How to Staff the Office to Utilize an EMR

1. How to Staff the Office to Utilize an EMR • Not the right question • That can be answered in 3 minutes • The real question is complex and is really asking "How to run an Efficient Medical Practice where staff learn, perform, and grow to create a dynamic environment for patient satisfaction, employee satisfaction, and physician satisfaction, while growing revenue." • I altered the topic

2. Your Medical Practice Financial Future (Opening the Door to Revenue)

3. More Importantly • Building a Practice and a Life (The Efficient Practice)

4. Your Current Medical Life • Student, Intern, Resident, Fellow • Learning by Immersion ("Drowning") • Focus on understanding the facts, processes, data, understanding science, your role in it all • Minds are fresh, open, curious, exploring, and protected. (Academic Setting) • "I don't care about making any money, I just want to treat and help my patients"

5. Or, Your Current Medical Life • Employed • What does my contract say? • What do I have to do? • How do I get paid? • Am I satisfied? Am I happy? • What can I control? • Are there any other options? • Am I enjoying my life outside of my job?

6. Or, Your Current Medical Life • Private Practice- small, medium, large • Are my patients satisfied? • Are my employees satisfied? • Am I satisfied? Am I happy? • Am I in control? • How do I control my destiny? • Insurance Companies, Government plans and regulations • Can I survive out here?

7. My Goals for Today • Never stop learning after "official training" • Be open to ideas outside of the medical field • Keep medicine as a big part of your life, but not your LIFE ! • Discover your purpose and your dream and go after it with all that you have. • Always work on yourself more than you work on your job

8. Ideas and Topics • Our current financial challenge in medical practice • Overview of my practice - Oliver Family Healthcare,P.C. • New Paradigm - “Think Twice” (White Coat / Dark Suit) • White Coat Thinking • Dark Suit Thinking • EHR – The Centerpiece of Profit Growth • Putting technologies together - Laddering technologies • Results – The profitable practice • Future enhancements and efficiencies for additional profit • See the possibilities for growth in my own practice. • Can I really still be in charge of my destiny?

9. Always Remember "If you don't work for your own dreams, You'll work for someone else's"

10. Dreams, Vision, Purpose • Sharing my journey as an illustration • Your path will be much different • It will be of your choosing, or of your not choosing • If you gain one bit of information today that helps you in your future, then my purpose will have been served.

11. Starting Off Right • Attitude • Quality Care • Right Staff • Servant Service • Systematized Business

12. Attitude • Physician First • Office will reflect Dr’s attitude • If Dr. treats staff coldly, staff treats patients coldly • Work to develop functional team • Avoid Hierarchy in the office • Direct physician communication with staff

13. Quality Care • Patients don’t care how much you know, until they know how much you care ! • Always put patient care first • My mentor: Dr. Steve Young, Cardiology • “If you take great care of the patient, you’ll never have to worry about the money”

14. The Right Staff • I choose attitude and personality over skill • Must have good skills, but skills can be taught… attitude and personality cannot • Attitude: Team, caring, ambitious, industrious, fast paced, teachable • Interview, screen, ½ day workview • I get input from current staff • If you make mistake, admit it, fire fast • Hire slow, fire fast • Eliminate “Deadwood”, Trim the plant

15. Servant Service • Entire office should be servant trained • Patients don’t want to feel like objects • We smile, use patients names often • Ask how we can help • Ask if everything was handled today • Dr. asks patient if any problems with office or staff to let him/her know personally • No automated attendants!!! • Call patients with every lab, test, procedure f/u

16. Systematized Business • Have systems in place for everything • System for how to greet patient, phones, scheduling, check-in, collections, insurance, settlement protocols, financial task redundancy, deposits, time off, every aspect of business. • Every team member must understand • Takes time, education, positive reinforcement • Morning Huddles • Monthly executive review • Annual strategic planning

17. Current Financial Challenges • Declining Reimbursements from 3rd party • Escalating Costs- rent, supplies, equip • Govt / Insur oversight / decision mgmt. • Performance initiatives – Pay 4 Perform • Consumer demands – patient pays more • Pressure to be clinically / tech up to date • "Healthcare Reform" is changing landscape • I believe we are moving toward "cookbook mediocrity"

18. My Experience, Practices, and Lessons Learned • Family Medicine for 28 years • ER Physician during first 7 years • Started with 2 other Dr’s • Developed a 4 location, 15 Dr. Group • Developed and operated 5 urgent cares • Sold entire group to Hospital • Was Medical Director of the hospital group • After contract up, bought back current practice • Last 9 years focused on small, efficient, profitable practice

19. My Current Practice • 1Dr., 1FNP, 2 PA-C • 20 total staff • Family Medicine with modified open access model • Use Allscripts Professional EHR and PM system • Wireless tablets for providers, laptops for nursing, desktops for administrative and reception staff • Onsite x-ray, dispensary, ancillary services • No hospital, nursing home care, I use hospitalists • On staff at two local community hospitals • 75,000 charts on system • Average 2300 patient visits per month

20. Change in My Paradigm • Medical practice has two independent mindsets operating • My clinical practice and my medical business • Decisions require “Think Twice” evaluations • White Coat Thinking – What’s best for the patient • Dark Suit Thinking – What’s best for my practice • Strategic Planning – Plan, Do, Review • Physician ownership mentality is required • Physician buy-in is imperative for greater profits • Learning the power of the EHR and partner technologies will create greater rewards for practice and Dr. • A resource ! Michael Gerber’s The E-Myth Revisited, and The E-Myth Physician

21. White Coat Thinking • Patient Care Enhancement • Diagnosis and Treatment • Quality of Care Issues • Safety for patients • Risk reduction • Continuing Education • Preventive Care implementation • Follow-up Care obligations • Results reporting to patients

22. Dark Suit Thinking • The business of our practices • Focusing on revenue expansion • New services • Greater efficiency in managing patient care • Controlling costs – transcription, employees, supplies • Schedule management • Intra office communication • Office – patient communication • Bringing it all to the bottom line - Greater profits

23. The EHR – Centerpiece for profits • Schedule management and visit expansion • Enhanced intra – office communication • Correct coding – E/M calculator • Test results reporting efficiency • Preventive care and visit outreach • In House service expansion - In House Dispensary • E-script efficiency • Patient follow-up reminders and tracking • Vendor interfaces – Lab, Hospital, Ancillary Equipment • Patient feels that Dr. is better, technology = quality

24. Schedule ManagementVisit # Expansion Vendor InterfacesLab, Hospital Enhanced Intra-officeCommunication EHR Patient Follow-UpReminders & Tracking Correct CodingE & M Calculator E-scriptEfficiency Preventive Care & Disease Management Outreach Service ExpansionFirst Fill (EKG, PFT, Holter) EHR – The Centerpiece for Profits

25. Schedule Management / Visit Expansion • Establish independent parameters for each Dr. / Provider • Establish appointment times for ancillaries in office • Track No-shows • Keep lists to fill appointment cancellations • Set up appointments for disease states or insurance types • Color coded patient appointment management

26. Enhanced Intra-office Communications • Messaging between phone intake and nursing staff • Messaging between Dr. and nursing staff • Messaging among nursing staff • Consult passing between Dr.s and midlevels • Sending charts for work to appropriate staff member • Sending dated reminders to staff regarding patient care • Create shared message boxes for general work • In exam room contact between Dr. and Nursing , EHR communication and voice command contact

27. Correct Coding = Profit • Most physicians undercode E & M codes • A review of our coding practiced showed following • $61,000 undercoding loss in 2005 • Captured this revenue following year with E&M calc. • $39,000 undercoding on New Patient Visits in 2006 • Captured this revenue in 2007 with E&M calculator and have continued to improve annually • Continue to enhance coding at point of care • Physician must take control of practice financial destiny

28. Test Results Reporting • Lab tests come overnight into patient chart • Single test review site in EHR. • Physician reports all tests by voicemail to each patient • Patients feel that “personal call” came from Dr. • Nursing staff use voicemail to notify patients also • EHR allows rapid movement to multiple patient charts • Medvoice is the technology we use, others available

29. Preventive Care OutreachDisease Management Outreach • Automatic search of EHR for preventive protocol • Automatic search of EHR for disease management protocol • Automated phone calls and confirmation of appointments • Patients can cancel appointments electronically • Open appointments can be filled immediately • First month revenue increase $ 13,500, continues to grow • Patients think service is incredible – they don’t have to think • 2008 start of program - Revenue increase of $300,000 • 2011 consistent revenue enhancement of $400,000

30. Outreach Revenue Report – Project Qtr 1

31. 2011 Outreach Revenue - $400K

32. Dispensing Meds • A-S Dispensing program • On premises medication dispensary • ½ of sales are cash, ½ of sales through insurance • Can order prescription in exam room – Checks inventory • Verifies patients medication insurance coverage level • Patient picks up RX at front office on check out • First 4 weeks profit = $2,600, continues to grow • Expansion of in office formulary easy • Inventory control easy • Automated reorder of medications • 2008 Dispensary revenues of $35,000 • 2011 Dispensary revenues of $51,000

33. E-Scripts • Scripts sent to any State Pharmacy from exam room • Patient satisfaction high. No wait at pharmacy • Rapid refills from E-Script requests from pharmacies • Enormous time savings = more time for revenue production • All of prescriptions are legible • Can send prescriptions electronically, by fax, to printer • Script management by nursing staff via grants

34. Patient Follow-Up RemindersFollow-Up Tracking • Send future reminders to staff for patient care • Track referrals as reports return • Send future action plans for patient tests or procedures • Automatic reminders about specific patient needs or desires • Eg: 32 y/o patient with breast lump, tender, freely moveable. Recommended 1 month of conservative care and observation. Patient advised to follow up in 4 weeks. Left a 6 week dated reminder to notify patient if she hadn’t returned. Patient had not returned, we called, she came in, got mammogram after re-evaluation. Lump was malignant and was removed early.

35. Vendor and Hospital Interfaces • Bi-directional interface with Lab, overnight lab results to chart • Pull electronic data and put in chart from local hospital network, Docs for Docs • Incoming fax reports directed to patient charts for review

36. Patient PerceptionTechnology = Better Care • We’ve had hundreds of patients enter our practice after friends, family members, and co-workers have experienced some of our technologic services. • In a time where patients will pay more out of pocket for primary care services, the office that provides the best service and care will have the most “good” patients.

37. Results • Immediate results when we went “live” on EHR 1. $39,000 reduction in transcription costs • Our transcription bill from year prior 2. $60,000 reduction in employee costs • Two employees left, didn’t want to learn “computers” • Did not need to replace them due to less paper handling 3. Loss of expenses related to charts, filing, space requirements for files 4. Employee satisfaction and lower turnover 5. Our EHR was paid for with this immediate cost savings

38. Results in Our Practice • 9 years • 50 patients a day to over 115 patients a day • 250 new patients a month • Patient satisfaction surveys average 95% in all categories • Increased Employee benefits every year – Dental , vision, 80% of health insurance cost, 100% matching 401K, profit sharing plan for all employees, monthly bonus plan for all employees, extremely low employee turnover, only 1 person has left in 6 years. • 25% + profit growth annually • Quadrupled revenues in 9 years –measured from year prior to renewed private practice implementation • 2008 with 27% increase revenue over previous year • 2009 provider time off expanded with same profitability • 2010, 2011 increased revenue with preventive business

39. Revenue Cycle Technologies • EHR and Mgmt. software integrated • Point of care Charges input by provider • Clean claims submission within 24 hours • Navicure real time claims interaction • Automated payment posting from insurers • Active in house collection management • Patient training for up front payment, discounts and deposits up front. • Accounts Receivable > 90 = 2.75%

40. Laddering of Technologies • Use fully integrated EHR / PM • Chart connect Labs, Hosp., Pharms • Chart connect in-house ancillaries • Data mining software • Point of service E/M coding • Intra-office and patient communication • Point of service quality care protocols • In-house profitable ancillaries patients want

41. Results • Increased Employee Benefits • Dental, vision, 80% of healthcare costs • 100% matching 401K • Profit sharing plan for all employees • 15-25% profit growth annually for 9 yrs • Increased provider time off • Able to add new ancillaries / update equipment • Employee Monthly Bonus Plan • Adequate profit to fund outside investment opportunities • 2009 – Added Preventive company –Cash Business • 2012 - Recruiting second physician actively

42. Revenue Results • 2002, employed Dr. + NP $ 625,000 • 2003, Private Practice Dr. + NP $ 875,000 • 2004, Private Practice Dr.+NP+PA $ 1,250,000 • 2005, Private Practice Dr.+NP+PA $ 1,635,000 • 2006, Private Practice Dr.+NP+PA $ 1,975,000 • 2007, Private Practice Dr.+NP+2PA $ 2,300,000 • 2008, Private Practice Dr.+NP+2PA $ 2,715,000 • 2009, Private Practice Dr.+NP+2PA $ 3,060,000 • 2010, Private Practice Dr.+NP+2PA $ 3,390,000 • 2011, Private Practice Dr.+NP+2PA $ 3,705,000

43. Beneficial Tactics • Morning huddles to future-face any problems of the day • Train staff to high level to off-load work of Dr./NP/PA • Always explore new technologies for possible benefits as time savers or revenue enhancers. • Get started now – review current status and write plan for improvement. Always “Think Twice”

44. How Can You Build an Efficient / Profitable Practice • Implement and understand your EHR • Mine and act on data acquired • Use automated systems for non complex actions • Train your patients to understand systems • Add profitable, necessary ancillaries • Make every staff member a patient advocate and revenue producer • Establish monthly and annual plan, do, review • Spend time working on your practice, not just in your practice

45. Review • Strategically plan implementation of laddering technologies • Stay up to date with upgrades, new technologies • Take advantage of training modules • Always think twice / “White Coat and Dark Suit” paradigm • Be a high quality, high profit practice • Focus on your patients and practice, not outside influences • Attitude is EVERYTHING, Take charge of it ! • Discover or remember your purpose in life. • Write down and take action on your dreams, goals, plans • Work on self-improvement • Understand it's OK to make a profit • Make every year Your Best Year Yet !!

46. Shameless Self-Promotion • Opportunity: Searching for a D.O. to join me in my practice in 2012. Entrepreneurial minded physician who would enjoy working in a small fast-growing private practice . To be part of a team that values working hard, playing hard, and deciding and taking actions on ideas that make our patients healthier, our employees satisfied, and our personal lives rich and rewarding. Email: ofhc.oliver@gmail.com 317-331-6160