Insuring Against Insurance



We all know the drudgery of dealing with insurance companies. It seems like they know every trick in the book to avoid reimbursing our physicians properly, and that's partly because they have a monopoly on the market.




Recently, I jotted down an outline of some ways to keep on top of the situation, and I thought I'd share them with you now:

• Costs - The cost of running a medical practice is varied and complicated. There's overhead, personnel, rent and supplies, just to name a few components. Some of our doctors think you can make up the difference through volume, but that's a losing strategy. Even if you are just in the ballpark, knowing the overall cost of operating your office will give you a stronger bargaining position.



• Your payer reps - They are the face of the insurance company and usually they get the brunt of the abuse. Become familiar with the person who does the job, and try to avoid confronting them. Remember that facts and data are a more powerful argument than emotion, regardless of how legitimate those feelings may be.



• Contracts - Always--always--keep a clean storage space devoted to contracts. This should be a constant, regardless of staff turnover. Also have off-site backups and maintain all versions; you never know when someone is going to argue a fine point.



• Renewal dates - Use your computer software to warn you about any upcoming renewal dates for contracts. Pay special attention to evergreen clauses. Sometimes I think insurance companies count on physicians missing these imporant deadlines.



• Obtain information - Before you sign with a carrier, get a complete fee schedule and coding guideline. Also read your contract carefully, and if possible have an attorney offer their opinion as well. Insist on written notification for any changes in the contract.



• Coding - Make sure to have a staff member who is coding-certified, and up-to-date on all of the current codes. Accurate information will allow you to obtain the maximum reimbursement for a given service.

Even though I will admit to some animosity toward insurance companies, I realize the folks who work for them are generally good people just trying to do their job. It's a shame we can't work more in concert for the sake of the patients, but I insist that all of our dealings with them remain on a professional level.

If you have any tips or suggestions on how you deal with them, by all means leave a comment. I enjoy hearing from you.

Security Breach



The other day one of our doctors forgot his cell phone at the restaurant where he was having lunch. He rushed back to retrieve it, but unfortunately it was gone. In the meantime, an employee at our practice had text messaged his phone some confidential information about a patient.



Needless-to-say, our doctor was mortified over the situation. We all know the serious consequences of breaching doctor-patient confidentiality, and while this was an unforeseen incident, it still felt like a serious betrayal.



Naturally, I went into research mode, and now I'd like to offer some handy tips to help prevent this from happening to anyone else in our profession:

• Use your cell phone autolocking feature. Practically every cell phone has a function that allows it to work only after a PIN has been entered to unlock it.


• Report a missing cell phone immediately. Call your carrier the minute you think it's gone, and have it disabled. You can always have it reactivated if you should find it, and while you may lose some information in the process, that's better than having it out there for all to see.


• Avoid having specific patient information text messaged. This was a particularly important lesson our doctor learned the hard way. From now on, no one in our office is allowed to text message unique patient information such as the date of birth or a social security number.


• Use password protection on all spreadsheets and word documents that have confidential data. This is an obvious step on any office software, but many of us never imagine the consequences of potential hackers out there.

Another step I took recently was to ban the use of Instant Messaging in the office. It was rarely used for work purposes, and seemed like a way for many employees to chat and waste time. Also, I worried about the security issues of having a direct portal from the outside world into our computer system.

I know a few employees were shocked about the IM, as I am known for being something of an old softie. Still, my reputation is such that when I make a business decision, people know that I mean business.

Of course, I'd love to hear suggestions or input from you regarding this issue of making technology more secure in the workplace. Please don't hesitate to leave a comment. I enjoy hearing from you!

Stray Cats




My husband likes to joke that I’m the patron saint of lost animals in our neighborhood, and it’s true. I have always felt an innate desire to help those less fortunate or who may be outsiders. While this can have a different dimension when you are dealing with people instead of pets, I feel an equally strong obligation to help others when I have the chance.

Several years ago, I fired a woman who had crossed the line. In our profession, a person is usually terminated either due to underperformance, excessive absenteeism or tardiness, inappropriate behavior with staff or patients, or a breach of patient confidentiality.

In this case, the employee was underperforming and failed to show up for several shifts without any notice whatsoever. Initially, I gave her a verbal warning, and she was grateful. She gave me a laundry list of personal issues and said she was so caught up in her personal drama that she didn’t realize how she was neglecting her work.

When things didn’t improve, I gave her a written warning. I also had a brief conversation with the head physician. After a sufficient length of time where she proved incapable of improvement, I had her sign a separation agreement, and she was terminated.

It should never be a surprise when someone is let go. The documentation and process involved should make all options clear, including the negative one. I try to give people as much latitude as possible, but sometimes that winds up being a case of giving them just enough rope to hang themselves.

Anyway, I thought I’d never hear from this woman again. In fact, we’d exchanged a few words on her way out, which I had always regretted. A few months ago, I got a call from her. She sounded calm and gracious, and she asked me if I would meet her for lunch. She said she was sorry for how things had turned out, and she wanted to talk to me about it.

I realize many of you wouldn’t have gone, but of course you know I did, and I’m glad for it. She was dressed nicely, and her demeanor was very different. She told me she had gotten out of her bad relationship, and finished her education. She said my firing her was a wake-up call, and that it made her determined to change her life.

She told me that she was up for a job at a medical technology company, and that she could use a good reference. It was a risk, but I backed her up. She got the job, and from all reports, is doing very well.

I realize that I took an enormous risk, but sometimes people change. I value my reputation in the local medical community, but I would be a poor steward of that authority if I didn’t occasionally use it to help people in need.

I’m not sure we’ll ever be friends, this woman and I, but like a stray cat, she wandered in and needed support. I gave her what help I could and let her go her own way. Sometimes all anyone needs is a nudge in the right direction.

As always, I’d love to hear what you have to say. Any stray cats you’ve helped straighten out from a wayward course?

Maximize Your Supplies!


One common mistake I've witnessed at every practice I've worked for is the overstocking of the supply closet. Piles of unused syringes and bandages stacked haphazardly. While it can be hard to anticipate need, a good practice approaches their supply closet like a supermarket or chain store, ordering just what is needed and at a reasonable quanity.



The first step I took in maintaining some kind of order was to put ordering supplies in the hands of one employee--Sonia. A bargain shopper whose idea of a great weekend is spent perusing flea markets for a decent working lamp under $3, she also finds a great many things cheaply and re-sells them at a mark-up on eBay as a hobby. To her, saving $1.50 on an order of tongue depressors is a big deal, and when you want to cut costs and save money, that is the attitude you want.



One of the first things Sonia did was to get online mailing lists from various suppliers. Every day she scrupulously checked specials and made note of deals for future reference. She didn't just rely on where we always did business, and she was more than willing to listen to the occasional pitch of a salesman, if it affected the bottom line.



Another thing she did was canvas the employees regarding what was and wasn't needed. She called the supplier and tried to negotiate returning overstocked items, and when they gave her a hard time, she burrowed down and negotiated, letting them know that she could just as easily get future stock elsewhere.



Sonia also organized the supply area, using tubs and bins. Putting yellow placards toward the back of a given item, she had an easily identifiable way of seeing when something was almost out.



In a fast-paced medical practice, it can be next to impossible for everyone to be conscious of waste and supplies. Putting one person in charge of it was an efficient way of organizing the situation, and it put a face on the problem, which made people more conscious of the situation. Also, once given the task-at-hand, the employee--Sonia--was very pro-active at finding solutions to problems which she could readily identify because she learned the specifics of how our supplies were used on daily and monthly basis.



Anyway, that was my solution to the burdensome issue of properly stocking supplies for my practice. As always, I'd love to hear any suggestions or insight you might have regarding it.