Vishal Gandhi

If you look at the different components of the U.S. healthcare delivery system, the first and most integral part is patients. A patient's journey starts with any medical practice, hospital, clinic, nursing home, or any other healthcare entity. Once the patients cross into a healthcare entity, they become a part of its technology, software, diagnostic testing, equipment, healthcare staff, and good knowledgeable providers. With these components utilized properly, the best desired outcome for institutions, in the end, is the well-being of the patient, quality of care, and minimal cost.

The first integral part of a successful healthcare enterprise is human resources (

The second integral part of a successful healthcare enterprise is innovation. Innovation, comprised of new ideas and concepts which can be evolved and utilized during the day-to-day operations management,is vital in every business.

Let's look closely at a simple innovation when it comes to taking care of elderly patients. Most elderly patients have compliance issues with medications, keeping up with their appointments, and taking care of the referrals that they need to schedule. I have observed a practice that went out of its way and involved their staff to come up with an innovative idea to help elderly patients go through these challenges much faster.

What they did was marvelous. Upon patient checkout, when patients were asked to come back for a follow-up visit or follow through on a referral, they would take the patient's phone and put a reminder within their cell phone with specific details of that reminder. Now most of the patients do have cell phones and most of them have smartphones; however, they may not have at times the skills to enter the information. Additionally, they may not remember to put a reminder properly into their phone. This practice's courteous action resulted in much better adherence towards recall visits or the referral visits for the elderly patients. This is just one example of how innovation can be helpful in day-to-day operations management.

Clearly, once any task is repeated consistently, it is essential that the staff is encouraged and asked:

• Is there a possibility of improving the end results?

With any operation and work flow planning, the ultimate goals are consistency, reliability, and success. If we invoke group thinking and planning throughout the team, it would definitely help the organization come up with better ideas and actions.

We can easily invoke group thinking through an organized, bi-monthly staff meeting to address the following:

• What are the tasks that are routinely performed?

• Is there anyone who has a better way of achieving that?

• Can we reduce time to perform our daily tasks?

• Can we benchmark for an expectable productivity for each team member?

The next most important element in the success of a healthcare enterprise is research. We have seen that technology has evolved at lightning speed, 10 times faster than it did 20 years ago. Part of the reason is research that goes into the day-to-day life to make it better. We have seen a lot of research going toward the pharmaceutical, technology side, and many other sectors in the industry. Healthcare delivery is no different.

Billions of dollars are spent on healthcare research toward the ultimate goals of the well-being of the patient, eradication of chronic conditions or minimizing them, and ultimately reducing the cost of overall healthcare delivery.

When it comes to a medical practice, a small hospital, or any small outpatient clinic, what is the research we need to do? The research in those areas should focus on identifying either a technological evolution or process evolution. The practice should evaluate the challenges they are facing and assign a dedicated "research" team, comprised of devoted individuals to face those challenges.

A specific number of hours every week or month should be dedicated towards attending seminars, webinars, and conferences. Those in attendance should seek technological and process-wise improvement that can be introduced within the entity to make things more efficient.

Staff meetings and innovative ideas can delve into the problem areas of an organization, and a team should be assigned to evaluate the problems and establish solutions. Every organization should probe the following:

• Is there automation or a defined work flow that can be introduced?

• Is there a defined knowledge team that can be utilized as an outsource partner?

This perpetual analysis, looking into the day-to-day operations, problems and developing solutions, leads towards the ultimate objective of research.

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Innovation and research are integral parts of a successful medical practice. Here's how to incorporate them toward the goal of excellent patient care.

Innovation and Research Essential for Medical Practices

The healthcare landscape is changing so fast that the leadership and management style from the past is becoming antique. The U.S. healthcare delivery system is geared toward being connected, patient-centric, patient-empowered, and risk-managed. The reimbursement model is shifting from fee-for-service to fee-for-value.

New leadership challenges have one more crucial task ahead: human resource development. Managing human resources effectively and efficiently plays a critical role in ensuring that a satisfied, motivated workforce delivers quality health services at your medical practice.

It also plays an important role in increasing staff performance and productivity, enhancing an organization's competitive advantage, and contributing directly to organizational goals.

We have seen top healthcare dollars spent towards technology upgrades, policy upgrades, and workflow reengineering for patient satisfaction ("the external customer"). We don't see many dollars spent towards employee satisfaction and development ("the internal customer").

It is essential to introduce an element of "customer service" in human resource development and management as well. Customer service is the provision of service to customers before, during, and after a purchase; or in the case of a medical practice, before, during, and after a visit. Customer service is a series of activities designed to enhance the level of customer satisfaction - that is, the feeling that a product or service has met the customer expectation.

With introduction of customer service elements in human resource management, we can focus on need analysis, skill analysis, and gap analysis.

Once we identify these three areas, we can plan for employee development programs that benefit both the organization and its employees. Well-developed employees with proper training and professional goals often perform better than employees who receive little development or training through their employer. Better performing employees will help an organization succeed, and employees may enjoy their work more when they work toward a goal.

Here are four methods to develop medical practice employees:



• Core training includes teaching new employees the basics of their job, such as job duties, expectations, and how to work on your EHR and related software. It may be recommended to have a "shadowing" timeframe wherein new hires follow existing employees for several days. Core training helps get a new employee off on the right foot, by giving him the training he needs to do his job.

• Personal development plans are a development method that focuses on the employee's professional life. With this method, the organization works with the employee to set individual professional goals. The organization and employee create a list of goals such as rising to a higher level within the organization, and a plan for achieving them. Personal development plans help keep employees on track within the organization, and encourage an employee to work harder.

• Leadership training is a development method used to help well-performing employees rise to a leadership level. With leadership training, the best employees are placed in a specialized training program that helps them develop the skills they need to become team leaders or supervisors. These programs also often involve creating individual goals. Leadership programs help organizations promote from within, and encourage employees to reach for higher levels.

• A mentor development program is a method of pairing a member of management with an employee to help the employee achieve more in her professional life. For example, a supervisor may become a mentor to a team leader. The supervisor will meet with the team leader on a regular basis, help the team leader develop professional goals, and create check points for making sure she meets those goals. Using the mentor program helps a healthcare entity develop stronger employees, and helps the employees develop better relationships with management.

Don't underestimate the value of employee satisfaction. Here are four methods to plan and start developing your medical practice staff. 

Human Resource Development and Your Medical Practice 

My work has allowed me to meet many physicians in the small and midsize practice space over a number of years in a variety of specialties. In my experience, they all have very specific things in common including that they studied medicine, not business. Additionally, these practice owners all have operational headaches. Healthcare is a business, after all, and no physician's practice is immune to the challenges that running a small- or medium-sized business presents.  While many physicians make great business owners, the back office is not where they want to focus their time, so finding smart solutions to help is the key.

We can pinpoint two very specific areas where physician's practices most often "leave money on the table," as we say, or rather, where money goes uncollected:

1. Denied or unpaid insurance claims; and

When it comes to unpaid insurance claims, relentless outreach to insurance companies can cost physicians and their staff precious time and money, and take a considerable toll on productivity. Instead of giving up on the collections, or putting too much time to the process, the third choice is to work smarter, not harder.

Four Characteristics of an Ideal Collections Partner

One solution is outsourcing collection to businesses knowledgeable in the space. If you do your homework and find a company that you're willing to work with on accounts receivable specifically in regards to insurance claims, there are a few things you should look for:

Do they handle electronic and paper/HCFA claims?

 As paper claims seem to taper off with the speed of technology adoption, be sure that whatever company you choose to spearhead your accounts receivable follow up can handle both appropriately.

 Electronic claims should be followed up on no less than 10 days after they are submitted to the insurance company. Any less time, and it's likely the claim hasn't been reviewed and filed appropriately. Any more time, and the likelihood of the claim getting "lost" or being perhaps incorrectly denied increases greatly.

Do they have numerous avenues for follow up?

 If the company doing follow up only has one way of contacting the insurance company, do you think they will be aggressive in collecting what is owed to you in a speedy fashion? Probably not. There should be online, phone, and other interactive ways of reaching insurance companies to get to the bottom of why a claim has been denied or unpaid.

Once a claim is addressed, yet still unpaid, can this company do what is needed to achieve a positive end result?

 Can the company fix an error or modify a claim and resubmit? Can they also address the patient's responsibility owed for in-network deductibles or non-covered benefits?

Once you've settled with the insurance company, collecting past-due balances from patients is an important component of the revenue cycle that physician practices must actively manage. Much easier said than done, efforts dedicated to collecting money due from patients is time consuming and labor intensive and only a relatively small percentage of efforts result in successful collection.

Back-office staff can take measures such as reporting debts to credit bureaus and taking legal action. But every dollar spent trying to gather owed money is one less dollar of profit for a practice. Not to mention, quite often the cost invested in gathering owed funds can exceed the past-due balance. If practices decide to forgo such collection measures, even small amounts owed can add up to hundreds of thousands.

If you’re looking to outsource such services, look to companies that will accomplish or offer the following:

Not unlike in insurance company follow-up, the longer a claim sits unanswered with a patient, the lower your chances are of collecting money owed. Don’t wait until it’s too late to engage a helping hand in this arena of your practice.

 Collection is all about balance. It’s imperative that you collect money owed to you, but not at the cost of a perturbed patient, a damaged reputation and lost potential referrals.

Knowing the best way to reach your patients will pay off big when it comes to collecting owed money. You will better your chances of a successful collection if you reach that patient on their terms. Is it via text? Perhaps e-mail and voicemail?

By implementing outsourced collection processes, not only will physicians stop "leaving money on the table," and enjoy greater financial reword, but they can also focus on patient care and not on back office paper work.

Small unpaid claims can add up to big problems for your medical practice. Here's how to find the best partner to collect what's owed for your medical services.

Getting Money in the Door: Streamlining Patient Collections 

Physician practices are very aware of the growing amount of deductible collection that will be necessary with the huge influx of eligible patients under the Affordable Care Act. But while they are very aware, this doesn’t necessarily mean they have measures set up to best prepare for this influx. If they have set preparatory measures, are those measures helping to simplify processes and work flow, or is there now just more work to be done?

All of the physicians I work with go into practice to help and heal people. They didn’t study medicine to then explore the ins and outs of all things payer, billing, and appointment reminders. For those with smaller practices, they and maybe one other clinical staff member are multitasking; handling everything from diagnosis to accounts receivable follow-up, and even eligibility verification. Add back- and front-office operations to that and you’ve got a formula for loss in revenue and harried business operations.

Some of the most prevalent and common issues I see physicians’ practices face include:

• Reimbursements and revenues decreasing
• High deductibles or increased patient deductibles
• Delays in collection of deductibles and other balances due to billing inaccuracies
• Employee compensation increases
• Overall inflation of business operation costs

• Confusion about healthcare reform specifications for small- to mid-sized practices
• Failure or lag in communications through traditional phone calls and mailed letters

But there is a better way: Automating billing and collection systems that will maximize profitability and increase time with patients. While undoubtedly there will be skepticism from some physicians after a decade of the failed promises of enhanced productivity and improved care from many EHRs and other systems, automated billing can be done, and at a cost that won’t elicit sticker shock.

 This can often be a bane for back-office operations to say the least. Manual collections often result in massive amounts of paper records, hard copy mailings, and staff hours following up with patients on balances owed. Your office staff should be welcoming patients and becoming more involved in their care to help keep them with the practice; not manually dialing phone number after phone number so you can get dollars in the door. Additionally, just because you have the staff to do the office work, doesn’t necessarily mean that work is done cost-effectively and successfully.

• Increase/better target use of communication such as secure text, e-mail, and phone calls.

 Similar to my above point, free up your back-office operations to do the most important things for your practice. By targeting communication channels specific to your patients’ likes and needs, you streamline your practice operations. You aren’t hard-copy mailing a young patient who only responds to text messages. You aren’t e-mailing a patient who checks e-mail once every month.

• Report non-responsive debtors to credit bureaus and/or legal departments to take the workload off of the practice staff.

 By automating processes, your staff isn’t bogged down by work when people don’t pay. There are solutions to freeing up their time and making sure your practice profits.

Here's an example that might apply to your practice: Take a look at your eligibility verification. If each claim denial costs your practice $25 to $30, and you know your denial rate is above the industry average of 3 percent, the monthly cost for eligibility verification in advance of patient visits shows an outsourcing company with this specialty effectively pays for itself.

As a patient, and with friends and family who are patients, I want to know that when I see the doctor that he is able to be clear minded and exclusively focused on my care or the care of my family member.

With automated billing solutions in place, physicians can focus on the practice of medicine, freeing their time to focus on patient care, and work with their office staff to maximize profitability.

is chief executive officer of ClinicSpectrum, 

leaders in hybrid work flow solutions consisting of both an innovative software suite and back-office operations. E-mail him 

If your practice is looking to boost its profitability and spend more time with patients, automating your billing and collections may be a solution. Here's why.

Author | Vishal Gandhi

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