A three-physician New York City surgery practice had a stellar year. It attributes its success to the fact that everybody follows strict and detailed procedures.
Procedures produce efficiency, says Veronica L. Mogerman, administrator at Manhattan Surgical Associates. And efficiency means the office operates at top capacity and staff give patients top quality service, which translates to good marketing.
The procedures are nothing more than good general business principles, she says. For the most part, they standardize every job.
- The work stations. Staff are cross trained in just about every job, and the procedures start with rules that make it possible for them to sit down at any desk and immediately take over the job.
The top drawer of everybody’s desk holds the stapler and paper clips and other general supplies. And everybody’s file drawer has the files labeled the same way. Even the medical assistant’s files are kept in an order that anybody can understand.
Also, everybody’s forms are organized either alphabetically or numerically, are labeled, and are kept on a shelf within reach of the desk. So if a patient has to sign a document or fill out a form, the replacement staffer knows exactly where to find it. There’s no time lost to “I wonder where that form is . . .”
- The system. Another procedure is that patients calling for appointments get immediate scheduling.
That’s possible because every staffer knows how to use all the applications of the practice management system. So whoever picks up the call knows how to schedule and can handle the request. The caller isn’t put on hold and transferred to somebody else.
The same for billing questions. Almost all the staff – and Mogerman as well – can look at the account and answer the question. The only staffer who can’t do that, she says, is the medical assistant, Mogerman explains, “but she can schedule and also fill in as receptionist.”
- The telephone. When staff get a patient question they can’t handle, they don’t immediately transfer the call or ask to take a message. The procedure is to say “Tell me what your question is. I will help you if I can.” They listen to all the patient has to say, and if they can’t resolve the matter, they send the patient to the correct person or take a message with a promise of a callback that same day.
“There’s no passing the buck,” Mogerman says. The approach is “Staffer A is out today, but I want to hear what your problem is.”
That applies even to clinical questions. The staffer hears the patient out and gives the complete message to the physician. And an additional procedure is that the staffer pulls the chart and clips the message to it so the doctor can return the call without having to hunt for the chart. All the doctors return all their calls by the end of the day.
- The up-front collection work. Procedure has also increased the office’s cash flow.
Surgeries are expensive, Mogerman says, and very few patients know what their insurance will cover or how much they will be responsible for.
So, at the outset, she explains to the patient what the procedure is and what the estimated total cost is and how much the insurance will cover.
Then she tells the patient that the office requires a percentage of the total amount up front and that when the insurance company pays the office, the office will refund any overpayment to the patient. For patients who can’t pay the full percentage, she sets a payment plan.
A key point is that the percentage she quotes is more than what the office expects the patient-pay amount to be. Consequently, the office has all but eliminated its collection work. “There are more refund checks than collection calls,” Mogerman says.
Revenues improved by 60% the first year the office started the procedure.
- The billing procedures. Cash flow has been improved further with a simple billing procedure.
Like most practice management software, the office’s system can produce reports that identify errors on claims. Therefore, the procedure is to use that function with all claims. And the result is that claims go out clean and get paid faster.
In addition, the office automatically sends the operative report for every claim. “The payer is going to ask for it,” Mogerman says, so the report gets mailed the same day the claim is submitted, and that eliminates the extra step (and time) of waiting for the request and then pulling the file, making copies, and mailing the report.
- The supplies. Even the supply orders are standardized. This is done with a spreadsheet that covers all the items the office orders. It shows the name of the product, when it was purchased, the vendor’s name, the quantity, order number, amount delivered, and so on. With all the information laid out, it’s possible to see immediately where to order an item, how much to order, and what the cost should be.
In addition, because space in New York City is both scarce and expensive, she has negotiated storage for the forms and chart folders until the office needs them. This allows the office to get the bulk price savings and bring in supplies as needed. And because the orders are large, most vendors don’t charge for either the warehousing or the extra deliveries.
- The reinforcement. To be of any value, procedures have to be clear and they have to be followed, Mogerman says. So each one is written out and reviewed from time to time at staff meetings so it becomes second nature to everybody.
With records, for example, the rule is that no record leaves without the patient’s signature. So when copies are sent out, the procedure is to log in what information is sent, when, and where it goes.
Going over that procedure from time to time ensures that staff always remember to follow it.
The same with the cashiering. There are procedures for entering transactions and tallying up the day’s deposits, and they get reviewed periodically in staff meetings.
With clear guides and constant reinforcement, the manager doesn’t have to “waste time checking up on people,” Mogerman says, because mistakes don’t happen. What’s more, the office runs as efficiently as possible, which in turn means staff have time to give patients their full attention.
“Staff have to give the same good service the doctor does,” she says. If their service doesn’t measure up to the quality of the medical services, “they detract from the doctor’s stature.”
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