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Your Top Questions Answered
Staff Bonuses; Disabled Physicians; Repair Codes; Patient Record Access; Charge-Capture Software; Team Building; OB/GYN Recruitment
STAFF BONUSES
QUESTION: I would like to be able to tie staff bonuses to quantifiable staff performance. Any suggestions?
ANSWER: I love this idea.
Here's a model I saw recently that I really like.
It's a two-part system: Staff members receive a revenue bonus if the practice collects a preset dollar amount (or more), which goes up over time. Twelve percent of any amount over the goal goes back to the employees. Of that 12 percent, half is divided equally among staff, and the other half is distributed based on staff members' anonymous evaluations of their coworkers. You can see how this approach keeps your staff focused on revenue collection and encourages a team environment.
The second part is based on patient satisfaction survey results. Each staff member receives $50 if all patients surveyed in a given period say they would recommend the practice to others. I like this because it also builds teamwork.
Other programs are geared to reward the success of specific staff members. For example, billers may receive extra cash or a profit share if collections are up.
Some general words of advice: You will get what you pay for, so be careful. I've seen practices give their billers incentives to work faster. As a result, more claims went out, but there were also more errors in those claims. So total accounts receivable actually dropped.
Reward your employees only for what they can control. For example, in the profit-sharing program mentioned above, the practice divides its top-line revenues or collections. The staff has little control over costs, so the practice doesn't base the bonus program on net revenue.
Keep it as simple as possible, and keep it as public as possible. Competition works. Set the rules clearly, and then stick to them. You don't want to change your plan halfway through the year. Although you can establish temporary programs for defined periods, don't give your staff a goal and then move the goal line.
DISABLED PHYSICIANS
QUESTION: I work for a disabled physician who is looking for ways to communicate with other disabled physicians or retired doctors. Can you suggest anything for him?
ANSWER: You should try the American Society of Handicapped Physicians. It has no Web site that I could find. But the director is William Lambert, and the society's address is 3424 South Culpepper Court, Springfield, MO., 65804.
There is also a Canadian Association for Physicians with Disabilities. Its Web site at www.capd.ca, has some nice links.
A similar group, The Association of Disabled Professionals (www.adp.org.uk.), exists in the United Kingdom.
These groups should be able to help your boss get in touch with others who share his concerns.
REPAIR CODES
QUESTION: When using the code 15822 (blepharoplasty upper lid), can we also bill a repair code?
ANSWER: No. Simple repairs (closing the wound you made) are always considered part of surgery codes.
PATIENT RECORD ACCESS
QUESTION: When patients ask for a copy of their exam notes and/or their records when checking out, what is the best way to handle this? Do we need to photocopy them immediately? One of my doctors would rather type up a summary than give out copies of medical records.
ANSWER: If this happens a lot, it's another great reason to get an EMR that lets you print a summary report right from the record.
The answer also depends on what the patients want it for. Billing? Their own records?
If it's the former, they might need the whole thing.
HIPAA simply states that patients need to be allowed access to their records. How you do so is somewhat discretionary. HIPAA allows you to require all patients to send you a written request for their records before you release them. And it states that you may offer patients a summary or their full records, according to their preference.
Otherwise, this is a work flow issue. Physicians who feel strongly about the summary approach should commit to sending a summary of the visit via e-mail to the patient on the next business day. If the patient won't agree to do that, then just copy the most recent note and hand it over. Postponing such work only serves to make it more time-consuming.
CHARGE-CAPTURE SOFTWARE
QUESTION: Do you know if there is any software available to install ICD-9 and CPT codes into a Pocket PC? I'd like to code at the hospital.
ANSWER: Sure.
The industry lingo for it is charge capture.
Here are some links to products to check out:
- www.medicalofficeonline.com/system/charge_capture.html
- www.mobiledesigntech.com
- www.medaptus.com
- www.pMDsoft.com
A Google search for charge capture will turn up many products, some with built in coding help and even e-prescribing.
TEAM BUILDING
QUESTION: I was wondering if you had a recommendation for a book on team-building exercises and/or customer service training games (with a "patient service" angle).
ANSWER: For team building, I recommend Patrick Lencioni's "Overcoming the Five Dysfunctions of a Team," as well as his other books. They aren't specific to practices, but they are totally on the money. For the other, Medical Group Management Association (MGMA) publishes "Star Studded Service: 6 Steps to Winning Patient Satisfaction."
OB/GYN RECRUITMENT
QUESTION: We are recruiting a half-time OB/GYN for our practice. What would be appropriate to offer as a starting salary?
ANSWER: According to the MGMA, the median salary for an OB/GYN is $262,000. Of course, a part-time physician can expect to make less.
When considering the starting offer, I would also factor in overhead. Overhead costs for someone working 20 hours a week are more than half of those working 40 hours a week. Many costs in medical practice are non-variable; they stay the same no matter how much anyone works.
So, present the whole package. What will be her share of overhead? What will malpractice insurance cost you? Will you need more staff or can she use existing staff?
I'd also encourage considering a productivity-based compensation so that she'd get, say, $100,000 guaranteed, then get another $30,000 if her RVUs meet or exceed 50 percent of benchmarks (use the norm in your practice or MGMA's). She could be eligible for another bonus or 10 percent of the revenue from any RVUs, provided that they exceed 50 percent of your benchmark by more than 20
percent.
Finally, I recommend asking your potential hires about what they need from the job. If they are happy just finding a part-time spot that let's them keep a hand in medicine, money may not be the motivating factor.
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