Posts Tagged value

Paying More Money Is Not the Best Way to Retain Great Staff

Paying More Money Is Not the Best Way to Retain Great Staff

Medical practices are painfully in need of keeping their top employees. The time, costs and dangers of recruiting replacement personnel are just part of the issue. Loss of key team members negatively impacts patient care, practice profitability, and staff morale. All administrators agree the retention of a trained, well-performing and mutually cooperative staff is a key to success in medicine. How do you increase your prospects of keeping your “keepers” so that you lose only the ones who needed to go anyway? There are three secrets to success in this area and none require pay raises or bonuses.

Most important is to show them that you respect them. Make them feel valued by your praise of their efforts and character. Try to “catch” them doing something good. Take an employee to the office of another physician in the group and praise some special thing they did recently. Prompt the physicians about special employee efforts and send them off to find and praise the staff member. Write key staff notes of thanks for their sacrificial efforts. Set aside time each week to praise one to three members of your team. Conduct “stay interviews” with select team members. Also, the physicians and practice leadership should be aware of the circumstances in their life. Do they have a child excelling at academics or athletics, are they planning a special vacation, are they approaching empty nest status, are they caregivers to parents or other family members, do they have a special hobby they enjoy discussing, are they saving for a major purchase like a vehicle, boat, or home?

Caring about the lives of your team affirms their value to you. Giving them a $500 bonus deposited into their joint checking account is a currency over which they may have limited control and when it is spent, it is forgotten. Giving them a handwritten note or sincere verbal praise is a “currency” they can keep for their very own and use again and again as they replay the message in their minds. The praise costs your practice a little of your time and a modicum of empathy.

After a culture of merited praise is established, it is easier to correct or discipline them when necessary. Ignoring mistakes or poor conduct is a sign of not caring about the person. Think of the influential family members, teachers and coaches in your life. Weren’t they candid with you about times when your efforts were not your best? If the staff rest in the certainty of your gratefulness for them, they can handle the truth about poor performance from you better. Always praise their character and criticize their actions. In other words, speak to the actions, but don’t attack their character. Avoid a “compliment sandwich” where you say something nice, slip in the problem, and then end with another positive. Be brief, be clear, be firm, but be nice.

New employees need some corrective discussion as early in their employment as possible. Not only is there usually an area for enhancement, but it establishes that you will exercise the right to address them when you deem necessary. For the millennials in your office, this discipline may come as a great shock. They were raised in an era when every child received a participation trophy just for showing up, and as children, they were assured they could be anything they wanted to be. If there were problems at school, their parents went to the school and took care of it for them. Now you are telling them they are special but not in a good way, and their only trophy may be dismissal if the behavior continues. This might be a difficult message to absorb, but you owe it to the great staff to communicate it in a timely manner.

At a recent practice management roundtable, we discussed the fact that some medical staff members underperform until the leadership assigns part of their duties to the better performing staff, so that things get done. Permitting this transfer of work, is unfair to all staff and must be remedied.

With a balance of praise and discipline in place, have some fun at work! Every holiday is a good time to have fun. At Christmas, let them have a contest to decorate a door. For Thanksgiving let them write something about each member of their work area for which they are thankful. Compile the results and share with the staff in a lunch meeting. Halloween, the start of football season, Groundhog Day and anything else is a reason to celebrate. Have each bring a baby photo of themselves, and let the team guess which baby is the staff member, let them send in photos of what they did this summer and have a collage review in the fall of the pictures with narrative by each staff to share the joy, take them bowling, have a new baby “pool” where all can guess the delivery details of an expectant mother on the team, and select secret pals among the staff with a low limit on any expenditures. The point is to permit them to have fun at work. You do not have to entertain them, just give them permission to entertain themselves.

It is essential medical practices provide a fair salary and benefit structure to their staff. Underpaying your people is not compensated by the provision of a good work environment. However, remember people accept a job for the initial pay and benefits, but they remain in a position because they feel appreciated, know their best efforts are expected, and they are encouraged to have fun at their work. Make your practice a place where these three things are true, and you will have a stable, patient-caring and happy staff. It will make everything else you have to do so much more enjoyable.

Article contributed by Sae Evans, Maddox Casey and Jim Stroud, Members, Warren Averett Healthcare Consulting Group. Warren Averett is an official Gold Partner with the Medical Association.

Posted in: Management

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Three Common Mistakes in Transferring Ownership of a Medical Practice

Three Common Mistakes in Transferring Ownership of a Medical Practice

Physicians spend their careers building top-quality practices, but many devote too little attention to the architecture and terms by which the practices will be transferred at their retirement, death or disability. In our experience, there are three areas, which if neglected, will lead to problems at the crucial point when the ownership of this valuable asset changes hands.

Determining Value

Our clients are most concerned with the value of their practice. While some practitioners underestimate the value of their practice, many overestimate the amount which can be captured in the sale of the practice interest they own. A common mistake is to use a value that was read or heard about from a transaction elsewhere. That transaction price might have been determined by a purchaser who was limited in the amount they could pay, such as a hospital. The transaction might have occurred in a state with a higher managed care payer mix than your practice, or in a state with different non-compete laws regarding health care professionals. Practice valuations vary widely and for many reasons. Two practices in the same city and same specialty could have much different values. The terms of the transaction are another powerful force on sales prices and are rarely publicized. Even if you get the value accurately determined, there are still ways to create problems in the monetization of your practice value.

Clear Conversations

The documents relative to the transfer of a group practice ownership percentage should reflect the plan to sell at a future date, and the design of the manner by which the price will be determined. Even for valuable practice interests absent a clear design, potential buyers may feel tricked by a plan to transfer your share of the practice if it is developed late in your career. The time for this understanding is when younger doctors are brought in to the ownership. Buy-sell agreements and cross-purchase agreements serve to clarify expectations at the time of their drafting but should be reviewed every few years for relevance to the current situation, and any needed changes made. The greater the price desired for a practice, the more the need for clear design, pricing and terms. With a good legal architecture and a fairly determined price, your practice liquidation is almost ready for your time to sell, except for one additional issue.

The Fine Print

The legal obligation to pay the fairly determined price is often accomplished by the purchase of life and/or disability insurance on the selling practitioner. That can become a problem if the policies are never obtained, or the premiums payments are halted. In this situation, the buyer has a responsibility to pay a price agreed but with no funds to pay it. No one will be pleased with the outcome of this situation. Compound this problem with the common mistake of letting the practice price be set by the amount of life insurance proceeds, which could be afforded when the transfer architecture was designed, and you have a purchaser obligated to pay too much and with nothing but after-tax dollars from their future earnings. The CEO, chief emotional officer, at home will not respond well to this deal.

If you have a valuable practice, and you negotiate a fair price and terms for its sale, this can be a valuable way to exit your professional career and move to your next endeavor of success. It takes a little planning and periodic monitoring to gain top value.

Article contributed by Warren Averett CPAs and Advisors, official Gold Partner with the Medical Association.

Posted in: Management

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2017 Chronic Care Management Changes and Outsourcing Chronic Care

2017 Chronic Care Management Changes and Outsourcing Chronic Care

Medicare’s shift towards value-based care means the traditional model of health care reimbursement has just had a major shakeup. With value-based care, providers’ payments are now based on the value of care physicians deliver to patients and their health outcomes.

Patients with chronic conditions often require greater care outside of the office. Beginning Jan. 1, 2015, The Centers for Medicare & Medicaid Services (CMS) began paying for Chronic Care Management (CCM) services. Requiring at least 20 minutes of non-face-to-face care, providers receive an average reimbursement of $42 per patient per month with two or more chronic conditions. CCM has grown in popularity and many providers are seeing the increase in revenue. However, a number of physicians are still struggling to incorporate chronic care management into their practice. While the CMS requirements of CCM may be overwhelming, chances are many physicians are already managing Medicare patients with two or more chronic conditions and not getting the extra reimbursement to help with the added care.

The 2017 Medicare Physician Fee Schedule rule was finalized on Nov. 2, 2016. Providers will see payment changes for care management services in 2017. There are several changes that CMS has proposed regarding chronic care management. These changes are set to make billing rules within CCM simpler as well as expand the payment for complex CCM, including patients with behavioral health conditions. The new fee schedule rule will offer a new set of codes for providing care management to those patients.

Highlights from the 2017 Medicare Physician Fee Schedule regarding CCM

  • Simplification of CCM billing rules
  • Payment for complex CCM patients (CPT code 99487)
  • Supervision requirement change for CCM by Rural Health Clinics (RHC) and Federally Qualified Health Clinics (FQHC)
  • Pay for non-face-to-face extended E & M services

Part of the simplification of the CCM billing rules means the possibility of no longer requiring a consent form from the patient, but rather the provider would simply document in the patient’s medical record that CCM information was provided to the patient. Another benefit of this final rule is that initiating visits no longer have to be face-to-face office visits, unless the patient is considered a new patient or the patient has not been seen within the year prior to commencement of CCM. However, if providers do initiate CCM on a face-to-face visit, they can use the new GPPP7 to bill for that visit and receive a higher payment of $63.68.

Along with these changes to CCM for 2017, there is also a 3.5 percent increase in the CCM payment rate for 2017. The current rate in 2016 for CPT code 99490 is $40.82. This increase would make the 2017 rate $42.21. For complex CCM payments (CPT code 99487), the proposed rate for 2017 is $92.66. The complex CCM, CPT code 99487 requires 60 minutes of non-face-to-face care per month. CMS has also proposed an add-on code for complex CCM (CPT 99489) for each additional 30-minute increments of non-face-to-face time, at a proposed 2017 rate of $46.87. Please note: reimbursement rates vary by region.

MediSYS has outsourced full-service CCM to ease the burden on providers of meeting the CCM requirements while saving providers time and resources to enhance patient care.

“Providers have been very responsive to outsource chronic care management services because of the additional help they receive that saves them time and brings in additional revenue,” explained Jennifer Woodward, director of operations with MediSYS.

Outsourcing your CCM solution can help you increase revenue and expand patient satisfaction as well as provide you better patient access through a broader clinical depiction. CCM will also prepare providers for 2017 and the changes that MACRA has implemented in the healthcare industry to improve patient care and focus on value-based quality goals.

“With MIPS starting next year, providers are working hard to prepare for the changes that coming. By outsourcing this portion of the program, it provides them more time to work on the other aspects of the quality payment program to report effective care coordination,” Woodward said.

For information on MediSYS electronic health records and practice management solutions as well as outsourcing CCM services, please contact MediSYS at sales@medisysinc.com and visit the website at www.medisysinc.com. MediSYS is an official partner with the Medical Association.

Posted in: MVP

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