Authorized Official vs. Delegated Official: What’s the Difference?

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Understanding the Difference Between Delegated and Authorized Officials According to Medicare

Medicare distinguishes between authorized officials and delegated officials on their enrollment forms and many people wonder what the difference is.

Authorized Official Definition

An authorized official means an appointed official (i.e. chief executive officer, chief financial officer, general partner, chairman of the board, or 5% or greater direct owner) to whom the organization has granted the legal authority to enroll it in the Medicare program, to make changes or updates to the organization’s enrollment information in the Medicare program, and to commit the organization to fully abide by the statutes, regulations, and program instructions of the Medicare program.

Authorized Official Authority

  • The authorized official is the only individual that has the authority to sign the initial CMS 855S application. By this signature the authorized official agrees to notify the Medicare program contractor if any of the information on the application is incorrect or untrue. Also, the authorized official agrees to notify the NSC of any changes within 30 days of the change (Supplier Standard 2).
  • An authorized official is the only individual that can add and remove delegated officials.
  • Suppliers may have as many authorized officials as desired as long as the individual meets the definition of an authorized official.

Delegated Official Definition

Delegated officials are persons who are delegated the legal authority by the authorized official to make changes to the supplier file.
A delegated official must be a W-2 employee of the supplier or an individual with 5 percent or greater direct ownership interest in, or an individual with partnership interest in the enrolling supplier. If the delegated official is the managing employee, this individual must be a W-2 employee and the NSC may request proof this individual is a W-2 employee.

Delegated Official Authority

  • A delegated official can make changes or updates to the supplier file, such as address changes or the addition of a part owner.
  • The delegated official may also sign and submit the CMS 855S to enroll additional locations, revalidate or reactivate an existing supplier.
  • A delegated official may not delegate its authority to another individual. Only the authorized official may appoint someone as a delegated official
  •  A delegated official may not sign the initial CMS 855S application for the initial location.
  • A supplier may have as many delegated officials as desired as long as the individual meets the definition of a delegated official.

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Posted in: Finance, Medicare & Reimbursement

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ICD-10: Practices Should Focus on Just 3 Things

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ICD1-10: Medical Practices Should Focus on Three Things

There is a lot of advice out there on making the transition to ICD-10.

Your medical practice may already have taken some of this advice and you are well on the way to readiness for I-10. But if you’ve not done anything yet for the transition, this article is for you. I’ve distilled all the blah-blah-blah down into three easy steps that any practice can follow to embrace the change.

1. Do You Need More Software Support?

There is no question that most everything hinges on your EMR and billing system’s management of ICD-10. Your vendor may say the system is I-10 ready, but what does that really mean?

Ask your vendor these questions:

  1. Are ICD-10 codes available in the system now? If not now, when?
  2. Can the providers and staff rehearse using I-10 inside the system by dual coding and assigning both an ICD-9 and an ICD-10 to services without having the I-10 drop to the claim?
  3. What support, if any, does the system give for choosing the right ICD-10? Is there any type of translator or crosswalk between I-9 and I-10?
  4. After October 1, 2015, will the software have the ability to use an I-10 or crosswalk from 10 to 9 if the payer does not accept 10? It should! Physicians and coders/billers should not have to look at the patient’s payer of record to decided which one to use, nor should they require you to change the I-10 to I-9 on the back end. It is very doable for software to crosswalk from 10 to 9 for you.

If the software supports getting to the most specific ICD-10 possible, not just picking the first one that vaguely matches, choosing the I-10 should be straightforward.  If your software does nothing more than save the I-10 codes you choose to a favorites or a pick list, then you will need a standalone piece of software called an “encoder.” Hospitals and mega practices have been using encoders for years to help navigate the maze of Medicare local and national rules.

Practices without sufficient support from their EMR/Billing software will need an encoder that can not only suggest possibilities for ICD-10 codes, but can also assist in finding the right code from a series of words algorithmically ordered. (If you want to know which encoder is my particular favorite, send me an email at marypat@managemypractice.com.) Encoders also usually have additional benefits that your billing software or claims scrubber may not have such as CCI edits, modifier rules, global period and wRVU information.

Example of the drilling down to the correct I-10 diagnosis assisted by an encoder:

Fracture:

  • Cause?
  • Which bone? Which part of the bone? Laterality?
  • Type of fracture? Open, closed, displaced, non-displaced?
  • Encounter? Initial, Subsequent, Sequela?
  • External cause?
  • Associates diagnoses, conditions?

2. Could Documentation Be Brushed Up?

In hospitals, entire teams of people (Clinical Documentation Improvement staff, usually nurses) are dedicated to making sure that the documentation can support the specificity of the I-10 code chosen. This is especially important for the hospital side of reimbursement.

In the hospitals there are often silos between the service providers and the coding review and billing staff. In practices, we have the good fortune to be able to reflect on the documentation once the I-10 code is chosen, and clarify the documentation on the spot if needed.

Some easy ways to make sure your documentation is as complete as possible to support the I-10 code are:

  • Think of MEAT when you document. Every condition in your documentation should be described as Monitored, Evaluated, Assessed and/or Treated. If the patient has an existing diagnosis that you did not address during the visit, don’t put it in the documentation or on the claim.
  • Use “due to” or “manifested by” for each problem that you describe, if you know that information.
  • Change/improve your EMR templates (or paper progress note format) to accommodate the points above.

3. Are You Ready for Cash Flow Interruption?

You’ve heard this for years and it remains a legitimate concern. If there is any problem with claims processing OR if you are not using ICD-10 properly causing denials, there is a good chance your money from insurance companies will slow down or even dry up for awhile. I suspect that insurance companies may use ICD-10 as a handy excuse to delay payment regardless of the plethora of other excuses they have to choose from.

Predictions on the cost of ICD-10 fluctuate wildly, but here are the places you are most likely to feel the financial pain:

  • If your EMR/Billing system wants you to pay for an upgrade to your software to compensate them for the money they’ve spent upgrading their software. Since the delay, I’ve heard of fewer companies requiring a special payment for the upgrade.
  • Reduction of productivity based on time spent to choose an I-10 code:
    • Any manual form in your practice that uses ICD-9 will need an ICD-10. How will you find those codes?
    • Physicians who choose codes through their EHR will need software support to find those codes. Because there are so many more codes due to the specificity of each code, it will take a while to get the hang of it if you are not using an encoder.
  • Inability of your clearinghouse to send claims. Unless you are directly submitting claims to any payers, your clearinghouse has probably tested (end-to-end, please) with payers. Ask your clearinghouse who they’ve tested end-to-end with and what the results were. If things really bog down with CMS, they may grant advance Medicare payments to physicians that are not receiving payments due to the ICD-10 transition.
  • Delay in payment from any payer due to ICD-10 general chaos.

Keep in mind that a lot of the hoopla over ICD-10 has been on the hospital side. Physician practices are very lucky in that we use CPTs for reimbursement (at this point), not diagnoses. This is a huge change for the hospital/facility side, but much less of a transition for medical practices. We are hoping that physician practices will have less impact to their bottom line, but you should be ready with a line of credit or some extra funds in the bank for this possible rainy day. Starting today, practices that make distributions to owners quarterly may want to scale this back until the smoke clears.

Resources to Help You:

AHIMA (American Health Information Management Association (AHIMA)  has an a nice set of tools relating to the adoption of ICD-10 here. Not all tools are available for non-members.

CMS Road to 10: The Small Physician Practice’s Route to ICD-10 compiles resources from the AAPC (American Association of Professional Coders) AHIMA, the AMA (requires AMA login) and CMS/PAHCOM (Professional Association of Healthcare Office Managers) produced resources.

The AAPC has lots of high-quality offerings here, most for members or for purchase by nonmembers. Although it was written for the original 2014 transition, here’s a good article to review for the creation of an ICD-10 superbill, or just to review your top I-9s and translate them to I-10s.

Your software vendor, claims clearinghouse and specialty society should also have ICD-10 tools.

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Posted in: Collections, Billing & Coding, Compliance, Day-to-Day Operations, Finance, Headlines, ICD-10

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MMP Classic: How to Apologize to a Patient

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Sincerely Apologizing to Patients

I like to get complaints from patients.

No, I’m not a glutton for punishment. What I like about complaints is that I hear directly from the patient what is bothering them, and I have an opportunity to connect with them personally. The ideal situation is having the opportunity to meet face-to-face with the patient when they are in the office.

Here’s how to apologize to a patient.

Step One: Introduce Yourself

I introduce myself and shake the patient’s hand and the hand of anyone else in the room.

Step Two: Sit Down

I sit down. There are two reasons for that. One is to send the message that they do not need to hurry – this conversation can take as long as they need it to. The second is to place myself physically below the patient. If they are in an exam room sitting on the exam table, I will sit in the chair. If they are sitting in the chair, I will sit on the step to the exam table. The message I am sending is “I do not consider myself to be above you.” It sends a strong message.

Step Three: Let Them Tell Their Story

I say “I understand we have not done a very good job with __________ (returning your calls, giving you an appointment, getting your test results back to you, etc.) Can you tell me about it?” I do not take notes as I want to maintain eye contact and focus on the patient, but I take good mental notes. The patient and/or anyone with them needs to be able to talk as long as they want. They might need to tell their story twice or many times to get to the point where they’ve gotten relief. The patient has to get the problem off their chest before the next part can happen.

Step Four: SINCERELY Apologize

I apologize, saying “I’d like to apologize on behalf of the practice and the staff that this happened. I want you to know this is not the way we intend for _______ to work in the practice.” If anything unusual has been happening, a policy has changed, or new staff have been hired, I let them know by saying “So-and-so has just happened, but that’s not your problem. We know our service has slipped, but we’re hoping we are on the way to getting it fixed.”

Don’t forget that patients can tell if you are not being sincere when you apologize.

Step Five: Answer Questions

Answer any questions the patient has. Why did the policy change? Why can’t I get an appointment when I need one? How will you fix this for me?

Step Six: Close the Meeting

If the patient complaint requires an investigation and resolution, I give the patient a date when I will be back in touch with more information. If the patient complaint does not require any resolution on the patient side, I offer my name again and give them a business card or a way for them to contact me if they have further problems.

Step Seven: Resolve the Situation

I follow-up on the information the patient has given me to find out where the system broke down or where a new system might need to be developed, and if needed, contact the patient with further information and/or resolution.

Although most people prefer not to hear complaints, paying close attention to patient complaints helps a manager to keep a pulse on the practice, know what patients are struggling with, and of course, practice humility. All good stuff.

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Posted in: Amazing Customer Service, Manage My Practice Classics

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CMS Hospital Compare: Patient Experience Translated Into Stars

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The CMS "Compare" Sites Translate Patient Experience Into Stars

Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide care to their patients. It allows consumers to select multiple hospitals and directly compare performance measure information related to heart attack, heart failure, pneumonia, surgery and other conditions.

What Is HCAHPS?

The HCAHPS – pronounced “H-CAPS” – (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey is a standardized questionnaire that measures patient perspectives of hospital care. HCAHPS results posted on Hospital Compare provide ratings, including comparisons to state and national averages, that help consumers understand how hospitals perform.

HCAHPS Star Ratings

On April 16, 2015, the Centers for Medicare & Medicaid Services (CMS) added HCAHPS Star Ratings to the Hospital Compare website as part of the initiative to add 5-star quality ratings to its Compare websites. CMS believes that star ratings spotlight excellence in health care quality and make it easier for consumers to use the information on the Compare websites. The ratings also support using quality measures as a key driver of health care system improvement.

Twelve HCAHPS Star Ratings appear on Hospital Compare: one for each of the 11 publicly reported HCAHPS measures, plus the new HCAHPS Summary Star Rating. HCAHPS Star Ratings are the first star ratings to appear on Hospital Compare and CMS plans to update the HCAHPS Star Ratings each quarter.

HCAHPS Measures Used to Determine Star Ratings

There is a star rating for each of the following HCAHPS measures:

  • HCAHPS Composites Measures
    • Communication with Nurses (Q1, Q2, Q3)
    • Communication with Doctors (Q5, Q6, Q7)
    • Responsiveness of Hospital Staff (Q4, Q11)
    • Pain Management (Q13, Q14)
    • Communication about Medicines (Q16, Q17)
    • Discharge Information (Q19, Q20)
    • Care Transition (Q23, Q24, Q25)
  • HCAHPS Individual Items
    • Cleanliness of Hospital Environment (Q8)
    • Quietness of Hospital Environment (Q9)
  • HCAHPS Global Items
    • Overall Hospital Rating (Q21)
    • Recommend the Hospital (Q22)

Other “Compares” with Stars

CMS already uses star ratings in other Compare websites:

Why Can’t I Find My Hospital?

All hospitals that participate in the HCAHPS Survey are eligible to receive HCAHPS Star Ratings, which includes both Inpatient Prospective Payment System (IPPS) hospitals and Critical Access Hospitals (CAH). IPPS hospitals are required to report HCAHPS as part of the Hospital Inpatient Quality Reporting (IQR) Program and CAHs voluntarily participate.

In addition, hospitals must have at least 100 completed surveys in the 12-month reporting period and be eligible for public reporting in order to receive HCAHPS Star Ratings.

Exploring Hospital Compare

If you or a loved one has had a hospital experience recently, go to Hospital Compare and see if your experience correlates with other patient feedback. Please share your comparison in the comments!

This post was originally published on the LinkedIn Pulse as part of the LI Influencer program.

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Posted in: Medicare & Reimbursement, Medicare This Week

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MMP Classic: How Many Staff Do You Need?

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Staffing your medical practice can be a daily balancing act.

There’s no simple formula for staffing that one can apply to every practice because each specialty and each situation requires something different. It is very important to right-size your staffing. Understaffing can cause patient dissatisfaction, frustration, burnout and a staff exodus. Overstaffing can cause lower productivity, reduction in profit and never really getting to the root of why some problems exist.

Matching FTE Providers to FTE Employees 

Most benchmarks utilize FTEs (full-time equivalents) which is an employee working a 40-hour week, or a provider working the number of hours considered full-time for providers. Although this works well for employees, it doesn’t always follow for providers. A .5 FTE provider that works two days a week may need more than a .5 clinical and .5 non-clinical person because patients still call for prescription refills and questions and test results still arrive to be reviewed on the days the provider is not there.

Back to basics

It helps to bring the equation down to the simplest formula of clinical and non-clinical staff. For now, disregard billing, lab, other ancillary services, management, and medical records and focus first on the number of staff needed to get the patient in the door (front desk), get the patient seen (clinic assistants), and get the patient out the door (front desk again.) 

Let’s imagine that Dr. Goodman is a full-time primary care physician with a mature practice and a full schedule. She works 4.5 days per week and has one non-clinical person who answers the phones, checks patients in, checks patients out and handles the medical records. She also has a clinical person who rooms the patient, performs the intake, and takes the vitals. The clinical person also answers patient phone calls with medical questions and contacts patients to give them their test results. Either employee may schedule tests and referrals for patients. Dr. Goodman has 2 full-time employees and if she’s really fortunate, both employees are interchangeable so each can fill in for the other if they want to take vacation or are sick for more than a few days, maybe with the help of a temp or a prn person if needed. If the practice has electronic medical records (EMR) and everything is as automated as possible, they can probably get by for short periods of time.

Most brand new practices start with just one employee who does all front office/administrative (reception, phones, registration, scheduling, referrals, time-of-service collections) and all back office/clinical (vitals, procedure prep and assistance, phlebotomy, injections, lab testing, patient call-backs.) As the practice grows, it becomes clear when a second employee is needed.

What about a practice with ancillaries or more providers?

Front desk as the number of providers grows, so does the need for more staff to check patients in or check patients out. Floating staff between these positions can be a temporary solution before adding full-time staff in both areas. Using a patient check-in kiosk can minimize the stress of checking-in many patients arriving simultaneously, and having patients register online or through a portal can save significant registration time.

 

Dedicated phone staff when employees are consistently pulled between answering the phone and working with the patient in front of them, it’s time to consider a separate phone position away from the front desk. Don’t overlook the possibility of having a remote employee taking calls from home full-time, or part-time during peak days and times.

 

“Nurse” triage if providers are seeing patients all day every day, clinical assistants may not have the capacity to answer phone calls between patients, or to manage the patient schedule. Nurse triage can keep the office flow even by deciding when patients need to come in for same day visits, answer questions, call patients with test results, and cover breaks for other clinical/non-clinical staff. Vaccines administered by the clinical staff can often be what determines when more staff is needed – if the clinical assistant is administering vaccines, s/he is not available to room the next patient. The appointment interval can be another defining factor in how many clinical staff are needed – the shorter the appointment intervals, the more help will be needed to keep the schedule moving.

 

Laboratory services can be as limited as the clinical person taking specimens, or as complex as a full-blown lab staffed with a full-time lab tech to draw blood and test it. Lab services are often determined by two factors – improved care for the patient (can the provider get test results during the visit that will assist in getting the patient diagnosed and on a treatment plan?) and convenience for the patient (how far will the patient have to go to get blood drawn at a lab?)

 

Referrals most primary care offices refer patients for lots of tests and if the process is not electronic and requires lots of time on the phone, you may need to dedicate a FTE person to this job if you have 3-4 providers.

 

Billing billing can be completely outsourced from the entering of charges to pushing accounts to collections, or it can be handled in-house. A typical ratio is one billing person to two providers for a practice that sends statements and one billing person to four providers if using credit card on file.

Imaging  for those offices that have onsite imaging, one employee is enough if there is another imaging facility close by. Depending on the imaging volume, some practices have mobile imaging services come to office once or twice a week, or have an imaging technician who can also perform other clinical duties.

Medical records  with the predominance of EMR, the designated medical record person has just about disappeared in smaller practices. Most remaining medical record functions (scanning mailed records, tracking down records from other providers or facilities, providing records to other providers, attorneys and to patients themselves) are performed by other staff as part of a litany of shared duties.

Management when does a practice need a manager? Well, that’s another post for another day, but typically a solo physician/provider does not need a manager, unless she has lots of ancillaries with lots of associated employees. A Fractional Administrator can offer part-time assistance that is enough to help a small but growing practice.

And in a specialist’s office: 

Surgery scheduling in some surgical practices, the clinical assistant does the scheduling while the physician is in surgery. Larger practices employ centralized surgery scheduling which usually takes 2 schedulers to make sure one scheduler is available at all times.

 

Specialized Testing  one technician is usually enough for each specialized testing modality, unless the practice is a referral center for other providers. The other exception is if the equipment, a nuclear camera for instance, is so expensive that the practice cannot afford to not be able to do tests if an employee is absent.

 

Why do some offices need more staff and some need less? 

Inefficiency requires more people! If people have to get out of their seats to solve a problem or get an answer, they’re inefficient. 

Systems and processes must support the work of the employees, not hinder it. Do your systems support your workflow?

Some physicians can keep two (or more) clinical assistants busy.

Some physician specialties order many more tests and need more staff to schedule them.

Poorly organized practices duplicate efforts, and in doing so, cause themselves more work. A good example of this is the patient calling the practice multiple times during the day when they do not get a callback, causing much more work than if the patient was called back within 2 hours.

What should you do if you can’t figure out if it’s taking too many people to do the work? 

  1. Do you know what every person is doing? Have everyone keep a log of all the jobs they do over the course of several weeks. Ask them to assign the percentage of time they spend doing each task. Evaluate their lists and see if staff are carrying equivalent workloads.
  2. Cross-train employees and see if jobs take more or less time when others do the tasks. There should be some variance, but not a significant variance.
  3. Is every task something that contributes to the practice? Does something absolutely need to be kept in two places in two formats? Are things being done because “we’ve always done them that way?” 
  4. Is one thing so far behind that it’s causing duplication of effort? Bring in a temp, ask staff to work on a Saturday, do whatever it takes to bring everyone back to ground zero again.
  5. Hold brainstorming sessions with staff and involve them in developing plans for improving efficiency. Also ask them one-on-one for their ideas for improvements.
  6. We expect more of everyone than we did before the economy tanked, and employees are responding by being more stressed and by being out sick more. Evaluate if everyone is out more than in the past and how that may be affecting the work. 
  7. Do a simple efficiency study by observing individual employees at work and documenting what they’re doing one minute at a time for a period of two hours. Graph the work by time to see what two hours of their day looks like. Some jobs are by nature “interruptable”, like phones, check-in and check-out, and some jobs are performed best when the employees are subjected to minimal interruption. Are these jobs defined in this way, or are the two interspersed creating inefficiencies?
  8. Try this exercise: create the ideal staff for your office as if you could afford every person you’d like to have. Then, start to work backwards, seeing how jobs could be combined and what positions would be nice, but not necessary. Compare the final product to what you have now, and see what the differences are. Another way to approach this is to pretend your practice doesn’t have the physical confines that it does, and see if you would staff it differently if the space was more accommodating.

Posted in: Day-to-Day Operations, Human Resources, Manage My Practice Classics

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New “One Patient” MU Rule Brings Relief

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Physician Check-In Sign

 

 

 

 

 

 

 

 

Last week, CMS published a new proposed rule for Meaningful (MU). This rule strives to  “…align Meaningful Use (MU) Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3…”. In other words, make the program simpler and make it easier to achieve.

The proposed rule would simplify MU by:

  • Reducing the overall number of objectives;
  • Removing measures that have become redundant, duplicative or have reached wide-spread adoption;
  • Allowing a 90 day reporting period in 2015 to accommodate the implementation of these proposed changes in 2015, and possibly of the greatest interest to medical practice,
  • Remove the 5 percent threshold for Measure 2 from the EP Stage 2 Patient Electronic Access objective, requiring that at least (only) 1 patient seen by the provider during the EHR reporting period views, downloads, or transmits his or her health information to a third party.

This last one is extremely important as practices have spent much time and money trying to encourage patients to use their portals to fulfill the view/download/transmit requirement. As a patient, I understand this. I only use my PCP’s portal a couple of times a year, so I invariably forget my user ID and password (yes, I do know there are programs to store and retrieve these for me, but that’s a conversation for a totally different post) and it all ends up just being a big pain. My health is important to me, but I don’t have reason to get on the portal on a regular basis, and practices are finding out that many patients just don’t care to use the portal or don’t have a need.

More light reading on the proposed rule is available here in the Federal Register.

Posted in: Compliance, Electronic Medical Records, Medicare & Reimbursement, Medicare This Week

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We Got Hacked! Or Something.

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A Baby Beats a Blog Any Day of the Week!

You may or may not have noticed that the Manage My Practice website has been, well, gone during the month of January. We are still not sure what exactly happened – it could have been hacked, but we’re not sure who might have done such a dastardly deed.

The bottom line is that we’ve been furiously working trying to reconstruct everything, and we know now that we have lost the last 100 or so posts from the blog. Many of these were posted on LinkedIn, so we can copy them back to the site, but many are probably gone forever. So…

I Am Asking You a Favor

If you’ve ever printed, copied to a Word document, or in any way kept a copy of one of my posts that was written after September 16, 2013, I would love to have a copy of your copy so I can repost it. Wouldn’t it be amazing to find every single one of those 100 posts? I don’t expect it to happen, and I’m not even sure all those posts deserve to be re-published, but I am going to take a crack at it.

Any post you find can be emailed to marypat@managemypractice.com. I’ll let you know what happens.

Thanks, and here’s to new beginnings!

p.s. Baby is my new granddaughter Lulu, born December 23, 2014 and probably the reason why I can’t get too freaked out about the whole website thing.

 

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Bringing Physicians and Patients Together Via Smartphone? Dr.Church Has An App For That!

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Text to Doctor

I am always excited when physicians design products for other physicians because they “get it.” Here’s the tale of a Midwest physician, Dr. Fred Church, who has developed  a free app  to communicate one-on-one with his patients via email or text.

Mary Pat: Dr. Church, tell me how you came to design e-Consult My Doctor, an app that lets physicians and patients communicate with the ease of email and text in a secure environment.
Dr. Church: I suppose the axiom of “necessity is the mother of all innovation/invention” applies here. I saw a growing need and had a growing entrepreneurial passion to solve the problem for more physician-patient interaction between scheduled visits. I believe we are at the precipice of still greater demand for mobile connectivity and services in America.
The premise of private communications to enhance doctor-patient relationships is not a novelty, but how to do it in a HIPAA-compliant manner that is also is simple and convenient is a significant challenge. We are delivering an elegant smartphone app that uniquely understands a busy doctor’s and patient’s lives and works to serve them. We have created a utility that enables any doctor to be a concierge-service doctor and every patient to be the beneficiary of that great personalized care – care that is direct from the doctors that know them and whom they trust.
Mary Pat: You describe e-Consult My Doctor as a tool to augment the physician-patient relationship, not replace the traditional office visit. Can you give some examples of this?

Dr. Church: In no way is our communication management tool intended to replace the face-to-face interaction and assessment between a physician and his established patient.  We have terms of service that users will explicitly understand and agree to prior to participation. Doctors will not have to worry about this being crystal clear to patients. Most reasonable people understand that emergency situations need to be dealt with in-person and this tool is not intended to deliver emergency communications.   Example Scenarios: 

  1. “Doctor, can you give me an evaluation of this mole as I think it has changed since you last saw me for my physical? You told me to watch it and document it myself on my phone… should I be seeing you now or wait until my next physical?”
  2. “Surgeon, I am three days post-op and it’s Sunday afternoon and I’m scheduled to see you tomorrow for follow-up.  Can you take a look at these two pictures of my wound to tell me if I need to go to the urgent care or ER tonight before tomorrow’s follow-up? I’m not alarmed but a little concerned at how it looks and I want to have your opinion before my scheduled follow-up.”
  3. “Doctor, one month ago I described to you during Betsy’s well-child visit the rare sounds and behavior changes I was hearing and seeing from my 3 month-old daughter and felt like I was having difficulty adequately explaining it to you. Guess what, I was able to capture it on this video with audio.  Can you listen to it and tell me your opinion if I should be concerned about it? Should I bring her back in after you view this so you can examine her again and/or do more lab workup?”
  4. “Doctor, we talked about considering certain omega 3 supplements and I want your opinion on this particular supplement (see picture of label) from XYZ that the pharmacist recommended. Do you think it’s a good one also?  I appreciate your opinion before my next follow up with you.”

Mary Pat: Foremost in everyone’s mind is the privacy and confidentiality of texting and emailing – how does e-Consult My Doctor achieve HIPAA compliance? 

Dr. Church: Our smartphone app technology uses best practice standards for data at rest and in transit using AES 256-bit encryption. Doctors and patients will have a secure login to their app so that if their phone is stolen or misplaced, the data is still encrypted and cannot be viewed without a user’s password. If a user’s account is somehow compromised, administratively we can suspend his account, his e-consulting relationships, and access to the information between those relationships.

Mary Pat: Do you see this product replacing the traditional function of a nurse triage in the medical practice?

Dr. Church: Absolutely not. In fact, it is intended to offload the burden that triage is often overwhelmed with. Traditional healthcare will always need people to properly triage communications at a doctor’s office.  Unfortunately, high volumes and increased costs mean that calls are not always responded to in a timely way. Doctors need communication tools that are portable and flexible and this describes e-Consult My Doctor.

Mary Pat: Your software has some interesting features, including a mini-EMR or PHR (Personal Health Record.) Can you describe the benefits of a mini-EMR available from a smartphone?

Dr. Church: Because our solution is much less complex than an EHR (Electronic Health Record), a single adult patient user may keep and manage all of his dependents’ information on one app securely. Our well-designed smartphone app stores all related health event reminders, vaccine history, and PHR information. The PHR on our smartphone app is viewable/editable without the requirement of an internet connection, which is a clear advantage over EHR portals.  When patients participate in managing their information and updating their PHR data between visits, it makes it easier for intake nurses/staff during scheduled visits to make sure the EHR’s data is also reflecting recent changes that may be more current than EHR updates from various sources: other urgent cares/ERs, other specialty doctors, other health providers/doctors/sub-specialists (DDS, DC, DPM, etc.), hospitals etc. One of the main advantages of patients participating in their own PHR information is it will hopefully improve PHR accuracy, contribute to better patient compliance, and help serve both patients and doctors in traditional healthcare delivery.

Mary Pat: How does the documentation of the communication between the physician and the patient get back into the practice EMR?

Dr. Church: The app will allow for exporting content via PDF and both doctors and patients will have their own copy of e-consultation data on their apps. Doctors may elect to attach the PDF of the e-consultation interaction to their respective EHR if they believe it is important enough and pertinent to a patient’s long-term record. For example, several EHRs do not have the ability to import pictures, audio, and video content which this app will easily store for minimal convenience fees.  Additionally, a doctor can simply summarize the exchange in her next scheduled office visit’s documentation if she feels the content is important enough. This will vary on an individual case-by-case basis and will be up to the doctor’s judgment.

Mary Pat: Between the secure communication and the mini-EMR, e-Consult My Doctor sounds very much like a patient portal. Can your software replace a patient portal for a medical practice?

Dr. Church: The mission of our software is to deliver a different and simpler solution for convenient communication and to augment the functionality of an EHR’s patient portal. An EHR patient portal is valuable for a singular patient to see what his doctor’s EHR documents as his current information including labs, vitals, etc.  The e-Consult My Doctor app will allow direct one-to-one communication any time and anywhere the doctor and patient are willing to participate.  One of the foundational premises of our product is that a doctor’s extra time and effort should be rewarded directly by the beneficiary… like having pay-as-you-go access to their mobile phone or email for enhanced, personalized care between scheduled visits.

Mary Pat: You have essentially designed a product that allows physicians to be reimbursed for care that they have been previously providing for free. Some patients will appreciate the convenience and be willing to pay for the personal attention and others will think it is akin to the airlines charging for luggage! How do you answer those who think healthcare is already too expensive without any additional fees? 

Dr. Church: I’m amazed how many people are willing to pay for the $1,000 – $2000 per patient per year for 24/7/365 access that they may only utilize a few times a year. I personally know concierge doctors who are eagerly looking forward to our HIPAA-compliant solution that will help them achieve better work-family life balance with our communication management tool.  We believe our smartphone app will bring a revolutionary solution that allows every doctor and every patient to participate in a concierge e-consulting relationship at a potentially lower price point. Our solution eliminates the middleman with a convenient and simple solution at a very affordable price and payment is directly and immediately received by the doctor.

Mary Pat: When will this product be available on the market and what will it cost physicians to purchase?

Dr. Church: The anticipated market delivery date is November 30, 2013. The app will be free and the basic subscription level will also be free. Users will be given a limited amount of secure storage space and may upgrade to larger amounts based on their individual needs. We will also offer a premium subscription level that will afford a larger secure space allotment and additional valuable service offerings. Our app will offer a pay-as-you-go, transactional model for the basic subscription level and a fixed-price price point for the value-minded user who wants more. Fred Church

Mary Pat: How can readers get in line to try your app?

Dr. Church: They can go to  http://e-ConsultMyDoctor.com and sign up for pre-launch information and be the first to try it out.  We invite physicians who want to be beta-testers!

Posted in: Amazing Customer Service, Electronic Medical Records, Innovation, Learn This: Technology Answers, Practice Marketing, Social Media

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Ch-Ch-Ch Changes: Endings & New Beginnings by Consultant Bob Cooper

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Managing Change by Bob Cooper

As we pass Labor Day I find myself thinking about the transition from summer to fall, even though the fall season doesn’t officially begin for a few more weeks. It seems as if the pace starts to pick up again. Vacations come to an end, students return to school, and business tends to accelerate.

Change is a constant. Why do some people embrace change and others struggle?

After all, we know that the seasons change, one ends and a new one begins. In business, projects come to an end, and new ones begin. Changes in expectations, new technologies, increased competition, reduced margins are just a few examples of the changes businesses face today.

As a leader, it is very important that you take a good look in the mirror and reflect on how you embrace change.  As a model for others, you set the tone for how your team will be able to demonstrate resilience when facing the business headwinds.

In order for you to assist others to move through the changing seasons, you need to understand what happens to others when facing change. Change is external to the individual. A new boss, revised policy, or a new role become understood once explained to staff.  However, individuals react to changes differently.  The reason for this is some team members psychologically struggle to come to terms with the change.  They find it difficult to make the internal transition.  In my experience, the number one reason for this is fear. Perhaps they are not confident in their ability to deliver on the change.  They may be hesitant to take a risk due to a fear of failure. They don’t feel as safe or secure.

Questions you should ask yourself during times of change.

What do my team members need to let go of?

What do they feel they are losing?

Transitions require endings. Great leaders understand that certain changes have a big impact on individuals. Some individual’s self-esteem is tied to the old process. They may have felt an enormous sense of pride in what they had accomplished.  Great leaders effectively assist others to work through these endings, and become comfortable with transition.

The following are a few suggestions to assist others through change and transition:

  1. Explain what is changing and why it is changing. Let others know what is not changing.
  2. Allow staff to express concern, and show empathy for anyone struggling to embrace the change. Be tolerant of mistakes. Mentor others to turn mistakes into opportunities for learning and growth.
  3. Maintain ongoing two-way communication throughout the change process.
  4. Engage others in making the change work.  Listen to staff ideas and incorporate suggestions that are beneficial for the business.
  5. Be positive and promote a feeling of optimism.

Great leaders assist team members to come to terms with their endings, and work hard to help others to find new beginnings. Things will not be the same, but as a leader you can help staff to develop the competence and confidence to move forward.

You will be able to assist most team members to move through the changing seasons and find comfort in new beginnings, if you move through the transition yourself.  If you are stuck in the summer, as we embark on the fall, how can you expect your team to turn the page?

Great leaders treat each and every team member as a unique individual who experiences change in their own way. Without judgment, great leaders meet staff wherever they need to be met.  Some staff become the champions of certain changes, and others need a lot more attention.

One of the most important lessons in leadership (and in life) is to treat every person you meet with total respect regardless of how they deal with the seasons of change. Not everyone can be the “A” student, but they all deserve to be in the classroom.  An individual may ultimately need to leave the room, but this should be handled with complete respect, understanding and compassion.

Bob Cooper: We are very pleased to announce that in collaboration with Consulting For A Cause, we will be providing another one day “Discovery Session” on Thursday, October 17 in Chappaqua, NY.  You will be provided with the opportunity to capture in your personal journal the following – how to turn talents into sustainable strengths, lead a life with purpose and passion, achieve quantum leaps in performance, brand yourself for future success, achieve a sense of work-life balance, and how to effectively execute your business strategies. Space is limited. To register, please go towww.consultingforacause.com

For a complete listing of our services, including our books “Huddle Up”, “Leadership Tips to Enhance Staff Satisfaction and Retention”, and “Heart and Soul in the Boardroom” please visit us at www.rlcooperassoc.com or call (845) 639-1741.

Bowie Photo Credit: Tim Yates via Compfightcc

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Posted in: Day-to-Day Operations, Human Resources, Leadership

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What Doctors Can Learn from Hip Hop Mogul Jay-Z

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Jay-Z could teach your Doctor something about MarketingDo you know who Jay-Z is?

If not, chances are your kids do. Jay-Z is one of the most successful rap artists of all time, and has parlayed that success into a career in fashion, merchandising, his own line of vodka, as well as an ownership stake in the NBA’s New Jersey Nets franchise that he recently sold to begin a new career as a sports agent. More than anything, Jay-Z has found a way to brand himself as someone who brings glamour, street credibility, and cool to any project he is involved with. His success, beyond the normal hard work and talent, is ultimately in marketing himself.

Where do Doctors come in?

The healthcare industry is focused on marketing more than ever. Declining reimbursement, increasing regulation, and the long-term shift from volume to value have turned the heat up on physicians, practices, hospitals and systems to change the way they  do healthcare business to cut costs, improve outcomes for patients and deliver more value. Cost matters now more than ever for all the stakeholders in healthcare, and with more competition comes the need for ways to separate yourself in the market, and engage with potential and current patients.

This summer Jay-Z put out a new album and he did it in a very unique way

To promote his album, Jay-Z ran a commercial during Game 5 of the 2013 NBA finals announcing that he had recorded a new album, and that it would be available to download, free of charge for the first million people to download it from a mobile app made especially for the release. The catch? The album would only be free to people who had a Samsung mobile device – a mobile phone or tablet. Jay-Z signed an exclusive deal with Samsung to promote the album (modestly titled Magna Carta Holy Grail), Samsung products and the free mobile app to get the album before it was available via retail. Because of the hype (and the price, of course) the million downloads happened almost as soon as the album was made available on July 4th.

    • Samsung purchased the albums from Jay-Z, so RIAA certified the album Platinum immediately.
    • Samsung was able to associate themselves with one of the biggest music releases of the year, and guarantee that only their current (and future) customers were first to hear it.
    • More than that, using the permissions of the mobile app, both Jay-Z and Samsung were able to get tons of valuable market research about the internet and mobile habits of the downloaders.
    • The fans (at least the first million of them with a Samsung) got a brand new album from Jay-Z for free.

This is a basic form of content marketing, but it was groundbreaking for an artist as big as Jay-Z and a company as big as Samsung.

What can doctors learn?

Market research is critical. Jay-Z made a few million selling the digital copies of his album to Samsung, but the information he gained from the app downloads was priceless for future collaborations. 

The more you know about your patient base and where they come from, the better. For niche specialists, your market might be global so you’ll need to know more about them to reach them. Market research can take many forms, from hard data from census and surveys to anecdotal methods as simple as asking one of your patients “What could we be doing better?” In a future where providers are reimbursed based on value, leveraging the data in your EMR to understand your patient population as a whole will be critical to many of your most important business operations.

You gain by giving things away for free. By buying and giving away a million Jay-Z albums, Samsung became aligned with a major force in global culture and music  – and probably sold a few phones too.

What about all of the questions you hear over and over again on the phone and in office visits? Seasonal stuff about allergies, sunburns, the flu and physicals for sports. What if you gave this info away to anyone who wanted it on your practice website? With the changes coming in the ACA, what if your practice manager wrote a post or white paper about how your patients can prepare for what will and won’t change? If your practice offers a special service that is hard to find locally for many people, what if you prepared an ebook about how your particular therapy benefits patients, or how they can change other lifestyle habits to complement their current therapy? All of these things are ways to reach a wide variety of people, gain credibility, and give away high-quality free information that can be converted to marketing leads for your practice.

Separate yourselfJay-Z probably couldn’t have released his first album in this manner. Jay-Z has been successfully building his brand for almost twenty years now though. The name Jay-Z has come to mean quality.

To compete and thrive, healthcare providers must be able to offer a level of service and execute that service in a way that makes them stand out from the crowd. If someone moves to town and Googles the name of family practice doctors in your area, do you know whose practice comes up in the results, and how you can capitalize on that? If people ask their neighbors who is the best cardiologist in town, would they say your name? If you treat a more specialized population, where do they gather to compare caregivers, and what do they say about you? To brand yourself today as a quality care provider, you have to actively highlight and grow your footprint and reputation for outstanding value and patient satisfaction.

Physicians and other healthcare providers may never listen to Jay-Z, or any rap. But chances are, Jay-Z’s marketing example could lead the way.

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Posted in: Innovation, Leadership, Practice Marketing, Quality, Social Media

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