The traditional raise isn’t so traditional anymore. Due in part to declining reimbursements and other struggles, some practices are finding themselves short when it comes to handing out yearly pay increases. The 2018 Physicians Practice Staff Salary Survey revealed that 13 percent of respondents have frozen or even cut workers’ salaries.
That doesn’t mean there’s less for employees to do. One challenge identified by 36 percent of survey respondents was dealing with increased workloads and employees who performed dual roles within the practice.
Knowing where financial and workforce difficulties intersect, practices are increasingly trying to get more out of staffers despite being unable to pay them more money. It’s tricky, but it is possible to juggle the issues of workload and pay.
The right staff, the right roles
Evaluating the need for staff against existing workloads is often a good place to start.
“There’s information that shows that overstaffing and understaffing are equally bad,” says Juliana Stanley, MBA, CMPE, practice management consultant at the Texas Medical Association. “If you’re overstaffed, you have too many people that you’re paying to do the same tasks. If you’re understaffed, you don’t have enough people to bring in the revenue that you need.”
Instead of increasing or decreasing headcount, she suggests it may be more effective to focus employees’ time on the tasks that matter most.
“It’s common in small practices to try to do more with less,” Stanley explains. “We have data that shows if you staff properly, instead of three staffers for billing and coding maybe you have three and a half or four, for example, you’ll make more money because you can bring in the revenue that’s generated.”
The strategy is also linked to what Stanley refers to as “hitting that cultural reset button,” where physicians ensure that everyone in the practice is on the same page. Establishing a culture centered on patient care can be useful in centering the staff’s efforts as well as creating job value and satisfaction without increasing salaries.
“We can take better care of our patients if we’re doing things really well, and when everyone is on the same page, employees feel more valued and empowered in their jobs,” Stanley says.
Shuffling responsibilities—either to better consolidate similar tasks or to take advantage of particular skill sets within the practice—may make existing employees more efficient.
At April Gardner DO and Associates Inc. in Lebanon, Ohio, practice administrator Alicia Overman, CMM, says over time, individuals hired to work at the front desk have evolved into other roles. They’ve gained knowledge about the practice’s operations and found ways to expand their skills.
“We’ve had some move to the back to become MAs, and then we’ve had one who started at the front desk and has now moved into a care manager role,” she says. The change has allowed the practice to shift some of the responsibilities away from the clinical staff and add it to the care management basket.
The care manager position now focuses on prior authorizations and the chronic care management program via telephone with patients, Overman says, reminding them of things such as getting labs done and checkup reminders. Clinical staff no longer need to take time out to handle these types of tasks, but patients still receive the level of care they require and the practice maintains a focus on the revenue cycle.
Making the most of clinical staff may require some additional considerations. Kate Othus, MHA, partner and healthcare consultant at Aldrich Advisors in Lake Oswego, Ore., says one area to think about is “making sure they [physicians] have the right types of licenses in their practice.”
Because some states have made changes to LPN, RN, and other licenses, it might be worthwhile to reevaluate how those workers are best utilized within the practice. “It’s about what each of those different levels of employees cost, plus what’s the best and most needed for your specialty from a clinical standpoint,” Othus explains. If practices can add additional responsibilities or roles that are currently distinct are combined, it may factor into how many employees are needed and how they are compensated.