Posts Tagged medical practice management

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Congress Expected to Further Delay SGR Cut to Medicare Physician Fee Schedule

UPDATE: On June 24, 2010 the House and Senate passed legislation to further delay the Medicare cuts until November 30, 2010. More here.

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Congress has yet to pass a bill delaying the June 1, 2010 21.2% reduction in physician reimbursement, but most believe it will happen and be effective retroactively.

CMS has said it is anticipating a further delay in Medicare fee schedule cuts, so they have “instructed contractors to hold claims containing services paid under the MPFS for the first 10 business days of June.”

More information on my post here.

Stay tuned!

Posted in: Headlines, Medicare & Reimbursement

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ARRA Eligible Providers: Who Is Eligible to Receive Stimulus Money and How Much is Available Per Provider?

Note: read my latest post on getting the EHR Incentives here.

Medicare Definition of Eligible Provider (EP)

For Medicare, physicians and some hospitals are eligible providers. “Physicians” includes doctors of medicine (MD) or osteopathy (DO), dentists or dental surgeons (DDS or DMD), podiatric medicine (DPM), and optometry (OD) and chiropractors (DC).

For providers, their annual payment will be equal to 75 percent of Medicare allowable charges for covered services in a year, not to exceed the incentives in the table below.  Payments will be made as additions to claims payments.

Hospitals include quick-care hospitals (subsection-d) and critical access hospitals  and only includes hospitals in the 50 States or the District of Columbia.

Medicaid Definition of Eligible Provider (EP)

Medicaid takes the Medicare definition of eligible providers (physicians) and adds nurse practitioners, certified nurse midwives and physician assistants, however, physician assistants are only eligible when they are employed at a federally qualified health center (FQHC) or rural health clinic (RHC) that is led by a Physician Assistant.  Eligible hospitals include quick care hospitals and children’s hospitals.

At minimum, 30 percent of an EP’s patient encounters must be attributable to Medicaid over any continuous 90-day period within the most recent calendar year. For pediatricians, however, this threshold is lowered to 20 percent.

The first year of payment the Medicaid provider must demonstrate that he is engaged in efforts to adopt, implement, or upgrade certified EHR technology.  For years of payment after year 1, the Medicaid provider must demonstrate meaningful use of certified EHR technology.

Change 1:

The  definition of “hospital-based physician” was recently clarified to include physicians working in hospital outpatient clinics (employed physicians) as opposed to the inpatient units, surgery suites or emergency departments.  This still excludes pathologists, anesthesiologists, ER physicians, hospitalists and others who see most of their patients in the ER as outpatients or as hospital inpatients.

Possible Change 2:

The Health Information Technology Extension for Behavioral Health Services Act of 2010 (HR 5040)  is a bill in the US Congress originating in the House of Representatives that would amend the Public Health Service Act and the Social Security Act to extend health information technology assistance eligibility to behavioral health, mental health, and substance abuse professionals and facilities, and for other purposes.  You can track the bill here.

For more information on stimulus money for meaningful use of an EMR, read my post here.

Posted in: Electronic Medical Records, Headlines, Medicare & Reimbursement

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Why are More Healthcare Management Job Postings Looking for Certification?

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©Sgame/Dreamstime.com

If you are working in practice management, you might want to explore the gold standard in certification through the American College of Medical Practice Executives (ACMPE). Disclaimer: I am Board Certified and a Fellow in the ACMPE but I receive no compensation for writing about the College or having a link to them on my blog.

Why certification as opposed to an undergraduate degree? I think this week’s opinion piece in the Wall Street Journal by Charles Murray says it better than I can. Read the article here.

Posted in: A Career in Practice Management

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How to Ask for a Raise

©Roxana González/Dreamstime.com

©Roxana González/Dreamstime.com

My son called me today and asked me how to ask for a raise. Here is how I told him I’d like an employee to ask me for a raise:

  1. Make an appointment with your boss and let her/him know that you’d like to discuss your compensation. Do not e-mail this request to your boss while s/he’s out of town, their first day back or has a big deadline coming up. Choose your moment. Ask for an appointment several days or a week in the future so you have time to prepare.
  2. Make a list of the things you’ve accomplished since your hire or last raise. Include things you’ve learned, ideas you’ve shared, projects you’ve participated in and benchmarks or goals you’ve met or exceeded. Add any new ideas you haven’t already shared. Print a copy of the list to give to your boss after your Mom has reviewed it you’ve spell-checked it.
  3. Research your job on the Internet and see how your wage compares with others of the same title or job description. Print out the information (if favorable) for your boss.
  4. if you feel heated about your compensation, take the time to write out your feelings or discuss them with someone who doesn’t work with you. Let go of any feelings of anger or frustration and make sure you are calm before the appointment with your boss. Keep yourself from holding any imaginary conversations with your boss before the meeting trying to guess what s/he will say.
  5. When meeting with your boss, thank her/him for his/her time and ask if you can share some information you’ve brought with you. After you’ve presented your info, let your boss know (if it’s true) that you really like your job and hope to be a part of the company’s future. Ask if s/he would consider increasing your compensation based on the material you’ve presented, and indicate that you understand s/he might need some time to review the information you’ve provided. Ask when you might be able to meet again to discuss her/his decision.

You’ve been professional, respectful, supported your request with information, and given me time to think about it. As a boss, I couldn’t ask for more.

Posted in: A Career in Practice Management

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Are Critical Conversations Hard for You?

©Dennis Owusu-ansah/Dreamstime.com

©Dennis Owusu-ansah/Dreamstime.com

A great column in last week’s BusinessWeek by Carmine Gallo gives the reader 4 steps to making difficult conversations with employees and coworkers more productive. I like his steps, but I have four of my own, and I’ll let you choose which works for you. Read Carmine’s suggestions here.

Here are my four steps:

Step 1. Always start with a question. I rarely feel that I know the complete story so I typically ask for more information about the issue or behavior in question. Nine times out of ten I learn something I didn’t know that helps the conversation. Asking questions and clarifying information usually gets both parties a little more comfortable.

Step 2. Express your concern about the issue or behavior and let the employee know why you’re concerned. More information helps the employee see how their work interacts with someone else’s or contributes to the organization as a whole.

Step 3. Ask for the employee’s input in solving the issue or behavior. There may be several solutions that would work, and choosing the best one together, or letting the employee choose one is a win/win.

Step 4. Restate the action plan for the resolution and close the meeting with an invitation for either of you to meet again if the issue needs revisiting.

It may be hard to talk to employees and coworkers about issues or behaviors, but if you are in a leadership position, you must learn how to have hard conversations of all types. The secret is asking questions and collaborating on solutions.

Posted in: Human Resources, Leadership

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Long Vacations are Good for Employees, the Company and Me!

When we first moved to the west coast, I was stunned to find that people routinely take two weeks of vacation off AT ONE TIME! On the east coast, my experience had been that taking more than a week off was reserved for getting married or going to Europe. Amazingly, and this was a revelation to me, people can take two weeks off at a time and the organization can go on! Now I am very much in favor of people taking longer vacations for a number of reasons:

  1. It forces the organization to cross-train employees and to make sure that there are at least three people in the company that know how to do every critical task.
  2. It requires the creation and maintenance of current, clearly written protocols associated with each job, in case the other two employees who are cross-trained on the job get sick, have jury duty, have a death in their family, or quit on short notice.
  3. It gives the company an opportunity to assess the workload and composition of a job from another person’s viewpoint. We’ve all had the experience where someone goes on an extended leave and you find out that the job is much more, or less, complex that you thought, or someone was telling you.
  4. It ensures that nothing untoward is going on with someone who has access to company money. Everyone’s heard of the manager who never takes a vacation, not because s/he’s so dedicated, but because s/he has sticky fingers.
  5. It gives the employee an opportunity to truly rest, heal, and remember that there is life outside of work (can you tell I’m thinking about myself here?)

Here’s an excellent article that has some great points about the ethics of taking Vacations. The author, Bruce Weinstein, PhD states:

Leaving work behind for a period of time is not only acceptable; it is our ethical obligation.

My advice to each of you is to fulfill your ethical duty as soon as possible.

Posted in: A Career in Practice Management, Human Resources, Memes

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While I Was Paying Attention to Other Things, a New Hoop Appeared for My Practice to Jump Through

©Pavel Losevsky/Dreamstime.com

©Pavel Losevsky/Dreamstime.com

Sometimes it’s hard to figure out what to pay attention to. There are projects, staffing, budgets, contracts, technology, Medicare cuts and on and on. While I’m trying to pay close attention to this stuff, along comes a program that I should have paid attention to and asked questions about before it launched, but I didn’t.

A local payer is requesting notification each time a physician orders an imaging study for a covered patient. In this case, the practice owns the MRI so practice staff are doing the paperwork. This advance notification is not DIRECTLY tied to payment, nor is it mandatory. I’ve been around the block a few times, however, and I know what non-mandatory means, and so I try to play nice when it’s reasonable to do so. But, I didn’t pay attention, and the next thing I know the practice is in a hubbub trying to insert the advance notification into a process that’s already unnecessarily complex. The reason it’s difficult is that the person who has the information the insurer wants, the physician, is two staff people removed from who actually is responsible for entering the data. As with most medical information, getting it from the physician to the insurer requires a series of hoops and a lot of dexterity.

The Wall Street Journal wrote about this type of advance notification program a few days ago, and I think it’s another interesting sign of the healthcare times. Read about it here.

Posted in: Medicare & Reimbursement

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Using What To Do What? Radiologists Use iTunes to…

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©Ron Chapple Studios/Dreamstime.com

Under the category of using existing software for new purposes, radiologists at Renji Hospital and Shanghai Jiaotong University School of Medicine are using iTunes to house and sort medical PDFs of images and research documents. Download Squad has the story here.

Posted in: Innovation

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5 Questions: A Deceptively Simple Performance Evaluation

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©Dmitriy Shironosov/Dreamstime.com

Here is a VERY succinct performance evaluation that I’ve used for years. Called 5 Questions, the employee completes it, submits it to the manager, then they discuss and refine it together during the evaluation interview. Here are the questions:

  1. What goals did you accomplish since your last evaluation (or hire)?
  2. What goals were you unable to accomplish and what hindered you from achieving them?
  3. What goals will you set for the next period?
  4. What resources do you need from the organization to achieve these goals?
  5. Based on YOUR personal satisfaction with your job (workload, environment, pay, challenge, etc.) how would you rate your satisfaction from 1 (poor) to 10 (excellent.) 1 2 3 4 5 6 7 8 9 10

You do have to stress that question #5 is not how well they think they’re doing their job, but how satisfied they are with the job.

The great thing about this evaluation is that it’s one piece of paper and not too intimidating. Staff can use phrases or sentences and write as little or as much as they like. If it’s hard to get a conversation going with the employee, ask them “What was your thought process when you assigned your job satisfaction a number __.” Usually that opens the flood gates!

If you use a goal-oriented evaluation like this one, you’ll find that employees will grasp that you are asking for their performance to be beyond the day-to-day tasks, and to focus on learning new skills, teaching others, creative thinking and problem-solving and new solutions for efficiency and productivity.

For help with job performance words and phrases, click here.

Posted in: Human Resources

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Every Ten Minutes is a New (or Lost) Opportunity

©Travis Manley/Dreamstime.com

©Travis Manley/Dreamstime.com

Here’s some information you probably already knew, but might have forgotten. After ten minutes of a presentation, the majority of an audience (your staff, your docs, your board, your referrers) tune out, or rather, their brains turn off. BusinessWeek’s Carmine Gallo recently wrote about John Medina’s book Brain Rules and the ten-minute rule.

If you want to hold people’s attention, I recommend you introduce some sort of engaging device at or shortly before each 10-minute increment of your presentation. This device doesn’t have to be complicated. A simple story will suffice, as will a review of the past 10 minutes. In my presentations, I often tell a relevant story, or better yet, show a video clip that is relevant to the previous discussion. If you’re presenting via Webinar software (BusinessWeek, 4/18/08), you can use a tool to push a poll or a question to your audience. Again, be sure to plan these exercises at 10-minute intervals. – Carmine Gallo

Some things I’ve used successfully to break up relatively dry information in staff meetings:

  • short dance break to wake everyone up ( James Brown’s ‘I Feel Good” is a classic favorite)
  • passing out party hats to everyone to announce a special event (can get silly)
  • visual interest slides at intervals – optical illusions (the gorilla on the basketball court is a classic but I don’t know if it’s available for groups unless you buy the DVD)
  • telling a tasteful joke if you can deliver it well – I personally can’t tell a joke to save my life
  • teach desk exercises to stave off stiff necks and sore backs
  • show pictures or movies from the last staff event, holiday party, etc.

Read the complete article here and let me know what you do to keep people from tuning you out.

Posted in: Human Resources

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