improving patient outcomes through clear comprehensive communication protocols - american podiatric...
TRANSCRIPT
Improving Patient Outcomes through Clear Comprehensive
Communication Protocols
Rem Jackson, CEO Top Practices
Conflict of Interest DisclosureRem Jackson is disclosing the following financial relationships. These relationships may or may not apply to this lecture:
CEO:• Top Practices Marketing Mastermind Group
• Top Practices Practice Management Institute
• Top Practices Virtual Marketing Director Services
• Top Practices Patient Newsletter Program
My Goal
Is that you are #1 in Your Market
•Internet
•Referral Sources
•“Your list”
•The Community
Patients Can Only Come From…
Internal
Marketing
Database
Internet External Marketing
Shoe
Leather
(Referral)
4 Pillars for Communication
What are your goals?
• More new patients? How Many?• 20% or more 80/20
• Double/Triple/More?
• 1 doctor -$1.2M collections
• Focus on specific Procedures?
What should you shoot for?
• Look at your trend line last year VS this year
• Create monthly goals BASED on your own trend
• Still lost? 12% or more
Excellent Communication Begins Before they Visit Your Office
•Online where they are searching for help
•On the Phone
•Any written communication
•A Smile and a Greeting as they enter
Internet
1. Local Search and Reviews
2. Website with Good SEO and
Analytics
3. Social Media• Blogs• Video• Facebook• Google+• Twitter• RSS –Hoot Suite• Pinterest• Instagram
4. Google Adwords/ Facebook
Advertising
WEB
Christmas in July:What did it do for us?
•Highest number of patients ever•50% increase in reviews• Increased interaction on social media•Overall increase in patient enthusiasm
Internal
Marketing
Database
Internet External Marketing
Shoe
Leather
(Referral)
4 Pillars for Communication
COMMUNICATING TO YOUR PATIENT LIST
• Email messages (1/week)
• Newsletters (1/month)
• Social Media
• Time sensitive content on your website• Articles, Blogs, Videos, FAQ’s, Contests, Games,
Current Events, Product Specials
• Nurturing your entire list to visit your web properties
Email CommunicationReview Strategy
Email analytics help you make informed decisions based on hard evidence. It gives you information about what is and isn’t working and helps you track your future performance.
Primary Performance Measurements:• Email Opens
• 15-25%• Email Clicks
• 10-25% of emails opened• Email Conversions
• 5-10% of email clicks
Internal
Marketing
Database
Internet External Marketing
Shoe
Leather
(Referral)
4 Pillars for Communication
v
• 10% will become solid referring sources
• 100/MO = 10• 150/MO = 15• 250/MO = 25
Effectiveness of Referral Marketing
How much is a new patient worth?
• In year one?
• Lifetime?
Effectiveness of Marketing• New Patient = $450
• 1 New Referral Source @1/week = $23,400
• 5 New Referral Sources @ 1/week =$117,000
• 10 New Referral Sources @ 1/week = $234,000
It Don’t Come Easy
What is Your Excellent Goal?
• What do you have a passionate desire for?
• Build Buffers to protect you from not executing
• Make execution effortless
• Execute in 12 week plans
The Slight Edge
Be here, actively immersed in the process, one year from
now
The Decision to Start Today is
the Most Important Decision
of Your Next 10 Years
TopPractices.com
17177270217
Rem Jackson [email protected]
Ensuring Your Practice Is ‘Ready For Takeoff’ Each
DayAndrew Schneider, DPM
President-Elect, AAPPM
Education Chair, AAPPM
Private Practice, Houston, TX
Conflict of Interest Disclosure
Andrew Schneider, DPM is disclosing the following financial relationships. These relationships may or may not apply to this lecture:
• None
The content of this presentation is that of the speaker’s, as well as any products or services mentioned is not endorsed by the AAPPM
Takeoff
• Steady stream of patients coming in
• Need to do planned and unplanned procedures
• Walk-ins
• Staff absence
How Efficient Is Your Practice?
Systems
Protocols
What are Systems and Protocols?
• A Step by step process
• The way YOU want patients to be treated
• The way YOU want to treat your patients
• Systems = Office Functions
• Protocols = Patient Care
Your Systems and Protocols Manual
•Your systems and protocols must change as your practice changes
•They MUST be available to your entire office team and updated as you bring in new modalities or discontinue others
Your Systems and Protocols Manual
Serves as a training tool for both new and existing TEAM members
Why do I Need Protocols?• Improves patient care
• Consistency between providers
• Keeps your entire TEAM on the same page on how a patient is treated, why you are approaching it that way, and how it will be the best way for your patient’s condition to improve
• Improves practice use of ancillary services, DME, etc.
• Effectively incorporates new treatment modalities
Characteristics of a Well-Designed Treatment Protocol
1. Will the protocols enhance patient outcomes?
2. Are the protocols logical and evidence based?
3. Will I be able to document effectively and set up templates to assure compliance? (DME, referrals to ancillary services)
4. Will the protocol make the staff and my life easier?
5. Will the protocols maximize revenue?
Your First System…• Start with your first impression
• How will your phone be answered??
Good morning/afternoon to Tanglewood Foot Specialists, This is _______. How may we help you?
• Write it in your Manual…accept NO OTHER ways.
Tanglewood Foot Specialists Systems Manual
Topic: Answering a Website Contact Goals:
To quickly and efficiently respond to website contacts
To convert website contacts into office patients
To start the new patient off on a “raving fan” experience in the office Specific Step-by-Step Approach:
1. Every team member will check their office email at least twice a day 2. The contact area of the website will send appointment requests to EVERYBODY on the team. 3. The contacts to respond to will have the subject: Tanglewood Foot Specialists Web Contact Form Completed 4. Do NOT respond to emails with the subject: Book/Report: One Step Ahead: A foot Owner’s Manual….those are handled
automatically 5. WEBSITE CONTACTS MUST BE RETURNED WITHIN 12 hours. Contacts received after hours or on weekends should be
returned on the next business morning. 6. The person responsible for returning the contact is Jessica M. Back up if out/ill is Neeta. 7. Unless the contact wishes otherwise, the best way to contact is by telephone. “Hello, my name is _________ calling from
Tanglewood Foot Specialists. We received your information from our website and am following up.” 8. If contact specifically requests contact by email, please do so with similar language as #7. If you feel that Dr. Schneider
needs to answer the question directly, let him know. 9. Be mindful that some of the contacts may be emergencies and will need a priority appointment. That’s why we have a
website.
Protocols
• Develop a treatment protocol for your top diagnoses
• Spell out initial and subsequent visits
• Be specific
Takeoff
• Steady stream of patients coming in
• Need to do planned and unplanned procedures
• Walk-ins
• Staff absence
Answer is Simplicity
Why a Checklist?
• Routine and mundane matters are often overlooked when there are more pressing events
• Missing one key thing can negate any effort put in
• People can lull themselves into skipping steps which don’t USUALLY happen
Checklists remind us of the MINIMUM necessary
steps to make them explicit
October 30, 1935
Pilot’s Checklist
Some Hospitals Have Embraced Checklists
• 2011 – Johns Hopkins Hospital
• Developed a checklist to minimize central line infections
• Previous infection rates were 11%
Central Line Checklist
Wash hands with soap
Clean the patient’s skin with chlorhexidine
Put sterile drapes over entire patient
Wear a mask, hat, sterile gown, and gloves
Put a sterile dressing over the insertion site once the line is in
Observations
• Prior to the checklist being implemented, nurses were asked to observe for a month
• Given the checklist and recorded how often they carried out each step
• At least one step was skipped more than 1/3 of the time
Implementation
• Nurses were authorized to stop a doctor if they saw them skipping a step
Results
• Central line infections rates dropped from 11% to ZERO
• Using this ONE checklist in ONE hospital prevented 43 infections and 8 deaths in one year
• Cost savings of $2 million
Where Can Checklists Be Used In Podiatry Practices?
• Morning Opening
• Treatment Room Setup
• Procedure Setup
• Treatment Room Turnover
• End of Day Close
• Preop
• Supply Ordering
• Month Closing
How Much Does One Missing Item Per Patient Cost You?
• 1 minute lost to getting missing supply
• 30 patient = 30 minutes• How many patients do you seen in 30 minutes?
• 3 patients/day
• 15 patients/week
• 60 patients/month
• 720 patients/year
• Think About Your PVV and multiply by 720
Checklists vs. Systems and Protocols
• Systems are very specific and very detailed
• Checklists cannot be too long or detailed• Will slow you down
• Focused on common oversights
• Keep tweaking your checklist
• Keep training your team
Morning Opening MA
Turn on Computers
Turn on x-ray processor
Turn on treatment room lights
Check treatment room setup and stock
Check email
Check schedule and plan flow
Implementing Checklists In Your Practice
• Start with one at a time for each staff position
• Have team help to develop checklists
• TRAINING, TRAINING, TRAINING!!!!
• Require hard copy to be used and handed in
Ensure a Problem-Free Landing
Quality Metrics to Improve Your Patient Care
John Guiliana, DPM, MSExecutive Vice President, NEMO Health
Fellow, American Academy of Podiatric Practice Management
We Often See Only What’s on the Surface
And blame the WRONG thing!
Too often, we jump to conclusions…
We focus on “X” when “Y” and “Z” are the REAL problems!
Jumping to Conclusions…
Benefits of Providing Quality Services
• Increasing customer satisfaction with subsequent increase in market share and revenues/profits
• Reducing the cost of poor quality
• Increasing staff productivity to increase morale by the standardization of work processes
The 3 Aspects of Quality Care
1. Measurable Quality
• Is the aspect of care which can be judged by the provider through comparative measures between the actual performance versus the standard one.
2. Appreciative Quality
• Is the aspect of care which can be charged by the experienced practitioners who rely not only on standards but on their personal judgments and experiences as well.
3. Perceptive Quality
• Is the aspect of care which is perceived or judged by the recipient of care.
Perceptive Quality- Important!
• Quality perceived by the patient is generally based on the degree of caring expressed by the healthcare providers rather than on the physical environment and technical competence
• The later two are essential to prevent dissatisfaction but do not necessarily lead to patient satisfaction
Key Dimensions of the Quality of Care
Key Dimensions of the Quality of Care
Key Dimensions of the Quality of Care
The Concept of Value
• Today, consumers and insurers are demanding proof that the quality of purchased care is worth the dollars that are paid.
Value = Quality/Cost
The Single Most Important Fundamental Leading to Quality?
Processes and “Measurables” (KPIs)
Why is A/R Management So Critical?
FACT: The longer it takes a claim to get paid, the more likely it is that it will NEVER be paid!
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
30 days 60 days 90 days 120
days
one
year
Top 5 Reasons for Denials
Improper demographicsWrong Insurance Untimely Submission CCI Edit Errors Stall Tactics
Total AR = not more than 2x monthly charges Aged claims (>90) not more than 20% of AR
Benchmarks
Gross versus Net Collection Ratio
(Collections + Adjustments/ Charges) x 100
>95%
Benchmarks
BenchmarksDays in Receivables
(Total AR / gross charges) x 360
< 45 days
First Pass Denial Rate
<3%
Benchmarks
The Appeals Process
Fee Schedule Confirmation
Accuracy can be as low as 68.08% (AMA)
Frequent Billing Pitfalls
Know your utilization distribution
7 steps to improve revenue cycle efficiency
1. Select a practice management system (PMS) that fits your needs2. Verify insurance eligibility before every patient appointment3. Submit claims electronically to save time and money4. Determine the status of your submitted claim5. Leverage electronic remittance advice (ERA) 6. Review electronic payment options
7. Maximize collection of patient payments
Root Cause Analysis of Quality Metrics
A/R Too High
• Poor Collection Policies
• Failure to Adjust
• Low Clean Claim Rate
• Factors Outside of Our Control
Denials Too High
• Processes broken
• Lack of education
• Lack of resources (technology, APMA CRC)
• No appeal Process
UNHAPPY PATIENTS!
Declining Per Visit Revenue (PVR)
• Payer Mix
• Lack of Integrated Services
• Low Collection Ratio (net)
• Staffing Issues
UNHAPPY PATIENTS!
