Sometimes a job just gets a little old, and even the best employees need a little something to get them re-engaged and excited again. Try one of the ideas below at your practice and let me know in the comments the ways you keep your staff energized and engaged!
1. Provide a career track and offer multiple levels of learning jobs. For instance, break the receptionist job into steps (see below) and set time lines for attaining those goals. You may want several steps to be accomplished at 90-days, more at 6-months, and more at 12-months. There may be monetary awards, honor awards, or qualifications for other acknowledgements.
Pre-registering patients by phone – demographics
Making appointments & mini-register for new patients
Registering patients face-to-face – demographics
Understanding insurance plans and registering their insurance
Taking photo ID or taking photos
Collecting co-pays
Answering basic patient questions
Answering advanced patient questions
Reviewing the financial policy with patients
Reviewing the Privacy Policy with patients.
2. Offer certifications and credentials – support staff emotionally, time-wise and financially so they can attend face-to-face or online courses.
Sometimes a job just gets a little old, and even the best employees need a little something to get them re-engaged and excited again. Try one of the ideas below at your practice and let me know in the comments the ways you keep your staff energized and engaged!
1. Provide a career track and offer multiple levels of learning jobs. For instance, break the receptionist job into steps (see below) and set time lines for attaining those goals. You may want several steps to be accomplished at 90-days, more at 6-months, and more at 12-months. There may be monetary awards, honor awards, or qualifications for other acknowledgements.
Pre-registering patients by phone – demographics
Making appointments & mini-register for new patients
Registering patients face-to-face – demographics
Understanding insurance plans and registering their insurance
Taking photo ID or taking photos and explaining the Red Flags Rule
Collecting co-pays
Answering basic patient questions
Answering advanced patient questions
Reviewing the financial policy with patients
Reviewing the Privacy Policy with patients.
2. Offer certifications and credentials – support staff emotionally, time-wise and financially so they can attend face-to-face or online courses.
3. Offer specific responsibilities and the title of lead person for that responsibility – don’t assume you know what staff are or are not capable of – they might surprise you!
4. Meet every 6 months or every quarter to set goals. A job can be a drag if there’s nothing new to learn or to accomplish.
5. Set up process improvement teams to work on problems that everyone complains about – give them the responsibility to come up with solutions and try them out.
6. Involve them in social media marketing of the practice. Make sure they understand your social media plan ( you do have a plan, don’t you?), give them guidelines to work within and let them work on your website, your blog, and your Facebook page.
7. Install a wiki (many are free) and have them work on loading all the practice knowledge into the wiki. Have different staff responsible for different parts of the wiki and set goals for adding all the information that runs your practice every day.
8. “Walk a Mile in My Shoes” – this is also great for getting the clinical and administrative staff to understand each other better. Have the staff shadow each other and take turns seeing parts of the practice they don’t know much about. I recently participated in this at my hospital and shadowed a nurse (and asked a million questions) for about an hour. It was wonderful! I felt better equipped to work with my hospitalist service after having been on a patient floor for just a short time.
9. If you are a practice that receives referrals from others, have staff responsible for regularly touching base with staff from referring practices and asking how service can be improved. Teach staff about relationship building and remember that it’s the staff that often choose where the patient is referred to instead of the provider.
10. Have staff take turns going with you to meetings, seminars and local events where you represent the practice and introduce them to everyone.
11. Forward listserv discussions to employees and have them monitor the discussions and bring things to you that they want to know more about.
12. Encourage employees to become the practice expert in a payer, an employer, a referrer, a process or a protocol and help them learn about their topic by sending them information from the web or your professional organizations.
13. Have the staff put together an internal or external newsletter and help them with concepts of internal and external marketing.
Your day might not be anything like what I’ve described below, but the point of the post is to suggest that most administrators put out fires all day long and juggle meetings, email, and employee and physician issues and have very little time for planning and thinking. Depending on how long you’ve been with your current group, how well trained your staff are, and how many supervisors you have working with you, you might have a much easier day than described below, or a much harder one!
7:00 – 8:00 a.m.
An employee calls you at home before 7 a.m. to say they will not be in. You check the schedule to see how staff can be re-arranged to cover all needs.
8:00 – 9:00 a.m.
As you arrive, two employees have been waiting for you and have things to discuss with you – one wants to reschedule her vacation for the third time and the other wants information on FMLA (Family Medical Leave Act.) You tell the first you’ll look at the schedule and get back to her and hand the second a packet of info on FMLA to review.
You check your schedule and note that Nurse’s Day is coming up soon and you need to make plans to celebrate their day.
You check your email and see that your state listserv has some interesting information that you forward to your billing manager, asking her to look into the issue and tell you if it applies to your practice.
9:00 – 11:00 a.m.
You handle a patient complaint. You round on everyone in the practice, checking to make sure everyone has what they need and checking on their weekends. On your way back to your office, a nurse mentions that the exam rooms are not being cleaned as thoroughly as they should be; you make a mental note to speak with the cleaning company.
Your 9:30 a.m. meeting is with a broker who has some quotes to share with you in anticipation of your June 30 benefits year-end. Your senior physician has asked that the group consider cutting benefits this year if health insurance rates go up again.
You listen to several voice mail messages that came in while you were meeting with the benefits broker. The first is your EMR project manager calling to say your go-live date might need to be changed; please call him back. Another is a payer asking to schedule a chart audit sometime in the next three weeks.
11:00 – 12:00 p.m.
A physician lets you know that she’s using the last of the Rx pads – could you order some more ASAP?
It is payroll week and you spend most of the hour finishing the payroll and checking with the four employees whose payroll record is missing a punch. You send the payroll file out and move money into the payroll account, checking the bank balance and noting the Electronic Funds Transfer that came in since you checked it on Friday.
12:00 – 1:00 p.m.
You meet with a physician who has concerns about the compensation schedule. He asks for a report showing his charges, receipts and work RVUs by month for the past two years.
You receive your mail, put bills in the to-be-paid file and note that an employee that you terminated is appealing her unemployment denial and there will be a hearing next week.
You call your printer and put a rush order on Rx pads.
1:00 – 2:00 p.m.
You look at your calendar and remember the accountant is coming for her quarterly visit today and you don’t have everything ready.
You realize lunch is out for today, grab a soft drink from the break room, grab a packet of crackers from your drawer and review your email. You’ve been advertising on craigslist for a medical records clerk and you take a quick look at the responses you’ve gotten and see there are two that look like they have possibilities. You call both candidates and leave messages that you’d like to speak with them about the position.
You get the rest of the information together for the accountant and clear a space at the desk where she works when she comes.
2:00 – 3:00 p.m.
The accountant arrives and starts working, and you know you’ll need to stay close to answer any questions she has.
You start working on the reports that the physician has asked for.
You call your EMR project manager but get his voice mail and leave a message. You call the payer and ask for a list of the charts needed for the chart review with a request letter detailing the type of audit.
You start reviewing the report from the benefits broker to see where you might be able to change other benefits to afford to continue the same health insurance plan.
3:00 – 4:00 p.m.
One of the medical record candidates calls back and you talk with her at length, then invite her to interview with you in two days.
You review the staff vacation schedule to see if you can change the schedule for the employee who has changed her mind about her dates.
You round on everyone in the practice again, checking to see that everyone got a lunch and that things are running smoothly.
When you return from the bathroom you have five voice mails (!), one of them the EMR project manager calling you back again.
4:00 – 6:00 p.m.
Your billing manager arrives for her standing weekly meeting and reviews the previous week’s dashboard numbers for charges, receipts, write-offs and accounts sent to collections. She tells you that one of the check posters has noticed that a payer is not adhering to the contract on payments. The manager wants to know what to do about it. You ask her to track back the payments and identify exactly when the payments started going off-schedule. You call the payer representative and ask for a meeting later this week.
You receive a call back from the second medical records candidate and after speaking with her on the phone, you decide not to invite her to interview.
The employee asking about FMLA stops by and makes an appointment to speak with you tomorrow morning. She tells you that her mother is ill and she will need to miss work to care for her intermittently.
The cleaning crew arrives and you walk through several exam rooms with them, talking about the level of cleanliness that is required. You make a mental note to touch base with the nurse who is monitoring the rooms and see if there is improvement in a few days.
You check your email, straighten your desk surface, notice the to-do list you started the day with that has nothing crossed off. You add two more things to the list, turn off the lights, and leave the office. There’s always tomorrow.
I wrote this post for the MGMA In Practice Blog and have republished it here for my readers.
I resigned from my job managing an orthopedic group on Jan. 20, 2009, and I remember thinking, Who leaves a job during a recession? Well, I did, and what follows is what I learned on my three-and-a-half month journey to my new position.
Visit the MGMA Career Center job search site often. Try different categories and occasionally check categories you don’t think you fit in ”“ you never know. I don’t suggest this because I am writing for the MGMA blog, I suggest it because it is a resource that I believe in.
Four state MGMA sites integrate their “jobs boards” with the MGMA Career Center: Colorado, Georgia, New Jersey and Montana. Search other state MGMA sites; some allow non-members to access the job listings.
Get a LinkedIn account (free) at LinkedIn.com and complete your profile, connect with colleagues, join groups and start networking. There are healthcare jobs listed exclusively on LinkedIn, as well as an aggregation of jobs listed elsewhere. Joining MGMA’s new LinkedIn group will help expand your network even more.
In addition to LinkedIn, be sure to have your expanded resume on the web. MGMA provides a platform for this, as does VisualCV.com(free). I use VisualCV.com because it allows me to include articles I’ve authored, recommendations from former employers and even video. I’ve gotten a number of quality calls from recruiters who saw my expanded resume online.
Contact consultants to let them know you are in the market. MGMA has a consulting arm that often places healthcare executives, and you can also search for consultants via the MGMA Member Directory (members only) which at last count numbered about 640.
Contact your colleagues and MGMA friends to let them know you’re looking. If you are looking for employment in a particular region or community, contact managers working there and let them know about your search.
Look on Craigslist.org. Yes, really! You would be amazed who advertises there.
If you expect to relocate, having a home to sell may be a hiring stumbling block because of the housing market. Employers want to know you’ll be available to work when they want you. If you don’t have a home to sell, mention that in your cover letter/e-mail.
When you apply for a position, ask the receiver to let you know that your e-mail arrived. If they respond, take the opportunity to respond back, which helps you to stand out from the pack and gives you a name to follow up with in a few weeks by e-mail.
There is a pack! Some employers told me they had received more than 200 mostly qualified applications for open positions. How do you stand out in that kind of a crowd? Network, network, network. Find out whether you or someone you know knows someone at the potential employer and work it. LinkedIn has an excellent system for finding out who you know that works at the employer you are targeting.
Join more listservs on the MGMA Member Community(members only).Step outside your current/past specialties and join other professional e-mail lists to listen and contribute to the conversation. Respond when someone talks about a job opening.
Don’t spend much time on non-healthcare job boards. The likelihood that you will find the job of your dreams on Monster.com or CareerBuilder.com is low.
Don’t be afraid to look for a job on Twitter. This is what I tweeted: “Calling on the Power of Twitter: looking for new job: private (phys) practice mgmt/other healthcare opp. Innovator, Blogger. DM me – Thx.” If you want to jump into Twitter but don’t know what it’s all about, read this post at my blog, Manage My Practice, or MGMA’s Twitter guide. Twitter has recruiters, consultants, employers, job boards and colleagues and is one of the fastest-growing social networks. It can significantly expand your networking scope.
Share information with other job seekers in your market. Don’t be afraid to share your leads with others ”“ it’s good networking karma!
Two sites I found useful during my job search are CareerAlley.com and Alltop.com. Career Alley is a good all-purpose site with lots of job search information and resources, such as a tracking spreadsheet that helps you document your leads. Alltop is an ever-growing aggregator of other sites ”“ try looking under “jobs” and “careers.”
Remember, the Internet doesn’t replace traditional networking ”“ it supercharges it! The important thing is to get out there and make connections, share information and let people know what value you bring to a practice. Even with all the social networking I did, my opportunity came the old-fashioned way: A colleague and consultant I knew well from the state and regional levels of MGMA recommended me for a job, and here I am. Good luck!
I wrote this article for the Physician Office Managers Association of America (POMAA) March/April 2009 Newletter. If you don’t know POMAA, check out their website.
Each of us have areas of expertise based on our experience, our education and what we find interesting and fun. IT knowledge and skills are no longer optional, however, and I suggest every medical practice manager learn as much as possible about the following five areas. Your work life and the life of your practice may depend on it!
Skill 1: Email Etiquette and Management
Email can rule your work life if you don’t make good choices with your messages. Managers need to know how to use the Rules Tool (Outlook) to automatically move messages into folders, and how to turn emails into Tasks and Appointments. Work communication can succeed or fail if you don’t have the basics under your command. Knowing how to archive your email will not only save you time when looking for important information, but will save you from the frustration of searching through hundreds of emails. Here are the basics of email management:
Most organizational experts recommend looking at your email twice a day, and turning off the setting that notifies you immediately when you have new email. Email can be very addictive, and can suck your time away from projects and other work.
Just like paper, try to only touch an email once. Once you read the email, decide whether to delete it, answer/forward it and delete it, or do something else with it like dragging it to the task list or calendar. Don’t get caught in the ugly cycle of reading it once, and going on to the next email without doing anything about it. If you do that, you’ll end up with lots of emails that you have to read again…and maybe a third time.
Never put anything critical (of a criticizing nature) in an email. If you need to have that type of conversation with a colleague, pick up the phone. A critique to an employee is best done in person, with a follow-up email for the file.
Always check your outgoing email for tone. The best tone for business email is professional. This means a greeting, a message, a “thank you” and footer with your full name, title, and contact information. Some organizations are more formal, and some are less formal, but I would err on the side of being more professional. You can always set your email signature to include the greeting and thank you and your name, so all you have to do is complete the middle.
For emails that do need to be saved for reference, make subfolders under your Inbox to place reference email. Even better, copy the email to a Word document, and delete the email.
Have high priority (your boss or bosses) and low priority (listservs, subscriptions) email automatically come into their own folders. The low priority email can wait and the high priority email can be dealt with first.
Group emails with jokes, homespun wisdom, clever tests and unbelievable pictures are a waste of your time. If you need a break from work, go for a walk, but get rid of the group emails. They take personal and server email space and can border on or be outright offensive, causing a problem if you don’t nip it in the bud. Remember that email is legally discoverable.
Be careful about answering emails off the top of your head, possibly when you’re angry, or rushed. If you need to delay answering an email because of your mood, drag the email over to the task list and set the to-do for tomorrow.
Skill 2: Understanding Medical Office Software
Acronyms come and go, but the basic software that supports medical practices remains the same. Practice Management Systems (PMS) typically include registration, scheduling, billing and reporting as one component. Today’s systems are built around the billing function, with scheduling and registration supporting the ability to generate electronic claims and post payments back to the transactions. Because billing is becoming more standardized, it is the reporting that can make or break a practice.
Electronic Medical Records (EMR) are sometimes referred to in a broader sense as EHR (Electronic Health Records) and range from the simplest of systems which act as a repository for the electronic chart to the most sophisticated systems which may include digital imaging, e-prescribing, complex messaging, medication reconciliation, and test alerting, among others. EMR and PMS can be totally integrated, or can interface with each other, populating the other uni-directionally or bi-directionally. Those mangers with a deeper understanding of their own software systems will find it easier to implement pay for performance measures such as PQRI and e-prescribing, and will not have to rely on vendors to educate them.
PACS is Picture Archiving and Communication System and allows easy indexing and retrieval of images. PACS exists primarily in radiology and surgical specialty offices, but as more hospitals extend EMR and PACS privileges to physician offices, managers will need to understand something about the technology.
Other systems that will interface to your system are transcription, outsourced billing systems, data warehouses, claims clearinghouse, electronic posting systems, and web services interfaces. Get or make a graphic representation of your software and hardware system/network so you can talk knowledgeably about it and understand the effects of adding new servers, workstations or software modules.
Skill 3: Using Technology to Stay Current in Your Field
Magazines, newspapers and even television news is losing favor as people find the latest and most in-depth news on the Internet. For physician office managers, news and important information is available through websites, newsletters, newsfeeds, webinars, podcasts, listservs and blogs. How does a manager sift through all these options and stay current with the demand of running a day-to-day practice?
One of the most important ways to consolidate this information is to subscribe to a feedreader or email from websites you like and have the news come to you (called “push technology”), instead of you checking the website every few days or whenever you remember (aka “pull technology”). These are the programs that will eventually do away with most, if not all, of your magazine subscriptions. You know that guilty pile of professional magazines that you have in your office or at home that you have scanned but still plan to read in-depth? Gone!
Most websites offer email or RSS options to their users. An email option asks you to enter your email address and will email you when new information is available, typically offering the full content inside the email itself. This is ideal for anyone who has these emails automatically placed into an email subfolder to read later.
RSS stand for Really Simple Syndication and is a way to push the content of many sites into a feedreader, which is an organizer of website feeds. There are many feedreaders available at no cost and adding a new website feed to your personal feedreader is as simple as clicking on the orange RSS icon on the website page and identifying the feedreader you use. The nice thing about using RSS is that you can group sites into categories you decide upon, it is easy to add new sites and drop sites that you find a waste of your time, and you do not clog up your email program with lots of emails.
Webinars and podcasts are another way to stay current. Many webinars are free and allow you to dip your toe into the pool of knowledge on a particular topic. Webinars with a fee attached are usually longer and more in-depth, and can replace the traditional go-to conference which has become a budget breaker for many practices.
eBooks are quickly becoming the way to get just the information you want when you want it. Most eBooks are reasonably priced (some are free) and can be stored or printed.
Skill 4: Online Patient Interactions and Web 2.0 Applications
Patient interactivity via practice websites is growing exponentially. Many practices are using web functionality to communicate with their patients via secure messaging. This allows bi-directional communication such as:
1. Request an appointment (patient) or appointment reminders (practice)
2. Send statements; patients pay online with a credit card (practice & patient)
3. Inform patients of test results (practice)
4. Create personal health records (patient)
5. Request a prescription refill (patient)
6. Virtual office visits (practice & patient)
7. Complete registration via fillable .pdf forms and download to practice management system (practice & patient)
8. Request medical records; send an electronic copy of same (practice & patient)
9. Complete a history of present illness prior to the on-site visit (patient)
10. Ask & answer questions for the doctor, nurse, or staff (patient & practice)
If you’re not looking into ways to communicate with your patients electronically, start now. Web 2.0 is now more typically referred to as social networking, social media or new media. What started out as a way for friends to communicate with each other is now an amazing, ever-expanding ability to connect/market to businesses, patients and referrers. Very few medical practices are using social media, but they should, because it is the way of the future, and in many cases, very affordable.
Skill 5: Knowledge Management and Retention
Most medical offices try hard to document processes such as “How To Make An Appointment For Dr. Jones,” but find it difficult to keep up with documenting changes to those written protocols. Documentation is crucial for operations in that it supports job performance and consistency, and is a basis for training new employees. The traditional documentation method for most practices is use of Word documents, which can create an immediate usability logjam. Due to cost, Microsoft Office is not installed on many workstations, and many office employees are not trained to use Word, so the onus for original creation of and changing of protocols falls to one person. Changes in healthcare are happening so quickly that it is not reasonable for one person to be able to update all documentation, unless they are dedicated to it on a full-time basis.
Better and more affordable solutions are becoming available. Speech recognition and office wikis are two possibilities for documenting office processes. Speech recognition (you may already be using it for your transcription) is a very affordable solution, but it does take time to train the program to recognize your voice. If you are not used to dictating, it may also be a learning curve, but it is one that will pay dividends down the road. Doctors can use it to help you by dictating their preferences, such as appointments, patient intake, room set-up, procedure set-up, patient phone protocol and after-hours call contact protocol.
Private wikis are another good bargain in the marketplace, as many are available at no cost, and may be installed and managed on the web. Wikis need at least one person to function as editor. Since you can have your entire staff work on documentation, the staff becomes very invested in the process of keeping the wiki fresh and up-to-date.
There are other free or low-cost project management web programs that can also be used to track changes and remind staff to document changes later. The one area that is most important for tracking changes and managing knowledge in the practice is in billing. Many practices are held hostage by their billers as their knowledge is so specific and proprietary that the manager feels s/he could not recoup it if they left. No practice should be vulnerable based on knowledge any single employee has, including the manager.
I am very interested in technology that creates value in medical office practices. If you are using something new and different in your practice, please email me and let me know. Also, if you have any questions about the ideas I discuss in this article, I am glad to answer them: marypatwhaley@gmail.com.
One of the most valuable, if not THE most valuable, resource a healthcare executive has are colleagues and their collective experiences. The issues that we confront daily are what we need and want to discuss with our comrades-in-arms.
The listserv is the most direct way of sharing information between colleagues. I belong to a number of MGMA (Medical Group Management Association) listservs and to the AAOE (American Academy of Orthopedic Executives, formerly BONES) listserv. These listservs are amazingly helpful and I have more often been the benefactor than the provider of information there. But listservs have their limitations.
You have to be a member of these organizations to participate in their listservs. This is not unreasonable, as the infrastructure and management of a listserv is not without cost. As healthcare continues to get squeezed, however, managers will have to make harder choices about which resources and memberships they and their practices can afford. Membership requirements also screen the participants, which may be important to some. The screening, however, may limit the amount of participation and the diversity of participation. Healthcare is becoming global, as any medical practice competing for the medical tourism dollar will tell you.
Listservs can also take time to read and delete or store. I have not found an easy solution to arranging the information I want to retain, although there is always deleting the listserv emails and searching the archives later.
I am finding Twitter to be a no-cost solution to many of my needs not fulfilled by listservs. I have access to thought leaders in and outside my field, and the conversations we have can be on or off the grid. Although it was initially difficult to constrain myself, I now find the limitation to 140 characters to be very liberating.
Tweets are brief pointers to people, conversations, blogs, and resources across the world. As Kenneth Yu says on his blog MindValley Labs:
…Twitter is currently the closest app on Earth that replicates the actual thought patterns of the human mind. You see, the human mind does not really think in blog and article form. It does not think in huge chunks of information. Instead, it thinks in a stream of consciousness way, random disjointed thought layered upon random disjointed thought.
Twitter also has a number of applications designed to organize information, contacts and conversations in ways that make information easy to retrieve. To follow me on Twitter, use my Twitter name @mpwhaley. To join a brand-new community of discussions around medical practice management, use the #medpractice hashtag to search and join the conversation.
I wrote this post for the 
Skill 4: Online Patient Interactions and Web 2.0 Applications
