• Creating a Culture of Change in Your Practice: Making Key Changes & Wins in Our Practice

    Written By:

    Rhonda BuckholtzThis is Part 3 of a three-part series about creating a culture of change in your practice.

    The third phase in practice change—looking for key changes and wins—happens when you’ve first established trust and fostered a willingness to change in your practice. Some key changes and wins can be found in establishing staff onboarding and training. Technology can also be a missed opportunity.

    When you look for ways to make key changes or wins, you’ll need to use data to influence the changes needed. When we’re caught up in the heat of the moment, we tend to immediately react to statements made by employees, which are not always true or based on facts.  An example might be the billing staff who complains that the front desk always forgets to use the correct insurance information when registering patients. The word always should trigger drilling down on data.

    Here are a series of questions that would help in clarifying this billing process issue:

    1. How often is the problem really occurring?
    2. How many denials is this creating?
    3. Which staff member is responsible for the largest number of mistakes?
    4. Can we fix it with training?

    It’s true that about 60 percent of all of our denials come from inadequate registration. This problem is most often due to lack of training for our front desk staff. Onboarding is sometimes shortened, we rely on long-time employees (who may or may not be doing it right) to train, or we throw them into the fire and let them learn on the go. Each denial costs us on average $25 to fix.

    If we assume it only happens twice a day, which is a very low estimate, it’s costing us $11,760 in inefficiencies. That does not take into account the impact on staff or patient satisfaction. In fact, staff and patient satisfaction are more important than the cost of the inefficiency.

    A formal training program costs significantly less than the re-works. Yet, we tend to continually discount the need for training or discredit the need to spend money on it. Financially, it makes absolutely no sense and also leads to higher staff turnover.

    Many practices also fail to try technology solutions to enhance their practice efficiency. Patient kiosks for check-in and patient portals can significantly increase patient satisfaction and help fix front desk registration errors. Typically, practices are hesitant to implement technology due to cost and employee fear of becoming obsolete.

    Patient insurance eligibility is a key function of most front desk teams. Patient volumes, lack of training, or sometimes even the willingness to perform pre-checks lead to major inefficiencies.

    On average, it takes two to three minutes to check in an existing patient and five minutes for a new patient. If eligibility is not performed ahead of time, this process can actually tack on an additional 10 minutes to patient registration. Not only does this cause a loss in revenue, but it is a major cause for both patient and employee dissatisfaction. Faulty performance of patient eligibility can actually cost your practice about $358,000 in inefficiencies each year based on a practice that sees only 20 patients a day.

    Another key area for practice change is providing education for techs or scribes. Both positions play a key role in documentation, but many are not trained to standards and most do not understand completely their role in the documentation process. Most often on audit we find that review of systems and patient histories are not adequately being performed. This limits the level of service that can be billed on an E/M code for all new patients.

    The difference between a new level 3 patient and a level 4 patient is on average about $57.60. If you assume a practice has five new patients a day per provider, the practice is on track to lose over $69,000 in revenue.

    It’s imperative that we shift the focus in our practice to a culture of collaboration and education. All improvements we make will influence not only employee engagement but also increase our patient engagement and satisfaction. As we move towards changing payment models, it’s necessary to break down our business process and rebuild the culture to optimize the changes coming our way. Investing in your staff through onboarding and ongoing education goes a long way in building a great staff, good morale and patient satisfaction and improves your bottom line.

    About the Author

    Rhonda Buckholtz CPC, CPMA, CPC-I, CRC, CDEO, CHPSE, COPC has more than 30 years of experience in healthcare, working in the management, reimbursement, billing, and coding sectors, in addition to being an instructor. She was responsible for all ICD-10 training and curriculum at AAPC. She has authored numerous articles for healthcare publications and has spoken at numerous national conferences for AAPC, AMA, HIMSS, AAO-HNS, AGA and ASOA. Rhonda is the chief compliance officer for Century Vision Global and also provides transformational services and revenue integrity for Ophthalmology practices.