1. Diagnosing and Treating Critical Practice Management Systems Sponsored by: Northern Colorado IPA June 17, 2011 Presented by: Karen Zupko, President

2. www.karenzupko.com 2

3. What’s Going On Now? Operational Roadblocks? 3

4. How Can You Improve the Patient Experience? 4

5. Physician Efficiency? 5

6. What Business Processes Have the Most Steps? 6

7. Barriers to Implementing Technology? 7

8. Average Tech Literacy? 8 Dr. Need Tech KZA Technology C

9. Governance, Management and Leadership 9

10. Criticisms No respect for organizational systems. Meetings start late. Evening meetings. Poor agenda, poor minutes. “Bomb throwers” reign. Deficient preparation. 10

11. “Dr. Sanders thinks he’s part of the solution.That’s part of the problem.” 11

12. Shortages will make recruitment of new partners challenging. “We don’t have enough doctors in primary care or in any specialty.” Rep. Shelley Berkley (D-Nevada) To cope with the growing shortage, suggested proposals include: “One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants.” “The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional doctors each year.” Source: Shortage of Doctors an Obstacle to Obama Goals, by Robert Pear; The New York Times, April 27, 2009 12

13. The urge to merge among independent practices will continue to accelerate. 13

14. Flawed Decision-Making:Ready! Fire! Aim! Examples: “We’re quitting all health plans!” “Spending money on marketing with no predictable ROI or ROE” “Hire her! Fire him!” “Buy the laser!” “Install the EMR – next week!”“We need an aesthetician.” 14

15. Confusing Control, Deligationand Abdication 15 I’m in control! How do you know? Of what?

16. Confusing Control, Deligationand Abdication Examples: “I can’t let anyone else do ________, I have to maintain control.” “Here you do this even though you don’t have the skills or training” “We told the nurse/manager to do it.” 16

17. How Do You Measure Up? Our Practice Management Reporting Visits Procedures, Surgeries, Treatments Collections Staff to Revenue Ration 17

19. Daily deposits

20. Monthly P&L

21. AR reports

22. Patient monthly statements

23. Point of service collection

24. Inventory (supplies)

25. Audit controls

26. Appeals18

27. 19 Read Reports!

28. Non-Physician Expenses As a % of Net Revenue (Overhead) 20 Source: AOA 2009

29. Open Your Eyes To Risks 21 Blinders off!

30. The Fraud Buster’s are out in force. Expect an audit. 60 Minute Rule Careless Coders Beware! 22

31. 2011 OIG Work Plan Excerpt Coding or Evaluation and Management Services Medicare paid $25 billion for E&M services Payments for Evaluation and Management Services Medical records with identical documentation across services Evaluation and Management Services During Global Surgery Periods The number of E&M services provided by physicians and reimbursed as part of the global surgery fee 23

32. What Does This Look Like? 24 2008 National 2008 NE State Dr. C

33. “There! Is that enough bullets for you?” 25

34. Risk Areas 26

35. Supervision and Scope of Practice: State and Payor Variations Matter Tech MD NP RN PA 27 27

36. “This board has to implement a compliance program. Please … we don’t need the visual aid.” 28

37. Trusting and Not Verifying “Background checks – nope we don’t do that unless, well you know, they look like we should.” “Sure I cleaned up the AR.” “Yep, we are appealing accounts.” “How would I know they weren’t sending patients statements?” “Well, I though we were _______.” “She told me we were ______.” 29

38. Right people? Right jobs? Right time? Right tools? Right training? 30

39. “Are they as good as they look?” 31

40. 32

41. Audit Controls Specific steps that ensure the integrity of the accounting system. Payables Receivables Inventory 33

42. Who Will It Be? 34

43. 35

44. 36 Receipt #102 For: John Patient On: July 28th, 2010 Paid: $40.00 Rona at Reception

45. Audit Controls in Action 37 Numbered superbills Daily Close Fidelity bonds Regular inventory reconciliation Background checks Computer passwords

46. Money Handling 38 Screen candidates Limit cash Watch patient complaints Safeguard credit card

47. Unallocated Cash 39

48. Suppressed Statements 40

49. 41 Insurance Coverage Check Today!

50. Personnel 42 Investment or Overhead?

51. 43 “It would be easier to massage a squid than to hold my staff accountable.”

52. Staffing Costs as a Percentage of Total Medical Revenue 24% on average in practices Salary + Retirement Benefits + Health Insurance + Training 44

53. 45 Finding qualified clinical support and business staff are a growing challenge.

54. 46 Do you test applicants?

55. Example of Total Test Results 47

56. 48 “Instead of my resume, I’ve printed out my daily horoscope for the past year. You’ll see that I’m a special person who is destined for great things!”

57. Staff Gap Analysis 49 What are my staffing needs?

58. Technology 50

59. Litmus Test for New Technologies Save Time Boost Efficiency Reduce Costs Improve Patient Experience Leverage Knowledge 51 If it doesn’t, don’t buy it!

60. More Common Than You Think 52 You Bought This… You Drive It Like This...

61. Race Car vs. Station Wagon Appointment Schedule Integrated with encounter form generator? Set-up templates by condition, MD? Integrated with batch eligibility processing? Billing & Collections Are you leveraging custom message on statements? Do staff use work queue features? Is anyone using the payment plan follow up tool? Flags & Account Alerts Reporting! 53

62. Reimbursement Process 54

63. Business Solutions Online/real-time claims submission Electronic claims remittance Batch eligibility Online eligibility look up – faster than phone! Remote deposit Auto collection Online banking 55

64. Pre-Registration 56 Done the RIGHT way in 2010 Gather detailed insurance information prior to the visit.

65. 57 Source: philly.com, August 13, 2010

66. Real Time Claims Adjudication 58

67. Remote Deposit Saves Time, Reduces Risk Example $150 set up fee $100 per month service fee .10 per item 59

68. SmileReminder.com 60

69. Understand.com 61

70. Solveras.com 62

71. Social Media 63

72. The Rise of Networks and Social Media 35% of online adults have social network profiles. Facebook reports ‘several million’ accounts of users older than 65. Source: Pew Internet and American Life 64

73. MGMA Survey Results Do you currently have a group practice web site? Yes - 81% Do you see the internet as an effective communication medium for basic information between you and your patients (office information, insurance information, downloadable forms etc)? Yes - 93% Assuming security is not an issue, do you see the internet as an effective communication medium for personal information between you and your patients for: 65

74. 66

75. Does Your Website Do This? New patient packet/pre-registration Referring physician section Digital forms and policies Appointment scheduling options Post-op instructions Patient stories Videos of surgeons and what to expect in the office Email staff and surgeons 67 See KZA’s Minimum Website Requirements–2009

77. Secure Patient Messaging

78. Ask a Clinician

79. VOV / Symptom Assessment

80. Referral Portal

81. PHR

82. Online Bill Payment

83. Auto-draft payment plans

84. Virtual Card Swiper

85. Ask a Biller

86. Pre-registration / Health forms

87. Appointment Requests

88. Patient MessagingSource: Medfusion Practice website, patient education, patient satisfaction surveys …

89. Use Key Features 69 Out of Office Reply Greetings! I am out of the office returning on August 24th. My phone access is limited and none to email. Call my office at 312.642.5616 x. 15 and ask for Mary if you need something or to schedule an appointment. Karen Custom Signature

90. 70 I don’t skate to where the puck is; I skate to where I think the puck is going to be.” -Wayne Gretzky