Best Practices by Physicians

In their own words, physicians describe 'best practices' which have helped them navigate the challenges of running a successful practice. Following is HCMS commentary when available.

 We had difficulty keeping up with inaccurate contract payments from payers.
Solution: We hired a full-time employee that checks collections from all payers against negotiated contract rates.
Outcome: We have found hundreds of thousands of dollars in payment errors.
Specialty: Oncology

  • Physicians should look at their net collection ratio to catch inaccurate contract payments from payers. The net collection ratio, also known as the adjusted collection ratio, indicates effectiveness in collecting the money you are allowed to collect.
    Compare contracted rates to payments to determine if the payer is allowing the contracted rate. Use data from four to six months back, to ensure claims had sufficient time to pay. Ideally, a practice should obtain 100 percent of the allowed amount, but a net collection rate of 95 percent denotes a healthy practice. If your practice has less than a 100 percent collection rate, check payments against the contracted rate. Also run an adjustment report to discover inappropriate write-offs. Additionally, run monthly adjustment reports by type to determine if the practice is making appropriate adjustments to identify trends and/or inappropriate adjustments. Adjustment trends to look for are bad debt, coding, bundling, and other denials. Use the calculation below to determine your net collections ratio. (Payments-credits) / (charges-contractuals) = net collections ratio. 

Situation: Patient office wait times were too long.
Solution: We started to inform waiting patients the reason (i.e., delivering a baby) for the delay and offer a convenient time to reschedule if they did not want to wait.
Outcome: By communicating with our patients we decreased patient stress about waiting.
Specialty: Ob-Gyn

  • Patients tend to have a love-hate relationship with healthcare waiting rooms. On the one hand, their presence is required in order to be seen by the physician. But on the other hand, the unknown wait times may add stress to an already tense and unpleasant situation.” (Physician’s Practice, August 2015) To read about hints on reducing patient wait time click here.

Situation: We had an issue with low staff morale.
Solution: We held an occasional employee party or lunch.
Outcome: By holding lunches or parties we have been able to keep staff motivated and their morale elevated.
Specialty: Ob-Gyn

Situation: We conducted a staff interview that went well.  However, we found out the person has a criminal background.
Solution: We began conducting pre-hiring criminal background checks.
Outcome: We have had a decrease in staff and office issues.
Specialty: Internal Medicine

  • Background checks are an integral part of the hiring process for the health care industry. Inadequate due diligence and negligent hiring practices in the healthcare sector harms not only an organization, but its patients as well. Click here to find out more about criminal background checks.

Situation: was spending too much time on Medicare data entry.
Solution: I decided to stop taking Medicare.
Outcome: I was able to focus more on patients and patient care. Doctors are the least costly part of patients' care. Be transparent about charges and time.
Specialty: Neurology

  • Every year physicians have the option of modifying their status with Medicare during the open enrollment period. Click here for more information on those options.

Situation: We needed a new revenue source.
Solution: We partnered with Green Light Behavioral Health.
Outcome: Outcome was 3-fold: Green Light is a CPIA measurement (Depression Screening) in MIPS, found a new revenue source to help pay the bills and most importantly the tool has helped in early patient diagnosis of behavioral health issues.
Specialty: Internal Medicine

  • More information about Green Light Behavioral Health can be found on the TMA PracticeEdge website.

Situation: Too much time on EHR.
Solution: Physician Angels - Virtual Medical Scribe.
Outcome: Less time on EHR, more time with patients and family.
Specialty: Pain Management

  • Physicians spend hours every day outside of the patient visit entering data into EHRs. Scribes, virtual or otherwise, can free physicians from much of this data entry allowing them to see more patients and/or spend more time with patients.

Situation: Too much time on EMR.
Solution: Dragon Medical One Speech Recognition Software - cloud-based.
Outcome: Decrease time working on EMR and increased personal free time.
Specialty: Psychiatry

  • Speech recognition software allows physicians to be more productive and efficient freeing them to focus on patients, not documentation.

Situation: Patients not paying co-pays.
Solution: Collect upon arrival.
Outcome: Increased co-payment revenue.
Specialty: Family Medicine

  • Collection of co-pays, deductibles, co-insurance, etc. is sound business practice, and there is a greater chance of not collecting it if not collected at the time of service. But collecting patient responsibilities isn't a choice, it's a necessity not just for revenue generation, but because failing to do so has legal ramifications. Click here for more information on best practices collecting from patients, and here for the legal ramifications of routinely waiving patient responsibilities.

Situation: High rate of uncontrolled hypertension within our patient population.
Solution: Created a hypertension campaign to focus on those patients and work with them more diligently.
Outcome: After testing the campaign at one of our locations and seeing positive results we implemented the program throughout our clinics and after analyzing data from before and after the campaign we saw significant improvement in our uncontrolled hypertension patients.
Specialty: Internal Medicine within an ACO

  • Chronic conditions and non-compliant patients can be very difficult on a practice both as a frustration and financial burden. Analyzing your patient data and identifying disease and patient outliers may be useful in selecting a focus and creating your own campaign to further assist your patients.

Situation: Trying to find ways to lower costs while improving quality and efficacy of patient care.
Solution: Putting an emphasis on ensuring all patients come in for their wellness visits, and identifying high risk patients/ER frequenters and providing assistance in connecting them with care managers.
Outcome: Data analysis of patients showed that patients who regularly came in for their wellness visits occurred fewer costs than those who did not.
Specialty: Family Medicine within an ACO 

  • With payment systems slowly changing from "fee-for-service" to "fee-for-value" it is important to identify ways to lower your practice costs while remaining or improving patient care. Finding simple ways to ensure your patients get the care they need without overburdening yourself and your practice can be difficult, but possible.

Situation: Difficulty collecting data for reporting and analysis.
Solution: Look into the possibility of joining or creating an Accountable Care Organization (ACO) or Independent Practice Association (IPA).
Outcome: ACOs and IPAs have many benefits that physicians and practices could utilize including data collection and analysis assistance, care managers, and better payer contracts.
Specialty: Any 

  • ACOs are provider and payer arrangements established to improve care coordination between primary care physicians, hospitals, specialists, and public or private health payers. Payment is based on "value" not volume." An IPA is an association of independent physicians, or other organization that contracts with independent physicians, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis. Both make it possible for physicians to remain independent in their own practices.

Situation: Burnout on massive clicking on EHRs.
Solution: Implemented a solution that eliminates repetitive typing of physician username and password by cutting clicks by allowing physicians to use their badges to tap in and out of EHRs throughout the day after a one-time login at the start of the day or shift.
Outcome: Saved each physician between 6 to 20 minutes daily, which is about 20 to 140 logins per physician per day.
Specialty: Any

  • Administrative burdens are increasing and the main cause of physician burnout. Look for solutions to minimize unnecessary work or find a work-around for time-consuming tasks that provide little benefit to your patients or practice. Check with your EHR vendor for assistance in making your EHR more efficient to use.

Situation: EHR contract language.
Solution: Calling TMA endorsed The Coker Group for EHR contract assistance.
Outcome: Saved the practice from a dire situation regarding our EMR/PM contract that was riddled with unfair and undue burdens. I can honestly tell you, I am profoundly grateful and impressed with the value and benefit the Coker Group has provided. They have a profound expertise, knowledge, and understanding of EMR/PM agreements.
Specialty: Neurosurgery

  • Membership in HCMS and the TMA have extensive benefits for members, but many are unaware of them and they are never used. Familiarize yourself with the benefits membership offers and utilize them. Our Buyers Guide provides access to vendors for a variety of practice management needs and many offer discounts to our members.

How to Submit Your Best Practices
HCMS is asking physicians and their staff to send us their 'best practices' to post for the benefit of all members. Click here to submit.