MGMA In Practice blog

By Nick Fabrizio, PhD, FACMPE, FACHE
Principal, MGMA Health Care Consulting Group

Cutting excess expenses in a medical practice makes good business sense – but there is such a thing as going too far.

Case in point: A recent MGMA Member Community discussion (member login required) centered around cutting all paid time off for all employees of a medical practice. Overhead in the form of employee salaries and benefits is undoubtedly the largest chunk of expense for your medical practice, but drastically changing employee benefits can damage the culture of your organization, as well as create legal issues (e.g., consult a lawyer to see if it's legal to eliminate previously earned time off).

One medical practice administrator suggested that because healthcare continues to show job growth, many staff may bail and potential new candidates will not be attracted to an organization that does not offer paid time off. I think eventually you will lose your best staff, and staff members who are less productive – and may not have any other options for employment – will remain.

Another member pointed out that many people can't afford to take unpaid time in this economy, resulting in staff taking no time off. This may not save the practice any money and leave you with angry and exhausted workers you wished had taken a vacation.

Eliminating all or most of the benefit of paid time-off is often a knee-jerk reaction to a much more complex financial issue. The goal of this action is to reduce overhead, but there are alternatives that will have the same budgetary impact. You could:

• Terminate an employee whose position is no longer necessary, or perhaps outsource the position.
• Reduce the number of hours worked per week. With the right spin, this can be looked upon as a benefit. Maybe 32 hours a week would be the magic number for your practice. You may find out that some staff want to work four days per week. This is a win-win scenario because you will save money on employee salaries without taking the drastic measure of penalizing everyone.
• Consider job sharing one position with two part-time employees who might not need full benefits.
• Meet with several vendors to ensure that you are getting the biggest bang for your buck. Changing insurance companies or benefits plan administrators might save you money.

As administrators, it's our job to protect the assets of the company – the employees. Do you agree, disagree? Tell me in the comments.

We asked MGMA members on the MGMA Member Community to send us their best medical practice customer service/interaction tips. Many medical practice administrators and marketing directors responded with innovative and personal touches that can make your practice stand out from the rest. Whether you implement one or several, you can't go wrong with these ideas to boost patient satisfaction.

• Continue to take customers until closing time, treating the last customer of the day with respect and courtesy, even if he or she arrive as the doors are being locked, suggests Kathy Winn, director of marketing, Primary Health Medical Group, Meridian, Idaho.
  
• Talk positively about coworkers and the practice to give customers the confidence that they will be appropriately cared for in any of your locations and by any of your staff. Both of these ideas, sent in by Winn, resulted from a large customer service initiative that the healthcare organization kicked off in 2008. "We take customer service very seriously," she says.
  
• Print personal business cards for each clinical employee, such as nurses. After rooming a patient, have the nurse exchange the card and encourage the patient to call and ask for him or her if there are any questions or concerns after the visit.
  
  "Some patients comment on what a personal touch they feel we have added to our practices," says Diane Zientek, manager, Morris (Ill.) Hospital, noting that the idea arose after a patient-perception survey found low satisfaction with nurses' "courtesy and caring."
  
• Make follow-up calls after a procedure is done in the office or if a well-child visit involved multiple immunizations. "By taking this proactive approach, we think we've eliminated some of the patient calls that might have come in," Zientek says.
  
• Buy a box of pens with your practice's logo and phone number on them and leave them near the sign-in sheet for your patients' convenience. "If a patient accidentally walks out with your pen... you have given your patient a thank you gift," says Colleen Mathias, CPC, CMPE, practice administrator, Ob-Gyn Associates of Hampton (Va.), A Division of Mid-Atlantic Womens Care.  
  
• Print your practice's logo, phone number and address on hand sanitizers and refrigerator magnets. Use them for patient giveaways and to hand out at community health fairs. Patients are more satisfied when they have an easy time finding information about your practice. Plus, "they're relatively inexpensive and are useful items that keep our name in front of [patients]," says Fred Rost, director of marketing, Maryland Primary Care Physicians, Millersville.
  
• Always be transparent with patients. If their doctor has an emergency, have the receptionist tell the waiting patient that he or she has an emergency and will be with them as soon as possible. "Saying nothing leaves the patient thinking they are forgotten or don't matter," says Marti Robles, practice administrator, Arroyo Medical Group Inc., Pismo Beach, Calif. "If patients understand what's going on, they are more likely to be satisfied."
  
• Encourage visual acknowledgement as soon as a patient walks in the door. Have front desk employees act as patients waiting to check in, and simulate ignoring them for 15 seconds. "Staff[members] don't realize how long 15 seconds is to a patient," says Gar Reed, clinical services director, Watson Clinic, Lakeland, Fla. Then, train them on making eye contact, smiling and using the phrases, "Excuse me, I'll be with you ina minute," or "I'm sorry I was busy. Can I help you?"

Have your own fabulous customer service ideas to share? Add to the comments.

When medical practice expenses creep too far into revenue, often a knee-jerk reaction is to cut staff. No practice administrator likes to lay off staff, so what can you do to keep them and their benefits? Find new ways to increase revenue. We've got 15 you can try:

1. Place an ideas box in a well-trafficked spot for staff to contribute their thoughts on increasing efficiency and productivity. Discuss the ideas in a meeting, and choose one a month to implement. Promote healthy competition among staff by rewarding the employee with the winning idea.
2. Convert paper explanation of benefits to an electronic format to save time on data entry.
3. Renegotiate with vendors. To keep your business, vendors will find creative ways to save you money while still delivering value.
4. Work with a group purchasing organization to lower supply costs by bundling your purchases. Also, be aware of how much product you're using and when so you avoid overstocking.
5. Reorganize the business office by functional area, such as claims, denials, follow-up and posting. This will help you define processes and best practices for each.
6. Add one more patient per day to your physician's schedule. "If a practice can see one more patient a day, it can add $25,000 to the annual bottom line for primary care (assuming $100 for a new patient visit) or $50,000 for specialty care (assuming $200 for a new patient visit)," according to Michael O'Connell's MGMA Connexion article "10 ways to manage better during difficult financial times."
7. Renegotiate your managed care contracts using fee schedules and relative value unit data to give you an edge when bargaining.
8. Create "standby" appointments for patients with a history of no-shows. (MGMA members: Get 13 other tips for preventing patient no-shows, a prime culprit of lost revenue.)
9. Encourage your patients to refer their friends. Offer a small gift certificate as a thank you. The more patients who become long-term clients, the higher your revenue.
10. Save energy by turning off unnecessary lights and installing energy-efficient light bulbs. Have employees discontinue use of screensavers, opting for turning off the screen at night instead. These small reductions in energy can add up over time, giving you back some overhead expenses.
11. Train physicians to code correctly. Because it's the physicians who get audited, not the nurses or certified billers and coders, it's important that physicians know how to code correctly. The bonus is that they'll end up capturing all levels of codes, which will increase revenue.
12. Re-evaluate your payer mix. If you have a flood of patients you can't see, dropping an insurance company may help. "You can positively influence your payer mix, thus improving your per-unit reimbursement, and you can gain operations benefits (by reducing the patient communications you have to handle out-of-office)," according to Mastering Patient Flow, by Elizabeth Woodcock, MBA, FACMPE, CPC.
13. Implement an electronic health record. This tip has become a no-brainer thanks to the American Recovery and Reinvestment Act.
14. Start social media accounts on Facebook and Twitter. They're free and can help grow your presence online when people search for your practice. Plus, you can engage potential and current patients, increasing their satisfaction and building community, making them more likely to return.
15. Take advantage of free or discounted online education for you and your staff. MGMA also offers free public resources and member benefits specifically for boosting revenue.

Have ideas of your own? Contribute to the comments.

When medical practice employees are seen by the physicians they work for, several complications can arise, including Health Insurance Portability and Accountability Act (HIPAA) privacy rules, special treatment and conflict of interest. If it makes sense for your practice to offer medical care as a benefit, how do you determine what your policy looks like?

We profiled three medical practices that have adopted policies according to their practices' needs. However, they all share a common principle: treat the employee as you would any patient.

• Informal, word-of-mouth policy with discount

Eureka (Calif.) Family Practice, a 22 full-time-equivalent physician primary care practice, allows its employees to become patients largely because the rural area lacks primary care providers. "I've been a patient at this practice since grade school," says Lorraine Gomes, practice manager, noting it would be difficult to turn somebody down just because they work there. "If there was a way for people to get quality medical care elsewhere, maybe we would rethink [our policy]."

Gomes addresses privacy issues by running monthly random audits of one employee's electronic medical record, plus one physician's chart. So far, she hasn't found any breaches of privacy.

Employees receive a 50 percent discount (services only) for immediate family, but don't find out about this perk until their first copay. That's because Gomes doesn't want discounted healthcare to be the candidates' motivation for employment. "I worry that I need a policy because of potential problems, but then again it brings medical treatment into employee/employer relations," she says. "I think it should be separate." For example, an employee in collections is treated by the billing department as any other patient.

One stipulation is that employees set their medical appointments on their own time. "They're not to be paid to seek medical treatment – they need to punch out," says Gomes. "They do need to arrange for coverage just like anything else."

• Informal policy without discount

PMG Physician Associates, a 41-provider primary care clinic in Plymouth, Mass., also has an informal policy that allows employees to be patients of the group with no discounts given. Operations and Special Projects Director Jessica Ellis-Wilson says "the understanding is that employees are 'the same' as any other patient when they need to be treated, and activities like curbsiding [when someone 'corners' a physician to seek an opinion about a medical condition], requesting prescriptions without an appointment, etc, are frowned upon."

To maintain privacy, all employee charts are marked as "sensitive" in the electronic medical record, which prompts staff with a privacy reminder when accessing those charts. "We do the same for the records of our employees' immediate family members and public figures," says Ellis-Wilson. The practice also gives HIPAA/privacy reminders at every group meeting, and has a counseling and corrective action process for employees who breach privacy.

• A strict written policy

Cheyenne (Wyo.) Medical Specialists, a 13-provider clinic, allows employees to be seen as patients but with written restrictions, says administrator Robin O'Gara, CMPE.

"Our policy basically states that employees who wish to be seen are to be handled as any other patient," she says. "They must choose a primary doctor; make appointments or leave a message with the nurse for any conversation with the provider; check in at our front desk for appointments and wait in the lobby," she says. "We do not allow any hallway medicine, and our providers report any employees who try to abuse this policy." 

The benefits package for employees allows them and their spouses to be seen at no cost up to six times per year (not including labs or X-rays) in the first five years of employment. After five years, they receive six no-cost visits and other clinic benefits up to a maximum benefit of $1,000, O'Gara says. Services not covered under the benefit are billed to the employee just like any other patient.

During recruitment interviews, O'Gara tells potential candidates about this program, and if they express interest she explains the details. Otherwise, it becomes part of their orientation. "We educate our staff on this policy and they generally have a good understanding of it and appreciate the benefit we offer," she says. 

What policy does your medical practice have in place for treating employees as patients? Share in the comments.

Can you imagine leaving a restaurant without knowing – or paying – the final cost of your meal?

That happens every day in healthcare.

And what's even more surprising is that while restaurants collect 100 percent of what's owed (or you wash dishes), it's not uncommon for medical practices to report a gross collection rate of 60 percent or less, according to The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid. That means for every $1 of services billed, the physician receives only 60 cents.

To make matters worse, that 60 cents travels a long and winding road before it ends up in your practice's bank account. While medical practice administrators know the physician billing process intimately, patients and even some practice employees aren't familiar with how it works.

• The payer (insurance company) and medical practice finalize their contract and agree on the terms for payment. Physician credentialing occurs to ensure that the medical provider is accepted by the insurance plan.
• Meanwhile, the patient's employer offers an insurance plan, collects the premium from the enrolled employee (usually via deductions through his or her paycheck) and pays the premium to the payer.
• The insured patient makes an appointment with his or her doctor. The practice verifies the patient's insurance coverage and benefits.
• When the patient checks in, the practice requests the copayment, coinsurance, deductible and/or prior balance. Also, his or her identity is verified and the insurance card is scanned (or swiped!). The physician documents the visit and completes a charge ticket, a document listing the most common procedures and billing codes for the medical specialty.
• After the visit, the practice's billing office audits the charge ticket and enters it into the practice management system. Then the claim is scrubbed, which means the claim is compared to the rules used by payers to decide if - and how - a claim will be paid.
• Once the claim is considered "clean," the practice sends it to the payer. The payer sends an acknowledgement of receipt.
• If the payer does not deny the claim, it pays the claim and sends the reimbursement and explanation of benefits to the practice.
• If the claim is denied, an explanation of benefits outlining the reason for the denial is sent to the practice. The practice corrects the claim and resends it to the payer.
• Next, the practice sends statements to patients to collect their portion. The practice sends outstanding, past-due patient accounts to the collection agency.
• Finally, the medical practice analyzes how well the process is working, checking for accuracy of coding and how the payer is performing. You may want to enhance your physician billing process if your medical practice can answer "no" to any of the following:

1. Is your practice's net collection rate greater than 97 percent?

2. Does your practice verify insurance and benefits eligibility prior to every patient visit?

3. Are your claims denied by payers less than 7 percent of the time?

Download this free, medical practice self-audit tool to determine if your practice's performance is consistent, or if there's an opportunity to improve your revenue stream.

By Cindy Dunn, RN, FACMPE
Senior consultant, MGMA Health Care Consulting Group

Many of us grew up with Highlights magazine and the stories of Goofus and Gallant. You may remember them: Goofus always did things wrong and Gallant always did things right. The goal was to be more like Gallant and less like Goofus.

Faced with the uncertainty and challenges of healthcare management in 2010, medical practice leaders should take a page from this playbook; we should all strive to run our medical practices the way Gallant would.

Here are some do's and don'ts for essential practice operations that mirror the way Goofus and Gallant would handle the situations.

• Change management

What not to do

Make quick decisions and fail to communicate how or why they were made. Become angry when staff complains they don't understand.

What to do

Communicate changes to staff, ask for their input and listen to their perspectives.

• Customer service

What not to do

Tell patients that they should be happy they have such skilled physicians available. If patients complain, let them go elsewhere.

What to do

Commit to patients' needs, respond professionally and promptly to their complaints and concerns; leaders' actions always reinforce positive practice values concerning patient treatment and care.

• Financial performance

What not to do

Produce a 15-page monthly report that doesn't make sense and send it to physicians knowing they will trash it; complain that practice management software is worthless when it comes to reports and do nothing about it.

What to do

Track key performance indicators during the year; identify trends and discuss with physicians and staff; use business intelligence software when management software can't produce the necessary reports.

• Staff training

What not to do

Eliminate your training budget due to a poor economy; have informal orientation and on-the-job training as the norm; severely reprimand or ridicule employees when they make mistakes.

What to do

Budget specific amounts to spend on staff training, understanding that it increases productivity and improves morale, which results in a more efficient operation; structure orientation required for all employees.

• Billing and collections

What not to do
Do things "the way they have always been done"; collect copays sometimes at the end of the visit; focus on backend collection processes and ignore front-end opportunities; neglect denials or the measurement of the percentage of claims denied on first submission.

What to do

Look for ways to streamline and simplify the process; work with the bank on a lockbox and remote check deposit; use electronic remittance and auto-posting; work with a clearinghouse to add functionality that saves employee time.

• Workflow and process

What not to do

Tell staff that quality improvement and Lean is "a bunch of hooey, for automobile plants not medical practices"; permitting and ignoring the negative actions of certain staff members as they sabotage practice efforts to make positive change.

What to do

Make workflow review a consistent part of weekly management meetings; seek out wasteful steps and eliminate them; identify opportunities to make physicians more efficient (e.g., identical stocking of exam rooms)

• Technology

What not to do

Make staff members share computers and other technology tools; follow the motto: "If we have one and it works, we don't necessarily need two or three – staff members always think they need their own copiers/faxes/printers!"

What to do

Embrace and understand that success depends on effective use of technology; conduct needs analysis and readiness assessment as physicians and staff prepare to implement an electronic health record.

We can learn all we need to know about how to successfully run our medical practice if we concentrate on the lessons Goofus and Gallant tried to teach us:

• Treat others like we want to be treated
• Be thrifty
• Help out
• Admit when you make a mistake
• Study and learn
• Communicate clearly and often

For more on managing operations effectively, attend the Achieving Efficient Practice Operations seminar, March 20-21, in St. Louis, Mo., where I'll speak along with principal MGMA Healthcare Consultant Rosemarie Nelson, MS.

When it comes to leading a team of people in your medical practice, it's easy to see that one style does not fit all. In your workplace, there are introverts and extroverts; detail-oriented taskmasters and visionaries; and differences between male and female communication styles. The problem is, "we think that our style, which is comfortable to us, will work with everyone," says communications and healthcare collections expert Jeff Staads.

How do you manage and lead your staff in a way that works for them and your medical practice? Recognize the difference between the two.

"People often use the words leadership and management interchangeably. Many of us assume that being a good manager also means being a good leader. In some cases this may be true, but it's the exception rather than the rule."

That quote from "Are you managing or leading your practice?" by MGMA member Regenia R. Regambal, FACMPE, in the MGMA Connexion magazine illustrates that achieving the balance is difficult, because they require two sets of skills:

• Management in medical practice is about coping with complexity.
• Leadership is about influence and change.

As a manager, you're tasked with being the decision maker, problem solver and creative thinker to drive your practice's operations – all in the midst of complexity.

"Complexity is what makes my career so invigorating, frustrating and rewarding all at the same time," says MGMA member Dea Robinson, MA, practice administrator for Inpatient Medicine Service, Englewood, Colo. She views management as the "micro" of day-to-day issues that arise, while leadership is the "macro."

Often, complexity doesn't just occur in the processes and compliance regulations that medical practice administrators deal with. It also happens within relationships among staff and physicians. To be successful at managing, Robinson says, "I know I have to understand individuals and, to the best of my ability, their motives in and outside of the office without getting wrapped up in the minutia." 

One of the ways you can cope is by tapping into staff to help solve problems. "I think we get some of the best answers from people who are on the front line," says Staads. Start with questions like, "How can we improve this process?" or "Is there something here that needs to be changed?" These perspectives will help reduce inefficiencies, as well as mitigate role conflict.

As a leader, you're focused on inspiring, motivating and ensuring understanding among people in your practice. Leadership "can be addictive because when you get it right you know it even when others don't see it," says Robinson.

To her, being a practice leader means:

• Listening as long as it takes for the other to be heard. "Sometimes it takes hours. If I listen, I might understand and I can make decisions with insight."
• Being unpopular a lot of the time
• Maintaining excellence and humility at all times

Being an effective leader also means setting a direction for your organization and mobilizing employees to work toward that goal. While managers often seek to bring order out of chaos, leaders can use chaos to transform the organization.

If leadership doesn't come naturally, there are plenty of training resources, including free MGMA podcasts and our Maximizing Performance Management Series.

Are you more of a leader or a manager? Tell us your thoughts in the comments.

We've written about which healthcare Twitterers to follow, how to create your medical practice's Facebook page, and why you should even be using social media. But when it comes down to it, using social media to advance the outreach of your practice is only as good as the strategy behind it.

Whether you have a communications/marketing department at the helm of your practice's publicity or you're doing it solo, it's still smart for you, the practice administrator, to understand the reasons and motivation behind using social media. Having a clear-cut strategy will get everyone in the practice on the same page and promote consistency and professionalism online – even in a network like Facebook.

Follow these tips to develop a strategic social media plan that's right for your healthcare organization.

(Photo by Mark Smiciklas)

• Do you simply want to increase visibility and awareness of your practice in the community?
• Are you looking for an easy way to bring staff and patient experiences together online?
• Will you use these channels to advertise new services, physicians or changes to your organization, possibly replacing some of the costs of mailings?

Knowing why you want to engage potential customers online will help determine which platform you should choose. For example, Facebook is great for creating a community where you can post events, pictures and video, while Twitter is ideal for reaching news outlets and increasing the visibility of your practice's services. Don't forget recruitment: LinkedIn offers a credible way to browse job candidates and post openings.

How often is it updated and what type of information do you post? What do patients and staff use it for? Often, they would be just as likely to look for the same information on your social network.

If you already house most of your organization's information on your Web site, consider using social media as a tease to drive traffic back to your site. Over time, you'll notice your social networks will begin to show up as referrals in your Web site's analytics.

Which social network do most of your patients use? Consider polling them, either on your Web site or in your office during an appointment. Remember that younger members are often more familiar and more likely to be on social networks. Enlist them as your champions by encouraging them to join.

So you have 500 fans on your Facebook page, but nobody's talking. Or maybe your patients don't understand the value of connecting with you on Twitter. Communicate what they can expect to see when they join your networks – whether it's office closures, notices about vaccines or party pics from your last community event. Great ways to promote the social media that you already use include: your Web site, e-mail communications and signs in your office (especially patient rooms!).

Pictures, audio, video and presentations are compelling ways to communicate with members – especially on social networks. If your Web site doesn't currently have that capability, all the better! Facebook has free video creation built-in, while both Facebook and LinkedIn have the SlideShare app, perfect for uploading and easily sharing health-focused PowerPoints online.

Urology San Antonio began creating YouTube videos about a year ago, and now its "Vasectomy. Get the Facts." video with 10,500 views appears first whenever someone searches for "vasectomy" on YouTube. The video was spontaneously produced in an hour while the crew waited to record videos on robotic surgery in the operating room. Communications Director Abbey Forney says urology lends itself to social media. "We deal with so many awkward topics – bladder issues and sexual issues," that patients are comfortable learning about in the privacy of their own homes, she says. "It's been great for our practice, especially for the things where people have the time to research online."

Smaller blurbs are more effective because users of social networks usually have short attention spans. For example, tweets have a shelf life of 24 hours. Content shouldn't go through a long review process, but it also shouldn't be posted without hitting spell check. Several medical practices have embraced Twitter because it takes only a few seconds to update throughout an employee's otherwise packed schedule.

Urology San Antonio has also used Twitter to make quick connections in the community. On Twitter, Forney spotted a family practice doctor who had just opened his business in the area, so she assembled some of the practice's physicians to visit and let him know they'd be happy to accept referrals.

The key to encouraging engagement in any of these social networks is to be informal and approachable. Think about a patient entering your office for the first time. What do you want your first impression to be? Your strategy will follow.

By Kenneth T. Hertz, CMPE
Principal, MGMA Health Care Consulting Group

Let's face it – none of us really like to attend meetings. My consulting experiences with medical practices bear this out: One of the more common refrains from practice administrators is, "I can't get my doctors to attend meetings! What can I do?"

Time is a limited resource. As administrators who work 40, 50, 60 or more hours a week we understand this. Our physicians do, too, given their clinic time, surgery schedules, hospital rounds, call schedules, etc. No wonder we have a difficult time getting them to attend meetings.

Increasing attendance requires a multi-level approach. Some people say it's like herding cats. (As the proud owner of 11 cats, I say it's easier!) Here are several things you can do right now to boost attendance at your meetings. And remember: Time and patience are mandatory.

When recruiting physicians, discuss governance participation requirements at the practice. Ensure the new doctor understands that partnership comes with the responsibility for attending meetings and participating in decisions related to group governance. Once the new physician is on site, include this information in the orientation session.

Take time to educate – or reeducate – current physician partners on the roles and responsibilities of board members. Talk about the board's governance duties of care, obedience and loyalty. It's difficult to meet those obligations if one does not participate in the practice's governance.

You can have this conversation at an annual orientation session for new physicians, present it as part of the preliminary work up to a strategic planning meeting, or take it piece-by-piece and discuss it at consecutive board meetings. In the case of a recent orthopedic group, I discussed these duties with the physicians during individual interviews as well as in the preliminary presentation at a retreat.

If a meeting doesn't have a written agenda, physicians will have no incentive to come because they won't know why their input is needed. Always begin planning meetings with a clear goal in mind – the agenda items should follow that goal.

This is critical to securing good attendance. Ensure all agenda items are relevant. For example, during a recent engagement with a gastoenterology practice, the physicians spent 45 minutes at a board meeting arguing whether or not Sally, one of the nurses, should get a $.45 per hour raise even though everyone else was receiving a $.30 per hour raise. Nobody controlled the conversation, and nobody suggested this was not the appropriate forum for discussion.

Was this an appropriate conversation for a board meeting? Did the physicians feel the discussion was worthwhile and therefore the meeting worthwhile? Of course not. Will the practice be able to get those physicians back to another meeting? Not any time soon. My recommendation: Raises should be handled by the administrator within limits established by the board. Result: Future meetings were shortened, agendas more carefully constructed and attendance slowly rose.

Make sure minutes from the previous meeting, financial reports or documents for discussion are provided to physicians prior to the meeting – not just an hour before, but several days.

"But," you say, "nobody reads the information!" Is it well-presented and formatted? Is the important information highlighted? Does the agenda indicate what actions the board will be asked to decide? It's not just a matter of supplying information; it has to be the right information, properly presented and formatted for easy review and assessment.

If you don't begin promptly, folks will continue to arrive later and later, allowing less time for board governance work. And for those physicians who do show up on time, is it fair for them to wait 25 minutes for the meeting to start? If you want to keep attendance up, start and end on time.

Do you schedule meetings at the end of the day when everyone's ready to go home, or at times when you know participants will be most alert? Also, examine how often you're holding meetings and ask the team if they feel the schedule is appropriate. Giving them input will demonstrate your flexibility in meeting their needs.

This may seem easy, but there are lots of ways participants can derail a meeting. I recently attended a practice's board meeting as an observer. There were two agenda items: one relatively complex financial issue and one personnel issue. The meeting lasted nearly two-and-a-half hours, but could have been completed in far less time. There was no direction and discussion rambled from participant to participant.

Following the meeting, I talked to the physician and surfaced the issue of how to chair a meeting. He acknowledged he probably wasn't very good at it, but this was how all his predecessors ran meetings. We discussed a few of the tools required to facilitate an effective and efficient meeting. I predict the next meeting will be shorter and more effective. As the president improves his skills, and the group gets used to the process, they will be able to accomplish more in less time.

There is no real mystery about getting physicians to attend meetings. It does, however, require a mastery of preparation, agendas and facilitation, coupled with a strong respect for the physicians' time and a clear understanding of the role of governance.

What are some techniques you use to encourage attendance? Share in the comments.

The most frequently asked question that Elizabeth Woodcock, MBA, FACMPE, CPC, gets from medical practice administrators is, "How can I get more money in the door?" It's the same question we recently asked the professional speaker, trainer and author specializing in medical practice management.

The environment you're dealing with in your practices isn't easy. The recession caused an increase in uninsured patients. Uninsured patients caused an increase in bad debt for practices. And insured patients are actually assuming higher financial responsibility, based on their employers' plans. Faced with all these pressures, how do you amp up your patient collections efforts?

Woodcock shared her 3-tiered strategy with us in an MGMA podcast, and we've transcribed part of it here:

This step sets up all the collection efforts to follow. Take a look at your contracts and participation agreements with insurance companies and see what you're allowed to do. For example, can you collect copayments or unmet deductibles?

Also, keep in mind whom you'll be collecting from. Woodcock says there are three types of patients: 

1. The happy patients who have their credit card ready and waiting
2. Those who need a little nudging, or maybe a compliment or two
3. Those who have no intention whatsoever of paying you

Expect your collection agency to step in and assist with the second group of patients - the nudgers.

This step combines pre-visit, time-of-service and post-visit communications. One of Woodcock's favorite time-of-service collection tips is the collection script. Instead of asking the patient if she would like to pay today, which can prompt someone to say no, ask her how she would like to pay. Changing one simple word can make a world of difference in the staff-patient interaction.

Woodcock also recommends offering a payment plan for a patient who simply cannot pay right now. "It's a great alternative to getting nothing," she says. But put parameters in place: don't extend the plan past six months and have a minimum monthly payment of $25 dollars. Ask the patient about their time frame; in general it will be a tighter time frame than you would have developed yourself.

Another step to remember is patient check-out. "Check-out is an opportunity to be a safety net for your collections process at the time of service," says Woodcock. It also offers an opportunity to recapture copayments you may not have collected at check-in. Plus, you can see if any account balances are due and possibly calculate any unmet deductibles or coinsurance based on the services rendered in the office that day.

See these 40 questions to ask yourself about patient collections to ensure you're doing all you can.

Should you hire more people? Have a financial counselor? Could a kiosk or predictive dialer employed in the business office help? How you implement your plan depends on what's best for your practice and staff.

Woodcock describes how one practice decided to use the patients' explanation of benefits (EOB) to help them collect unmet deductibles and account balances. The front office initiated the payment conversation, and when a patient would make an excuse about paying, the staff handed them the printed EOB and explained how the insurance company already took care of a portion of their bill. Staff invited the patient to call the insurance company if they had any questions, then asked again for payment.

"It is a wonderful best practice and a great success because it really allows the practice to be put in an advocacy position instead of the bad guy," says Woodcock. "Truly, a medical practice administrator and all of the front office and business office team members really are advocates for the patient. And unfortunately, they've been put into the 'bad guy' position. This was a way to turn that around and be successful in collecting as well."

For more patient collection tips from Woodcock, check out her book, The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid, 2nd Edition, or meet her in person at the following upcoming MGMA specialty conferences:

• MGMA 2010 Academic Practice Management Conference
• MGMA 2010 Financial Management and Payer Contracting Conference
• MGMA 2010 Obstetrics and Gynecology Practice Management Conference