Don't lose your people. You know, the people behind the desks in your office - the ones actually running the ship while you do the doctoring. These are the people who answer the phones and put the face on your practice before the public gets to meet you.
When you feel the pressure, your people are feeling the pressure, too. If you've felt the pressure created by third-party scrutiny, reduced collections and the need to improve your clinic documentation, your staff is feeling it as well. You need to become more efficient and make fewer mistakes, and so does everyone else on your team. This can create a dilemma. Unless you're giving them the tools they need to perform at a higher level of efficiency and quality, they're not going to be able to do much better than they are now without creating serious friction in your practice.
So, what's the secret to having a faster, better crew without the chance of a mutiny? I think it can be reduced to three major components: near-perfect billing and coding; clinic streamlining that values employee input; and encouraging worksite readiness. Put these three things together and you'll raise the value of what you already do as your people benefit from practical applications of employee empowerment.
Here's the catch: It takes a digital clinic and full electronic health records to successfully do all three simultaneously. Let me show you why.
Near-Perfect Billing and Coding
Billing and coding is where the rubber meets the road for your clinic. You can be the best doctor in the world, but unless you're running a strictly cash practice, your ability to get paid is determined not only by the quality of your care, but also by how well you document that care to support the necessity of the services billed. If there's any disconnect between procedures, codes, diagnoses and third-party-pay policies, your ability to collect diminishes.
Even in the perfect practice, chiropractors rarely collect close to 100 percent. Getting more than 85 percent means you're doing extremely well. Yet the actual cost of our collections can sometimes be hidden from us. Especially if we don't account for honest mistakes in coding and billing that force us to submit and resubmit claims. Every time we go back and correct the most minor coding error, that's money we spend trying to collect the money we've already earned. The value of our service decreases every time our billings are rejected on some technicality. The more mistakes we make, the lower our compensation becomes.
Coding by hand or with certain software is a great way to drive down the value of your services through errors. Even the most agile billings officer is tripped up by fatigue or using different documentation and billings programs together. Little mistakes end in rejected claims or excessive time spent recoding, resubmitting and recalculating proper balances. In the worst cases, repeated mistakes end in rejection and third-party profiling of the practice, which leads to greater scrutiny.
What you require for near-perfect billings is a digital safety net that identifies codes and billing practices for which one third-party payer has certain policy restrictions or another has rules on how to submit certain services. You need to know all these variances before they leave your practice, before you find it, correct it and explain the mistake to a claims reviewer, and before you have to correct your staff for the mistake. The safety net knows and understands common coding mistakes and alerts your staff to problems as they are made. It helps your billing and coding reach a higher level of accuracy, even while increasing your staff efficiency.
Greater efficiency is difficult in the traditional practice that relies on human observation alone. If you want fewer mistakes, you have to put up with less-efficient processing. Any increases in practice volume can increase error rates unless you expand your employee numbers.
But experiencing practice growth with a true electronic records system, integrated with an intuitive billing system and documentation software, will create a digital safety net. This means your staff does not have to expand, since the efficiencies will allow the same number of staff to do more and they don't have to feel the pressure. It's a standard that can only be comfortably maintained in a fully functional, digital clinic.
Clinic Streamlining With Employee Input
This borrows heavily from other employee-management concepts that basically say: Involve your staff in workplace changes so they can have ownership in increased efficiencies. Fortune 500 companies have used changes suggested by workers to cut production times in half. This same principle can work in your practice, provided you have the clinical tools to initiate it.
Electronic health records combined with digital documentation offer the clearest example of the way employees can increase productive value. The key is to have the digital tools that empower employee problem-solving rather than stifle it. Customization, particularly in documentation, is the key.
Customization capabilities serve as a quick benchmark for the quality of the digital-documentation program and the EHR that contains it. Too little customization and the doctor must conform to a generic patient workup that slows them down. On the other hand, nonintuitive customization causes clunky documentation that forces you to choose every software feature, while months of efficient documenting pass you by. What you need is intuitive customization that is functional and ready for your changes when you want to make them.
Customization can be a powerful way for your staff to increase the efficiency of everyday clinical tasks, such as scheduling, documenting and billing. Is there a benefit to setting your SOAP notes to open on your computer workstation in a particular format for patients with a certain third-party-pay program? Then customize it. Does your staff want to add intake and exam questions that will help them properly contact patients regarding payment? Then standardize it. Does your staff want to create alerts that warn you to follow up on certain kinds of patient presentations for billing purposes? Then empower them with customization so they can increase their productivity - and yours.
Clinic customization is the best way to take the everyday learning experiences of practice and codify them in workflow procedures that save you time. It's a great way to involve your people in making your whole ship sail faster.
Encourage Worksite Readiness
This is an obvious management principle, but it's also underrated. It says work efficiency is easier to initiate and sustain in an environment that is organized, uncluttered and ready for the work at hand. Various industries have their own procedures and lingo for getting their employees to think about the quality of the work environment. It might sound cliché at first, but worksite readiness is a principle you can use in your own clinic to empower employees as you encourage efficiency.
This simple principle might be the hardest to implement in practice without the power of the digital clinic. It requires changes in organizational behavior in the face of years of bad habits. In a traditional practice, real worksite readiness requires controlling stray papers and files, and an emphasis on workstation organization and cleanliness. In reality, it's seemingly petty cleaning and sorting tasks that would make you feel like a dictator to enforce in your practice. Your staff probably wouldn't appreciate it, either. What is amazing is how a completely digital clinic can manage these things for you.
A paperless practice creates space efficiency that is difficult to create in a traditional practice. Sometimes it's even hard to imagine if you haven't experienced it firsthand. Once you see how the digital clinic works, you understand the concept of worksite efficiency. There are no stray papers. There are no stacks of files waiting for attention. There is no duplication of clinic computers, so your staff can run a separate billing and scheduling program for the same patient record. There are no workstations cluttered with last month's EOBs. There are no stacks of films waiting to be filed. Ultimately, there is no visual and organizational chaos.
If you choose the most advanced software, everything you and your staff do will be run from multiple flat-screen monitors, voice-recognition software and computer workstations or kiosks. Most of it will be accessible from one screen. This is the efficiency created by having everything at your fingertips without requiring you to police staff behavior, overhaul your office floor plan or invest in new paper-file storage. The digital clinic organizes it all for you. Worksite readiness comes standard to the digital practice. Best of all, your staff will realize reduced stress in the clinic of the future.
Are there other areas of your practice you could focus on in order to increase your efficiency without alienating your staff? Of course there are. Giving your staff the clinical tools they need to increase successful collections and customize your clinic workflow is a powerful place to start, especially when the technology actually improves the work environment while placing everything your staff wants and needs at their fingertips. There is no need to lose your people over the stresses of today's practice. Find yourself the right digital clinic system and it will be smooth sailing in calm waters with (best of all) a happy crew.
Click here for previous articles by Steven Kraus, DC, DIBCN, CCSP, FASA, FICC.