work on a daily basis greatly affects the entire staff. Dividing tasks into two categories: clinical and non-clinical, so the physician isn’t doing tasks that take away from seeing patients. Reducing unnecessary inbound calls and interruptions by nurses will help give the physician more structure throughout the day and maximize the amount of face-to-face time with patients.

5) Evaluation
Evaluating medical staff regularly and consistently can help you stay on top of staff performance. From the start of employment, a physician should know about your evaluation system and that they will be evaluated on regular basis. This will help doctors and nonclinical staff know that you will be evaluating them in order to better their job performance and better the practice overall. If you notice an employee is underperforming, there should be a set time limit for improvements. Documenting problems with a staff member will help you in the long term in case termination is necessary.

6) Mutual Respect
Holding weekly staff meeting will help develop respect between clinical and nonclinical staff. Meetings are a good way to keep in touch and stay on top of things. This does not mean your staff should feel like they are being micromanaged. Giving your staff enough room to excel at their jobs while staying on track of their performance will have a positive effect on your office culture.

Improving Medical Office Efficiency

In order for your medical practice to run at its optimal level, you must take the time to evaluate your current practice and fix what’s keeping you from having an efficient medical office space. First, start by evaluating your own productivity; make a list of tasks you perform every day and see what most of your daily efforts are going towards. Some tasks might be responsibilities only you can perform while others could be delegated and therefore your time could be better spent focused on other things. How you handle your workload greatly affects the rest of the office’s workflow. You must set the tone for how the office should operate. For instance, if you’re disorganized and run late with patients then your staff falls behind on their own work. Some staff members might even pick up on your bad habits and emulate them, making the office run ineffectively.

You should also take the time to hire qualified staff members, both clinical and non-clinical, to work for you. How the medical staff operates depends greatly on how well they can do the job you’ve hired them for. If you don’t feel like you have time to dedicate going through resumes, you can always hire a third party medical recruiting company to only send you qualified candidates and perform background checks.

Another way to help your medical practice is to have a system of employee evaluation in place. Allowing staff members to asses themselves and be evaluated by the physician or practice manager can help improve employee satisfaction and this will cross over into other areas of the practice. By fixing small problems, committing to timeliness, and planning ahead your practice will only improve and become more efficient.

Hiring a Nurse Practitioner / Physician Assistant Increases Patient Satisfaction!

If you’re looking to hire an NP or PA the benefits can have a great impact on your practice. The American Association of Medical Colleges (AAMC) estimates that the U.S. will face a physician shortage of over 90,000 physicians by 2020. Due to this fact NPPs are becoming increasingly important to primary care and overall patient satisfaction.

Patient satisfaction is the most important aspect of your medical practice.

In some cases, Physicians might be concerned that an Nurse Practitioner or Physician Assistant won’t garner the same respect as an MD, but this has proven not to be the case in many instances. Studies have shown NP/PAs score equally with physicians in terms of patient satisfaction. The Kaiser Permanente Center for Health Research found that patient satisfaction levels based upon interpersonal care, confidence in the provider and understanding of patient problems ranged between 89 and 96 percent for PAs. Nurse Practioners & Physician Assistants handle many types of office visits that a physician may be too busy to do, including: preventative care services, diagnose conditions, evaluations and therapeutic plans. If NP/PAs take time to establish relationships with their patients, they can build a positive rapport that will increase satisfaction, accessibility, and productivity. Hiring NPs and PAs are not only a financial benefit, due to the decreased salary expenses, but they also ensure that your medical practice will run more efficiently. If your practice is running more smoothly, then patients will be happy with their quality of care making Nurse Practitioners / Physician Assistants an invaluable benefit to your practice.

Utilizing a Third Party Medical Biller

Medical billing for your practice can be a stressful task. A lot of medical practices use in-house medical billers to file claims, but more often than not the process is lengthy and mistakes can slip through the cracks.

Outsourcing medical billing can help the billing process run more efficiently. In-house billing can increase the overall costs of your practice for a few reasons:

1) In-house billing requires a significant investment keeping up-to-date with practice software.
2) If you have a high turnover rate for your billing staff then this could slow down the billing process and the practice will suffer.
3) You might be a new provider and you have a lot more to worry about, and hiring a billing staff can be hassle that takes up time spent on patient care.

Outsourcing your practice’s medical billing can relieve some of these stressors. Third party services typically have a decreased number of rejected claims and reduce the time it takes to receive payment. Your practice is also saving thousands of dollars on annual salaries and benefits it would take to employ an in-house staff. Increasing your practices revenue by reducing overhead costs will lead to better quality of care for patients. Experienced third party billers ensure that claims are filed properly and in a timely manner. However, if you hire a company that is known for poor service but is cheap you won’t be seeing a big difference. You have to do some background work and look into billing companies that have good reviews and are known for providing great service then you will see why outsourcing medical billing is the right choice for your practice.

Hiring a Medical Marketer for Your Practice

Physicians may not see the benefits in hiring a medical marketer but good marketing can help double or triple your current business. Of Course you’d want to hire an experienced marketer with a resume to back it up; a marketer’s salary can be high depending on what state your practice is located in. You don’t want to be paying a marketer to do a job they are not equipped to do that’s why a candidate needs ample experience listed on his/her resume.

Medical practices are using more technology than ever before and patients can search for a practice on the internet before making an appointment. A marketer can help advertise for your practice on social media and manage your practice’s website. Also, a medical marketer should be utilized to handle public relations; this means they may be working odd hours and not the typical 9 to 5 work day. Remember that a medical marketer does not need a healthcare degree, but he/she should have a good understanding of your practice and your practice’s specialty. A degree in business/marketing may be more suitable, but someone who has worked with a hospital or medical practice before is a necessity. You do not want a marketer who has zero experience working with some type of medical practice. If you feel like your practice can’t afford a new hire you may want to ask your office manager if they can fulfill some of the marketing tasks, but make sure your office manager is on board with these new responsibilities. You want to see results and if your office manager can’t commit to that then you should talk to a financial consultant and see if you can budget to afford a medical marketer even if it’s just part time.

Take the proper steps to hire a medical marketer and be involved in the hiring process. Medical marketers can really help a practice on so many levels; it’s better to hire someone else to do the marketing than trying to treat patients and keep track of public relations and social media.

What do Medical Apps Mean for Your Practice?

Medical practices have adopted more technology throughout the years and currently more practices have been adopting Electronic Health Records systems (HER). However, patients have been using technology to track their health, while health care providers have been using it to keep track of their patients’; Medical Apps are growing steadily. Patients can track their own health and wellness, while doctors can view a patient’s x-rays on their mobile device. One major concern is privacy. The FDA has made efforts to regulate mobile apps by overseeing the safety and effectiveness and they ask for feedback from health care providers, but is this enough? More than 50 percent of doctors use a smartphone for work purposes. A doctor in a hospital or medical practice can use their phone to receive pages or to access EMR/EHR systems. Since the use of EHR/EMR systems is on the rise medical practices will need to make adjustments to accommodate the new technology. Maintaining patient privacy needs to be the number one priority. In order for medical apps to be effective both patients and doctors need to become mindful of pros and cons. Doctors, Nurse Practitioners and Physician Assistants should make patients aware that although some medical apps can help them stay on track with diet and health, they should only be supplementary to care they receive from a doctor. Doctors should also be careful about accessing EMR/HER information through a mobile device, and using the proper password protection to ensure patient confidentiality.