Not the right question That can be answered in 3 minutes The real question is complex and is really asking "How to run an Efficient Medical Practice where.

How to Staff the Office to Utilize an EMR

Not the right question That can be answered in 3 minutes The real question is complex and is really

asking "How to run an Efficient Medical Practice where staff learn, perform, and grow to create a dynamic environment for patient satisfaction, employee satisfaction, and physician satisfaction, while growing revenue."

I altered the topic

YOUR MEDICAL PRACTICE FINANCIAL

FUTURE

(Opening the Door to Revenue)

More Importantly

Building a Practice and a Life

(The Efficient Practice)

Your Current Medical Life

Student, Intern, Resident, Fellow Learning by Immersion ("Drowning") Focus on understanding the facts,

processes, data, understanding science, your role in it all

Minds are fresh, open, curious, exploring, and protected. (Academic Setting)

"I don't care about making any money, I just want to treat and help my patients"

Or, Your Current Medical Life

Employed What does my contract say? What do I have to do? How do I get paid? Am I satisfied? Am I happy? What can I control? Are there any other options? Am I enjoying my life outside of my job?

Or, Your Current Medical Life

Private Practice- small, medium, large Are my patients satisfied? Are my employees satisfied? Am I satisfied? Am I happy? Am I in control? How do I control my destiny? Insurance Companies, Government plans

and regulations Can I survive out here?

My Goals for Today

Never stop learning after "official training"

Be open to ideas outside of the medical field

Keep medicine as a big part of your life, but not your LIFE !

Discover your purpose and your dream and go after it with all that you have.

Always work on yourself more than you work on your job

Ideas and Topics

Our current financial challenge in medical practice Overview of my practice - Oliver Family Healthcare,P.C. New Paradigm - “Think Twice” (White Coat / Dark Suit) White Coat Thinking Dark Suit Thinking EHR – The Centerpiece of Profit Growth Putting technologies together - Laddering technologies Results – The profitable practice Future enhancements and efficiencies for additional profit See the possibilities for growth in my own practice. Can I really still be in charge of my destiny?

Always Remember

"If you don't work for your own dreams, You'll work for someone else's"

Dreams, Vision, Purpose

Sharing my journey as an illustration Your path will be much different It will be of your choosing, or of your not

choosing If you gain one bit of information today

that helps you in your future, then my purpose will have been served.

Starting Off Right

Attitude Quality Care Right Staff Servant Service Systematized Business

Attitude

Physician First Office will reflect Dr’s attitude If Dr. treats staff coldly, staff treats

patients coldly Work to develop functional team Avoid Hierarchy in the office Direct physician communication with staff

Quality Care

Patients don’t care how much you know, until they know how much you care !

Always put patient care first My mentor: Dr. Steve Young, Cardiology “If you take great care of the patient,

you’ll never have to worry about the money”

The Right Staff

I choose attitude and personality over skill

Must have good skills, but skills can be taught… attitude and personality cannot

Attitude: Team, caring, ambitious, industrious, fast paced, teachable

Interview, screen, ½ day workview I get input from current staff If you make mistake, admit it, fire fast Hire slow, fire fast Eliminate “Deadwood”, Trim the plant

Servant Service

Entire office should be servant trained Patients don’t want to feel like objects We smile, use patients names often Ask how we can help Ask if everything was handled today Dr. asks patient if any problems with

office or staff to let him/her know personally

No automated attendants!!! Call patients with every lab, test,

procedure f/u

Systematized Business

Have systems in place for everything System for how to greet patient, phones,

scheduling, check-in, collections, insurance, settlement protocols, financial task redundancy, deposits, time off, every aspect of business.

Every team member must understand Takes time, education, positive reinforcement Morning Huddles Monthly executive review Annual strategic planning

Current Financial Challenges

Declining Reimbursements from 3rd party Escalating Costs- rent, supplies, equip Govt / Insur oversight / decision mgmt. Performance initiatives – Pay 4 Perform Consumer demands – patient pays more Pressure to be clinically / tech up to date "Healthcare Reform" is changing landscape I believe we are moving toward "cookbook

mediocrity"

My Experience, Practices, and Lessons Learned

Family Medicine for 28 years ER Physician during first 7 years Started with 2 other Dr’s Developed a 4 location, 15 Dr. Group Developed and operated 5 urgent cares Sold entire group to Hospital Was Medical Director of the hospital

group After contract up, bought back current

practice Last 9 years focused on small, efficient,

profitable practice

My Current Practice

1Dr., 1FNP, 2 PA-C 20 total staff Family Medicine with modified open access model Use Allscripts Professional EHR and PM system Wireless tablets for providers, laptops for nursing,

desktops for administrative and reception staff Onsite x-ray, dispensary, ancillary services No hospital, nursing home care, I use hospitalists On staff at two local community hospitals 75,000 charts on system Average 2300 patient visits per month

Change in My Paradigm Medical practice has two independent mindsets operating My clinical practice and my medical business Decisions require “Think Twice” evaluations White Coat Thinking – What’s best for the patient Dark Suit Thinking – What’s best for my practice Strategic Planning – Plan, Do, Review Physician ownership mentality is required Physician buy-in is imperative for greater profits Learning the power of the EHR and partner technologies

will create greater rewards for practice and Dr. A resource ! Michael Gerber’s The E-Myth Revisited, and

The E-Myth Physician

White Coat Thinking

Patient Care Enhancement Diagnosis and Treatment Quality of Care Issues Safety for patients Risk reduction Continuing Education Preventive Care implementation Follow-up Care obligations Results reporting to patients

Dark Suit Thinking

The business of our practices Focusing on revenue expansion New services Greater efficiency in managing patient care Controlling costs – transcription, employees, supplies Schedule management Intra office communication Office – patient communication Bringing it all to the bottom line - Greater profits

The EHR – Centerpiece for profits

Schedule management and visit expansion Enhanced intra – office communication Correct coding – E/M calculator Test results reporting efficiency Preventive care and visit outreach In House service expansion - In House Dispensary E-script efficiency Patient follow-up reminders and tracking Vendor interfaces – Lab, Hospital, Ancillary Equipment Patient feels that Dr. is better, technology = quality

EHR – The Centerpiece for Profits

Correct CodingE & M Calculator

Schedule ManagementVisit # Expansion

Service ExpansionFirst Fill

(EKG, PFT, Holter)

EHR

Enhanced Intra-officeCommunication

Preventive Care & Disease Management Outreach

E-scriptEfficiency

Patient Follow-UpReminders & Tracking

Vendor InterfacesLab, Hospital

Schedule Management / Visit Expansion

Establish independent parameters for each Dr. / Provider

Establish appointment times for ancillaries in office

Track No-shows

Keep lists to fill appointment cancellations

Set up appointments for disease states or insurance types

Color coded patient appointment management

Enhanced Intra-office Communications

Messaging between phone intake and nursing staff Messaging between Dr. and nursing staff Messaging among nursing staff Consult passing between Dr.s and midlevels Sending charts for work to appropriate staff member Sending dated reminders to staff regarding patient care Create shared message boxes for general work In exam room contact between Dr. and Nursing , EHR

communication and voice command contact

Correct Coding = Profit

Most physicians undercode E & M codes A review of our coding practiced showed following

$61,000 undercoding loss in 2005 Captured this revenue following year with E&M calc. $39,000 undercoding on New Patient Visits in 2006 Captured this revenue in 2007 with E&M calculator and

have continued to improve annually

Continue to enhance coding at point of care Physician must take control of practice financial destiny

Test Results Reporting

Lab tests come overnight into patient chart Single test review site in EHR. Physician reports all tests by voicemail to each patient Patients feel that “personal call” came from Dr. Nursing staff use voicemail to notify patients also EHR allows rapid movement to multiple patient charts Medvoice is the technology we use, others available

Preventive Care OutreachDisease Management Outreach

Automatic search of EHR for preventive protocol Automatic search of EHR for disease management

protocol Automated phone calls and confirmation of appointments Patients can cancel appointments electronically Open appointments can be filled immediately First month revenue increase $ 13,500, continues to grow Patients think service is incredible – they don’t have to

think 2008 start of program - Revenue increase of $300,000 2011 consistent revenue enhancement of $400,000

Outreach Revenue Report – Project Qtr 1

2011 Outreach Revenue - $400K

Dispensing Meds

A-S Dispensing program On premises medication dispensary ½ of sales are cash, ½ of sales through insurance Can order prescription in exam room – Checks inventory Verifies patients medication insurance coverage level Patient picks up RX at front office on check out First 4 weeks profit = $2,600, continues to grow Expansion of in office formulary easy Inventory control easy Automated reorder of medications 2008 Dispensary revenues of $35,000 2011 Dispensary revenues of $51,000

E-Scripts

Scripts sent to any State Pharmacy from exam room Patient satisfaction high. No wait at pharmacy Rapid refills from E-Script requests from pharmacies Enormous time savings = more time for revenue

production All of prescriptions are legible Can send prescriptions electronically, by fax, to printer Script management by nursing staff via grants

Patient Follow-Up RemindersFollow-Up Tracking

Send future reminders to staff for patient care Track referrals as reports return Send future action plans for patient tests or procedures Automatic reminders about specific patient needs or

desires

Eg: 32 y/o patient with breast lump, tender, freely moveable. Recommended 1 month of conservative care and observation. Patient advised to follow up in 4 weeks. Left a 6 week dated reminder to notify patient if she hadn’t returned. Patient had not returned, we called, she came in, got mammogram after re-evaluation. Lump was malignant and was removed early.

Vendor and Hospital Interfaces

Bi-directional interface with Lab, overnight lab results to chart

Pull electronic data and put in chart from local hospital network, Docs for Docs

Incoming fax reports directed to patient charts for review

Patient PerceptionTechnology = Better Care

We’ve had hundreds of patients enter our practice after friends, family members, and co-workers have experienced some of our technologic services.

In a time where patients will pay more out of pocket for primary care services, the office that provides the best service and care will have the most “good” patients.

Results

Immediate results when we went “live” on EHR 1. $39,000 reduction in transcription costs

Our transcription bill from year prior 2. $60,000 reduction in employee costs

Two employees left, didn’t want to learn “computers”

Did not need to replace them due to less paper handling

3. Loss of expenses related to charts, filing, space requirements for files 4. Employee satisfaction and lower turnover 5. Our EHR was paid for with this immediate cost

savings

Results in Our Practice 9 years 50 patients a day to over 115 patients a day 250 new patients a month Patient satisfaction surveys average 95% in all

categories Increased Employee benefits every year – Dental ,

vision, 80% of health insurance cost, 100% matching 401K, profit sharing plan for all employees, monthly bonus plan for all employees, extremely low employee turnover, only 1 person has left in 6 years.

25% + profit growth annually Quadrupled revenues in 9 years –measured from

year prior to renewed private practice implementation

2008 with 27% increase revenue over previous year

2009 provider time off expanded with same profitability

2010, 2011 increased revenue with preventive business

Revenue Cycle Technologies

EHR and Mgmt. software integrated Point of care Charges input by provider Clean claims submission within 24 hours Navicure real time claims interaction Automated payment posting from

insurers Active in house collection management Patient training for up front payment,

discounts and deposits up front. Accounts Receivable > 90 = 2.75%

Laddering of Technologies

Use fully integrated EHR / PM Chart connect Labs, Hosp., Pharms Chart connect in-house ancillaries Data mining software Point of service E/M coding Intra-office and patient communication Point of service quality care protocols In-house profitable ancillaries patients

want

Results

Increased Employee Benefits Dental, vision, 80% of healthcare costs 100% matching 401K Profit sharing plan for all employees 15-25% profit growth annually for 9 yrs Increased provider time off Able to add new ancillaries / update equipment Employee Monthly Bonus Plan Adequate profit to fund outside investment

opportunities 2009 – Added Preventive company –Cash Business 2012 - Recruiting second physician actively

Revenue Results

2002, employed Dr. + NP $ 625,000 2003, Private Practice Dr. + NP $ 875,000 2004, Private Practice Dr.+NP+PA $ 1,250,000 2005, Private Practice Dr.+NP+PA $ 1,635,000 2006, Private Practice Dr.+NP+PA $ 1,975,000 2007, Private Practice Dr.+NP+2PA $ 2,300,000 2008, Private Practice Dr.+NP+2PA $ 2,715,000 2009, Private Practice Dr.+NP+2PA $ 3,060,000 2010, Private Practice Dr.+NP+2PA $ 3,390,000 2011, Private Practice Dr.+NP+2PA $ 3,705,000

Beneficial Tactics

Morning huddles to future-face any problems of the day Train staff to high level to off-load work of Dr./NP/PA Always explore new technologies for possible benefits as

time savers or revenue enhancers. Get started now – review current status and write plan for

improvement. Always “Think Twice”

How Can You Build an Efficient / Profitable Practice

Implement and understand your EHR Mine and act on data acquired Use automated systems for non complex

actions Train your patients to understand systems Add profitable, necessary ancillaries Make every staff member a patient advocate

and revenue producer Establish monthly and annual plan, do,

review Spend time working on your practice, not

just in your practice

Review Strategically plan implementation of laddering

technologies Stay up to date with upgrades, new technologies Take advantage of training modules Always think twice / “White Coat and Dark Suit” paradigm Be a high quality, high profit practice Focus on your patients and practice, not outside

influences Attitude is EVERYTHING, Take charge of it ! Discover or remember your purpose in life. Write down and take action on your dreams, goals, plans Work on self-improvement Understand it's OK to make a profit Make every year Your Best Year Yet !!

Shameless Self-Promotion

Opportunity: Searching for a D.O. to join me in

my practice in 2012. Entrepreneurial minded physician who would enjoy working in a small fast-growing private practice . To be part of a team that values working hard, playing hard, and deciding and taking actions on ideas that make our patients healthier, our employees satisfied, and our personal lives rich and rewarding.

Email: [email protected] 317-331-6160