A Healthy Medical Practice

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A Healthy Medical Practice

• Sarah J. Holt, FACMPE
• Cape Girardeau Surgical Clinic
• Cape Girardeau, MO 63703

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A Healthy Medical Practice

• Integrates
• Organizational Structure
• People
• Process
• Technology

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A Healthy Medical Practice Organizational
Structure
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Organizational Structure

• Governance
• Who are stakeholders?
• Who governs?
• Is governance formalized?
• Is governance understood?
• Is governance systematic?
• Who has authority, responsibility?
• Is accountability required?

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Organizational Structure

• Organizational Dynamics
• What is group culture?
• What are expectations of group?
• Does group encourage professionalism?
• Does group develop leadership qualities?
• Does group recognize various roles?
• Does group respect all roles?

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Organizational Structure

• Human Resources
• Are organizational policies and practices well
  communicated to employees?
• Are federal, state, local laws and regulations
  known and adhered to?
• Are all supervisors trained appropriately?
• Are all supervisors held accountable for their
  responsibilities?
• Do employees understand their rights and
  responsibilities?
• Do employees have grievance procedures?

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Organizational Structure

• Problem Solving
• Are employees empowered to solve problems?
• Do employees have full range of knowledge
  relating to situation?
• Do employees have educational requirements to
  solve problems?
• Do employees have experience, skills and
  abilities to solve problems?

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Organizational Structure

• Communication
• Do open lines of communication exist?
• Are reporting relationships well defined and
  utilized?
• Are changes communicated to the entire practice?
• Are expectations communicated to entire practice?
• Is feedback constructive?

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Organizational Structure

• Planning Marketing
• Does your organization engage in a strategic
  planning process?
• Does your organization implement processes based
  on strategic planning?
• Are meetings well planned and facilitated
  efficiently?
• Does your organization utilize target marketing?
• Does your organization utilize industry standards
  and trend analysis for planning and marketing?

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Organizational Structure

• Risk Management
• Do you communicate effectively with patients?
• Do you document history, instructions, tests, and
  procedures?
• Do physicians review and document key points of
  informed consent relating to risks, benefits,
  alternatives, and consequences of no treatment?
• Is confidentiality maintained throughout the
  organization?

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Organizational Structure

• Decision Making
• Are decisions made unilaterally?
• Is staff involved in decisions about workforce?
• Is staff involved in decisions that create major
  changes?
• Is staff involved in conflict resolution?
• Are all decisions made based on what is best for
  the organization as a whole?
• Are decisions that have been communicated to
  staff adhered to by all organizational members?

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A Healthy Medical Practice

• People

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A Healthy Medical Practice People
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People

• Share a Unified Practice Philosophy
• Who are we?
• What do we offer?
• Who do we wish to purchase our services?
• What differentiates us from others?
• Does our organization live a unified
  patient-centered mission?

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People

• Team Ethic
• Do teams develop a problem solving approach?
• Do teams develop decision-making skills?
• Do teams consist of the right mix skills
  people?
• Do teams self-regulate?
• Do teams practice open discussion?
• Do teams share work assignments?
• Do teams feel satisfied with their effort?
• Do teams win collectively?

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People

• Long Term Employees
• Does your organization hire the best people it
  can find?
• Does your organization train employees with
  cross-functionality in mind?
• Does your organization allow flexible time off
  and apply limits to all employees equally?
• Do you laugh and celebrate small successes?
• Does your organization demonstrate that it
  genuinely care about employees welfare?
• Does your organization understand that peer
  expectations keep employees motivated and in
  check?

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People

• Excellent Customer Service
• Does your organization make customers feel
  welcome?
• Do all members of the organization understand
  that they depend on customers more than customers
  depend on them?
• Do you treat others like you want to be treated?
• Do you leave personal baggage at home?
• Do you give customers more than they expect?
• Is the whole organization is responsible for
  customer service?

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A Healthy Medical Practice

• Process

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A Healthy Medical Practice Process
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Process

• Registration Intake Process
• Are patients educated about what they can and
  cannot expect from the practice, about their role
  and responsibility about insurance terms?
• Do you obtain and verify adequate insurance
  information?
• Is your organization categorizing patients in
  financial classes based on predetermined criteria
  or on patient preference?
• Do patients sign release of information forms and
  designate persons to obtain medical information
  about them?

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Process

• Charge Capture
• Are all co-pays collected at time of service?
• Are all office visit charges and hospital charges
  are entered timely?
• Do physicians understand that they are critical
  to this process? Are they given in-house coding
  seminars?
• Are physicians paid on salary with bonuses based
  on RVUs?
• Are clinical staff responsible for
  pre-certifications?
• Do you utilize self-addressed, stamped envelopes
  for patients unable to pay at time of service
  follow-up if payment is not paid as agreed?

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Process

• Insurance Filing and Tracking
• Are all claims filed electronically every day?
• Do you ensure that clean claims are sent?
• Is insurance tracked daily?
• Are all incorrectly paid claims tracked by
  carrier and appealed?
• Do you bring patients into the process early?
• Do you keep all time frames short?

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Process

• Collections
• Is your organization bashful about collecting
  money?
• Does the accounts manager speak to every patient
  with an outstanding balance when they are in the
  office?
• Are bad debts and write offs flagged so future
  appointments wont be made until debt is
  resolved?
• Are statement messages appropriate to seriousness
  of delinquency?
• Is every attempt made to collect personal
  balances before they are turned over for
  collections?
• Are accounts in tickler queues to be worked by
  aging and dollar amount?

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A Healthy Medical Practice

• Technology

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A Healthy Medical Practice Technology
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Technology

• Assessment
• Do you know what you need to know?
• Is technology planning done and taken seriously?
• How is staff using technology?
• What business problems can technology solve?
• Is technology integrated throughout system?
• What level of technology does it take to track
  everything you do?
• Do the organizational decision makers understand
  that technology will dictate your organizations
  ability to be effective and efficient?

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Technology

• Functionality
• Does your organization understand that the
  functionality of technology is more important
  than the technology itself?
• Does your technology manage sound processes?
• Does your organization use technology as a tool
  to get the job done?
• Does your organization use technology to
  determine the way you do your work, track your
  work, and report what you have done?
• Do you automate every task that can be automated?

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Technology

• Integration of Clinical and Business Operations
• Are you effectively managing clinical
  information, such as tests, reports, and
  pre-certification that support the business side
  of the organization?
• Is the coordination between the clinical and
  business function harmonious?
• Are clinical employees trained to make and check
  next appointment in system?
• Does your organization provide financial support
  for adequate integrated systems, installation,
  training and support?
• Are you using technology for patient
  applications?

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Technology

• Maximize Current System
• Who oversees the management of and maintains the
  system?
• Are you getting the most from your current
  system?
• Have you evaluated the way your current system is
  used?
• Will your current system support needed new
  functions?
• Do all members of the organization trust the
  data?
• Does your current system have the ability to
  track everything you do?
• Does your current system have the ability to make
  reports meaningful?

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Technology

• Information Management
• Are the right reports produced?
• Are the right people getting the right reports?
• Are those people getting reports taking
  organizational action based on the data?
• Does your organization chart the information flow
  of clinical information?
• Does your organization chart the information flow
  of business information?
• Can information in system be pulled in any
  combination needed?

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Technology

• Security
• Does your organizations mission and vision
  support secure information?
• Does your organization maintain proper release
  and disclosure of information policies?
• Is security considered in making all business and
  management decisions?
• Does your system have a systems administrator or
  administrative team?
• Does your organization have a disaster management
  plan?
• Are security policies and procedures in place and
  taken seriously?
• Do all staff understand their role in security?

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A Healthy Medical Practice

• Integrates
• Organizational Structure
• People
• Process
• Technology
• Questions???
• Sarah J. Holt, FACMPE
• sholt_at_ldd.net