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Physicians
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Q
How can I keep supervisors on task
and sharing in the responsibility of overseeing staff? All
too often, one person is left to do all the work. All of the
supervisors on the team seem to have great ideas, but administering
and organizing them is not on their to-do list.
A
First, recognize that what you describe is the most difficult
part of management — everyone struggles with this. Start
by assessing supervisors' job duties. Is it possible that
your supervisors just don’t have the tools or training
to do what you've asked of them?
Interview the supervisors to see what their
strengths and weaknesses are. Some people are better with
human resources while others really shine when it comes to
crunching numbers. Cooperatively establish short-term and
long-term, measurable objectives for each one. Include team
as well as individual objectives.
Are job descriptions up-to-date? Make
it unquestionably clear in a written, detailed job description
what is expected of each supervisor.
Now, let them work. Give support and advice,
make midcourse adjustments if necessary, but hold them accountable
to meet their goals and deadlines. Don't get dragged into
solving every single day-to-day problem for them. When they
come to you with a problem, ask, "How would you handle
this?"
Hold quarterly, rather than annual, performance
reviews for a while — tell them it's because as managers
they are critical to the practice's success.
Focus performance evaluations on objective
measures that help establish practice values. For example,
if getting claims out fast is a priority, measure it. If an
employee has suggested an idea, measure his ability to implement
it. Include the employee in the review process by asking for
a self-evaluation.
You may have to take extra steps to
keep supervisors energized. Try perks like inexpensive gifts,
handwritten notes on hiring anniversary or birthday, and,
of course, expressing thanks when you see a job done well.
If a supervisor still isn't meeting
his clearly (and fairly) defined objectives, maybe he isn’t
right for the job.
Q
We are a four-physician group with a practice manager
who oversees everything except our bookkeeper’s work.
I would like to know the average salary for this position
in this size group in our area. Also, we’d like to provide
performance bonuses to this employee. But how do we figure
out how big a bonus to give her?
A
According to the Medical Group Management Association's "Management
Compensation Survey: 2003 Report Based on 2002 Data,"
managers in practices with six and fewer physicians earn a
median of $81,489.
The Health Care Group also publishes
staff salary data. For the central United States, it reports
the average salary for someone with two to five years' experience
as $57,624 and for more than five years' experience as $68,353.
(Salaries vary by region.)
Since these numbers are all over the
map, they won't help much, but that is the best answer there
is unless your local medical society does a survey. You can
also call around to some practices that you refer to or get
referrals from and do an informal survey of your own.
As far as incentives, a profit-sharing
plan would work nicely. She gets, say, 5 percent of her salary
as a profit-sharing bonus payment at the end of the fiscal
year. If profits exceed a specified amount, you can agree
on a higher amount than last year, but not anything unreasonable.
This can be better than tying it to
more specific measures, such as lower days in accounts receivable,
fewer denials or lower overhead because profit-sharing is
tied only to what really matters and keeps the manager's eye
on the bigger picture. No sense cutting overhead just to end
up decreasing productivity, for example.
It also makes the manager a sort-of
semi-partner, in that he/she shares in profits the same way
the partners do.
Q
I am a general practitioner opening
up my new private practice. Is it appropriate to distribute
my business flier door-to-door in the neighborhood?
A
What an exciting time for you!
I can't think of any reason not to
proceed with your plan, especially if you are not offering
any (financial) incentives.
One caveat, however: The U.S. Postal
Service does not approve of you putting such fliers in mailboxes.
That is why they are usually thrust in doorjambs or under
welcome mats.
As far as appropriateness, it does
put you in the realm of pizza delivery guys and gutter cleaners.
Not exactly panache, but that doesn't mean it's a terrible
idea.
Perhaps you could invest in some slightly
finer stock paper from an office supply store and play with
your word processor program to produce a better-than-average
flier. Print it in color at a copy center. Even make it an
invitation to meet you and see your new office at an open
house. Set a date — Saturday or after work hours. Offer
organic juice or something healthy and do tours. Invite the
press — call the city and local papers. More bang for
the buck.
Q
Can you direct me to an algorithm that
will walk me through the IT maze? Our practice is looking
at document management systems instead of a full electronic
medical record (EMR), but how do I pick the right technology?
A
I'm afraid there is no alternative but to do a total operational
analysis of your practice and decide for yourself what your
needs are, then hunt for products that can meet those needs.
You need to define your needs based
on your particulars.
Do you need to track labs better?
How will you do so with the document management system?
Why do you want less paper? Paper
itself is not the problem. The problem is that you can’t
find what you want when you need it. What do you want to be
able to find? Charts? EOBs? HIPAA and registration info? All
of the above and more?
How would you ideally enter information
into the document management system? Who will scan it, and
how fast does the system have to work?
How serious do the version control
and rules need to be? If you have a lot of people storing
stuff, you’ll need hard rules built into the system
to make sure items are stored where they need to be. But perhaps
in your situation, you can be a little more relaxed.
In short, look at IT as any other
business decision.
Q
Are there any published statistics
on the average turnaround time for postoperative reports for
orthopedics? Some of our physicians turn them in on the same
day, some almost a month later.
A
We don't know of any published data. An informal survey of
orthopedic practices says the norm is 24-48 hours from service
to dictation.
If you want more official numbers,
you could ask your transcription company — if you have
one — if it can run a report showing the difference
between date of service and date of submission to the transcriptionist
for all orthopedic practices it serves.
However, allow me to suggest that
it may be a moot point. I assume that your goal is to speed
things up? If you throw benchmarks at your doctors, their
reaction is likely to be to dither about the accuracy of the
benchmark, complain about their schedule or some other such
thing. It won’t by itself change behavior.
What will? Money.
Institute a fine for anything more
than, say, two days. Or if your compensation is production-based
at all, then don't process payment to them until the documentation
is in and the claim is submitted.
Of course, you should make sure it’s
convenient for your surgeons to do their dictation. A physician
who has scheduled time for it after each visit or surgery
is more apt to get it done. Set up dictation pods on site
that give physicians some privacy to do their reports without
taking them completely off the floor. Give them handheld phones,
recorders or some other such mobile devices to use for dictation.
Remember, this is not only a billing
issue; it’s a risk management issue for you. The longer
physicians wait to do their dictation, the harder it is for
them to remember all the important clinical details. It’s
important to take delays
seriously.
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