Before You GROW. . Analyze your FLOW

1. Before You GROW. . Analyze your FLOW Cindy Pezza, PMAC Pinnacle Practice Achievement, LLC

2. The old Adage . . .

3. It Happens to All of Us • We leave these meetings full of inspiration, motivation and at times unrealistic expectations. • We return to our offices and surprise our staff/managers with ideas of grandeur.

4. Unfortunately . . • They may not share our enthusiasm and wonder exactly what we were doing at the “Meeting”

5. Before you Start Growing • Take a look at your current practice • Have you mastered the main points of efficiency that will assure the success of your practice as it gains momentum? • Education and Training • Office Flow/Time management • Financial aptitude and responsibility • Delegation • Compliance • Mental status

6. 1. Education/Training • This applies to every member of your TEAM (podiatric assistants- front and back office, billing staff, managers, associate doctors, and YES even senior DOCS!! • Everyone works together- because there is NO I IN TEAM. . .

7. Start with the Basics • How is the phone answered in your practice? • Is each staff member trained to say? • “Good Morning, Affiliated Foot and Ankle Associates, This is Cindy, How may I help you?” • Remember, first impressions are important!

8. The Training Process • Basic podiatry terms and anatomy. • The common reasons patients are seen • Triage questions to assess the difference between urgent/non-urgent and emergent patients (over the phone). • The appropriate questions involved in evaluation of patients • How much time is needed to treat

9. Cross Training • There should be no such thing as “That’s not my job.” • Each member of your staff should be crossed trained at some level and know when it is appropriate and necessary to jump in and help. TEAMS WORK TOGETHER

10. “Meaningful” Information • Staff and doctors should all be aware of the essential information to capture as well as the proper documentation of each patient encounter. • Height, Weight, BMI, Blood Pressure, Smoking Status, Medications, Allergies, Medical and Family history, race, ethnicity, language, Insurance ID #s, subscriber, Primary care physician, etc.

11. The List Goes on and on

12. It Has to be Done • The more that staff and doctors work together to input the correct information and capture the needed data to comply with meaningful use requirements and quality measures, the easier life becomes.

13. Systems and Protocols • Do you have systems in place for training of new hires, preparing for the patient day, setting up procedures, stocking treatment room drawers, evaluation of new patients, sterilization of instruments, compliance documentation? • Does your policies and procedures manual have more than 1 inch of dust on it!?

14. Your Systems in Writing • If you have systems in place and protocols developed, are they written down somewhere, or are they swimming around in your mental waters?

15. The worst part • If you have not taken the time to write out these systems/protocols. . . . • Make time and do it!

16. Encourage help • You don’t have to go it alone. • Ask for the input of your “seasoned” team members. • They know your treatment styles and plans and will guide you down the path to success. • Include them in the process and let them know how much you value their knowledge.

17. Start with the Big Ones • Heel pain • Initial visit • Follow up visit 1, 2, 3 . . . . • Condition improved/worsened/unchanged

18. Use Universal Language • Written protocols are to be used for training of doctors and podiatric assistants (new and “seasoned”) and should be easy to follow and understood by (almost) anyone.

19. 2. Office Flow is Next • Think of a ride at Disney World . . . Have you ever been handed a colorful plastic card?

20. Are you Adequately staffed? • How many staff members do you currently have? • Do you feel as if you are understaffed/overstaffed? • How do you determine this? • Let’s take a look. . . .

21. Are you Really Ready? • Take a look at your average day? • How well is your schedule running? • Are you averagely running more than 15, 30 or 45 minutes behind? • Some days is it worse than that?

22. Are you stressed right now?

23. Do you Feel Like this By Wednesday. . .

24. Is Something Not Quite Right?

25. Scheduling Patients • Your “scheduler” holds the power. • The art of positive flow requires highly trained staff members, doctors who are constantly kept moving and most importantly, a schedule that is made and kept according to patient types and needs (NOT JUST BLOCKED AMOUNTS OF TIME THAT ARE FILLED IN).

26. It can be Just that Easy • Reason Codes are a beautiful thing • Example: New Patient (30 minutes- Yellow) scheduled across from Corns and Calluses- RFC (15 minutes-gray) and laser treatment of plantar wart (15 minutes-blue)

27. Like This. . . • C&C PTis roomed and prepared while NP is processed at front desk. Laser PTis roomed as doctor treats C&C. NP evaluated and X-rays taken/ procedure set up while doctor moves from C&Cto laser and then to NP.

28. Non-Verbal Communication • Rest assured, Your team will tell you where to go!

29. Time Management • Every member of your team’s time is equally valuable. . . With one exception. . .

30. Time Vampires • Stop wasting time playing “Words with Friends” and see some more patients. . .

31. 3. Financial Matters • Preparing for growth and achieving your goals costs money. • Hiring of additional staff, associate doctors, additional rents/overhead, purchasing of additional equipment, computers, etc is expensive. • Not to mention. . .

32. The Obvious expenses • Hiring of consultants, marketing costs, etc. Investing in the future of your practice.

33. The Current Situation • Do you know and understand you PVV (Patient Visit Value)? • Do you know how to calculate this figure? • Is the A/R situation in your practice within normal limits? • If you use a billing service, are you paying too much? • Are they chasing after deductibles, co-insurances, etc.

34. How much are you “Writing Off?” • Are you collecting what is owed to you? • Are you collecting copays at the time of service? • Is your staff asking for past due amounts in a firm yet empathetic manner? • Do you have policies in place for patients who present without required information, copays and other owed monies?

35. Think about it. . .

36. Your own Expenses • Do you/your manager have a good grasp on your payables? • Payroll/overtime • Medical supplies • Durable medical equipment • Stationary, business cards, brochures • Office supplies • Equipment maintanence and repair

37. Don’t Assume

38. Leverage your Growth • Talk to your current vendors (or consider using new vendors) about your plans to expand/grow. • Seek out volume discounts, shipping reductions, auto ship program benefits, etc. and save as you grow. • You’ll be amazed at how much you can save if you know how to ask.

39. 4. Delegation • Delegation is an art form that is often under-utilized by DPMs. • “It’s just easier if I do it myself” • “No one does it like me” • “My patients will complain” • “It’s only a few extra minutes” • “But they don’t care, it’s not their practice”

40. Trust in your TEAM • Highly trained and well educated team members are fully capable of performing many tasks that do not require a DPM degree. • Start making a list of tasks you perform on a daily basis (as a DPM) that are tedious or not worth your time.

41. Just for Starters • It will vary from state to state, however. . • Casting for orthotics and custom braces • Evaluating patients thoroughly and inputting all history, chief complaint and most items dispensed during visit into the electronic health record • Dispensing of all DME • Running an efficient and lucrative diabetic shoe program

42. There’s more • Nail care • X-Rays • Assisting in procedures • Performing vascular testing • Removing sutures • Bandage changes • Ordering supplies • Filling out disability forms

43. Electronic Delegation It is also possible to improve the efficiency of your practice through electronic/outsourced delegation. Examples: Automated reminder systems Collection agencies Hiring agencies/employee testing analysis Digital and improved digital x-ray systems

44. 5. Compliance • Compliance regulations have significantly changed over the past few years. • Medicare DME compliance is one of the most misunderstood and least followed programs in practices throughout the country. • DME audits are becoming more common • Be prepared by getting educated

45. Compliance Officer • Many practices designate “compliance officers” who are responsible for keeping up with changes in regulations and staying compliant while running an efficient and profitable DME program. • Compliance documentation is required for all DME dispensed to Medicare patients (shoes, custom devices and pre fabricated AFOs)

46. Other Compliance Issues • HIPPA, OSHA, and other government regulated programs which require employee trainings, posted information and documentation of incident must be taken seriously and abided by to avoid costly fines to the practice. • If you are not confident of compliance, contact an expert and have a mock audit performed.

47. 6. Mental Status • Finally, we enter the last area of preparing your practice for growth. . . • Mental Status

48. Thinking Forward • It is important to be able to see the “Big Picture” • Focus on the important aspects of building your practice today and everyday to achieve your goals. • Live “The Slight Edge Theory”

49. Be Wise with your Money • Negotiate and save where appropriate (supplies, equipment) and invest where is most valuable (education, hiring and training of staff, electronic health records, digital systems). • Use caution when cutting corners.

50. Do unto Others • Remember what your mother taught you. . . • Treat your team and your patients with respect and show them appreciation everyday.