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Saturday, September 4, 2010

Manage Your Time

I like ideas for making my day more efficient, so I can manage the everyday tasks and still find time to work on interesting ideas. Here are some ideas I find work for me.
1. Schedule vendor visits for specific days. Limit the time for an appointment and set alarms, or have your staff remind you about the time to end the meeting. Use uncomfortable chairs for the visitors (I’ve actually done this.)
2. Deal with staff questions immediately. Trade five minutes now vs. time to find them and talk to them later. If you are busy when they come to you and you cannot stop, give them a time and ask them to come back. That frees you from adding the task to your list. I suggest that if you finish before the time you asked them to return, go to them. Don’t start a new task. Instead take the opportunity to check on the rest of the office as you go. It provides a little exercise and it shows the staff that you value their time enough to come to them.
3. Give your front office staff instructions on drop-in vendors: Stop them at the front, accept anything they are dropping off for you, and inform them that you are busy and not available. No exceptions. If you are expecting someone on a day you don’t usually schedule vendors, tell your front office.
4. When you have something to tell a provider, go to their clinical assistant, ask for the time you want and ask them to call you when the physician is available. Guard your physician’s time. That is the income generator. Guard your own time by keeping the conversation focused and by doing it where the clinical assistant can keep tabs on the physician’s time. This keeps you on task and on time.
5. Use folders to organize your task. I use a “Today” folder with anything I need to accomplish or want to work on. It sits on my desk for me to find first thing in the morning. I have used the work-week folders (Monday – Friday, with a Next Month folder) with each day’s folder becoming the current Today folder. Why not use your computer calendar or PDA or smart phone? That can work, but pick something that appeals to you. I do use my calendar and I sync it to my phone. But much of what I do involves paper, so the folders work for me. If using your phone/PDA requires writing the information down on more than one place, look for another option.
6. I keep two notebooks. One is small enough to fit in my back pocket or an inside coat pocket. I use it to record anything I need to remember when I move through the office. It’s fast and easy and takes less effort than tapping the information in my phone. The second notebook is usually a larger one that I use to record meeting notes and phone calls. I date each entry and keep a running record of conversations, thoughts, phone calls, etc. I used to keep a third notebook, a steno pad by my phone to record conversations, but I found it easier to record phone calls in the larger notebook. I use sticky flags to mark topics I need to find quickly.
7. When I check my newsfeeds or RSS reader I try to read the interesting items immediately. If I find something I want to read more carefully or explore further I either bookmark it or use a neat service called iCyte. iCyte is a free plug-in for your browser. When I am on a page I want to keep, I click on the iCyte button. A window opens that allows me to assign the page to a topic folder, add tags about the article, and add a note. The great part is that iCyte stores the information on the web. I installed it on my home PC and my laptop. When I’m home and want to look at the article again, I click on iCyte and the list opens. I can read, save and delete the day’s collection from any PC.
8. I use my break time to stroll through the office. I keep in touch with the flow of the day, remember things I want to check on with my staff, and get some exercise. I can become deskbound. When I do, I find myself looking for things I can do without moving. That is my alert signal – Danger! Get up and move! My job is taking care of the office, not checking off the tasks on my to-do list.
9. Go to your local managers’ meeting. The Charlotte MGMA chapter meets monthly. How does this save time? Shared ideas! I find vendors already vetted by people I know and trust. I find out about services I didn’t know were available, that save me time or money. I get out of my office. And since I drive about 30 minutes each way I get contemplative time without interruptions.
10. Delegate ruthlessly. If it isn’t yours to do, get it to the right person quickly. Decide together a date for completion and check on it that day. Setting deadlines keeps you and the task owner focused.
11. Turn aside someone’s attempts to manage up. Return it, with advice or requirements, but keep it where it belongs. Your staff may point out that they are busy all day with patients. But they do have time, and collectively they have more than you.
What do you think? Useful, practical, or dumb? What is your favorite tool to manage your time?

Lee Barbieri

We are faced with insurmountable opportunities.
- Pogo

Monday, May 31, 2010

Service vs. Care

In a recent posting from healthcarewarrior (see he made this observation:

"Service is the vehicle. Care is the outcome. The harder you drive the service, the better the care."

As I've noted before, for a profession that is dedicated to provide care, we frequently miss the service component. It is a stressful profession. I include everyone who has contact with our patients regardless of the role. We care for them, get involved in their private lives, know things that even family members don't know, and have obligations to them that we cannot shed by walking away. Few other professions are so involved in actual life and death matters. Very few require that our members be there at the end. And we are not allowed to be comforted by accepting that a death is a better option. It's trained out of us. [This is a topic of a full discussion, but let's save that for another post.]

So, maybe part of the reason we miss on the service aspect is that we try to buffer ourselves from the pain that can come from the relationships we have to maintain with patients and families. Whatever the reason, it compromises the care we owe our patients. And I believe that we want to provide the care. It's a part of why we stay in healthcare.

"OK, what's your point?" you say.

It's this – Without great service, care is compromised. If you have a leadership role in your organization, official or not, and you want to improve the care your patients receive, focus on service. Every day, in every interaction you have, look for a way to improve the service you provide. Don't look for a way to set an example; just BE the example. Smile, console, touch, listen, offer assistance, fix a problem, own the issue, take the initiative, be the leader. If we do this every day at every opportunity we will improve the service to our patients and the care that they receive will be spectacular.

This is not easy. It requires attention, dedication and work. But we will come home much happier than we do now.

'Til next time.

Monday, May 24, 2010

Medicine - retail lessons

I have been paying closer attention to the service I receive at the various healthcare providers I visit. I'm including physicians, labs, imaging services and pharmacies. I thought I paid attention before, when I was employed with one and therefore 'scouting the competition. But I was always comparing them to the way 'we' do it. Now, I'm comparing them to other retail operations I use. And healthcare sucks at service.

Randomly, because I don;t know which episodes bother me the mos, here are some of my observations. At one large discount retailer I notice that when the line gets long, someone pages for more cashiers. Lines grow shorter and the wait is cleared up. Bit not in the pharmacy. There is a clerk there who remembers me and will pull my information up as I walk to the register. I like that. She has noticed problems with my order and taken steps to correct them. That is great service. But I realized that she is reworking someone else's work: muda. Why didn't the person filling the prescription notice that my insurance had not been submitted? They can see that my policy is still in effect. When I had a Flex account (FSA) it was confirmed as active and funded within seconds. Blue Cross can't do that? Why?

I'll skip the obvious issue with visiting my physician and filling out the same information, again. They are on a PMIS, but the system that owns them has been unable to roll out a well known and widely used EMR. The system has the resources. From other contacts I know they have skilled IT staff who have installed equally as complex systems in multiple locations, on time, and to the users' satisfaction. But the physician office EMR has been a disaster.

I visited my dentist - actually a new dentist for me. They were amazing! Good dentists, too, but I mean they had their stuff together. The visit was organized, might even say choreographed. They showed me video of their findings seconds after the exam. They filed my insurance (I have a quibble there, but with the insurer,not the provider, and then bugged the daylights out of me about the follow up services I might need. OK, I was irritated, but they were marketing to ME, offering services I needed. Nothing generic (like my physician: "If you are over 50 you should consider a ... Don't they have my age on record?). They were right on the money. My doctor doesn't know if I need a visit for my next refill unless I call the office. Shameful.

One last pique - I stopped at FoodLion (an unpaid testimonial) to pick up some specials. I have my loyalty card so I get extra discounts. At the door I was greeted by an employee telling me about the special coupons I can get by scanning my card. They are good for the day and are linked to my buying history. And then she said "the coupons are better on the weekend." You think I might stop by and see if that is true. You think I will buy something while I am there, even if the coupon doesn't help?

OK, medicine is not the same as selling clothes or food. But it is providing a very personal service. And we don't do much to put the personal into the service. We think that saying thanks and saying your name at the window when we read it off the charge ticket counts. It doesn't. Patients have NO way to compare providers, to measure quality, to put a value on the services received. If they ever do, talk about a revolution.

Til next time.

Friday, April 23, 2010

Another warm & sunny day! I have to work, but today I work on the porch.

Tuesday, April 20, 2010

Does the Patient Protection and Affordable Care Act do anything FOR me?

Tuesday, April 20, 2010
So, let’s jump into the fray: The Patient Protection and Affordable Care Act. Disregarding the title, this is an insurance access reform act, doing little to ‘reform’ healthcare, which I define as providing actual care to patients. But there are things to like in the bill if you are uninsured or might be, especially if you have a pre-existing condition.

Question: If insurance is a pooling of risks to keep the cost down, why do the companies create tiny pools when they insure a small business instead of combining the pools and spreading the risk? When I search for coverage for a company I worry about having a staff large enough to dilute the effect of one or two incidents. I would think the companies would benefit from creating larger risk pools so that they can buffer losses. What have I missed?

But for good or bad, as a practice manager the questions are “How does this affect my practice, and how do I deal with the changes?” Are there any good effects? What do I have to do to benefit?

One good effect, perhaps, is that some of your uninsured patients will qualify for insurance. The health exchanges are in the future. Most of the immediate effects apply to insured individuals: Effective March 24, 2010 [6 months after passage which was March 23, 2010] there will be 1) No rescission except for fraud or intentional misrepresentation, applies to all existing and all new plans; 2) no pre-existing exclusion for children born with health problems, applies to all employer plans and any new individual plans; (no pre-existing exclusions for employer insured patients starts in 2014); 3) no lifetime limits on anyone; and 4) tighter regulation of annual spending limits, prior to removing annual limits effective in 2014 for all employer plans and any new individual plans. None of these are retroactive, but you should prepare for the changes. No one knows how the insurers will involve patients in making the changes to the policies. You can provide some guidance to patients by reviewing your denials and identifying those accounts that will be affected, then reminding those patients of the pending changes. If you are using a PMIS that allows these queries, start compiling the lists and have your patient counselors inform patients on each visit to contact their insurer about the changes. The insurers will deal only with the insured, not your practice. The patients will have to do the work for you. And while you may benefit by having more of your care covered by insurance, if you have not been collecting from patients the patients won’t see a benefit in helping you get paid. You will have to persuade them to help you.

There is a cost coming to you from the reforms that is not discussed in the Act, nor is it in the cost/savings calculations of the CBO. The cost is the time you, your providers and your staff will spend explaining the impact that the Act will have on your patients. You are going to be the only expert they can reach. They are going to have questions and expect you to have answers. I believe you should have some answers ready. It is a part of the customer service that we provide. In fact, I suggest that you start asking patients what questions they have before they start asking. Find out what worries them and concentrate on answering those concerns. You don’t need brochures and pre-printed information. If your specialty organization provides something, you can use that, but be prepared with your own answers. It will reassure your patients to know you are knowledgeable and it is a smart marketing tool.

This bill will cause shifts in who gets paid and how much. Each of us responsible for a practice will have to dig through the details, look to our professional societies and practice advisors for advice, and find the opportunities to benefit from the changes. The pessimists among us will complain and resist. The optimists will hope this goes away. The rest of us will do what we always do: find the golden nugget in the heap of words and mine it. Don’t forget to tell your physicians about it when you do.


Tuesday, April 13, 2010

This is my opportunity to comment on some of the many issues that have an effect on the delivery of health care.  In it I intend to offer my opinions on a variety of topics, depending on what is happening, and what catches my interest.  I won’t use this to debate, since there are lots of give-and-take blogs around. I might respond to a comment if I think I have something to offer.  Don’t look for internal consistency in my opinions.  I am not an ideologue, so my opinions will change as I learn.  Not that I don’t have principles; I do.  I believe that most people want to work and want to perform effectively.  I believe that in health care the patient can be the only central focus – all else revolves around the patient.  I believe less government is better than more government.  I believe some government is better than no government.  I believe local is more important than national, but I don’t have a definition of ‘local’.  I believe polite discussion provides insight, and heated discussion causes confusion.  I believe Va Tech has the best football program in the ACC and Duke has the best basketball teams in the country.   Surely something in all that will stir some comments.

I have worked in health care delivery for over 30 years.  In some jobs I have been a provider, in some I have been ancillary, but with direct patient interaction.  I have been a HC manager and an executive.  [My definition: A manager turns directions into operations.  An executive provides direction, and turns policy into processes.  No one acts alone.]  I have seen health care from the perspective of large corporate and large academic providers, and from that of private practice, small practice providers.  I have worked financial mistakes could cost me my job and where financial mistakes could cost everyone in the organization their jobs.  I have watched technology move successfully and unsuccessfully through an organization.   All of that will color my vision of things.   I will be honest.  And I hope to have some fun.

Oh, and why LoneJack?  I grew up in Virginia, near Lynchburg, in Campbell County.  The railroad flag stop had a community name: Lone Jack.  I wanted something of my roots to remind me that the past prepares but does not prescribe your course in life.  I learned many good things there.  And some not so good, but useful.