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Customer Service and Pediatric Practice Management

May 11, 2012 in Blog by support Team  |  Comments Off on Customer Service and Pediatric Practice Management

I had a HORRIBLE customer service experience with a technology company this week. During business hours, I waited on hold for 29 minutes prior to a representative being available. After about 20 minutes on the phone with the customer service representative, it was obvious that she did not understand the issue
or how to resolve. She asked for another 20 minutes to check out some aspects of the issue but was unsure if she would be able to resolve the issue (technical issue with a phone they support for us). At this point I was extremely frustrated and needed to take charge of the call to provide options to her (she should have provided the options to me). She did not have an understanding of the problem for us – unsure if it was lack of listening skills or lack of knowledge. Investing more of my time on hold would have increased my frustration so we terminated the call with no resolution – missed opportunity. What could have this organization done differently? Plenty. First, no customer should wait more than 5 minutes to speak to a customer service representative. Management needs to be on the hook for staffing as well as monitoring customer service. Second, the company posted a ‘green light’ on their systems while the customer representative stated there is a major problem with their systems. The internal processes and procedures need to align when there is a problem. There are other items this company could do to further the customer service experience after they can move to an acceptable/basic level. Although we are not perfect, we are on the pursuit of perfection each day which causes continuous improvement of a ‘good’ customer experience. Constant re-engineering of processes and methods should be the norm with all organizations including the investment of people and resources.

How does this relate to Pediatric Practice Management? Pediatric practice management requires good customer service. When a patient calls during business hours, they need to be able to speak to a live person without waiting for more than a few minutes or receive a voicemail that they can leave a message when the question relates to a bill or other administrative function (e.g. follow-up on insurance information). Also, patients need to be able to leave a message any time after hours (this saves them time). We have picked up clients for which the previous billing service did not provide this level of service. Appropriate level of service is critical to managing the revenue cycle and the revenue cycle is a ‘team’ effort.

Some Questions to Ask when Starting a Pediatric Practice

May 3, 2012 in Blog by support Team  |  1 Comments

Although Integrating Delivery Networks in the United States are growing, there are still many Pediatricians whom leave a large group, a Hospital Group or other Integrated Delivery System to start their own practice. Starting a Pediatric Practice can be both an exciting and scary at the same time. Before any Pediatrician considers staring a practice they should look at the primary reasons why they are interested in starting a practice. Is it financial? A different level of service? What if they start the practice and makeSome of these questions include:

1. What is the demand in my market for another Pediatric Group and what additional value will my new group bring? Patients and parents need a Pediatrician. How fast your practice grows depends on the market and their choices within this market. If they have 5 other choices of Pediatric groups within a small radius and two of the practices have availability to new patients as well as many hours, the growth rate of the practice will be much less than in a town for which there is only family practice physicians. The research that should be done is to look at the population demographics and match this up with the number of Pediatricians in the area then evaluate the number of Family Practice Physicians in the area. I know of cases in which very good clinical Pediatricians make minimal salary due to the demand in the area and growth rate of their practice.

2. How should my office be configured and what are the best options for commercial real estate? When establishing a new practice, know what your goal is for the practice as well as the needed space. Fortunately, this is a buyers/renters market so the practice should be able to negotiate some favorable terms. Before looking at any commercial real estate, decide what is the appropriate square footage needed for the practice. You might consider calling a contact or service that has a background in Medical Space planning. Be careful to not over size your start-up practice: many start-up practices can manage with 2-3 exam rooms (8X10 feet), a reception area, a small lab/kitchen area and a waiting room. Some commercial real estate spaces manage the rest rooms outside of the practice while others will require the tenants to have bathrooms in their space. The location, quality and cost of the space is very important. Choosing a ‘great’ facility in a ‘bad’ location can cost the practice significant growth. Also, choosing a facility that is much larger than what is needed can cost the owner in higher expenses (this is reduced salary for you as the owner).

3. Should I start on my own or with another Pediatrician? This is a personal decision. The advantage of another owner is someone else to divide the work load with managing a Pediatric practice including seeing patients, managing staff, after-hours call, administrative items and other tasks associated with managing a practice. Some disadvantages with another partner in the start-up phases are: need a larger patient load for both Pediatricians to meet the previous income when you were a salaried employee, conflicts on choices/decisions, different work ethics/beliefs, two decision makers is less efficient than one. Being in a practice together with a partner is similar to a working marriage. Make sure that you explore this option real closely prior to joining together.

4. How should I finance my practice? There are a number of options to finance a practice including taking a line of credit on your home, obtaining a SBA loan or working with a banker to obtain a business loan. I helped my wife start her Pediatric practice through using 0% interest credit cards and our savings in the bank then moving the debt from the credit cards to a line of credit on the house. I would not suggest this method for most individuals but this allowed us to minimize the interest payments and delay a loan until we understood the amount of debt we would need. For most individuals that are pursuing financing, recommend either a SBA loan or a business loan.

5. Do I hire a medical biller or outsource my Medical Billing? Managing the revenue cycle for most Pediatric practices can be done more effectively by outsourcing to a Pediatric Medical Billing company. I have seen some pediatric practices move the ‘brink’ of bankruptcy because they had the medical billing managed by a front desk person or a biller with minimal experience in Pediatric Medical billing or questionable performance. Most Pediatrician owners can manage the front desk and Medical Assistant/nursing staff very effectively since both of these work functions are in the middle of their work flow. Managing a back office billing team requires monthly verification processes to check the claims as well as training and re-training of billing staff in the area of Pediatrics. This is outside of the scope of the expertise of most Pediatricians. Even some larger practices with Medical office staffs are not aware that half their billing staff is out of date and they are personally losing thousands of dollars a month. Unfortunately, according to the Medical Group Management Association, a high percentage (>50%) of practices have theft at the practice. Establishing strong processes and leveraging an outside Pediatric Medical Biller can help with these risks while optimizing the revenue for the practice. Additionally, this team can reduce the work load from the Pediatric Owner(s).

These are a few of the questions to ask when starting a Pediatric Practice. There are many more to ask prior to starting up a practice.

Continuity of Care in Pediatric Practices & the Link to Cloud-Based E.H.R. Systems

April 13, 2012 in Blog by support Team  |  Comments Off on Continuity of Care in Pediatric Practices & the Link to Cloud-Based E.H.R. Systems

While at the pharmacy waiting for prescription Medication, I experienced the gap in knowledge by the average patient. One patient requested a medication to treat his wife’s pink eye from the pharmacist. When she explained that his wife will need an antibiotic he asked if he could use the antibiotic he was using to treat his ears. She explained to him that his wife needed a health care provider to exam her then based on the diagnosis, prescribe the appropriate medication for her red eyes. The husband was not coordinating care with his wife’s primary care physician.

Many in the health care system are missing the big picture when they do not call their primary care physician. In pediatrics, the outcome of the patient can be improved via strong continuity of care. If a patient is atopic and calls the office about a reaction to a medication, the pediatrician can use this information to appropriately manage the patient as well as record the incidence in the patient’s history. From the patient’s point of view, strong coordination with their pediatric office could reduce their burden and costs associated with using the Emergency Room. The pediatrician receives calls after office hours. The information available to the pediatrician should be able to be accessed easily at any time. Cloud-based Pediatric E.H.R. systems provide the best option for easy access to patient information on multiple devices in multiple locations…smart phones, IPads, lap tops, home computers. Who wants the burden of ‘dial in’ to the office server as well as maintaining constant security of the server?

As coordination of care continues to evolve as well as the option in wireless devices, Pediatricians can continue to reduce admin burden, costs and improve continuity of care with cloud-based E.H.R. Systems.

Minimizing Technology Burden in a Pediatric Practice Using the new IPAD

March 30, 2012 in Blog by support Team  |  Comments Off on Minimizing Technology Burden in a Pediatric Practice Using the new IPAD

Most Pediatricians want to focus on treating their patients and not all the technology burden associated with Electronic Health Records. A Pediatric Health Record system should align with the technology in today’s market. The ‘old’ days of Television sets were large furniture or appliance size devices with low quality screens. Today every person seems to own multiple flat screen TVs in the House. The computer field evolved from a difficult to use device that had a mono chrome (usually green) screen to a wireless tablet that you can check your e-mail and banking while sitting on the couch. Less weight, less technology burden for the owner, less space with more features. The new IPAD (“IPAD 3”) has some features that a small Pediatric Practice could use to reduce their technology burden.

If you purchase the 4G model of the IPAD (about $640 with a $15-$30 4G cost), you can use the IPAD as a 4G Hot Spot. This means that the IPAD appears like a “WIFI” to the other lap tops/tablets in the practice. A small Pediatric practice could have a Desktop, the IPAD with 4G and a previous IPAD or another tablet computer to see patients all day (assuming all your systems are on the cloud). The practice could either use the existing internet connection or the 4G connection provided by the IPAD. Additionally, the physician on call can review charts on the IPAD (vs. using a smart phone) no matter where they are located. What would be the cost of this set-up? Two new IPADs, Desk Top computer and wireless router….less than $1500 brand new. Let’s say you also purchase a ‘good’ copier/scanner/fax machine…another $500. What is the maintenance? No back-ups, no IT people needed, no hassles…..this technology is now here today so that you can reduce the cost and hassle to your practice using the latest technology. Think of the freedom that you will achieve by moving to this model as well as improved operation by using a Pediatric Specific Cloud E.H.R. system.

There is plenty of supply of IPADs available at stores like Best Buy. Speaking of Best Buy, their leaders understand the importance of reducing overhead and space. They understand that due to the changes in technology, cloud systems and the high utilization of smart phones that there is not a need for a large store (the management of Best Buy announced recently that they will reduce the number of large stores and lay off 400+ individuals). Using the ‘right’ technology should lead many Pediatric Offices to evaluate the appropriate space for their practice. No need for the practice to have a file room, a server room (think of a server similar to that old box TV), extra break rooms, large storage. With the right system and devices, Pediatric Practices can be optimized to eliminate the burden of these extra spaces. Additionally, the practice can improve the scheduling so that the focus of the practice is the Exam rooms, Front Desk and small lab/nurse prep area. I recommend you consider leveraging the IPAD in your Pediatric Practice to see if you can remove the administrative and IT burden.

Potential Impact of Consumer Directed Health Plans (CDHP) on Your Pediatric Practice

March 24, 2012 in Blog by support Team  |  Comments Off on Potential Impact of Consumer Directed Health Plans (CDHP) on Your Pediatric Practice

Both cost and quality are important in the Healthcare system. Patients want to be treated and maintain their health with minimal costs to them. Employers want to reduce expenses like Healthcare costs. Health Plans want to provide a product that meets the needs of their employers and patients. The Consumer Directed Health Plan option provides deductible for all services (except well visits) in the range of $1000-$2000 per year. Services include: sick visits, hospital, specialists, as well as medications. A consumer that rarely engages with the healthcare system, could place $2000 in an account and just use the funds as needed (might even last for years). With the change in Healthcare laws, well visits are usually covered with no cost. The value proposition is that the employer and employee save on the monthly premium (or maintain the premium cost), planned/well visits to the physician are usually no cost and the employee can save the money to use for items not covered via the deductiable for the times they access their physician. Sounds like a win! Not so fast…..individuals with chronic conditions, medium and high users of the healthcare system are burden with the $1000-$3000 deductible every year so their total cost might increase (or they ‘avoid care’).

Let’s look at this for a Pediatric Practice. A parent would usually experience $0 co-pay/cost on all well checks and need to pay out of pocket (at the contract rate) for sick visits until their healthcare deductible is established. For patients that do not have chronic conditions whom are not on routine branded medications, this option can save total costs. The issues that this plan design can cause with appropriate Medical Care and/or operational issues to the Pediatric Practice include:
• Patients in the practice that have asthma will need to pay for sick/treatment patients out of their budget (not the plan). This might cause many to not seek routine asthma treatment at the Pediatric Office and instead wait until ‘crisis’ mode. Does this lead to higher ER costs? Does the ‘disincentive’ to gain treatment endanger patients?
• Patients in the practice with ADHD whom also have a CDHP will either spend the $1000-$3000 per year to hit the deductible or will forgo treatment due to the high cost of the treatments.
• In a well-managed Pediatric Practice, the practice should maintain >99% collection rate to contract amount. There will be an extra cost burden with the billing team sending statements to patients as well as follow-up calls. Patients have a much higher default/no-pay rate than insurance companies.

Employers seem to be leaning more toward options like CDHP to control the rate increase in premiums. What are some steps that your Pediatric Practice can take to monitor and manage this trend?
• Benchmark the number of patients with either H.S.A. or CDHP plans.
• Identify if these patients come to the office for both well and sick visits
• Confirm the current collection rate for this subset of insurances. Is the rate the same as the overall practice?
• What is the billing team handling time for managing H.S.A. and/or CDHP plans?

Some employers share in the Health Plan decision making with employees. Most employees do not want any cost increase (similar to employer). When the decision is shared between staying with the traditional plan with a co-pay (no in-network deductiable) and the employee paying an extra $100/month or moving to a CDHP, most employees would pay the extra money per month out of their paycheck. Although this might be the best financial move from them if they rarely use their insurance except for well checks, individuals are usually not comfortable with the change in payment system. As the Health System moves forward, the CDHP is a growing option.