Laurie Morgan, MBA is a partner and senior consultant for 

. Her consulting focuses on practice management effectiveness and practice profitability. She is the author of the book 

People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business

Laurie Morgan

Practices have begun to resume services and 

, especially patients who’ve put it off because of anxiety about COVID-19. While ensuring (and communicating about) patient safety naturally takes center stage, the revenue side of practice management needs extra attention, too. Patients may hesitate to visit your office not just because of fear of infection, but because of financial concerns.

Some patients face uncertainty about their job security. Some may have already suffered a job loss (and even a corresponding loss of insurance). For patients who are struggling financially, or are simply anxious about money, anything but urgent health concerns may be pushed to the back burner—even though this might increase the risk of more dangerous problems down the road.

Of course, practice managers and physician owners also have their own financial concerns to contend with. Generating and capturing revenue is crucial to ensure employees can be retained and the bottom line remains healthy, especially as government supports expire.

The high cost-sharing many patients face may seem like a formidable obstacle when patients are already nervous. But there are ways you can shore up your practice’s financial picture and collect more effectively from patients—without jeopardizing your patient relationships. In fact, with the right efforts, your practice may be able to improve both your financial picture and the patient experience.

5 questions every older physician should ask themselves

One way practices can help reassure patients is by helping them get a handle on their costs. Often, the out-of-pocket owed is less than patients fear. Even when it will be more than they hoped, patients will be better served by a 

straightforward and honest conversation about costs

Providing accurate information depends on staff training and technology. Be sure your schedulers are aware of how to access an up-to-date estimate of costs from your patients’ health plans. Proper training, including role-playing, can help staff become more comfortable with broaching financial terms.

Sharing this information with patients at the time of scheduling also provides an opportunity to 

 to process payments after services are provided. Storing a credit card (in a PCI-compliant fashion, with a maximum charge amount authorized by the patient) eliminates the need for the patient to hand over their card at the front desk—one less physical point of contact for patients to worry about. At the same time, knowing you can charge the account automatically, even if the payments must be spread out over a few months, helps ensure you’ll be paid in full.

Sometimes, patients may avoid care out of fear of costs when copays and deductibles don’t even apply. Make sure staff knows which services are typically covered as preventive, with no cost-sharing, or as follow-up visits included with a globally billed service.

Be sure you’re current on payer policies

AHIP (America’s Health Insurance Plans, the trade group for health plans) recently shared 

 its members have made to help patients and providers cope with the pandemic. While some responses are common across most plans, such as waiving copays for coronavirus testing, individual plans in your area may offer unexpected extra concessions. For example, some plans are waiving copays for regular office visits or telemedicine. Knowing about cost-savings like these can be handy when trying to coax wary patients to book an overdue visit.

Waiving copays or discounting cash services that apply towards deductibles may be a violation of your contract, but it can’t hurt to check in with payers to be sure you can’t offer some flexibility to cash-strapped patients. In some cases, payers may be willing to allow such discounts (just be sure to get that confirmed in writing before proceeding).

You may also find that some of your patients will have swapped their employer plan for an ACA marketplace one if they’ve been laid off. Make sure your staff asks each patient what their current health plan is, and that it’s clear which networks your practice is part of. (Marketplace plans offered by large payers may or may not be part of your contract with them. Knowledgeable staff can help avoid unpleasant denied-claim surprises for both your practice and your patients.)

 RVUs: The basics of physician compensation

A surefire way to put your patient receivables at higher risk of non-payment is to bill your patients months after they visited your office. If the bill arrives long after services are rendered, your patient may have forgotten it was coming and believe it to be in error. That sets the stage for disagreement, unpleasant interactions, and extra handling and collection costs (at best), or even non-payment.

Ensuring your patient statements are delivered promptly starts with 

billing patient insurance quickly and accurately

. With some payers short-staffed due to the pandemic, it’s even more important to get claims right the first time. It may be much harder to get assistance by phone or email.

Many practice management systems have rolled out more advanced claim scrubbing tools in recent years. Much more of the billing process can be automated than ever before. Make sure your billing team is up-to-date on all the billing features of your system and prepared to take advantage of them to get bills submitted and paid as quickly as possible. And make sure all clinicians understand that it’s more important than ever to complete documentation and sign notes so that claims can be generated within a day or two of services being provided.

MBA is a partner and senior consultant for 

. Her consulting focuses on practice management effectiveness and practice profitability. She is the author of the book 

People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice 

business as well as the Management Rx series of e-books, and blogs at 

Articles

For patients who are struggling financially, or are simply anxious about money, anything but urgent health concerns may be pushed to the back burner.

Protecting revenue and patient relationships during the pandemic

Have you heard of the marketing rule of seven? I’m guessing you haven’t-and even if you have, you’re probably wondering what it has to do with rebuilding patient volume as the novel coronavirus pandemic evolves. 

The rule of seven is a longstanding idea in marketing that a message must be seen at least seven times before a prospect is primed to buy. It takes that many interactions, the theory goes, for a person to remember you and your communication.

It’s a guideline that’s been around for decades. But since it touches on both human psychology and the barrage of media communication, it’s more relevant than ever, given the tsunami information delivered by platforms we visit every day.

So what does this have to do with COVID-19? If you’re like many practices that had to slow down (or even temporarily shut down) in response to the pandemic, the marketing lesson of the rule of seven could be crucial to starting back up effectively.

Most practices we work with at Capko & Morgan are concerned about contacting patients too frequently, except, of course, for the most urgent reasons. Whether it’s the result of people in healthcare being kinder and less sales-oriented, or because physicians themselves get too much annoying email, practices may hold back on communicating about the same things more than once. Yet even in normal times, being too cautious could cause some patients to overlook important non-urgent information.

Consider the structural forces working against your communication efforts. Social media, for example, is great for getting the word out inexpensively. But because of recent algorithm changes, a message posted on your Facebook page is only seen by a fraction of your followers. You will need to rotate that same message through multiple times just to approach one view per person.

Email messages are easily missed, too. Spam filters can be too aggressive. Many patients use Gmail, which automatically sorts mail into categories and may wrongly sort yours as a “promotion.” And regardless of the email system, most of us receive so many emails, it’s easy to miss ones that are not urgent, even when they’re important.

Add these technology problems to the normal challenge of getting a message into a busy patient’s consciousness, and it’s easy to see you’re probably not communicating enough-and that’s before even considering the extra challenge the pandemic presents.

Remember that your task of encouraging patients to resume regular visits to your office may be hampered by public health advice that is in flux. Some patients may be afraid to come to the office simply because they aren’t sure they understand their risk of COVID-19 infection, or how to weigh it.

The trust you’ve established with your patients can help you help them break through the clutter of confusing messages and rules. The need to clarify or explain expert information that changes on the fly also provides a reason and opportunity to reach out to patients more frequently.

RVUs: The basics of physician compensation

Use multiple platforms, multiple times-and the personal touch

One easy way to boost the signal of your messages is to share them on multiple platforms. Technology can help. For example, if your website is set up in Wordpress, plugins can automatically share your blog posts on social media. (And even if not, your web developer may be able to automate cross-posting using a protocol called RSS.)

Facebook enables the scheduling of future posts. Set up important information to post multiple times and reach more followers. 

Your newsletter platform also likely enables “view this message in a browser.” Sharing that link on your Facebook page and website is another way to get multiple views (and more use) out of your newsletter.

Of course, nothing beats the personal touch for encouraging patients to take better care of themselves. All of the general messages sent to all patients via newsletters, your website, and social media can be accompanied by direct phone and/or your portal outreach to individual patients. Nothing more effectively communicates that you and your practice are concerned for a patient’s well-being.

When reaching out to patients, keep the focus on the things that will help them feel comfortable getting back on track.

For example, explain all the steps your practice has taken to keep patients safe. If you’ve added technology for telemedicine or the ability to schedule appointments or pay online, share how these innovations add convenience and help reduce the risk of germs spreading in your office.  

Remember that patients may need to be told about your safety measures multiple times, simply because they’re worried. Fearful patients may have trouble hearing what you’re saying the first time.

In their focus on the coronavirus, patients may also forget other threats to their health. For example, they may delay follow-up care, vaccinations, or preventive screenings. Help them put these needs in context and prioritize.

And if some of your patients have been laid off or furloughed, they may have had to switch health plans or be stressed about finances. Patients may skip preventive care or follow-up visits because they don’t realize those services don’t require out-of-pocket costs. Be sure staff is prepared to explain these differences to patients during outreach, to avoid an unnecessary fear causing some patients to delay care.

People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice

 business as well as the Management Rx series of e-books, and blogs at 

You’ll have to routinely reach out to patients to get your safety messages to stick.

The rule of seven and restarting your business 

If your practice is looking to add new staff, either as you re-open for business or contemplate expansion, you may be facing a tough labor market. Give yourself the best chance of attracting the right people by using all of the assets at your disposal-including presenting your location in its best possible light.

Location may not seem like a particularly valuable asset for recruiting staff. Won’t job-seekers simply search for open positions near them? How can location be an advantage when, for most people, the city where they’ll work is a simple yea or nay decision?

It’s unlikely staff workers will be lured from far away based solely on the city you’re in, but details about your specific location can make your job more attractive to the candidates looking for work in your community. Here are a few to consider spotlighting:

Telehealth compliance programs avoid and mitigate risk

Many candidates will focus primarily on how far away your office is from their home, not realizing that the surroundings of the workplace can provide a lot of convenience and enjoyment.

For example, if your office is close to amenities like a shopping district, promote that. (It can make it easy for staff to pick up essentials or just have a fun break during lunch.) A location near the city center can make burdensome errands like going to the post office, library, or DMV easier to accomplish. An affordable gym nearby can make it possible to squeeze in workouts before or after work. (Maybe you can even negotiate a membership discount for your staff.) And if your office is located near walking paths (or just in pleasant environs for strolling), staff can take advantage of that, too-and get fresh air and exercise during lunchtime for free.

Is your office in or near a major medical center? Are you surrounded by many medical offices? This can be an advantage for job-seeking healthcare workers. Especially when starting out in a first job, it’s reassuring to know colleagues are nearby and friendships can be maintained as people move from one office to another. Working near large medical campuses may also offer easier access to continuing education and networking for future advancement.

While being located near other job opportunities may not seem like something you’d want to promote, remember that your retention of employees will depend on the kind of experience you can provide. Use your location in a fertile career area help attract employees, and your competitive salaries and positive work culture to keep them. 

Employees may also value being in a healthcare hub because it makes pursuing their own medical care easier. 

Is commuting in your area a hassle? If commuting is a challenge in your area, your practice may still have advantages that ease the pain. Even something as mundane as being located near a freeway exit can make a difference in daily travel to and from work. If the commute is easier than candidates might assume, be sure to let them know.

If there’s no getting around congested traffic, is working an off-peak or staggered schedule possible for any of your roles? Could a biller work from home part of the time? Be sure to spotlight that if so. 

Public transit may appeal to some commuters in urban areas-especially if you can provide financial assistance for it. Make it clear if you do.

Easy parking-whether in a lot at your office, or affordably nearby-may be the best commute amenity of all. Be sure to promote it if you have it!

Repurpose materials from physician recruiting

If you’ve created a location packet for physician recruiting, consider reusing appropriate materials from it on your website. Although a medical assistant or biller might not be planning to pick up and move to a new city, they may need to if their spouse is searching nationwide for a new job. Any materials you can provide that sell your local area could help you attract candidates who are on the hunt with a partner.

Details about your location can make your job more attractive to candidates looking for work in your community.

Leveraging your practice’s location to attract staff

I had an inspiring conversation with a young physician recently. He is looking forward to one day owning a practice. He envisions himself establishing a practice ethos that encourages colleagueship and respects physician excellence. “Expert culture,” he says, is the key to physician engagement and avoiding burnout. 

His passion was infectious. I can’t help be animated by the idea of brilliant doctors motivating each other to be even better! Moreover, like many of us in healthcare, I’m concerned about the rise in physician burnout, and I agree with this ambitious doctor that more respect for expertise could help alleviate it. 

But a question occurred to me as we were talking: What about applying the same thinking to the business side of medicine?

Tips for addressing negative online reviews

The idea of setting a similar standard of professionalism for administration may not be intuitively obvious. It only makes sense that clinical expertise is king in our practices. Sometimes, though, even unintentionally, acknowledging this can translate into a more casual attitude about the administrative work being done to support the practice of medicine. This can mean that important business pillars of the practice are not as strong as they could be.

This is not unique to medicine. It’s become a clichÃ© that law firms, for example, often struggle with business management, despite being populated by brainy overachievers. Many fast-growing startups are created by smart people with an avid interest in a particular invention, technology, or service-and less interest in the daily nuts-and-bolts of management, which gets the short shrift. In all these examples, when management takes too much of a back seat, the financial success of the organization-and even the ability to achieve the core mission-may suffer.

Adopting the same professional standards on the business side that you aim for on the clinical side can help avoid unnecessary costs. What’s more, it can encourage profitability and growth, building the value of your asset. It can also make your practice a much more pleasant place to work! 

So what are the hallmarks of a professional practice organization? Here are a few:

Formalized, forward-thinking human resources policies


	
	Small businesses of all stripes are notorious for casual approaches to hiring decisions, including employing relatives and friends. The reasoning is always the same: trust. But over the long term, taking a less professional approach to hiring will make it difficult to attract the skilled employees needed to help your practice grow. Because of the unbalanced dynamic it creates, many talented practice management professionals simply refuse to work in a practice where a spouse or other relative is employee. 
	
	Similarly, the kind of driven and meticulous employees you most desire for your practice will also want to know they’ll be able to grow professionally. Consciously creating policies that enable employees to develop their skills and make career progress will help you retain your best people. Examples include formal job descriptions, career paths, and a budget and policies for continuing education for non-clinicians.

These steps will not just help you hire and retain the best people, the investment in development will help them bring new skills to your practice that can help it thrive.
	 


	
	When an organization is small and growing, a few people may end up, by default, doing all the decision-making-and they may feel time-constrained and make decisions based purely on instinct. But developing a more data-driven culture can help your practice make better decisions and reduce risk. Using data allows others to contribute ideas that can be objectively evaluated, giving them a chance to shine professionally, and your business a chance to explore new options you otherwise might not have considered.
	
	Becoming more data-driven also enables a closer handle on practice profitability. Building these habits can help you project your financial performance as the year unfolds and avoid surprises at year end or tax time.
	 


	
	Meetings or memos can seem like a waste of precious time in a small organization. But it doesn’t take long for lack of communication (or even a perceived lack of communication) to undermine employees’ trust. If it feels to employees like all decisions are made behind closed doors, for example, they might believe they’re on shaky ground, and that can lead to turnover.
	
	On the other hand, making the effort to communicate on a regular basis not only reassures employees, it engages them in the work of your practice. 
	 

Respect for roles, organization, and boundaries


	
	Creating a formal structure is another way to help assure employees that decisions that affect them will be made in predictable ways. Knowing that managers’ authority will be respected helps ensure that decisions are made fairly, and that employees aren’t encouraged to engage in time-wasting disputes or to go over their manager’s head. 

This can be hard for owners to adapt to at first. When owning a business, it’s tempting to want to make exceptions when you feel like it, even if your professional managers have a different perspective. But, in the long run, creating a structure with clear reporting lines frees the people at the top for more important tasks. Plus, it allows others on staff to feel sure about who can make day-to-day decisions, and how they’ll do so.

If your practice is small, it may seem like overkill to implement these at your current stage. But in business, we have an expression, “Dress for the job you want.” The idea is that even when you’re in a more junior role, you can present the image and attitude-to yourself, not just to others-that you’re aiming higher. Remember, too, that being more organized doesn’t mean giving up on a warm and supportive work environment. In fact, creating more structure can have the opposite effect, since predictability allows people to relax and focus on their work.

. Her consulting focuses on practice management effectiveness and practice profitability. She is the author of the book People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice business as well as the Management Rx series of e-books, and blogs at 

When management takes too much of a back seat, the financial success and goal achievements of the organization suffer.

Author | Laurie Morgan

Articles

Protecting revenue and patient relationships during the pandemic

The rule of seven and restarting your business

Leveraging your practice’s location to attract staff

Professionalism for practice growth