The Business of Medicine v2

THE BUSINESS OF MEDICINE Relentlessly Dedicated to Your Success

SETTING AN EXCELLENT EXAMPLE MEDICINE IS A SERVICE INDUSTRY ASK THE CONSULTANT

March 2022

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THE BUSINESS OF MEDICINE CONTENTS

INSIDE THIS ISSUE YOUR STAFF 2 TRAINING A vital component of any practice IS A SERVICE INDUSTRY 4 MEDICINE Without your patients, you have nothing CONSULTING 6 BURKMAN Practice Management AN EXCELLENT EXAMPLE 8 SETTING Excellent employees need an excellent example to follow DISCIPLINE OF GETTING THINGS DONE 10 THE Why do people fail to execute?

THE CONSULTANT 12 ASK What do you want to know?

FOR HIRING GREAT EMPLOYEES 16 TIPS Ten tips plus a bonus tip MARKETING IS ALIVE & WELL 18 PRINT Where does print marketing fit into my strategy?

VERIFICATION 20 INSURANCE How important is it?

SPOTLIGHT 22 PHYSICIAN Meet Dr. Arti Chopra Amin CARE CENTER OF EXCELLENCE 24 WOUND Keep your patients out of the hospital

TRAINING YOUR

STAFF Training your staff is a vital component of any practice. It will allow your practice to run smoothly and efficiently. Good training allows you as a physician to do your job and not have to micromanage everything and everyone.

1. Have a plan. Never start to train your staff without a plan. Make a list of everything that an employee needs to know for them to do their job correctly. This is best achieved by having an employee, currently in that position, make an initial list and then add to it as they do things. Use this list to create a checklist of what needs to be taught and their importance. Give this to the new employee when they are hired so you can both see what their position entails. Set a time frame so they know what should be accomplished and when.

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2. Hold regular training sessions. You may have trained your staff when they started, but everyone needs continuous training. Make training fun. Have contests to see who can answer the most questions correctly. Do role playing. Ask for suggestions on how to make the clinic run better.

3. Incentivize your staff to learn and teach. If you want them to learn a new skill or read a new book, give them parameters, and let them soar. If you want to improve customer service, ask them to read a book on it and give a short presentation to the staff on how to improve customer service. Reward them with a gift card, etc. If they are to teach it and recommend changes, they are more apt to implement those changes rather than just being told what to do.

4. Cross train, cross train, cross train. What happens if the person who knows how to order supplies goes into the hospital, or your biller walks out? What are you going to do? You should always have two people that know how to do a job. It is not enough for them to have just been trained on it. They should perform the job at regular intervals to keep it fresh in their minds. If your receptionist is cross trained as an MA and your MA as a receptionist, have them switch jobs a couple times a month or at least once a month. If you have a backup biller, make sure they’re helping the biller once or twice a month. Being an MA or a biller is not like riding a bike, you won’t just remember how to do it if you haven’t done it in years. Procedures, protocols, and policies change quickly. Your staff needs to be cross trained and then actually perform those jobs regularly. Sometimes it’s just nice to have a change of pace.

5. Remember that checklist (#1)? Every six months sit down with your staff and review the checklist you have for that position. Are they performing all the job duties correctly?

Do they need to be retrained? Have them add additional job duties that they have acquired to the list. Keep it up to date.

You can have the best employees in the world but if you do not train them correctly and continually, they are no longer going to be the best employees in the world. You and they will get frustrated with one another. Eventually they will quit or you will fire them. You will be the one that is at fault. It is your job and duty to train and continually train your employees.

Training is not something that can be done once and then walked away from.

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MEDICINE IS A SERVICE INDUSTRY Medicine is a service industry. We are the same as a restaurant, beautician, or spa.

You may be thinking “What? We are a medical clinic we are not a service industry”. You unequivocally are in the service industry and your patients are your clients. They can choose to go anywhere they want. Very few of us are under coaptation contracts that require patients to only see you. Your patients are the most important asset to your practice, not the physician and not your staff. Without your patients you have nothing.

There are many companies that are known for their service. One personal experience comes to mind. I was at a Four Seasons hotel sitting in at the bar indulging in my love of ice cream. Blake, the bartender, taught

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me valuable lessons and customer service.

He was a great server. He made suggestions, was quick with my order and was very friendly. While, I was indulging in my sweet tooth, I watched him hand squeeze cases of lemons and grapefruit to use in his signature cocktails. Blake told me of the cases and cases of limes he hand squeezes for his spicy lime margaritas. “Why?” I asked. He could have used a premade lime Margarita mix. He could have saved himself countless hours and 800 limes. After questioning Blake about why he chose to hand squeeze his juice, he simply stated that it tastes better; there is simply no comparison to freshly squeezed juice. Blake could have used the premade mix, but the quality was not the same. The customer experience would not be the same.

Is it worth the time and effort? To the Four Seasons it is. To this bartender it is. Quality and the customer experience are what make The Four Seasons spectacular. They never asked Blake to hand squeeze fruit or to develop his signature cocktails. They only demand exceptional customer service. It is up to every employee to deliver this in their own signature style.

The next day I was sitting by the outside fire with three children, and he came out. He greeted me by name, asked if I was ready for an ice cream repeat and preceded to bring out ice cream for me and my children. When he found out that my 5-year-old son had the same name, he quickly removed his name tag and placed it on my Blake’s shirt. He told him he was now an honorary employee.

in my mind three years after it happened.

Will I go back to that hotel? Absolutely. Will I refer people to stay there? Absolutely.

What makes your practice spectacular? What makes your patient experience exceptional? When someone leaves your office, are they amazed with the experience they had?

Does something set your office apart? Or are you just the run of the mill medical practice? What can you do today to make your practice different? Start small. Smile at your patients, call them by name, ask them about their grandchildren. Make sure they feel like the MVP that they are to your office.

Whatever you do, demand exceptional customer service, both from your staff AND yourself. Make your patients experience spectacular. In return, they will be as loyal The bartender went out of his way to make as a Four Seasons guest drinking a fresh sure that we felt special and went beyond just squeezed lime margarita... Or in my case customer service. This experience is still fresh indulging my sweet tooth.

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NEED HELP? B

urkman Consulting works with practices that are struggling and need to improve to make their medical practice efficient, profitable, and amazing. We identify missed and additional revenue sources within these practices. We take the time to understand the unique situations through data and practice observation. We offer honest, and sometimes brutal, opinions on what is working, what is not, and what needs to change. We identify the issues and implement protocols and solutions to ensure the continued success of all of our clients’ practices.

LET AN UNBIASED PARTY OFFER A FRESH PERSPECTIVE

Burkman Consulting is a nononsense, straightforward onsite consultant. Through honest opinion and thorough analysis, we guide your business toward necessary changes. We audit medical charts, billing, workflow, and more. Allow us to give you the tools you need to overcome your practice’s biggest obstacles.

PROVIDING SOLUTIONS TAILORED TO YOUR NEEDS

While you can go to a conference and ask questions, no one can really know what is happening in your practice unless they are in your shoes. That is why we come to you!

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WHAT WE DO

Claim, Documentation, and Billing Audits Optimize Workflow and Alleviate Bottlenecks Sets Up, Revise or Complete Protocols CPT Analysis Help Solve Billing Concerns Increasing Revenue Mystery Patient (visiting the practice as a patient) A/R and A/P Audit - Where are you losing money?

Embezzlement Detection and Prevention Staff Training Goal Planning Mips Completion Offer an Unbiased Opinion of the Identified Issues Complete Confidentiality - WE DO NOT disclose our clients (unless authorized by the physician).

WE DO NOT work with any doctors with competing specialties within an agreed upon radius.

THE MORE WE LEARN ABOUT YOU, THE MORE WE CAN HELP

It is impossible to offer appropriate advice for a practice that is only a name and set of

numbers. From implementing new protocols, increasing per patient value (PPV) to audit charts and billing, Burkman Consulting is there to offer solutions for success.

BECOME A TOPPERFORMING PRACTICE

Running a medical practice is difficult. But you can overcome challenges with help from Burkman Consulting . We have proven solutions to help you achieve the results that your practice needs.

CUSTOMIZING SOLUTIONS BASED ON YOUR NEEDS

Burkman Consulting specializes in medical practices. I take the time to understand your unique situation and offer solutions that your practice needs. In most cases, I do all the work that is needed. I come to your office and spend 2-5 days in your practice, working one-on-one to diagnose the issues and provide a solution.

FREE QUOTES AND ESTIMATES ARE AVAILABLE

After a personalized consultation, we offer quotes and estimates free of charge.

PROBLEMS I CAN ASSIST YOU WITH

Cash flow issues Spending your nights and weekends charting Dissatisfied staff Physicians treating each patient differently Staff has no idea what to do Patients are complaining Don’t have time to train staff correctly Per-Patient Value is down Not getting paid for what you are doing These problems all have individual solutions.

CPT AUDITS AND ANALYSIS

What additional revenue are you leaving behind?

Are you bringing in less and less money?

Are you concerned about audits?

Do you know how your practice compares to others in your state and in the country?

Find out the answers to your questions with a CPT Analysis from Burkman Consulting. Visit burkmanconsulting.com/auditsand-analysis.

Holly Burkman, CEO

BURKMANCONSULTING.COM 216-355-0291 7

Setting An

Excellent Example Several years ago, my daughter had to have an extraordinarily complex spine surgery. This was performed at a very well-known Children’s Hospital by a very well-known spine surgeon. He only performed the most complex cases and was very revered in his industry. During the 12-hour procedure he broke scrub to come out and speak with me. A janitor was cleaning up the waiting room and his hands were full. The surgeon suddenly stopped, held open the door for the janitor and picked up the item the janitor had dropped. Then he thanked the janitor for keeping the surgical waiting room clean.

The next day this doctor was doing rounds on my daughter and the CNA, and I were trying to change her diaper. Due to having to keep her spine 100% in alignment, we were waiting for an extra set of hands to help roll my daughter. The doctor never hesitated. He grabbed gloves and help changed her without missing a beat. He discussed her case and left for the next room. I told the nurse how shocked I was that the doctor help change my daughter’s diaper. The nurse quickly replied, “That doctor always helps, everyone loves him.”

While it only took the physician 30 seconds to help the janitor and one minute to help the nurse, his example spoke volumes about who he was. I am a big believer in physicians using their time wisely and only doing what they are legally required to do.

Lending a helping hand to clean up or help an overworked staff member, goes a long way to help morale an office or hospital.

Do you know what your staff does every day? Do you know what their job entails? It is important that a physician understand all the roles in the office. Spend time with your staff and let them train you. This will allow

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you to understand what part of their job most stressful and what problems they encounter.

Very few of you know what your receptionist does all day. She does not just answer phones.

By spending a few hours learning what they do, it will give you a greater appreciation for the work that they do.

Do the work: There is nothing more frustrating than having a boss that does not work hard. They come in late, and they don’t finish their work. They say they will do something and never do. You set the example. Make sure that if you demand punctuality from your staff members that you are also punctual. If you expect them to finish their work before they can leave, you must finish yours as well. You expect them to follow treatment protocols so you must also follow treatment protocols. You expect them to do what you ask in a short amount of time, you must also do what they ask. You must be the example they follow. If you break the rules, they feel like they can break the rules.

Doing these few things will allow you to set an example and let the staff know that you are not above them. Yes, you have more training, and your time is worth more per hour, but you are still a normal human being. You can help mop the floor and change the trash if needed.

Your staff wants to work with a “normal doctor”, not one that feels superior. If you are helping, your staff will also go out of their way to help. If you want excellent employees, you must set the example by being an excellent employer.

THE

GETTING Unless I can make this plan happen, it won’t matter.

Execution is critical to any business. You can plan, dream, complain, brainstorm, scream, think of 50 different ways to achieve something, or throw money at it, but unless you execute it, none of those matter.

Sometimes people need to get out of their own way. They over analyze, make lists, come up with 50 different excuses and do everything else but execute and complete a project. Without completion, nothing matters. It did not matter that you got 90% there.

Why do people fail to execute?

They fail to know themselves: I love bright, shiny new projects. I love to fix things. I love to brainstorm. I will get 90% there and never finish. Why?

Because I hate trivial and monotonous tasks which usually need to be done to execute the project. I used to get mad and beat myself up over never finishing those projects. I quickly learned that I need to assign those completion tasks to someone else to finish. My strengths lied in the brainstorming and in the fixing; it did not lie in finalizing the project. Once those tasks got delegated to the correct people, they got done. It is important that you think about what is holding you back from executing a goal.

How bad do you want it?

People fail to execute because they value something more. Several years ago, I worked with a doctor that wanted to raise profits and increase patient satisfaction. We did studies where they brought me in as a consultant.

We found it was critical that he show up in the morning. This allowed him to meet

DISCIPLINE OF

THINGS

DONE

with his staff, go over patient deductibles, and insurance information. Clinic started at 9:00 AM and it was essential that he was at the clinic at 8:00 AM. 8 months later nothing changed. In the end, he was the problem. He stayed up too late watching TV and could not get up in the morning to get to the office by 8:00 AM. In the end he valued TV over the success of his practice period. He threw money at the problem, he got upset at his staff for failing to raise profits, he blamed everyone else but in the end he was the problem. It is a sad story but true. He didn’t want it bad enough. You make your own choices, you choose what you want more in life.

or the quickest to do. Pick the most important. To do that, ask yourself the following questions:

Prioritizing: Everyone has lists of things that need to get done but we usually fail to do the most important things. It is essential that you look at your to do list and pick the top three critical things that need to be done. Get those three things done first. Don’t just pick the easiest

Execution is vital to your business and to your life. Do not allow trivial things to stand in your way of achieving success. Know yourself and know your limitations. Prioritize what you really want in your life. What is stopping you from your execution? Concentrate on what is important and delegate.

1.

hat is the one thing that will help W me achieve my goal the most?

2. What one thing must be done?

3. What one thing will make the maximum impact on my life?

4. What do I personally have to do?

Not everything on your to do list has to be done. Not everything on your list needs to be done by you. Delegate tasks if you can.

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ASK THE CONSULTANT We need to let an employee go. She has not done anything horrible that I can document, but she just is not a “good fit” for our office.

First thing you need to do is consult your own handbook.

What does it say about firing an employee? Does it state that their employment is at will and can be discontinued at any time for any reason, by either party?

Do you have a specific procedure that is laid out that includes verbal and written warnings?

Your handbook is a legal document and is in addition to any state and federal laws.

Secondly are you located in an “at will state”? Meaning you can fire an employee for any reason at any time as long as you are not discriminating.

Third are they in a protected class: Pregnant, or over 50.

Can they state that you fired them for their religious beliefs, sexual orientation, cultural or racial background?

If you can pass these 3 major questions, then you can terminate their employment.

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How to fire an employee:

Be frank. Do not be wishy washy. Don’t try to do the firing in a complaint sandwich. “You are a wonderful individual and have so many strengths, but we are going to have to let you go. I know you will be an asset anywhere you choose to work.” This is so confusing to the employee. You are letting them go but you think they are wonderful and an asset to the company. Do not do it.

Make sure you have the employee’s final paycheck with all worked hours to present at time of dismissal. Collect any keys, uniform and key cards.

Confirm that you have changed all passwords to computers and emails. Change your alarm code, lock them out of the EHR, and anything else containing patient data. Verify that when they exit that they have taken all personal items and are not taking anything that would have patient data.

Firing is incredibly difficult to do. It is essential to your practice that you remove individuals that are not performing well.

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MEDICARE & CHARTING GUIDELINES ARE CONTINUOUSLY CHANGING

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Tips for Hiring Great Employees 1. H ave an applicant make an additional effort when applying: ask for a cover letter, for them to complete a qualification exam (indeed another hiring sites have tests), or ask them to include three reasons why they should be hired, etc. Put these items in the employment ad. If the applicant does not follow the instructions, does not include a cover letter, or answer your questions, immediately delete them. If they cannot follow instructions when they’re applying, they will never follow instructions in the future.

2. U se the Calendly website or app to have them schedule phone interviews with you and ask that they call you. Only serious applicants will schedule a phone interview, only 50% of those will call you and call you on time. This allows you to do whatever you need to do and just wait for the phone to ring. I will schedule 20 in a day and only have an average of 10 actually call me.

3. I f the applicant calls you, ask specific questions and tell them a bit about the job. Discuss the hours and pay. Ask them what they know about your company. Ask them to tell you how they structure their day at their current job. What are three characteristics that they feel are their strongest? What would the supervisor of their current employer tell you?

4. I f they pass the phone interview and you like them, schedule an in-person interview with them. You can also ask them to come shadow for a few hours to see how they fit into your work environment.

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5. Test their typing, give them a list of tasks and have them put them in order of importance, role play with them, have them take a personality test.

6. Call their references.

7. Check them out on social networks. You do not want an employee that doesn’t know how to hide bad content or is a bad image for your practice. (I cannot stress this enough.)

8. Run background checks.

9. Make sure that they are not on the CMS cannot work website.

10. I f you think they are a good fit, offer them the job. Have them start at $1 an hour less and once they are done training they get the $1 an hour wage increase. This will encourage them to train quickly and make sure they are passing off all their requirements to get their raise.

11. I f you don’t like any of the candidates, don’t hire one.

Yes, you may be short staffed, but it is better than hiring an employee that is not good.

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PRINT

marketing is Alive & Well With the rise of social media, many people are asking, “Is print marketing still a viable marketing strategy.” The answer is, yes with a comprehensive strategy, it can be very effective.

Most companies still use print marketing for postcards, business cards, brochures, coupons, and even simple thank you cards.

Print marketing capabilities have become more personalized in the last few years. Many companies not only use print marketing to build their brand (and increase brand loyalty) but to also generate leads used to help build a multipronged campaign strategy. Print marketing can offer many more ways to effectively reach your target audience that other marketing strategies using social media just can’t offer.

Print marketing can reinforce your brand much longer than a social media post. Several studies have shown that the shelf life of a Twitter, Facebook or Linkedin post is approximately 15

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minutes. Have you posted to any of these social media sites, lately? You are likely aware that daily content is essential to keeping the attention of people. However, though these social media sites are an excellent way to engage in conversations with current or potential clients, they tend to be short lived conversations at best. Developing the daily content necessary to maintain these conversations can be a time consuming endeavor especially for a medical professional whose day is already completely filled with a multitude of things to do. It’s true that a social media post may give you instant results and can direct people to your website within a short period of time. But, it’s just that - a “short period” of time.

Print, on the other hand, has the potential shelf life of several weeks. Why? Because many people want to hang onto unique printed materials.

Andy Blau, senior vice president of finance and advertising at Time Inc says, “Print is really for

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establishing brand worthiness in the marketplace, for establishing the value of the brand, for communicating very broadly, with broad reach, to the right target audience. Print advertising is a very efficient way of establishing a brand identity and for communicating that to the target market.”

To clarify, done correctly, print marketing enables your company to tell current and potential clients your story without them having to wade through thousands of other tweets and headlines.

When you personalize your printed material going beyond the standard “Hi (Your Name Here).

We have a sale!” - it has the power to make your company more memorable. Print marketing goes beyond the simple everyday email and encourages clients to engage in ways they are unable to via a website or social media page or post. A good example of personalized print marketing from a medical professional is to ensure that a thank you card goes out to each patient who used your

DAY CARD. T AN EMPTY BIRTH NO ONE LIKES YOU CHOOSE NO ___ EVERY YEAR __ __ $_ G SIN LIES IN OFFICE. PP YOU ARE LO SU RE CA D UN TO DISPENSE WO MINUTE CALL SCHEDULE A 15 DAY! EE WEBINAR, TO OR WATCH A FR

services twice. The first time when their treatment has ended and the second on the anniversary of their initial visit. This small, yet simple effort goes a long way in keeping the physician and the brand in the mind of the patient making the patient more likely to recommend the physician to a friend who may be in need of their services.

Personalizing something, even a simple thank you card, goes above and beyond for many people and helps to improve customer retention.

Your clients know you care about them because you have taken the time to send them something to acknowledge that you appreciate them and their business.

In conclusion, print marketing is alive and well.

It’s now a more efficient marketing asset that businesses should utilize in their marketing strategy. The key, as with anything, is you just have to know how to use it.

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Insurance

VERIFICATION Insurance verifications. Do you know what they are? How important are they? Who oversees them and when they should get done?

People don’t commonly consider insurance verifications to be part of the billing process.

Once you see the patient, it becomes a billing problem if there is an issue with the insurance and nonpayment. Therefore, they are a large part of the billing process.

Your staff must obtain correct information from the patient, such as name, date of birth, member ID and group numbers, etc. Ideally, one person would oversee performing insurance verifications before your patients are seen, preferably even before their first appointment in your office. There will be clear communication and information to give the patient about their visit, what is covered and what isn’t, so there are no surprises. Patients think they know what their insurance covers, but usually, they do not. It is our job, as providers, to inform them

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before they make any financial decisions in our office. By doing this, you’re helping your patients and ensuring your office is appropriately compensated for their visit.

Billers rely on the information the office staff has collected to be correct. They don’t independently check everyone’s insurance every time they submit a claim. Each insurance has a timely filing limit on how long you must submit your claim for reimbursement. When information is incorrect, that eats away at some of your time.

The insurance companies don’t care that you had the wrong ID number, birthday, etc. They don’t have to pay for that visit.

Train your staff on what information to collect from patients and when. Train them to perform insurance verifications, what questions to ask and what that means for your patients when they’re in your office. These steps may not seem important in your practice each day, but they are the first step in getting paid for your services.

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PHYSICIAN SPOTLIGHT Dr. Arti Chopra Amin 1820 Fullerton Ave., Ste. 125 Corona, CA 92881 What is your #1 practice management pearl?

Review your financials regularly In the last 5 years, what new belief, behavior, or habit has most improved your life?

Hire qualified consultants to help you, personally and professionally, grow.

What book or person has influenced you most and why?

I believe my “team” of professionals have helped me to become more knowledgeable in the areas of my practice that I did not understand or have experience.

Name a favorite product, supply or DME item that you use in your clinic and why?

The IQ brace is my favorite product because it really works! Most of my patients, who use the device diligently, have great outcomes.

Is there a failure, apparent failure or business mistake that you overcame that others can learn from?

Completely trusting others for my business success without oversite from me.

What is your favorite food or sweet?

Gluten free, flourless chocolate cake

What makes you the happiest?

Being with my family

To nominate someone or to be considered for the Physician Spotlight, please contact us at burkmanconsulting.com

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KEEP YOUR PATIENTS OUT OF THE HOSPITAL

CERTIFY YOUR OFFICE AS A

WOUND CARE CENTER

OF

EXCELLENCE

Your office can be a Nationally Accredited Wound Care Center of Excellence certified office.

You don’t have to send your patients to a hospital-based wound care clinic.

Your patients can be fully treated at your clinic and never step foot in the hospital.

You can be OPEN and ready to treat your wound care patients and help them heal and stay safe by completing the Wound Care Center of Excellence training.

For more information, please contact the

Wound Care Center of Excellence

woundcare-excellence.com

(216) 355-0291

Cancer vs. Ulcers which one is more deadly?

Look at the graph.

Wound care is essential! It may not be as sexy as cancer, but it is vital to our patients.

Doing wound care in your office is not enough. Your office needs to become a Wound Care Center of Excellence.

Many oncologists have developed Cancer Centers of Excellence. Now is your time to develop a Wound Care Center of Excellence and save the life and limbs of your patients.

Wound care centers are not difficult to develop if you know where to start.

We have created a program that will get your whole office certified as a Wound Care Center of Excellence. It gives you step by step instructions on how to implement, train your staff and market your Wound Care Center of Excellence

5 Year Mortality % Breast Cancer

Charcot

Diabetic Foot Ulcer All Cancers Minor Amputation Major Amputation Lung Cancer 25%

50%

75%

100%

ATTENTION PHYSICIANS GOT PROBLEMS? Are you working long hours, but seeing little profit?

Do you find that you are struggling as a business owner?

THE ANSWERS ARE HERE. Got Protocols? is a down-to-Earth, no-nonsense guide to creating and maintaining practice protocols.

Learn the insider secrets from practice management consultant, Holly Burkman.

Discover how YOU can increase your revenue while decreasing your stress and learn to enjoy medicine again.

For your copy, visit: burkmanconsulting.com or https://www.amazon.com/ Got-Protocols-lucrativeefficient-protocols/ dp/169898085X

It is NOT too Late!

Worried about the 9% MIPS and MACRA reduction?

Want an easier Solution?

Contact Burkman Consulting for help with 2022 and 2023.

We make MIPS and MACRA simple!

216-355-0291 | burkmanconsulting.com