Vicki Estrin

 As the nation’s healthcare capital, Nashville is home to a broad array of experts and innovators. We asked a group of local consultants, with a depth of knowledge in various aspects of practice and hospital management, to outline common mistakes they see time and again and to offer practical solutions to turn those negatives into positives.

The result was invaluable insight into ways to enhance revenue, bring down costs, boost patient retention, improve efficiency and increase productivity. We also gave our expert panel the opportunity to share their biggest pet peeve when it comes to running a healthcare business efficiently and effectively.

Often, the best solution is a fairly simple one. It doesn’t take long to turn a routine into a habit, which is great when it comes to adopting the common sense approaches prescribed by the panel. Unfortunately, too many hospitals and practices have allowed flawed routines to turn into bad habits … and those can be hard to break.

A consistent theme among area consultants was to recognize the value that comes with stepping back and truly taking objective stock of your organization’s workflow processes. The results could be quite eye opening … and perhaps a little disturbing.

For even more great tips and insight, be sure to check out the extended version of this article on our website, www.NashvilleMedicalNews.com.

Boosting the Bottom Line

While healthcare is all about the patients, the simple reality is that you can’t serve anyone if you can’t keep your doors open. There are all types of revenue traps that cost practices and hospitals money, but there are also smart ways to avoid those pitfalls.

Vicki Y. Estrin, Principal, C³ Consulting, LLC: “The first basic rule is ‘garbage in/garbage out.’ If the information at intake isn’t correct, the revenue stream is delayed and potentially stopped. It is typical for the person who captures the patient’s key billing information to be one of the lowest paid employees in the practice or hospital, and often their performance is measured by how many patients they can register quickly … not accurately. The staff costs are enormous on the back end to fix the errors that should have never happened on the front end and impact revenue significantly. When will healthcare learn that an investment in people and processes on the front end will pay out in the short term with real dollars?”

Earl T. Winter, CEO, nTelagent, Inc.: “It’s a new world, with patients responsible for an ever-increasing percentage of their healthcare bill. Deductibles and co-pays are higher than they have ever been. Many plans have gone back to having coinsurance rather than co-pays. In short, healthcare providers will be paid less by insurance payors, and the patient will owe more.

Providers that don’t know how to talk with patients about financial responsibilities … to tell them how much they owe and then offer discounts and payment plans or get them signed up for assistance programs … are in real trouble.”

Andrew D. McDonald, Sr., FACHE, Director, Healthcare Consulting Group, Lattimore Black Morgan & Cain, PC: “As a healthcare consultant, it is remarkable how many times we see practices that do not update their fees schedules on an annual basis, input negotiated payor contracts fee schedules into the practice management system to assure contract compliance, utilize coding audits to assure appropriate information is contained on all claims to enhance the clean claim percentage and to assure appropriate staffing levels are in place.

Another area is the lack of appropriate investment in practice startup once a physician has been successfully recruited and retained by a hospital or health system. Hospital leadership is, many times, not aware how critical this process can be to cash flow if it is not properly monitored to assure that the process is completed in an efficient fashion.”

Sara S. Lankford, CPA, Partner, Carter Lankford CPAs, PC: “Lost charges … especially surgical fees. Charges for services either never get billed, or they are billed untimely. An easy fix is to keep control over the fee tickets. For office visits, compare the sign-in sheet to the fee tickets daily, and make sure all office visits are billed daily. For surgical tickets, keep a surgical log and check it off every two days. Best practices indicate a one-day turnaround for office visits and no more than three days for surgery fees.”

Trimming Costs

Raising revenue is certainly one way to boost the bottom line, but cutting unnecessary costs also improves margins and keeps the bank balance in the black.

Michael E. Collins, CEO, 2^nd Generation Capital, LLC: “Occupancy cost is one of the highest fixed costs of any physician practice. Medical center space rent per square foot often greatly exceeds commercial office space. Too often, for convenience of the physician or by historical practice, physician groups will house their administrative offices together with their clinics. With today’s Internet and mobile technology, that is simply not necessary. Significant savings to the practice, often with increased job satisfaction for non-medical employees can result from proper planning.”

Brandon Harrison, Senior Consultant, Kraft Healthcare Consulting, LLC: “Staffing is a major area where practices can find opportunities for cost reduction. In most cases, a practice can realign their staff’s responsibilities to better suit the changing needs within the operation versus hiring more staff. Practice assessments are great tools that provide an action plan on how to operate more efficiently and cost effectively.

Focusing on supplies management provides additional opportunities. It is important to designate an individual to manage the inventory and supply needs of the practice. This allows better control over supply management and reduces supplies expense.”

Winter, nTelagent: “We have found that one way providers can bring down costs and reduce bad debt is by addressing challenges in the emergency room. ERs can be misused by non-emergent patients because the ERs typically don’t’ provide pricing or try to collect money. After the patient has been medically screened according to EMTALA guidelines, properly processing non-emergent ER patients … including reviewing financial expectations … will often result in those individuals seeking care a free clinic, primary care office, or other more appropriate setting.

We often hear that facilities are hesitant to ask ER patients for payment for fear of violating EMTALA. Certainly, there are clear rules and processes that must be followed. However, imperfect registration and discharge procedures result in missed opportunities for collections, as well as misclassified charity care. Additionally, in a hectic ER, there is often a failure to screen for financial assistance programs such as Medicaid and other state and local social services programs.”

McDonald, LBMC: “Typically, the largest expense for a physician practice is staffing and associated benefits. If a practice is going to offer benefits in addition to competitive salaries, leadership should investigate the many options for the provision of said benefits. A professional employment organization (“PEO”) will typically afford the practice with the opportunity to access comparative health/dental benefits at much lower costs.”

Encouraging ‘Customer’ Loyalty

Patient retention is the lifeblood of any practice or hospital. In the quest to build a pipeline of new patients, sometimes those who have already signed on for your service can get overlooked. So how do you keep the patients you already have?

Estrin, C³ Consulting: “It is very simple … patients want respect. Providers need to understand that it is not okay for a patient to wait upwards of an hour to see them. It is not okay to ‘forget’ to share basic health information with the patient like their blood pressure, BMI, lab results, etc. It is not okay to offer office hours that work for the provider and not the patient. It is not okay to assume the patient is incapable or unwilling to learn about their medical conditions. Patients have choices and will continue to feel more empowered to exercise those choices, and they will choose to see providers that respect them.”

R. Brian White, Managing Partner, Competitive Solutions, LLC: “Physicians and staff need to be mindful that the practice of medicine is an intimate relationship with the patient/customer. Practices that present a timely, empathetic and comforting environment of care will rarely struggle to retain patients.”

Winter, nTelagent: “While it may seem counterintuitive at first, hospitals that let the patient know how much the service is going to cost prior to care can really improve patient satisfaction. No one wants to buy a product or service without knowing the price.”

Lankford, Carter Lankford: “Providing patients with feedback, results from tests and the ability to communicate with the practice (builds loyalty). This is from not only my professional experience, but personal, also. My husband was the patient; he had a chronic illness. After five years visiting the same doctor … often times weekly … each time we called the doctor, we would go through at least four different people before they talked to the doctor, and he told them what to do. There has to be a better way to help very sick people. Practices are notorious for not communicating to patients after the visit. Sometimes, the patient never hears back from lab or x-ray results. That patient is not going to be loyal.”

Taming Time Gobblers

No one is immune from the little … and sometimes big … inefficiencies that gobble up too much time each day.

Harrison, Kraft Healthcare Consulting: “Workflow design and practice layout can create barriers to efficiency within a practice or facility. Patient-centered or pod-style layouts create a centralized and efficient floor plan for improved workflow within a department or practice.

Another ‘time gobbler’ is always waiting until a patient arrives to fill out and/or update paperwork. Whenever possible, this should be done in advance to reduce patient wait time and bottlenecking for front office staff.”

White, Competitive Solutions: “Effective time management in any business is the right person or resource performing the right task at the right time. Physicians and practice managers need to constantly remind staff and reinforce the priorities of every individual in the practice. Many managers consider priorities obvious while employees fail to see the correct order of tasks.”

Increasing Patient Load without Sacrificing Quality

Is it possible to do more and do it well? The experts say ‘yes,’ as long as you plan appropriately.

Rhonda W. Sides, CPA/ABV, CVA, CFF, Principal of Healthcare Services, Business Valuation, and Litigation Support Services, Crosslin & Associates, P.C.: “Ineffective patient scheduling is one of the most frequent ‘time gobblers’ in healthcare businesses. Often times, practices stack early appointments but then do not start on time, which in turn disrupts the entire day. In trying to compensate for the morning backlog, patients are not scheduled in the afternoon causing the provider to see fewer patients. If the schedule was timely, more patients could be treated on a daily basis.

In order to improve these frequent time inefficiencies, more effective scheduling with the right kind of appointment is necessary so that overlapping appointments are ‘doable’ for the provider and do not keep the patient waiting. An example is scheduling follow-up visits at the same time as a new patient rather than two new patient visits at the same time. If the physicians and providers do not pay attention to appointment scheduling, it can get out of hand and became a schedule that is convenient for the staff rather than the patients and providers.”

White, Competitive Solutions: “Careful consideration and streamlining of internal processes can allow practices to effectively grow patient load without compromise on quality. Accurate and maximum collection of information at all stages of the patient encounter will increase the velocity of decision-making during the encounter and provide a quality, timely completion of the encounter. Combine those elements with the appropriate level of physician engagement for the patient’s personality, and those goals will be met.”

Pet Peeves

These are the sins of commission or omission that area experts must address time and again. So what are some of the biggest pet peeves?

Collins, 2^nd Generation Capital: “Tilting at windmills. Healthcare is complicated on just about every front. Providers have little to say once a new rule or procedure is imposed. One must quickly and effectively adapt to the changing environment and encourage all involved to develop best practices in light of the circumstances. Tilting at windmills is just not productive and certainly does not help morale.”

Sides, Crosslin & Associates: “Two pet peeves, which lead to inefficiency in physician practices, are 1) keeping the ‘sacred cow’ employees who continually disrupt the business, and 2) not infesting in trained, experienced, and motivated billing and collection staff.”

Lankford, Carter Lankford: “Lack of control, oversight and accountability. Practices should establish goals for every level of staff.”

McDonald, LBMC: “The lack of appropriate information technology being used in our healthcare system today … we are way behind when we address this area. When a surgeon can take someone’s gall bladder out utilizing a robot and then turn around and have to document that procedure in a paper chart, that should tell you how far behind we are from an IT-standpoint.”

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