diagnosing & treating practice mgmt 6.17.11 karen zupko
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2011 KarenZupko & Associates, Inc.
Sponsored by:
Northern Colorado IPA
June 17, 2011
Presented by:
Karen Zupko, President
2011 KarenZupko & Associates, Inc.
www.karenzupko.com
2
2011 KarenZupko & Associates, Inc.
What’s Going On Now?
Operational Roadblocks?
3
2011 KarenZupko & Associates, Inc.
How Can You Improve
the Patient
Experience?
4
2011 KarenZupko & Associates, Inc.
Physician Efficiency?
5
2011 KarenZupko & Associates, Inc.
What Business Processes Have
the Most Steps?
6
2011 KarenZupko & Associates, Inc.
Barriers to Implementing
Technology?
7
2011 KarenZupko & Associates, Inc.
Average Tech Literacy?
8
Technology C
Dr. Need Tech KZA
2011 KarenZupko & Associates, Inc.
Governance, Management
and Leadership
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2011 KarenZupko & Associates, Inc.
Criticisms
1. No respect for organizational systems.
2. Meetings start late.
3. Evening meetings.
4. Poor agenda, poor minutes.
5. “Bomb throwers” reign.
6. Deficient preparation.
10
2011 KarenZupko & Associates, Inc.
“Dr. Sanders thinks he’s part of the solution.That’s part of the problem.”
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2011 KarenZupko & Associates, Inc.
Shortages will make recruitment of
new partners challenging.
Source: Shortage of Doctors an Obstacle to Obama Goals, by Robert Pear; The New York Times, April 27, 2009
“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.”
12
2011 KarenZupko & Associates, Inc.
The urge to merge among
independent practices will
continue to accelerate.13
2011 KarenZupko & Associates, Inc.
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.”
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2011 KarenZupko & Associates, Inc.
Confusing Control, Deligation
and Abdication
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How do
you know?
I’m in
control!
Of what?
2011 KarenZupko & Associates, Inc.
Confusing Control, Deligation
and AbdicationExamples:
“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
2011 KarenZupko & Associates, Inc.
How Do You Measure Up?
Our Practice Management Reporting
Visits
Procedures, Surgeries, Treatments
Collections
Staff to Revenue Ration
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2011 KarenZupko & Associates, Inc.
Taking Your Eyes of the Ball(s)Strike!“We stopped looking at the:”
Surgery deposits
Daily deposits
Monthly P&L
AR reports
Patient monthly statements
Point of service collection
Inventory (supplies)
Audit controls
Appeals 18
2011 KarenZupko & Associates, Inc.
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Read Reports!
2011 KarenZupko & Associates, Inc.
Non-Physician Expenses As a
% of Net Revenue (Overhead)
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Overhead # Respondents % Amount
Overall Practice 54 60.7%
Allergy Services 29 55.4%
Audiology Services 40 74.3%
In-Office Imaging
Services
13 52.1%
Source: AOA 2009
2011 KarenZupko & Associates, Inc.
Open Your Eyes To Risks
21Blinders off!
2011 KarenZupko & Associates, Inc.
The Fraud Buster’s are out in
force. Expect an audit.
60
Minute
Rule
Careless Coders Beware!
22
2011 KarenZupko & Associates, Inc.
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
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2011 KarenZupko & Associates, Inc.
What Does This Look Like?
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Office or Outpatient Consultation
0%
20%
40%
60%
80%
100%
99241 99242 99243 99244 99245
2007 National
2007 Midwest State
Dr. C
2008 National
2008 NE State
Dr. C
2011 KarenZupko & Associates, Inc.
“There! Is that enough bullets for you?”
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2011 KarenZupko & Associates, Inc.
Risk Areas
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CERT
OIG
Hiring
PracticesIdentity
Issues
Red Flag
Rules
Commercial
Plans
State
Authorities
RAC
2011 KarenZupko & Associates, Inc.
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Tech
NP RN
MD
PA
Supervision and Scope of
Practice:
State and Payor Variations Matter
27
2011 KarenZupko & Associates, Inc.
“This board has to implement a compliance
program. Please … we don’t need the visual aid.”
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2011 KarenZupko & Associates, Inc.
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 ______.”
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2011 KarenZupko & Associates, Inc.
Right people?
Right jobs?
Right time?
Right tools?
Right training?
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2011 KarenZupko & Associates, Inc.
“Are they as good as they look?”
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2011 KarenZupko & Associates, Inc.
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2011 KarenZupko & Associates, Inc.
Audit Controls
Specific steps that ensure the integrity of
the accounting system.
Payables
Receivables
Inventory
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2011 KarenZupko & Associates, Inc.
Who Will It Be?
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2011 KarenZupko & Associates, Inc.
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2011 KarenZupko & Associates, Inc.
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Receipt #102
For: John Patient
On: July 28th, 2010
Paid: $40.00
Rona at Reception
2011 KarenZupko & Associates, Inc.
Audit Controls in Action
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Daily Close
Fidelity bonds
Background checks
Numbered superbills
Regular inventory
reconciliation
Computer
passwords
2011 KarenZupko & Associates, Inc.
Money Handling
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Limit cash
Safeguard credit card
Screen candidates
Watch patient
complaints
2011 KarenZupko & Associates, Inc.
Unallocated Cash
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2011 KarenZupko & Associates, Inc.
Suppressed Statements
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2011 KarenZupko & Associates, Inc.
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Insurance Coverage
Check Today!
2011 KarenZupko & Associates, Inc.
Personnel
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Investment or
Overhead?
2011 KarenZupko & Associates, Inc.
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“It would be easier to
massage a squid than
to hold my staff
accountable.”
2011 KarenZupko & Associates, Inc.
Staffing Costs as a Percentage of
Total Medical Revenue
24%on average in practices
Salary + Retirement Benefits + Health
Insurance + Training
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2011 KarenZupko & Associates, Inc.
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Finding qualified
clinical support
and business staff
are a growing
challenge.
2011 KarenZupko & Associates, Inc.
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Do you test applicants?
2011 KarenZupko & Associates, Inc.
Example of Total Test Results
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2011 KarenZupko & Associates, Inc.
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“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!”
2011 KarenZupko & Associates, Inc.
Staff Gap Analysis
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What are my
staffing
needs?
2011 KarenZupko & Associates, Inc.
Technology
50
2011 KarenZupko & Associates, Inc.
Litmus Test for New Technologies
Save Time
Boost Efficiency
Reduce Costs
Improve Patient Experience
Leverage Knowledge
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2011 KarenZupko & Associates, Inc.
More Common Than You Think
52
You Bought This…
You Drive It
Like This...
2011 KarenZupko & Associates, Inc.
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
2011 KarenZupko & Associates, Inc.
Reimbursement Process
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Reimbursement
Proper Claim
Submission Accurate Coding CPT
ICD-9
Payment Posting,
EOB Analysis, &
Appeals
Insurance
Verification Appointment Scheduling
Supportive
Documentation
Pre-Surgical Financial
Counseling
Pre-Certification Written Prior
Authorization
Pre- Registration
2011 KarenZupko & Associates, Inc.
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
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2011 KarenZupko & Associates, Inc.
Pre-Registration
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Done the RIGHT way in 2010
Gather detailed insurance information
prior to the visit.
2011 KarenZupko & Associates, Inc.
57Source: philly.com, August 13, 2010
2011 KarenZupko & Associates, Inc.
Real Time Claims Adjudication
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2011 KarenZupko & Associates, Inc.
Remote Deposit
Example
$150 set up fee
$100 per month
service fee
.10 per item
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2011 KarenZupko & Associates, Inc.
SmileReminder.com
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2011 KarenZupko & Associates, Inc.
Understand.com
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2011 KarenZupko & Associates, Inc.
Solveras.com
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2011 KarenZupko & Associates, Inc.
Social Media
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2011 KarenZupko & Associates, Inc.
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 Life64
2011 KarenZupko & Associates, Inc.
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:
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Pre-registration Yes - 89%
Appointment Requests Yes - 79%
Prescription Requests Yes - 74%
Lab Results Reporting Yes - 79%
Online Bill Payment Yes - 79%
2011 KarenZupko & Associates, Inc.
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2011 KarenZupko & Associates, Inc.
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
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See KZA’s
Minimum Website
Requirements–2009
2011 KarenZupko & Associates, Inc.
Patient Portal
68Source: Medfusion
• Pre-
registration /
Health forms
• Appointment
Requests
• Patient
Messaging
• Online Bill
Payment
• Auto-draft
payment
plans
• Virtual Card
Swiper
• Ask a Biller
• Prescription
Renewal
• Secure Patient
Messaging
• Ask a Clinician
• VOV /
Symptom
Assessment
• Referral Portal
• PHR
Practice website, patient education, patient satisfaction surveys …
What: An online application that allows practices and patients to
communicate and interact with physicians.
2011 KarenZupko & Associates, Inc.
Use Key Features
69
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
Out of Office
Reply
Custom
Signature
2011 KarenZupko & Associates, Inc.
70
I don’t skate to
where the puck
is; I skate to
where I think the
puck is going to
be.”
-Wayne Gretzky
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