In the past year, SIP has spent time looking at how they orient clerical staff. "People at the front desk are the first face that parents and children see when they come into the office. We care how those people are treated and greeted and how we're collecting information," says DeWeese.

Once a good fit between the staff and practice is established, they build on it: SIP tends to promote nonclinical staff from within the practice.

"When I started at the practice, I started as a receptionist. I know what is involved in that job. Each of my billing staff members started as receptionists. So they understand what that job entails, and then they were kind of groomed into the billing department," says Tommi Dukes, health information manager.

As a result, the "SIP heart" is as evident between employees as it is in the practice's core values. "We are just like a close-knit family here at SIP. We're a really good team, and the doctors are really supportive," says Mary Ann Gardner, LPN, a billing representative who also works part-time as a nurse for the practice.

Self-assessment and improvement

In an effort to constantly improve as a practice, SIP has implemented its own quality assurance program. Audit tools are developed based on standards of care and other criteria; a select group then pulls charts from each physician and compiles both individual and comparative data.

"The question that drives the topic is, 'Are there areas where we can improve the care to our children?'" DeWeese says. "We identify those areas and discuss where we might have the greatest impact on care." In the past, the practice has reviewed data on radiology overreads, the diagnosis and treatment of ADHD patients, and the appropriate use of antibiotics. "When you do something like this and you pull the data out and you see that you're doing a great job with, say, radiation overreads, that can be rewarding," says DeWeese.

The practice also performs an annual audit of its documentation and coding to check for compliance. It also breaks down productivity indicators — volume of visits, average charges, revenue per visit, expenses, overhead percentage — by individual physician and reports these numbers back to the partners.

DeWeese stresses that this is a group effort, one to which the partners are dedicated. "A key component for this working is a high level of trust among the providers," she says. "Our quality improvement is in no way punitive. It's intended to say, 'Let's look at this ourselves and see how we can be better.'"

The practice also conducts regular patient satisfaction surveys, which routinely score over 90 percent on questions having to do with practice responsiveness and provision of information. DeWeese also used to track patient wait periods, but now she prefers to measure how long patients perceive their wait time. "Because it doesn't really matter what the clock says, does it?" she points out. "It's how long they feel they waited."

All of this is part of Southern Indiana Pediatrics' strategic plan, which DeWeese uses in making day-to-day decisions. The practice outlines operational, provider planning, and financial goals they want to accomplish in the next year, two years, and five years, and revisits and revises it every year. "This is a working document," she says. "The strategic plan is on my desk 100 percent of the time."

Collections count

Just as it does in other areas, SIP audits its billing and collections department and compares itself to the national average. When it discovered two years ago that its rate for collections within 60 days was only 58 percent — in the average range for most practices — the practice decided to take action.

"We involved our billing staff and asked what was slowing us down," says DeWeese. "What were some things we could do, improvements we could make, to really make this be more efficient."