Tips to Effectively Operate Your Medical Practice to Endure a Crisis

September 24, 2020 | Article

Operating a medical or dental practice involves a lot of moving parts that go beyond patient care, like communications, billing, insurance and documentation. Both internal and external team members must be engaged for things to run smoothly. It can be a juggling act, and if you add in unforeseen crises like the COVID-19 pandemic, even the most carefully organized operations will get stress-tested. Some even face the prospect of closing permanently.

Simply “operating” isn’t enough if you want to buffer your practice against hardship and pave the way for growth. Ensure your practice thrives in the good times and endures through future crises by improving the efficacy of your operations. Whether your specialty is medical or dental, here are nine ways to build greater efficiencies into your practice.

1. Measure performance.

Defined, relevant metrics are necessary for measuring performance. During stable times, they help you reach goals, improve where needed, and benchmark your practice against standards. In times of uncertainty or drastic change, they help you determine the actual impacts to your practice and solve for them—or evolve. Without metrics, it’s harder to plan for growth or appropriately respond to change.

Examples of metrics/benchmarks include:

  • Number of patient visits
  • Average length of appointments
  • Patient satisfaction ratings
  • Number and frequency of clinical errors
  • Average time from visit to payment by patients and insurance
  • Billing/collection efficiency

You can monitor these metrics internally, but you should also consider medical practice consulting. With this type of consulting, you’re enlisting an experienced third party to examine your performance from an outside objective perspective. A dental or medical practice consultant can discover valuable insights your team may miss otherwise. They may catch mistakes that are costing money or leading to patient dissatisfaction. Additionally, they can draw comparisons to similar practices and factor for current industry issues.

Dental or medical practice consulting firms are especially useful when opening a new practice or reopening a practice after a crisis such as the COVID-19 pandemic. Consultants with expertise in your industry can help you cover your bases, define important and relevant metrics, and strategize to reach goals.

2. Develop your technological capabilities.

Technology is integral to running an effective medical or dental practice. Before the pandemic, doctors were already using technology to manage and document patient information, manage prescriptions, store data and perform virtual visits. Then, to reduce the spread of COVID-19 while continuing quality patient care, doctors accelerated their adoption of telemedicine. The American Medical Association even released a guide for telehealth to help practices implement it quickly.

Technology takes investment, from its upfront cost to time spent training staff. But it’s become an essential part of running a medical or dental practice, and it will ensure continued operations if similar shutdowns occur in the future.

It also saves money and improves the patient experience. Software automation and workflows mean your staff can focus on patients and their needs, rather than devoting their time to data entry and payment processing. Virtual visits can free up your waiting room for issues that demand in-person services. And the convenience of telemedicine may mean more regular virtual visits so you can monitor patient health and deliver quality care.

Medical practice consultants, like our professionals at Eide Bailly, can help you identify the right technology for your practice’s operations, integrate it into your processes, and train your staff to use it effectively.

When implementing new technologies, work with a consultant to ensure proper cybersecurity measures. Dental and medical practices handle sensitive personal information about patients and should remain vigilant about regulations and compliance relevant to protecting that information.

HOW TO PREVENT, DETECT AND RESPOND TO CYBERSECURITY INCIDENTS

3. Use data analytics for meaningful insights.

Bring data analytics into your strategy to amplify the usefulness of your metrics and technology. When you use real-time data, you can make decisions using the most current information and use leading indicators to forecast near-future outcomes. Medical and dental practices already have a wealth of data on hand, and new practices can access publicly available data such as Medicare data provided by the government.

Leverage data in all aspects of your practice:

  • Operational analytics and leading indicators for relevant decision-making
  • Capabilities like real-time location services (RTLS) to gain insight into provider performance
  • Business Intelligence to inform operational improvements
  • Population health data to improve patient outcomes and provide the best quality care

4. Strengthen communication channels.

Communications are vital to your operations and should be a top priority. This is another lesson that was driven home by the COVID-19 pandemic. Practices rushed to inform their patients and staff of new guidelines for visits and to provide access to telemedicine resources. If their communications were disorganized and primarily manual, they struggled. Focus on these core communications:

  • Patient communications. If you need to send an appointment reminder or a notice of office closure, what does that process look like? How can you improve it to make it more immediate and automatic without losing the human touch?
  • Employee communications. Does your staff feel informed every step of the way? How can you deliver clearer, more immediate messaging to them, especially during a crisis? Are they communicating clearly among themselves concerning patient and office information? How can you help them improve?
  • Third-party communications. How do you inform relevant third parties when needed? For instance, if you have to close your office, who must you inform and how will you do so?
  • Marketing communications. Do you have access to update your website, social media and relevant third-party sites that display information about your practice? Do these channels currently reflect accurate information? Current and future patients often look to these sources for vital details like office hours, visit procedures, telemedicine resources and payment options.

5. Build immediacy into decision-making.

The American Medical Association stresses the importance of fast decision-making, especially concerning the COVID-19 pandemic. This crisis had an impact on medical and dental practices in ways that couldn’t be postponed or ignored. Decision-making that halts action or leaves expectations unclear leads to confusion, miscommunication and, ultimately, poor patient care. To build immediacy into your processes, clearly define and document key decision-makers, rules for communications and approvals, and best-practice responses for various scenarios (more on scenario planning later). Each staff member should understand their role in the decision-making process, who to inform and when it’s appropriate to take action.

6. Plan scenarios for key operations.

Planning for multiple scenarios in key areas of your practice will help you adapt and remain in operation through any disruption or change. This planning should include worst-case to best-case, keeping in mind that even best-case scenarios can be mismanaged. For instance, if you have an influx of new patients but your processes aren’t sufficient to manage them, you’re not set up to succeed. Here are a few key areas to plan scenarios for:

  • Staff. You may need to reduce, increase or alter your workforce. Develop processes for properly managing each scenario. Enlist a legal consultant to ensure your plans meet legal guidelines. Additionally, the American Medical Association recommends helping any relieved staff find alternative opportunities.
  • Office closures. Should you need to close your office, plan how you’ll communicate that closure to patients, staff and relevant third parties like vendors. Remember to assign the responsibility of patient communications throughout your office closure to specific staff members in case your patients need immediate assistance. Also, plan for varying phases of reopening.
  • Supply shortages. The COVID-19 pandemic has taught us about the impact of PPE shortages. Plan for scenarios in which various items run low and you’re unable to resupply as you would regularly. What alternatives do you have? How will you communicate any resultant cancellations?
  • Financial disruption. Planning for various forms of financial disruption is vital for any business. Medical and professional financial management begins with an analysis of where you stand today to help you understand the possibilities ahead. What steps will you take first, second and third should you experience a significant disruption? Who must you communicate with concerning the disruption?
  • Infection and exposure. You need to plan for exposure to COVID-19. If a staff member, patient, vendor or visitor tests positive, how will you inform those who may have been exposed? Will you close your practice for a period of time? What are the legal requirements?

Fully reopening goes beyond following health safety guidelines and being prepared for new closures or exposure. COVID-19 has likely affected all aspects of your operations, and you must assess everything: your liquidity, technology, cybersecurity, supply chain, business processes, and more. You may need to restructure many key functions before you reopen. And if you’ve already reopened, a reset—and shift—is still in order.

7. Maintain quality reporting and documentation.

It may seem like a given that medical and dental practices should be careful about documentation and reporting. However, it’s not uncommon for busy practices to get too relaxed about these key activities. Issues like illegible writing, lack of notation about a complaint or condition, and patient misidentification can lead to poor or improper care. And some situations call for specific reporting, such as with opioid use.

The American Health Information Management Association has developed seven key strategies for proper clinical documentation that should be present in every entry in a patient’s health record, regardless of diagnosis:

  1. Legibility: Illegible documentation can lead to inaccurate coding and improper patient care.
  2. Reliability: An example of unreliable documentation is a record stating a patient should continue methadone therapy without a correlating diagnosis, such as OxyContin addiction.
  3. Precision: The more details you can document about patient condition, treatment and patient-provider interaction, the more precise the record will be.
  4. Completion: All details should be recorded and every entry should be authenticated with the provider’s signature and date. An example of an incomplete record is one that mentions abnormal laboratory findings without explaining those findings.
  5. Consistency: In a consistent record, there is no conflicting documentation. Common inconsistencies are interchanging “use” and “abuse” or using varying genders.
  6. Clarity: Clear documentation leaves no room for interpretation and is as informative as possible. Ambiguous documentation can be detrimental to continued care.
  7. Timeliness: It’s difficult to prioritize documentation amid a busy patient schedule, but if a diagnosis or treatment is not documented, the patient is put at risk.

To ensure proper documentation as technologies evolve and new error types arise, refer to resources like the American Health Information Management Association’s Best Practices for EHR Documentation. Reduce errors by using the latest EHR and EMR technology to manage patient information. And consider that medical practice consulting firms can assess your compliance with rules around documentation and reporting, help you identify the right technology to manage your processes, and ensure you’re using the technology according to regulations. They can also help you stay compliant and up to date as requirements change from one day to the next.

Documenting for Opioid Use Amid the Opioid Crisis

In late 2017, The Department of Health and Human Services declared an opioid crisis. The Centers for Medicare and Medicaid (CMS) then released a Medicare Learning Network (MLN) discussing the importance of documenting current patients’ opioid usage and likelihood of all other patients starting on opioids.

Medicare has declared that opioid discussion is an integral part of the Initial Preventative Physical Examination (IPPE/Welcome to Medicare Exam/G0402) as well as the Annual Wellness Visit (AWV/G0438/G0439). Failure to document opioid review can result in claims denial. Documentation should show that the provider assessed the benefit of non-opioid therapies as an alternative treatment method.

8. Stay vigilant with real-time evaluations.

To build resilience and strength into your practice, you must remain observant and do ongoing evaluations. Evaluate several internal and external components to manage your finances, processes, risks and operations:

  • News. Keep an eye on news that is relevant to your business, especially if it could affect your day-to-day operations.
  • Services. Are you providing optimum services? Can you adjust your offerings to improve efficiency, impact and benefit?
  • Operations. Are there regular errors, delays or issues at your practice? How can you work with your staff to reduce them?
  • Finances. Are you capturing payments and cash flow in a balanced, sustainable timeframe? How can you improve on this?

These are just a few examples of components you should keep an eye on to stay vigilant. In most instances, regularly revisiting your metrics and making meaningful adjustments is effective. Additionally, hiring a medical or dental practice consultant to review your performance can lead to expert insights you can use to transform your practice.

9. Weigh your option to sell, consolidate or stay put.

New practices and those facing hardship, such as managing the COVID-19 pandemic, have to choose if they’ll run an independent practice, join a health system or join a private equity group. The way health systems have bought and divested practices over the past decades, the intensity of private equity firm consolidations and transactions, and the constraints of running independently have many believing it’s the end for private practices. However, we still see successful groups and individuals. You must weigh the decision carefully.

  • Health system: You get paid to see patients, with some administrative pay. The main way to make more money is to increase patient volumes. If you’re a good doctor, however, the health system might be willing to lose money on your practice to support your service in the community.
  • Private equity group: In this setting, the entity must make money. This leaves only two basic options: see more patients or get paid less in anticipation of a payout when the group potentially flips the business.
  • Independent practice: In this scenario, you have control over your schedule, how many patients you see and how you manage your staff. Successful independent owners enjoy running a business of their own and often invest in many services. Their income isn’t based solely on how many patients they see each day. Owning your own business isn’t for everyone, but it can be very rewarding.

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