Note: Susan Childs, FACMPE, is a popular national speaker and noted healthcare consultant. Her talk at a recent MGMA meeting in Memphis was highly praised. She has graciously allowed the Memphis Medical News to print her message. The following is the second segment of her message.

One of the best bosses I ever had greeted me with: ‘‘My job is to make it so you can do your job as easily as possible.“ Who would not want to do everything for this person!?

As a community leader we are the ones setting the new standards for a new generation of care. And that is very very important.

Be a part of it and be seen! Volunteer and act – it does not have to be a physician. It can be anyone you deem a good agent of the practice. This can be at chamber meetings, health fairs, clinics etc. I am sure any of us are doing this and have discovered that it is true you get back what you give.

Employee Engagement

To do the best job possible, I have to believe in what I’m doing – and so do your best employees.

It is true that being the example for the practice is not easy -- even challenging at times. As you consider each staff member’s accountability please also think about how they ended up in that specific position. Were they hired for their training, initiative or because you needed somebody to sit in that seat at that moment?

I once interviewed a staff member when the first thing she asked me was, “I am not qualified to do my job, what am I going to do?” This person had been placed in a position that they needed filled at the moment with minimal training, and expected her to do a great job!

Then there are those who are given the tools/training they need, and ask questions such as, “What reports can I run so I know I’m doing a good job?”

We can teach new tasks, and those people that can be trained and identified also considering the best and appropriate demeanor for each position.

What is an instant way to get to know your staff’s daily issues and success? Let them show you and watch them swell with pride. Sit with them in their station for 30 minutes. Ask them the following questions, “What do you like about your job, what do you not like about your job, and how would you change it?”

Those who are interested in doing a good job will immediately have some tips as to how their life can be easier right now. Those who have already given up are probably looking at the want ads, which is maybe what they should be doing. Or you can opt to try to get them actively engaged to your practice.

An extra bonus from spending time with your employees is a bonding on a one on one basis finding some tips that save your staff time and they will respect you for it.

We want people to believe in and feel good about where they are. This is not just a matter of emotion. If somebody likes their job and feels dedicated they will work harder for you. It’s that simple.

The best marketing tool is your staff. Internal marketing goes way beyond the practice walls. I have noticed that hiring priorities lean more towards culture, initiative, drive and knowledge. If you can teach someone a task, that’s one thing. Demeanor cannot be changed. As we know, some people are just not meant to work at the front desk and ask for money. Others are naturals.

Your job descriptions tell a lot too. If it is more than two years old, t technology alone declares it should be updated.

While being an official document, listing specific requirements needed, tasks to be done, who to report to, physical demands, and education, knowledge of systems or processes etc. A job description is not a judgment of personality. It is strictly a description of tasks to be done within a certain position within an organization.

Again, patients notice what is going on in the practice. It is amazing to think that a few simple measures make a massive difference. Indeed they do! One practice I work with raised the standards of accountability along with the pay. This resulted with great success for this practice. Employees are accountable, engaged, and the patients notice.

Long-term employees also equal long-term patients. Both staff members and patients prefer predictability especially in a fearful setting, offering a sense of security. This is what we want for our practice.

This is reflected with patient surveys to their insurance plans, which in turn can increase reimbursement as value-based indicators enter the formula. There’s momentum and expertise with every project. A decent wage to go with those expectations goes along way.

A United Front

Ask yourself, who are your practice’s leaders? As we follow standards, please, please, please do not let staff members play on your sympathies regarding any disruptions with the administrator. This renders the administrator absolutely powerless with that and any other employee aware of the situation.

Talk about wanting to present a united front. As an administrator, we realize that when a physician leader or other managers support us, it strengthens our standing with the practice staff and other providers.

Catch Everything Early

To revamp your revenue cycle process, consider migrating your billing to electronic options such as E-statements and remittance through your patient portal or other vendor. Payments in this venue have been received within 30 minutes of the statement being issued.

The more I research this, the more I totally believe this is one of those things we sit and wonder why have we not done this before? It’s a win-win situation. The benefits begin with the cost of issuing statements being free with many vendors. Think about what you’re paying for issuing statements today.

Of course we all know there is no such thing as a free lunch, so be sure to ask “Who gets the swipe?” Each vendor gets a percentage of credit card processing and is clearly stated within each of their contracts and should be reviewed as you enter relationships with these companies.

Anything electronic can be quickly verified of receipt. It is also easier to locate patients; e.g. if they move physically, his or her email may remain the same.

We still need to offer multiple payment options including paper that some patients may still prefer.

As with any new or updated procedure that includes patient interaction, please be sure to test it first either with a ghost patient or friend for ease of use and accessibility to easy remittance and payment options.

The Golden Door

About 75 percent of your patients will look at your website before either selecting you as a physician or reviewing your services as a preselected physician on their insurance preferred provider list.

The one thing the patients really want is access, access, and access! We all know delayed care can be seen as denied care. So how can we welcome them at the door while educating patients on your standards procedures and processes along the way?

Your patient truly sees this as a doorway into your practice. So be sure that what you are clarifying on your website is also reiterated on your voice attendance. For example, “non-urgent “messages are answered in how much time?

Your website could also be a plethora of information for post procedure care as well as frequently asked business and insurance questions.

As patients believe that this is the most direct way to access to their physician they do not need to know it may be the nurse actually responding. It is our role to convey the doctor’s part of the care.

Being able to electronically request an appointment, lab results or a callback is amazing in itself as it allows your staff to look at the patient in front of them at the counter instead of answering the phone. We could have dedicated staff to addressing patient portal payments, issues and questions.

One Of The First Questions Is And Should Be...How Will Our Patients React? Now we get to educate our patients on opting for the patient portal versus telephone or in person conversations. What else is new as we are the ones who often update our patients on their benefits anyway?

As often happens with change, patients will put off doing so until absolutely necessary. As you consider changing habits also realize that most people are somewhat addicted to their devices - younger and older patients alike. As most people live on their computers and already remitting bills online, such as telephone and credit card bills, why not include medical bills in that grouping?

A great way to get your patients engaged is to ask them to enter their own information, such as their history form and insurance information. Once they begin in the actual transaction whether with healthcare; pain levels, Rx refill request, or remittance of a statement, they naturally become more involved in the process.

Our Financial Future

There is no doubt that our revenue cycle has changed. The timing of everything has kicked it up a notch. How much we know about the patient ahead of time and when we turn over to collections is at a much faster pace and essential with each visit.

Remember that the front desk is your billing department too. Time of service collections is no longer an option – it is a must! It also sends a clear message that payment is indeed expected in a timely manner.

Work with your billing department and establish boundaries as to the money amount the front desk is to ask for before referring to the billing department or back office needing to be a part of the conversation in a more private area. Any previous balances or bad debt should be approached before the patient presents for a visit or receives any other services.

As we all know sometimes we are the resource the patients depend upon to inform them of their benefits and when something is due. Check with your vendors to see which forms, calculators and estimators that may be already available with your product.

Depending upon your state, any estimate may need to in a specific format to be considered a legal document.

Defining the True Costs

There are of course the traditional costs such as labor, building and others. What exactly is the cost to rehire and re-train staff? Remember that patients see and hear when staff is not happy, and as a result may choose to leave the practice with no hint to you whatsoever . . . and then it’s too late.

Please track patients leaving the practice, and if you see an uncomfortable amount you may want to consider calling patients asking why if not moving to another area etc.

If you retain staff, can you also retain patients? Do you want to keep your staff happy with tools that they need to get their job done? That includes technological changes such as template improvements, auto remittance applications, billing and e-pay options.

Another consideration? What is the cost of signing on in remaining with a bad insurance plan? Think about authorizations and other administrative work that may not reimburse your staff enough to warrant maintaining a relationship with that particular plan.

Authorizations alone are huge cost. It is anticipated that physicians spend at least 4 hours per week, nurses and clinical staff 15 hours and nonclinical 4-8 hours per week strictly for authorizations.

Viewing the Visit

Between the ACA and employers forced to revaluate affordability of benefits on an annual basis, patients are experiencing “high-deductible sticker-shock” as they select physicians.

While narrow networks and other venues to control costs are popping up across the country, some plans offer open access to any physician.

So, how does the average patient begin to find the right doctor? Along with other options, one of the most successful remains asking neighbors and friends. The individual testimonial still speaks to be the most reliant for referrals.

What Makes You Special?

Ask yourself, what makes you so special that I would choose to see you versus another provider? Most physicians will say they spend more time with each patient and provide more preventive care than other providers. Beyond that what is it that you do that makes you different than other physicians of your specialty?

From a patient’s point of view, one thing always noticed is the familial feel, or lack of it, within your practice walls.

Anyone can offer medical care but no one can be you except you. Show that you are 100% involved with your practice including interactions with staff. Patients notice a cohesive and supportive office.

Ready for the future?

You have a world of information at your fingertips. It’s now up to us how we retrieve and what we do with information obtained and the power to control our future.

We have worked hard to establish a foundation of care that only strengthens our role as physicians and community leaders. Continue and extend that long-term patient relationship to include the best partnership including his or her financial responsibilities.

We are indeed setting the new standards of healthcare. Let’s do it right.

Healthcare is local and most importantly between the physician and patient. No one can ever replace that.

You, your heart and your brain – that’s the true business of medicine.