Stephen Tramontana

Let’s pretend you’re short on time and you want to do some quick research on medical practices in your area. Maybe a family member is ill while visiting you and you need to find a physician nearby. What you’re looking for is concise, pertinent, easy-to-find information.

Join us Sept. 19 & 20 in Philadelphia at 

, our new conference for physicians and office administrators to help improve your medical practice and your bottom line.

Designing a website that conveys a lot of information in a short amount of time can be the difference between gaining a customer or losing him to a competitor. The following are a few common medical practice website mistakes:

 A mistake many people make when designing their website is trying to cram too much information into one paragraph. Rather than trying to convey every bit of information about your company and what you do on the homepage, try to make the homepage feel like a “home.” Keep it light on content and heavy on mood. Use large, bright images and large, descriptive text. Keep it short and sweet.

 Don’t overwhelm your visitors with options. Try to keep your tabs and pages to a minimum. Having pages with unimportant information will navigate your visitors away from the information that really is important. Also, steer clear of duplicating information and links. Having more than one link to a page on your site will make it look disorganized and cluttered. Keep tabs where visitors expect them: at the top of the page.

 Keep the design of your website consistent. This applies to the design and the content. If you’re using a specific font and color for headings, use that combination site-wide. Keeping the design and content consistent will allow for easier navigation and a more effective exchange of information.

 Any website can provide basic information, but if you can provide value beyond that, visitors will be more likely to return. One way a medical practice can add value is by offering a patient portal. Additionally, this will help reduce calls coming in from patients asking for test results, medication refills, etc.

We’ve all heard the buzzword: SEO. SEO stands for search engine optimization and it’s how people find you online. It used to be that designers utilized Flash to make up large portions of websites, but the problem with Flash is that the content within the images is not searchable, so search engines like Google can't identify what a website is all about. Now, most websites use keywords that can be searched and, as a result, place the site higher on search engine results pages. Adding additional content such as blogs and social media plug ins will further increase the number of times those keywords are used and will, once again, increase your results ranking.

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A website that conveys a lot of information in the right way can be the difference between gaining a patient or losing one to a competitor.

Five Common Medical Practice Website Mistakes

On July 7, CMS published proposed changes to the Medicare Home Health Prospective Payment System. Most notably, it modified the need for the provider to document a narrative on the face-to-face form, instead allowing a simple diagnosis and supporting documentation in the SOAP notes.

It was a disappointing revision to say the least. Over the last 10 years, and particularly the last three, CMS and the Office of Inspector General have turned an almost blind eye to the way their inaction disproportionately affects the home health sector of healthcare.

What is more troubling is that it directly hurts a key initiative for reining in healthcare costs: keeping patients out of the hospital by moving more services into the home or assisted living facility. 

Here are two key areas (to start) where CMS could make adjustments to home health regulations that would benefit not just home health, but the industry in general:

1. Increased and diversified reimbursement. 

Although it may seem counterintuitive when discussing healthcare spending reductions, increasing reimbursement for home-based visits would help in the long run. Immediately, it would solve a historic problem in the house-call space: upcoding, or variations of upcoding.

These providers are working with some of the most complicated patients currently in the system many are elderly, frail, with three or more chronic conditions. The reimbursement should be more in line with that level of care.

Additionally, there should be expanded reimbursement coverage for telehealth, travel options, and social worker resources. These tools fall outside of the direct patient-provider relationship, but are effective in managing this difficult population and getting in front of hospital readmissions. 

Reimbursement should also be revised to properly compensate physicians for supervising/collaborating work for reasons we’ll discuss below.

2. Greater autonomy for physician extenders. 

Not requiring a narrative for the initial face-to-face certification is helpful, but not as helpful as allowing a nurse practitioner or physician assistant to certify the patient.  Currently, the nonphysician provider can fill out the face-to-face form, but the supervising physician has to execute the certification.

With the oncoming physician shortage, it makes zero sense to have faith in the ability of a nonphysician provider to assess a patient in his home, but not certify those observations.
 

Here are two key areas where CMS could make adjustments to home health regulations that would benefit not just home health, but the industry in general.

Why CMS Needs to Increase Reimbursement for Home Health Care

With providers feeling anxious over the many reimbursement experiments occurring (accountable care organizations, those tied to the Affordable Care Act, Independence at Home program, bundled payments, etc.), it’s easy to forget there are other areas where providers, and administrators, can find significant savings and maximize the reimbursements coming in.

Time and time again, we have discovered that several practices are overlooking areas of key savings, and we’d like to discuss the more universal ones:

: As more practices adopt EHR solutions, this will become less of an issue. Over half our clients still utilize copier/fax solutions on a 36-month to 60-month lease option. Usually, these lease options come with a preset amount of "images" included in the price, with an uptick in per-image cost once that ceiling has been met. This can add significant increases depending on the volume of paperwork coming over the attached fax line. An "image" is defined as anything that’s printed out of the copier, including confirmation pages. You would be surprised how many machines are pre-programmed to print confirmations for faxes that went through, and that were denied. During the negotiation process (and it has to be done here, before the machine is delivered), insist that the machine only print denied fax reports, so your staff can note and resend. Or, better yet, if the machine has the capability to print to folder (and they all should at this point), insist that all confirmations are sent there. Reduce those images!

 During negotiations for almost anything involving a multi-year contract, you should have some kind of language giving your practice an out at minimal cost. Most notably, this can be used for both office leases and EHR agreements. Will this add some drama and frustration to the contract negotiation? Definitely. Will you be happy you sacrificed a week to make sure it was in the contract if you need to pull the trigger? Certainly. For office leases, I would say negotiate a 15-month out on a standard 36-month lease; 12-month out if you’re feeling bold. I’ve seen success with both options. For EHRs, vendors are usually amendable to an out; the real negotiation is the back-end payout. The point is, always have an eye out for minimizing back-end loss if, for some reason, the practice fails.

 Over the last four years, there have been some tremendous products introduced in this area that create real value for little investment. It seems most management teams are still focused on the POTS (Plain Old Telephone System) vs.. VOIP (Voice Over Internet Protocol) debate. In our minds, that debate is over, even if some practices are still opting for traditional landlines. The service, speed, and capabilities of VOIP make it a viable solution, and the only question is what VOIP solution is best for your practice. To be certain, you’ll probably spend a little more money implementing the systems, but the savings will be realized in the first year. Some reliable VOIP systems can be purchased for as low as $20 per line and $60 per phone. By switching from POTS to VOIP, a single practice can literally save thousands in operating costs.

And these are just three examples. When looking at cost reduction, the finer details are a good place to start. Two of these examples require an appetite for a little frustration and tenacity during the negotiation process, but you’ll be rewarded for the effort.

If you are willing to trade short-term frustration for long-term financial gain, here are three key areas of potential savings for your medical practice.

Cutting Costs at Your Medical Practice: 3 Areas to Review

Over the last seven years, the healthcare industry has faced a seemingly growing set of challenges. Economic downturn, regulatory changes, and market consolidation have created an ecosystem where a once stable (if imperfect) industry is in an era of innovation.

Of course, that statement is not meant to ignore the positive developments of the past decade, including the surge in graduate student brain power that is available to medical practices.

Looking to weather the economic storm of the most recent recession, many graduates opted to continue their studies and further their skill sets post-bachelor's degree. As they finished graduate school, though, many students found the economy was still in limbo and, worse, that while their studies may have prepared them to tackle more complex problems, employers were not ready to utilize them in a significant capacity.

In one extreme example, a physician practice management organization hired a recent graduate with a master of public health degree to assist in their growth efforts. Initially, the group capitalized on this individual's analytical abilities by requiring assessments of new markets, identification of ways to streamline operating costs, and providing liaison support between various practices and the executive office.

However, after a short period of time, the organization purchased a building and relocated parts of its operations; it elected to have this person focus on building renovation and relocation logistics. This was a complex project that fully utilized the employee's brain power with the understanding that, after the project was complete, the graduate would return to the analytical role.

However, rather than going back to the original position, this individual became the de facto building manager, with days constantly interrupted by requests for light bulbs, meetings with pest control companies, complaints about water pressure, and other tasks that did not properly utilize the graduate’s education or abilities. The prevailing thought of the executive team was, "This person is young and will accept any work assignments."

It shouldn't be surprising that, after a short time, this individual resigned to accept a substantial analytics role with a major healthcare system. It was a shame to see that, rather than focus on the abilities of this bright young employee, the organization instead marginalized those assets, ultimately, to the competition's benefit.

While this is an extreme example, the situation and its results are not uncommon. As consultants, we routinely encounter physician practices that employ recent college graduates, but don’t fully utilize their knowledge. It's surprising to see the number of graduates with master's degrees that are being relegated to supporting administrative roles, with the prevailing thought being that, while the employee has completed advanced education, he still needs to “put in his time.”

Healthcare as an industry would do well to take a page from the tech industry in this regard, an area that routinely puts young (but very accomplished) minds in challenging positions to great benefit for all involved. In those roles, graduates feel challenged and needed, and companies benefit from their knowledge and low turnover.

That's not to imply that every master's of public health graduate should be offered a COO role, but they should be fully utilized.

Here are a few questions employers should be asking themselves about their recent graduates:

• Do we have a program to mentor these employees and aid their growth?
• Within the larger projects our practice has undertaken, is there an opportunity for these employees to contribute in a meaningful way?
• Is there a plan in place to identify advanced opportunities and assist graduates into those roles?

While it’s true that you need to combine experience with education to realize a valuable employee, there is a great deal that these progressive young minds can add to any physician practice, particularly in light of growth, advancement, and innovation. With all of the challenges that the industry is facing today, we do not need to add mismanagement of human capital to that list.

 

New graduates are an untapped resource that can add innovative assets to your physician practice.

Making the Most of Recently Graduated Medical Practice Staff

Historically, healthcare marketing has always embraced traditional branding aesthetics: accentuate the positive, never mention or attack the competition. The dynamics of both marketing and healthcare are changing, and some health systems and practices that are looking to distinguish themselves in crowded markets may want to consider more modern branding strategies for inspiration.

For instance, Domino's Pizza created one of the most attention-grabbing campaigns in recent memory when it disavowed its own pizza recipe, admitting it was subpar and asking the public to sample its improvements. On the surface, it seemed like brand suicide; but by embracing the negative, Domino's demonstrated that it values quality over complacency. 

Here are some suggestions on how your practice can embrace the negative to achieve positive results:

1. Customer service questionnaires and the good news of bad news.

  While major health systems have been utilizing customer service questionnaires for decades, not all small and medium-sized practices have implemented them. This is a shame, as these practices usually have more to gain from the prompt assessments of their patient base. 

The ability to get feedback in real time can facilitate prompt action before your patient base quietly migrates to a new practice.  And while the first recommendation is to implement this tool in the first place, the second is not to bury the bad results.  An infamous business school model is, “Bad news needs to travel fast.”

Experience is 90 percent perception and if the perception is that your practice isn’t appealing to patients, embrace that data and immediately begin working on corrections.  Most patients will forgive one bad experience.  They very rarely forgive two.



Healthcare is one of the few industries in which entities don't address the weakness in their competition directly.  It traces back to the notion that, although we’re competitors, we’re all in this for the same mission.  As the healthcare market becomes more crowded and more diversified in equal measure (the rise of retail medicine, for instance), health systems and private practices alike will need to clearly and quickly define their strengths to discerning patients. 

If your wait time for new patient appointments is shorter than the practice down the street, there is no shame in highlighting that.  Just look at how effective Esurance has been at marginalizing Geico’s famous “15 Minutes or Less” mantra with a new campaign that promises similar results in half the time.  Maybe it’s time to put out an ad showing your average wait time is only two weeks as opposed to the six of your competition. 



 One of the trickiest aspects of identifying where improvements are needed in a practice is getting sincere feedback on the practice's management team (including physicians).  Often, employees are reluctant to share their true thoughts regarding supervisor performance for fear of reprisals from management should their feedback become public knowledge.  Previously, the ability to get confidential feedback was limited, but with today’s tools it’s fairly easy.  For instance, SurveyMonkey can be used to great effect.  You simply construct the survey, send it to the e-mails of the intended employee pool, and the results come back anonymously.  The employees can then complete the survey from home, and feel comfortable giving more candid advice.  If management adjustments need to be made, they can be made before key staff member talent leaves your practice.

These are just three examples of how negative information can be embraced to produce positive outcomes, both inside and outside of your practice.  Too often, this valuable data is marginalized, or worse, ignored.  By accepting the negative, and proactively developing ways to discover it, you will be serving your practice, your employees, and, most importantly, your patients. 
 

Three examples of how your medical practice can embrace negative information to improve marketing and operations. 