By Emilie J DiChristina, MBA for Practicefirst
Meeting quality indicators and incentives actually requires a bit more thought than it does technology or additional (or more expensive) staffing. This is good news for smaller practices that do not have the capital to invest in PCs in every exam room, or tablets for each staff member and who often cannot afford to hire more individuals to handle quality reporting.
In thinking through the ways to improve any aspect of your office, including quality the first thing to remember is that technology (like the EMR) is our friend, but also our enemy. The Meaningful Use requirements sound good on the incentive side, but they may actually cost more than you might expect. The costs I am referring to are not only those related to the purchase of the technology, but also to lost productivity due to provider, staff and patient disassociation with the process.
Even the largest office may have trouble effecting the changes necessary to meet Meaningful Use, and the quality incentive plans of multiple private payers. This is not necessarily due to lack of intent, it may instead be the fact that ingrained habits are hard to break for you, your staff and your patients! Look around at your staff – have they been taking any formal training in any aspect (billing, office management, ICD-10 coding…quality)?
The good news is that with planning, forethought and even relaxation, quality translates to increased revenue, and decreased risk for your practice. It is a worthwhile activity. The key is in not just in meeting the incentives, but above and beyond based on getting paid for the services you provide in meeting these quality objectives.
The first step is to consider “waste” in our offices. In this case, “waste” refers to inefficiencies that a) increase expenses, b) prevent you from capturing more revenue, and c) can result in opportunities for receiving all the incentives your office may qualify for.
Some of the areas to consider within your practice include
a) How many FTEs do you have in your office?
b) What is the role of each FTE? Can you break it down or are you relying on the staff to tell you what they do?
c) How does your staffing patterns compare to the national benchmark for your specialty?
d) Who does your billing?
e) Who (or what) does your coding?
f) Who pays your bills and does payroll, benefits, staff scheduling?
g) What ancillary services do you offer in your office AND are they owned by you, sub-contracted to you, linked with a hospital?
h) How much time are you as a provider involved in non-patient care duties? YOU are usually the most expensive employee!
One thing you may wish to consider would be allowing a professional to assist in evaluating your practice. Why would this be a good start? Remember that ingrained habits are hard to break for you, your staff and your patients – more importantly, it may prevent you and your staff from identifying areas of improvement.
Another area of concern is that the physician or physician(s) leading the intent to change will be the most expensive employees in the practice. If you lack the depth within your office staff to actually perform the analysis of both areas for improvement, and how to integrate such improvement in your practice, it may fall to you as the physician. A professional will usually cost you less per hour than your time would cost, plus it gives you the fresh eyes you need.
Still not convinced? Remember that no one wants to say the 62 year old receptionist (or worse, your spouse) needs to go, but if it needs to be said – let it be someone without skin in the game.
Looking at Quality from a Fresh Point of View:
a) May point out wasted staff, but evidence they can be trained to improve your quality outcomes
b) May point out that your practice has lost strategic advantage because your practice is trying to do everything (billing, coding, management, and bookkeeping) in your practice, instead of focusing on patient care and of course quality!
c) You may find that you may need a different type of staff – don’t forget the licensing scope of practice
d) You may not be maximizing the EMR you have in place
e) You may be missing opportunities for quality care because of time and workflow
f) Your quality care can be revenue generating – NOT just in incentives but in actually billable services
g) When your office has a handle on quality – your patient’s receive better coordination of care, which makes your referral partners and hospitals happy AND reduces risk
Once you have identified waste in your practice. If it is non-staff related, make that your first quality priority – eliminate it! If is staff related:
a) Consider whether your excess staff can make YOU more effective in managing quality.
b) What if you do not HAVE enough staff, or the appropriate level of staff? You will have to make changes in roles or types of positions to make the quality projects work
c) Focus next on the big issues for your patient base that meet both CMS and private payer quality requirements. These are usually DM, CVD, HTN, COPD/Asthma. The key is to get your biggest quality bang for the buck.
d) Also consider how patients measure quality which includes MD time spent with the patient (not spent waiting), not having to return for tests, treatments, etc. because they didn’t get what was needed in the first place AND the perception that the provider “did nothing” or “didn’t do what the patient wanted”.
e) Do not be afraid to look to projects being undertaken or reported within your peer group or professional organization – just remember that NY State is NOT Kansas, and not every practice has 40 staff members.
Of course there are costs associated with Quality but it is better to implement quality procedures now when there is still some carrot, than to be forced to bear the cost once the stick is applied. Also, if you have eliminated waste as your first step, you have probably found some money that can be dedicated to quality, or perhaps a way to improve revenue, again allowing for some quality dedicated money.
There is also the benefit! Improved patient care is always the prime desired benefit – but just ordering a test or screening doesn’t mean the patient will comply, so while we can assume patient benefit, it is important to look at the benefit to your practice overall.
a) If you eliminate waste in your practice your expenses will drop – improving your bottom line.
b) If you find that the waste in your practice applies to inefficiencies which can be corrected you can improve your patient care and quality measures, see that the patients are “touched” more often and enhance care at less expense.
c) You can potentially increase your revenue 10 – 15% (not just the .5 to 1% from quality incentives) from doing what is needed and charging for what you are doing.
d) You will become more valuable for your strategic abilities and insight.
e) Your patients will love you and recommend your practice even more.
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