March, 2015:

Improving Patient Satisfaction

Improving the patient experience can be of benefit to patients, staff, leadership and providers.  There are many reasons to solicit feedback from the patient experience.     Some of the reasons include identifying strategic planning issues, differentiating your practice from its competition, confirming skills which staff need more training and reducing patient complaints.    Feedback can come from a formal tool, a conversation or a short exit survey.  All methods provide valuable insight to the “voice” of the patient.      Put yourself in the “shoes of the patient.”  Look for inefficiencies, barriers and bottlenecks.   Prioritize these issues and plan a corrective action if warranted.   Below are some suggestions to improve the patient experience during the visit:

Compare staffing in the medical practice to practices of the same specialty and/or industry benchmarking surveys.  Does the medical practice have enough registration staff to accommodate the number of patients scheduled to be seen?   Would “flexing” staff on busy days and times alleviate a backlog?  Would adding ancillary staff (i.e. phlebotomists, medical assistants, Radiology Technicians, DME Assistants) improve the clinical workflow and eliminate tasks currently being performed by a provider?  Ensuring staff are working to the “top of their license” is an important consideration.

Examine tasks performed by staff prior to the clinical visit.   Has the provider ordered labs or imaging studies?  What steps are in place to ensure the provider has the data prior to entering the room?  Is a copy of the results needed for the patient? With the results flagged and available, the provider will be able to concentrate his/her efforts on educating the patient about the results and potential next steps.

Review all documents completed by the patient.  Avoid duplicate questionnaires.  Determine if the patient questionnaire can be completed on an Ipad or through a patient portal prior to the visit.  When staff input the data elements for the provider, overall documentation time can be reduced.  Some of the elements can include patient, family and social history, medications, allergies and the reason for visit in the electronic medical record.

Train staff to anticipate the needs of the provider and set up medical supplies in the room (i.e. Injection kits, bandages, suture supplies).   Standardizing the exam room set up can streamline the process Ensure each exam room is set up identically in the practice and across all locations.   Clean out cabinets to ensure they are not filled with supplies that are no longer needed.   Labeling the cabinets is a good way to improve efficiency.  When setting up the rooms, consult with providers and medical assistants to best organize supplies.  These items can reduce time during the visit.

Ensure the patient discharge process is thorough.  Many times patients call the office after an office visit with questions regarding the follow up instructions, medication protocols, refill requests, test results or scheduling of additional procedures.  Circumvent these calls by having team members review the instructions with the patient at the end of the visit.  Confirm with patients they understand the instructions.    Monitor the phone messages and identify trends in terms of patient complaints or comments.

Encourage staff and providers to return phone calls throughout the day between patients rather than batching calls until the end of the business day.  This reduces the likelihood of patients calling the practice a second or a third time.   Ensure staff understands the process for paperwork which has been dropped off for completion, the timeframe to process refill requests and when patients can expect a call back.    Document all actions in the electronic medical record in order to inform others regarding the status of the request.

Be on alert for signs of frustration.  These can manifest in new behaviors after changes are made to a routine.  Once a process is improved, be sure to re-visit the process and determine if the workflow is effective.   Improving patient satisfaction is not a one-time event, but it is an on-going process.  Examining patient flow can be helpful in identifying opportunities for improvement from the perspective of the patient.




Jill Berger-Fiffy

Issues to Consider When Sunsetting a Legacy Practice Management System

There are numerous issues which must be taken into consideration when determining staffing needs for supporting a practice management system which is being sunsetted. Quite often there is substantial volume being passed through the system for several months after the transition from old system to new system has taken place. Late filing of old charges, follow up and rebilling of existing AR can result in the same volume of issue reporting which existed prior to the switch to new systems. Data files must be maintained and updated, user logons supported and claim forms and electronic exchanges must be modified in accordance with payer requirements. In addition, mandates such as v5010 and ICD-10 must be taken into consideration even though the system is being wound down. These mandates are date sensitive and do not take into consideration that they are tied to an old system. As a result there are several consideration which need to be considered when trying to determine the amount of staffing and specific skill sets needed to support a legacy system.

Application support

Overall application support must be provided in order to resolve day to day issues which arise. This includes: changes to incorrect data files, problems with end user security and system errors which periodically surface which may require vendor intervention in order to be resolved. These tasks may result in the management of a series of external systems which are used to track statuses on the various issues reported.

5010 –electronic exchange expertise

With changes to ANSI standards which are in process there may be spin off project such as the conversion of all exchanges to the v5010 format in order to meet compliance requirements. As part of follow up on old and existing claims, the submission of these claims must be compliant with newer versions for those claims which are resubmitted electronically.  Implementing this process may require a small team of EDI staff working on an aggressive timeline for a limited period of time in order to get this accomplished.

Operation/production staff to support on-going operations

There are numerous considerations for production and operations staff with regards to spinning down an old system.  Although the volume will steadily decrease, there is a continued need for both electronic and paper claims submissions to continue as part of AR spin down.   In addition, electronic eligibility checking is still likely to take place in the back end office setting as part of follow up processes so these queries and payer check processes must be maintained as well.

Method for converting data to outside vendor

In the back end setting, after all billing efforts have been exhausted, remaining invoices (both insurance and self-pay receivable) are generally sent to an outside company (receivables management/collection agency) as a last stop along the way prior to writing off any residual balances. IT staff are generally responsible for delivery of this data. Depending upon the database size and number of unpaid invoices IT may provide a “data dump” of information to this company. This may be completed by creating flat files from the old system to be converted into a format by the outside vendor. In addition, many organizations are allowing access to their old systems by the vendor to simplify the receivable spin down process.

The above considerations are just a few things to keep in mind when trying to determine specific skill sets which will be needed from a staffing standpoint when preparing to wind down an old system. When planning for a system conversion it is recommended to keep maintenance costs of the legacy system in mind as system support will be required for up to a year post conversion.


Allscripts PM -Truly Effective Practice Management with Custom Reporting

Practice management (PM) software operates the full revenue cycle of a medical practice, from patient registration and scheduling to claim submission, claim follow up and payment posting; it operates the all-important business side of healthcare.  And, while all of these activities are vital components for the successful operation of a medical office, without reporting, practices cannot assess the true health of the business and have a lesser ability to be proactive with corrective measures.

We all know that the running of daily, monthly, annual reports is so critical to assessing the health of a medical practice and Allscripts-delivered reports represent a great start to understanding how healthy a practice is at any given time.  Like all well-developed practice management systems, Allscripts PM offers a wide range of performance reports to help assess practice health in terms of operations, statistics and productivity.  However, what if there is information a practice desires that cannot be delivered using a canned report?  What if you need a full patient list based on visits grouped by rendering provider and grouped by particular age groups?  What if you want to explore the top 20 diagnoses or procedure codes submitted by your providers, grouped by provider with textual and graphical representations?  What if you want a complex payormix report with textual and graphical representation as well with user-defined parameters (by particular date range per query run, for particular payors or insurance categories)?  This is where a custom reporting strategy can help.

So, what does the strategy look like?  Well, it doesn’t have to be complex.  It can be made up of one individual in your organization who is familiar with Crystal Reports and a basic understanding of relational databases.  One user can create queries in Crystal and distribute the reports to end users as requested or you can implement a Crystal reader solution on one of your PM servers so end users can run the reports themselves, with security to run the queries dictated by Active Directory or the like.

You don’t have to have an expert in Crystal Reports to extract data, however.  In fact, you can extract data from the back end SQL database utilizing any data mining tool such as Microsoft Access or Microsoft Excel as well.

Whatever tool you choose to use, do think about the following when considering your solution:

  • What IT expertise do you have in house that we can use to develop a custom reporting solution? Do you have anyone who is well-versed in Crystal, Excel or Access? If not, look into getting help outside the organization to assist with developing and implementing a solution as well as training current staff on report writing so you can be self-sufficient in the end.
  • Do your custom reporting needs or organizational size dictate consideration of an enterprise Crystal Reader solution or does it make more sense to designate one person to write queries and distribute reports to end users? Enterprise Crystal Readers can be purchased and most are reasonably priced and you will get much bang for the buck in terms of the valuable data you will now be able to access.
  • Assess whether the data you are looking to study is actually being entered into the system and if it is, determine if it is it being entered into an available, reportable field. If data you need is not currently being captured, refine workflows or add an element to the current workflow (Additional Info custom question, for example) so that the data is captured and thus, extractable and useable.

Developing a custom reporting strategy can allow you to take the management of your practice to a whole new level.  Additional reporting opportunities will allow for more opportunity to monitor your practice’s health and well-being because a well thought out solution will help you better understand the full spectrum of your business operations.  With the development of a cost-effective, custom reporting solution, the management of your practice will be at your fingertips and will be well worth the effort to implement.