It is the time for giving…

Chastity Werner, Health Care Consultant

…are you and your staff giving your patients the treatment and services they deserve? 

It is so easy to get caught up in the hustle and bustle of the holidays.  The question really is “how is your staff handling the emotional roller coaster of the holiday season?”  Do your patients feel welcome and wanted or do they feel they are obstacles interfering with the staff’s holiday shopping and scheduling of events?  

It takes one bad patient experience to explode over the internet reaching thousands of people within minutes.  The evolution of social media can make or break a business today.  While the patient is in the office they can be sending Yelp or FaceBook reviews on how they feel about your practice – good or bad! 

Your best course of action to avoid bad reviews is to be proactive.  Consistently train your staff on the importance of good customer service.  

Here are a few tips to review: 

• Smile and greet patients when they enter the facility.  If you are on the phone – multitask (smile and talk at the same time!).
• Make eye contact
• If the patient is talking, stop what you are doing and listen.  Even better act interested!
• Remember details about the patients and they will love you forever.
• Remember to not take it personally.  You never know why a patient is in a bad mood and with the exception of extreme situations, it is just part of being involved in a service environment.

 Have you googled your practice today?

First Time at NextGen User Group 2011 in Las Vegas?

Chastity Werner, Senior Health Care Consultant

This is a great conference; here are some tips for first time (and returning) attendees:

1. Determine whether the pre-conference is of value.  Remember you will already be sitting through two and half days of sessions.  If it is not a topic of interest, it will be better to save your energy and brain space for the other days.
2. Ask veteran attendees which presenters are the best or most knowledgeable of NextGen.   NextGen UGM is like any other event in that there are interesting speakers who are great at presenting and some that are not.  This is especially important on day two and three.
3. Focus on the “Track” and the “Level” that fits you when determining which session you would like to attend remember to always  If this is your first year using NextGen ideally you should attend a 100 level session. 
4. Visit the vendor area.  Talk to them about their services and how it might fit your organization.  Some of the vendors are NextGen specific.  Write notes on their business cards so when you return you will remember why they were of interest.
5. Visit the NextGen booths in the Vendor area.  NextGen has all of the different products on display and available to demo.
6. Visit the Hands on Area as much as possible.   The Hands on Area allows you to work with an experienced NextGen Representative (commonly trainers).  So the question(s) that you have had as to why the system will or will not do something or better yet you know it will but cannot figure out how…you have them right there and they cannot put you on hold!
7. Network- this is a prime time to get contacts from across the country of other users.  Make sure to reach out afterwards by sending a card or giving them a call after UGM.  If you have an issue it is always nice to be able to call someone that also uses the software to see if they have had the same situation. 
8. Bring your laptop or iPad to take notes. This makes it easier to organize notes from all the sessions.
9. Pack so that you can dress in layers.  Wear comfortable shoes-you will be doing a lot of walking! 
10. Allow yourself time each morning to grab something to drink and eat.  There are typically stands throughout the facility that are provided.
11. If in doubt about anything, ask. There will usually be 2000-3000 people at the event, so you won’t be the first.
12. Don’t miss the “client event” it’s always a great time! 

Questions for Your EHR Vendor

Brian D. Meyers, CPA, Tax Supervisor

Buying an EHR system can be a daunting task.  This is not only because of the price tag associated with the software, but because of the complex nature of the implementation project.  Many practices probably do not know where to even start, which is where connections come in quite handy.  If one of your staff members knows of another practice which has implemented an EHR, then you have an easy place to begin gaining an understanding of the questions you should ask.

If you and none of your staff know anyone, then it can be a challenge to know the right questions to ask.  This list provides 20 questions to ask potential vendors to gain a better understanding of their product.  I hope this list helps you in your information gathering process.

20 Questions to Ask Your EHR Vendor

By Marisa Torrieri | July 6, 2011

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Whether your practice is shopping around for an EHR or waiting for upgrades, it’s good to know what you’re in for, technology- and time-wise. That’s why we asked our readers, practice consultants, IT experts, and members of our Physicians Practice Group on LinkedIn to submit their thoughts for the most crucial questions you should be asking your vendor. Here are our favorites:

1. Do you have an implementation team that will make an assessment of the readiness of your practice and staff?

2. Do you have a user group that meets annually and that has a listserv for sharing information online?

3. Do you have a dashboard report to track phone message turnaround time by nurses and providers?

4. How often do you update your software; what updates are you planning for your next two releases?

5. Have your clients been more successful with a “big bang” implementation approach or a phase-in approach?

6. What happens when your office is hit by a disaster; are the records safe?

7. How many providers in our specialty use this system? Can you refer our practice to at least three who have set up this current version to see how it went?

8. Which systems failed implementation or were replaced within 24 months of implementation?

9. How many clients can demonstrate they have achieved their ROI?

10. Can we load our insurance contracts and see apples-to-apples performance comparisons?

11. Do you carry cyber and privacy liability insurance coverage?

12. Will an EHR migration absorb all of the patient demographics through a reverse migration from the billing data?

13. How often are coding updates incorporated (if the vendor provides this component)?

14. Do you, the vendor, have a complete inventory of drug, allergy, food interactions and their respective alerts incorporated into the system and again, how often is the database updated?

15. What is the pricing structure, by practitioner? By location? Are there different prices for varying types of practitioners?

16. Is the specific system version you are proposing: the same system that won the awards you tout; the same one that’s CCHIT/ONC certified; and the same one that is certified as interoperable with our regional health information exchange or health information organization?

17. You say your system is template-driven and completely customizable. For my specific specialty, how much time do I need to devote to populate and customize the templates to become functional in my practice?

18. What reporting capabilities are natively embedded in your system? Is it a separate module? How easy is it to generate my own custom reports?

19. To achieve meaningful use qualification, do you have dashboards and other tools to allow me to evaluate how our providers are doing in the specific areas needed to qualify for ARRA/HITECH funds?

20. Do you have a money-back guarantee for Stage 2 and Stage 3 of meaningful use qualification?

Contributors: Ronald Cline, manager, Physician Consulting Services at QHR; Robert Evans, healthcare consultant; Gayle Gottlich, owner, Pathfinder Consulting; Ken Groff, executive, Beacon Insurance Group; Marion Jenkins, CEO, QSE Technologies; Bruce Miller, owner, M&M Practice Consulting; and Rosemarie Nelson, healthcare consultant, MGMA.

Marisa Torrieri is associate editor for Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

FASB Approves EITF-100H as Final Standard

Jon Waitukaitis, CPA, Audit Manager

The Financial Accounting Standards Board (“FASB”) has approved EITF-100H, Other Expenses (Topic 720):  Fees Paid to the Federal Government by Health Insurers as a final standard.  

When Will This Apply?

The changes to Other Expenses (Topic 720) are effective for calendar years beginning after December 31, 2013 (the fees become effective beginning in 2014). 

What Changes Will Be Required?

The amendments specify that the liability for the fees mandated by the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act (the “Acts”) should be estimated and recorded in full once the entity provides qualifying health insurance in the applicable calendar year in which the fee is payable with a corresponding deferred cost that is amortized to expense using a straight-line method of allocation unless another method better allocates the fee over the calendar year that it is payable.

Why the Changes?

The FASB believed it was unclear how existing GAAP would be applied to the fee that is the subject of the amendment to Other Expenses (Topic 720).  As a result, the amendment is simply a clarification of the application of existing GAAP to a specific situation.

FASB Approves EITF090H2 as Final Standard

Jon Waitukaitis, CPA, Audit Manager

The Financial Accounting Standards Board (“FASB”) has approved EITF090H2, Health Care Entities (Topic 954):  Presentation and Disclosure of Net Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts, as a final standard.  

When Will These Apply?

Private companies won’t have to apply the changes to Health Care Entities (Topic 954) until 2013, although earlier adoption is permitted.

What Changes Will Be Required?

The amendments to Health Care Entities (Topic 954) would require a health care entity to change the presentation of its statement of operations by reclassifying the provision for bad debts from an operating expense to a reduction from revenue (net of contractual allowances and discounts).  Additionally, a health care entity would be required to provide enhanced disclosures about how it considers collectibility in determining the amount and timing of revenue and bad-debt expense.  The amendments also would require disclosures of revenue (net of contractual allowances and discounts) as well as a reconciliation of the activity in the allowance for doubtful accounts by major payor type.

Why the Changes?

The amendments change the presentation of the statement of operations and add new disclosures that are not required under current GAAP. FASB believes the change in the presentation of the statement of operations would be an improvement from current GAAP because it would result in the presentation of an amount of net revenue (after any provision for bad debts) that is closer to the amount that the health care entity ultimately expects to collect.  The provision for bad debts still would be required to be disclosed on a separate line as a reduction from revenue (net of contractual allowances and discounts) in the statement of operations.  The new disclosures would assist users of financial statements to better understand how a health care entity has considered collectibility and customer credit risk in applying its revenue recognition policies.

Keys to an Outstanding Patient Experience

Brian D. Meyers, CPA, Health Care Consultant

A physician’s primary responsibility is the well-being of his patients.  They strive to provide high quality care to their patients, thus demonstrating excellent skills to diagnose and treat patients effectively.   They are so engrossed in the care of their patients that they often forget about the element of patient service. 

Physicians have a direct influence on their work environment.  Behaviors adopted by them that create an atmosphere of teamwork, collaboration and support, leads to the ability of all health care team members to provide patients with high quality care experiences and patient satisfaction.

Below are a few practical examples to implement within your practice:

• Hire the best and friendliest receptionist
• Train employees on patient relations
• Conduct patient satisfaction surveys
• Include patient relation skills as a significant and highly weighted component of the performance appraisal
• Terminate employees who are unkind, rude and do not adhere to patient service policies and training
• Require employees to keep their social conversations among themselves to a minimum during the patient flow in the office
• Make patient service and patient relations a regular agenda item at your office staff meetings

Understanding patients’ experiences outside your exam room, leveraging staff to work as a team, serving as a role model for service behavior, and sharing your knowledge are keys to comprehensive quality care.  Small changes in behavior can reap big rewards.

Why Should Every Practice Have a Compliance Plan?

Kathleen Enger, RN, CPC, Senior Health Care Consultant

What does a compliance plan mean to a medical practice?  It demonstrates buy-in by a professional staff, individually and as part of a team, that they understand their role in contributing to a successful practice’s reputation for quality and integrity.  The plan is designed to prevent violations of laws, regulations and policies.

A practice that incorporates a compliance plan demonstrates their willingness as a participant to comply with all federal, state and private health plans.   The plan should be maintained and regularly updated to ensure that those involved with the performance, medical billing and coding of the services provided, preserve the highest degree of integrity. 

Every practice should have a designated compliance officer.  It is their responsibility to design and implement internal controls to assure compliance with policies and procedures, specifically standards of conduct that are to be upheld by each and every employee.  An effective compliance plan can improve the operational processes and practices of an organization. 

A compliance plan won’t prevent you from being audited or sued.  But an effective one can serve as a solid defense in these cases.  Compliance plans are just good business sense.

If it Wasn’t Documented, it Wasn’t Done

Kathleen Enger, RN, CPC, Senior Health Care Consultant

The “wasn’t documented, wasn’t done” motto is a common one in healthcare settings, particularly as it applies to medical record documentation. Consistent and complete documentation in the medical record for every patient is an essential component of providing quality patient care.

This documentation is required to record pertinent facts, observations and findings, and must meet certain compliance standards.  It is also an avenue of communication among healthcare providers in order to design the patient’s treatment plan over time.

The medical record continues to become increasingly important, and has become a tool to:

• Track health care statistics
•  Act as a legal document
• Justify to third party payers that charges billed were for medically necessary services

For these reasons and more, every healthcare professional should focus on accuracy and completeness in the patient’s medical record.

Healthcare professionals have an obligation to document appropriately and adequately to ensure standards of care are being met.  Ways to stay current on accurate documentation standards can include the following:

• Periodic re-training of staff
• A compliance program that includes an audit plan

Ultimately, a well organized and well maintained medical record will provide a comprehensive source of information for staff, physicians, auditors and insurance payers. It is one source of past and present diagnosis and treatment.  It is a history and a future plan for each patient at your fingertips.  So, if that crucial information is not documented, for many patients, it really is just as if it wasn’t done at all.    

Valuing Medical Practices – Accounts Receivable

Kevin P. Summers, JD, CPA/ABV/CFF, ASA, CVA, CDFA, Senior Manager, Forensics and Valuation

When using the asset approach to value a medical practice, one of the medical practice’s most valuable assets will most likely not appear on the historical financial statements.  What asset are we talking about?  The answer is accounts receivable. 

Most professional services, including medical practices, use the cash basis of accounting.  Under the cash basis of accounting, accounts receivable do not appear on the financial statements because they reflect the future receipt of cash for previously rendered services.  Utilizing this method of accounting, the medical practice only needs to recognize income when cash has actually been received. 

When valuing a medical practice using the asset approach, it is important for the valuation analyst to include the accounts receivable in his or her analysis.  However, valuation analysts need to realize that medical practices do not generally collect 100% of their accounts receivable.  Depending on the mix of payors and contracts, a medical practice may only collect between 50% and 60% of its account receivable.  Thus, when adding the accounts receivable to the fair market value balance sheet, a valuation analyst must take into account the collection rate for the medical practice in order to not overstate the value of the accounts receivable.

Preventing Staff Turnover – Do the Small Things

Brian M. McCook, CPA, Director of Health Care Services

One of the major concerns for physician practices is whether they are paying their employees appropriately.  When discussing this issue, it is crucial to keep in mind that there will always be a higher paying job somewhere.  Although it is critical to make sure your practice is competitive in the marketplace in terms of pay and benefits, focusing on the small things could make all the difference in the world.

So what are some of the small things you can do: 

• 1. Teamwork
• 2. Work-Life Balance
• 3. Continuing Education
• 4. Communication

Establishing a sense of teamwork among all members of the practice, from the physicians to the front desk staff, is crucial to the success of the practice.  Everyone enjoys working towards common goals as one cohesive unit…working individually isn’t much fun.  Empower people by giving them responsibility and allowing them to be involved in work-flow processes and improvement.

Work-life balance is important to everyone.  Allowing for flexible schedules, such as working four-day workweeks, can be a major incentive for employees.  Taking the time to develop relationships with your employees will allow you to work with them and help them meet their personal needs while meeting the practice’s needs as well.

Show employees you are investing in them by offering continuing education.  Sending them to appropriate training courses to gains skills to do their jobs more effectively and efficiently can increase productivity.  Ultimately, that helps make the practice more profitable.

Finally, none of the above factors can obtain the desired goal without good communication.  Taking the time to develop relationships with all employees and making sure you regularly provide them timely feedback will show you are committed to them as a productive member of the practice.

Maintaining good staff is an investment of time, energy and money.  Many people ask “can I afford to do this for an employee?”  I would counter with “can you afford not to?”