"This morning one of our billing staff just came down to tell us she'd like to come in on Saturday and do some extra work," DeWeese says. "They're self-motivated by reaching these goals." The incentive plan has been good news for the practice as well. After choosing percentage of dollars collected within 60 days as its benchmark, the practice has increased that figure to 71 percent, up from 62 percent.

The practice has spent time cleaning up its claims, making sure that all information — from a patient's insurance to the physician's coding — is entered correctly into the system. "Our practice is 36 percent Medicaid, so doing things correctly is absolutely critical for us," says DeWeese. The practice's two certified professional coders help the physicians, nurses, and clerical staff with coding education, while the billing staff proofs claims before submission.

Generating clean claims from the outset has made a big difference, according to Dukes. "We used to have rejections from Medicaid 20 pages long. When we went to clean claims, it's now eight pages or less."

"We can't collect what we're due if we make mistakes," adds Laughlin.

While the self-audits, the weekend work, and the charity involvement all add to the effort involved in running a large, multisite pediatric practice, the partners and staff at SIP take on these tasks happily. "We really see tangible results in our community, and the physicians that work in this practice, and the NPs and the staff - they love doing this," says DeWeese. "You can feel that in everything they do."

Robert Anthony, managing editor, special projects, for Physicians Practice, can be reached at ranthony@physicianspractice.com.

This article originally appeared in the November/December 2003 issue of Physicians Practice.

Our Regional Winners

Western Region
Shepherd Eye Center
Las Vegas, Nev.
Practice type: Ophthalmology
Established: 1968
Physicians: 8
Employees: 100
Patients: 50,000
Locations: 3 clinics, 1 surgical center
Web site: www.shepherdeye.com In hindsight, John Shepherd, MD, regrets allowing his successful practice to be acquired by a large management firm in 1996. It was a popular trend at the time, but "after that, we never had control of our finances," he says. "The financial information was inaccurate, and we had no idea what the real financial status was."
By the time he and his partners reacquired the practice from the now-defunct management company, it was in trouble: Overhead was too high by 20 percent, the practice was overstaffed by some 15 percent, and its sinking laser surgery center was causing a drag on revenue. "We had to make some drastic changes," Shepherd recalls.
Among them: it assigned a "problem area" to each owner-physician and began holding weekly management meetings to discuss progress. It also implemented cost-saving technologies, including an electronic medical record and practice management system. As a result, the practice saves more than $52,000 a year, including the salary of one office assistant. For example, it saves 10 hours a week by printing medical records for patients and referring physicians straight from the electronic document, rather than pulling the chart, copying it, and refiling it.
But with all the changes Shepherd Eye Center has made, its founding philosophies of patient service and positive staff relations remain. Shepherd and his partners believe a happy staff and happy patients are two sides of the same coin. "They're on the front line: patients have contact with staff a lot more than they do with us physicians," says partner Steven Montgomery. So the practice works hard to address employee concerns about professional development and flexible scheduling.
The effort to keep staff happy as a way of keeping patients happy appears to be working: patient satisfaction survey scores hover around 98 percent.
Such flexibility for staff can be expensive, says practice administrator Christina Kennelley, "but certainly not as expensive as hiring and training a new employee." And happy employees are loath to quit, even though raises are modest. "We have several employees who have been working here for 20 years, and others who've been here for over 10 years," says partner Steven Hanson.

Southwest Region
Southeast Texas Medical Associates
Beaumont, Texas
Practice type: Multidisciplinary
Established: 1995
Physicians: 19
Employees: 175
Patients: up to 800 patients per day
in clinic, home health, physical therapy,
nursing home, hospital, and hospice care
Locations: 3
Web site: www.setma.com
When James L. Holly, MD, and his partners launched Southeast Texas Medical Associates, or SETMA, by combining three smaller groups, they started with four physicians and 23 employees. Today, the group has 34 clinical providers (including 15 nonphysicians) and 300 employees, serving virtually every medical need of the population of Beaumont, about 80 miles east of Houston, from pediatrics to a nursing home practice.
"We also run a moderately complex reference laboratory and we do lab work for 22 nursing homes and 100 other physicians," says Holly. "And we operate a home health agency, a physical therapy department, a hospice mobile X-ray, and we have a very large hospital practice. We manage about 60 percent of the emergency care in this community. What we're trying to do is build an integrated network that works in an integrated fashion."
To do it, SETMA has gone almost entirely digital. Its NextGen EMR and practice management systems allow the practice to incorporate disease-state management tools to "make it easier to do things right [clinically]," says Holly, while electronic documentation allows the practice to prove it did everything right. For that reason, diabetic patients in Beaumont receive the same standard of care that they would in, say, New York City, because the EMR reminds providers of the standards of care.
Technology has also offered SETMA a host of practice management and financial advantages, Holly says, noting hundreds of thousands of dollars saved over the years in transcription and staff costs associated with paper charts, administrative supplies, reduced time on the phone, and substantial increases in collections and charge capture. Transcription costs alone have been reduced by $340,000 a year, collections have increased by more than $1.2 million annually, and coding and charge capture are up 20 percent.
"You can [manage a practice] without [technology] systems, no question about it - people have done it," he says. "But ... you can't be aware of what you're doing and really control what you're doing without the systems."

Southeast Region
A Woman's View
Hickory, N.C.
Practice type: Gynecology and
internal medicine
Established: 1996
Physicians: 2
Employees: 27
Patients: 16,000
Locations: 1
Web site: www.awomansview.com

Soon after John Lovin became the administrator for his wife's gynecology practice a few years ago, he saw that some processes needed improving. And as a former fast food restaurant manager where speed and customer service are crucial, Lovin was in his element.
The way the practice evaluates new technologies is one example of how Lovin put his experience to work - and the staff and physicians do their part to make the process a success.
"[My wife] keeps up with medical research, new procedures, and new technologies," says Lovin. But the practice doesn't jump at every technological advancement that comes along; it makes deliberate decisions about adding new equipment that will ultimately benefit patients. If there is a financial benefit for the practice, so much the better.
"Two easy decisions were [adding] ultrasound and DEXA [bone density scanning]," says Lovin. "We were able to call the payers and find out how much they would pay us. We knew how much it would be to lease the machine and pay a technician. We also knew how many we were referring out. It made financial sense as well as sense for our patients."
Patients save time and may get a quicker diagnosis than they would by making an extra trip to a lab. "We are doing 12 to 14 [DEXA scans] a week," says Lovin. "Seventy-eight percent of those either have mild or severe bone loss. That, to me, is why we are here - to find that kind of problem."
The practice has also worked hard at improving patient access and collections. It hired new staff, including one dedicated to answering phones and another to auditing superbills. In addition, it has doubled the number of phone lines open to patients.
Despite making these strides, members of the practice know their work isn't done. "I think the mistake many offices make, particularly doctors, is they get to a point where everything is running smoothly and they think they've got it fixed forever," says Lovin. "There's no silver bullet. It's not a drain, it's more like plugging a colander - a lot of little things are leaking away. Likewise, a lot of little things added together make a difference in our revenues and doing more things for our patients and employees."

Central Region
The Asthma and Allergy Center
Fort Wayne, Ind.
Practice type: Asthma and allergy
Established: 1997
Physicians: 1
Employees: 47
Patients: 10,000
Locations: 3
Web site: www.allergyasthmacenter.com