Practice Points

What is credentialing and how does it work?

2009-08-12T06:33:00.000-07:00

Credentialing is the process of obtaining and reviewing the documentation (licensure, certifications, insurance, etc.) of health professionals.

Visit VantagePoint's new website, www.credentialingphysicians.com, to learn more about the process of credentialing and how VantagePoint can help your practice.

Retaining Patients when an MD leaves the practice

2009-03-11T19:44:00.000-07:00

When a provider leaves a practice, there are a significant number of steps that the practice should take in an attempt to retain patients. The value of each patient is hard to measure, but in some practices when the patient can potentially be followed for 20 years or more, the value is immeasurable. Losing patients has a devastating financial impact on your practice.

When the departing physician opens his own practice within close proximity to your location, the likelihood that patients will follow him is pretty high. What, then, are the steps that you can take to insure that your patients stay with your practice?
1. Run a report from your practice management system identifying those patients affected by the departure.
2. After the news about the departure is public, compose a letter to those patients. Ask each patient to consider staying with the practice. Highlight benefits to doing so (keep it short). Include an updated practice brochure.
3. Pay special attention to internal marketing (superior patient service), friendly staff, timely return of phone calls, ease of Rx refills, no-hassle completion of paperwork, etc.
4. When patients request their records for transfer, phone them and ask if they would reconsider staying with your practice. Offer a “complimentary” visit. If the patient agrees, make sure that visit is to establish a relationship with the patient; a one hour-consultation would exceed anyone’s expectations.
5. Insure that you have sufficient coverage for existing patients and those who stay with the practice even if it means hiring a locum tenens.
6. Increase/Improve services:
a. Expand office hours to early morning (before work) and evenings (after work) as well as during the lunch hour
b. Expand office hours to weekends (Saturday AND Sunday)
c. Accept walk-in’s and urgent appointments – leave sufficient time in schedule
d. Make house calls
e. Return patient phone calls within one hour
f. DO NOT keep patients waiting
g. Insure that your web site is interactive; patients should be able to make appointments, register, etc. on line
h. Allow patients to e-mail providers (or have a designated e-mail box for clinical triage)
i. Offer patients a copy of your dictated or recorded medical note at the end of each visit
j. Offer patients a MEDI-KEY that is updated after every visit
k. Consider financial arrangements for co-pays (even the smaller amounts)
l. Place ads in local newspapers outlining your expanded services. Ads should be run frequently over several months
m. Consider other forms of marketing such as radio, TV, billboard, web, etc.
Understand that you will lose some of the departing physician’s patients, but if you do nothing, you may lose all of the patients.

Protecting Your Practice

2009-02-08T13:06:00.000-08:00

Even in the best of times, protecting your practice and its assets should be at the top of your priority list. The fact is, however, given the choice (especially when things seem to be running smoothly), you’ll choose to treat patients over dealing with business matters virtually every time. But these are far from the best of times – probably the most challenging you’ve faced – and protecting your practice must be at the top of your list.

Who’s Minding the Store?
By now you’ve probably taken every measure you can think of to reduce expenses and increase revenue. But one issue that most physicians ignore until it’s too late is employee fraud.* Ranging from theft of office or medical supplies and making long distance phone calls to skimming cash, creating fictitious refunds or over-billing, the possibilities are almost limitless. You’d like to think that you hired good people who would never do anything like that to you, but the sad truth is that some experts estimate three of four physicians will suffer a significant loss due to employee dishonesty at least once in their careers. And, once again, don’t underestimate the potential impact of today’s dismal economy. Any doctor who has experienced this situation knows that the discovery of fraud is just the beginning. Oftentimes the monetary value of the fraud is outweighed by the accompanying employee morale problems, personal grief, loss of productive time, administrative burden, and litigation costs.

∗ For purposes of this article, the term “fraud” is used to cover various forms of employee dishonesty including theft and embezzlement. The Law.com Dictionary defines fraud as “the intentional use of deceit, a trick or some dishonest means to deprive another of his/her/its money, property or a legal right.”

The “Fraud Triangle”
Researchers have identified three key factors commonly known as the “fraud triangle” that are typically present and usually determine whether someone will commit fraud:
• Need or pressure – this can be financial in nature (e.g., high debt due to overspending or reduced household income), personal (e.g., a chemical addiction), or work-related (e.g., feeling underpaid or underappreciated)
• Opportunity – when an employee feels he or she has gained a substantial level of trust and/or the organization’s internal controls are weak, the employee could see an opportunity to commit fraud and get away with it
• Attitude/Rationalization – is the employee’s rationalization of the dishonesty strong enough to outweigh his personal moral code? (e.g., “I’m only borrowing the money; I’ll pay it back.” “They make so much money; they’ll never miss it.”). An individual can perceive both a need and an opportunity, but a strong enough moral code can stop them from rationalizing the dishonest behavior.

Some Schemes
In 2008, we saw an increase in the number of clients where, through practice reviews, we uncovered some internal schemes that were undetected. These included, but were not limited to:
• Paying a relative who was not employed by the practice
• Paying for overtime not worked
• Paying vendors for services not performed; vendors were related to the employee
• Paying for services to a company owned by the employee; where no services were rendered
• Processing refunds to an employee via the credit card machine
• Using practice credit card to make personal purchases
• Endorsing checks and depositing them to a personal account
• Skimming co-pays
• Purchasing office equipment and having it delivered home
• Posting payments to patient accounts and pocketing checks & cash

Physicians need to understand the business of medicine, what is going on in their practices and how to prevent what can be financial disasters. Annual reviews and unannounced spot checks by professional advisors are recommended; even with the most trustworthy employees. Ask how VantagePoint consultants can help.

"We had a LOT of irate patients!"

2009-01-03T17:20:00.000-08:00

This is what the secretary of my husband’s PCP office told me four days after we had left a message in the voice mailbox for prescription refills. It seems they had left for the holidays, but no one bothered to plan for handling incoming messages left in various mailboxes. Her response when I suggested that they develop protocols was, “Well, I guess we won’t do that again!”

Combine this lack of protocols (and lackadaisical attitude) with a second failure in their system. My e-mail message on the same day to the physician’s personal e-mail address (which he supplied) was never answered.

Imagine the risk to patients due to this lack of basic risk management procedures. What would my 80 year old mother have done if she phoned and couldn’t get a refill? You’re right…she would have gone without the medication and waited until she heard back from the doctor. How many patients in this practice went without medication for FOUR days?

Risk Management procedures must be developed for even the most basic processes. Every practice should develop policies and procedures that include:

1. Signing In. When calls are retrieved each morning (from answering service), how do you ensure that there is immediate follow-up and contact with those patients? Who is responsible and how are the calls documented?
2. Automated Answering vs. Answering Service. If you DO NOT use an answering service, is your automated message CHANGED when necessary? Is the message clear that you are not available, and does the message inform the patient what to do for urgent or emergent matters?
3. Patient Calls After Hours. If a patient is cared for after hours, via phone, how is that conversation documented in the medical record? If prescriptions are called in, how are they tracked? How do you ensure that patients are not calling each of your physicians on different nights to obtain controlled drugs?
4. Automated Voice Attendant. Do you regularly check and monitor your automated attendant to ensure that all extensions go somewhere? Do you include an immediate message that allows the patient to press “0” for a human? Do you include an immediate message that informs the patient what to do in case of emergency?
5. Voice Mailboxes. What policies are in place to ensure that EVERY mailbox is checked regularly (more than once per day)? When an employee who terminates from the practice has a voice mailbox, how is it changed or monitored?
6. Prescription Refill Mailbox. Is the mailbox checked HOURLY during the day? Are all refills called in to the pharmacy (or contact made with the patient) by 5 p.m.? Are these refills recorded in the patient’s medical record?
7. On Call Coverage. When you sign out to another practice or physician, is it made clear to your answering service? Is it clear in your automated message? Have you contacted the covering physician’s office to verify that she is covering, and is her office staff aware of the coverage?
8. Returning Calls. Are patient phone calls returned in a timely manner? Are all calls returned by the end of each day? Do patients know when to expect a call back so that they don’t keep calling you?
9. Reviewing test results while provider is away. When a physician is out of the office, is someone else responsible for reviewing test/lab results that are coming in? How are you handling “abnormal” test results while the provider is away?
10. Managing e-mails. Once you provide patients with your e-mail address, then e-mails must be managed like any other patient message. Are you checking them regularly during the day? Are you responding? How are these messages being recorded in the medical record?

These and other risk management policies protect your patients, your practice, AND the providers. Be diligent about establishing written protocols, train your staff, and hold everyone accountable.

Practice Pointers: Five Hiring Tips

2008-03-24T18:02:00.000-07:00

Recruiting and hiring competent support personnel is an on-going challenge in every medical practice. Here are a few tips to keep in mind:
1. Advertise using multiple sources. Different candidates will seek jobs from a variety of sources (on-line postings, newspapers, job boards, professional magazines/periodicals). Be sure to use all sources to place your ads.
2. Create an ad that will generate activity. If your ad reads as a generic job opening, you will have a lower response rate than writing an ad that includes descriptive phrases and outlines opportunities, benefits, and compensation package.
3. Ask for a handwritten response. You can ascertain a person's ability to put pen to paper, what they write, how they organize thoughts, the "neatness" factor, clarity, and presentation.
4. Check references. Call references provided, but also call all previous employers to validate dates of employment, positions, and responsibilities. While previous employers can only provide limited information, you should ask, "Would you re-hire this individual?"
5. Have more than one individual interview the candidate. Involve multiple individuals interview the candidate. Managers and supervisors are a given, but also consider involving co-workers in the process. Make a decision together.