MIPS: Which Improvement Activities Work Best for Your Practice?

By Sonda Eunus, MHA, CMPE, CPB

MIPS, or the Merit-based Incentive Payment System, will have a significant impact on eligible Medicare clinicians in coming years. MIPS will measure clinician performance in 4 categories, and will assign each clinician a MIPS score that will then result in either a payment increase or decrease to the clinician’s Medicare reimbursement. The 4 performance categories include Quality Measures, Cost and Resource Utilization, Advancing Care Information, and Improvement Activities.

In this article, we will explore the Improvement Activities category in more detail. Clinicians and practices will have over 90 different improvement activities to choose from to implement in their practice. The ultimate goal of this performance category is to improve the quality of patient care provided. There are several subcategories that these improvement activities fall in:

• Achieving Health Equity
• Behavioral and Mental Health
• Beneficiary Engagement
• Care Coordination
• Emergency Response and Preparedness
• Expanded Practice Access
• Patient Safety and Practice Assessment

Let’s discuss these subcategories in greater detail.

Achieving Health Equity

This category wants you to provide quality care to patients while also taking into account social factors in health, such as income level, food security, employment, and housing.

• Measure Example: Seeing new and follow-up Medicaid patients in a timely manner, including individuals dually eligible for Medicaid and Medicare (IA_AHE_1)

Behavioral and Mental Health

This category emphasizes the importance of factoring in behavioral and mental health and its effect on the patient’s overall well-being.

• Measure Example: Diabetes screening for people with schizophrenia or bipolar disease who are using antipsychotic medication (IA_BMH_1).

Beneficiary Engagement

This category measures your efforts in engaging the patient’s family to ensure that they fully understand the patient’s condition and are included in important medical decisions and the development of a plan of care.

• Measure Example: Engage patients, family and caregivers in developing a plan of care and prioritizing their goals for action, documented in the certified EHR technology (IA_BE_15).

Care Coordination

This category holds clinicians accountable for ensuring that the patient’s care is coordinated among the different healthcare providers and facilities that are participating in his or her care, and that there is clear communication between all parties involved.

• Measure Example: Timely communication of test results defined as timely identification of abnormal test results with timely follow-up (IA_CC_2).

Emergency Response and Preparedness

This category gets clinicians ready to respond in the event of a natural disaster or other emergencies, and to ensure that all employees and patients at the facility are protected from harm.

• Measure Example: Participation in Disaster Medical Assistance Teams, or Community Emergency Responder Teams. Activities that simply involve registration are not sufficient.  MIPS eligible clinicians and MIPS eligible clinician groups must be registered for a minimum of 6 months as a volunteer for disaster or emergency response (IA_ERP_1).

Expanded Practice Access

This category wants clinicians to make medical care as easily accessible to patients as possible, by opening longer hours or providing different means of communication with the practice.

• Measure Example: Use of telehealth services and analysis of data for quality improvement, such as participation in remote specialty care consults or teleaudiology pilots that assess ability to still deliver quality care to patients (IA_EPA_2). 

Patient Safety and Practice Assessment

In this category, clinicians must ensure that they are implementing processes that will ensure that safe and quality care is provided to patients across the board, at every visit. Also takes into account population health management.  

• Measure Example: Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs (IA_PSPA_16).

Population Management

In this category, you focus on patient populations with chronic conditions. You are encouraged to come up with initiatives that will benefit your targeted populations, as well as the local community that you serve.

• Measure Example: Implementation of regular reviews of targeted patient population needs which includes access to reports that show unique characteristics of eligible professional's patient population, identification of vulnerable patients, and how clinical treatment needs are being tailored, if necessary, to address unique needs and what resources in the community have been identified as additional resources (IA_PM_11).

Which of these subcategories would be the most beneficial and feasible to implement in your practice? 

Leading Management Solutions provides MIPS Assistance and Reporting services. Learn more here: www.lmsmips.com and download a free MIPS E-Book containing valuable information and links to useful resources.

MIPS 2017: Avoid a 4% Medicare Reimbursement Decrease

By Sonda Eunus, MHA, CMPE, CPB

As the first year of MIPS reporting comes to an end, healthcare practices and providers don’t have much time left to learn about the Merit-Based Incentive Payment System and how it will affect their revenue and credibility. To make things simpler, I have put together some of the most frequently asked questions about MIPS.

1. How do I know if I am required to report?

Physicians (MD/DO and DMD/DDS), Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists that bill Medicare are required to report for 2017. If you meet any of the below exclusion criteria, you are not MIPS-eligible:

·         You are newly enrolled in Medicare.

·         You see 100 or fewer Medicare Part B patients per year.

·         You have less than or equal to $30,000 allowed Medicare Part B charges annually.

·         You are on the participant list for a model that CMS has deemed an Advanced Alternative Payment Model (AAPM).

Look up your participation status here with your NPI: 

https://qpp.cms.gov/participation-lookup

2. What happens if I don’t report at all?

If you are an eligible clinician who chooses to not participate in the MIPS program, you will face a 4% decrease in your Medicare payments in 2019. These payment adjustments will become greater every year, with a maximum penalty of 9% of your Medicare reimbursement. Additionally, every clinician’s score is publicly displayed on the Medicare Physician Compare website, for everyone to see. Having a low MIPS score can cost you patients, as well as can undermine your credibility with insurance payers.

3. What measures should I report on?

It is recommended that you choose measures that are most representative of your practice, such as those that apply to the patients you see or the procedures that you perform frequently to ensure you have a minimum of 20 cases. If possible, avoid reporting on quality measures that most clinicians generally perform well on across the board, because you may have to achieve nearly the highest possible score on the measure to receive more than the minimum number of points for that measure.

4. I am part of a group practice, what is the difference between reporting as an individual and reporting as a group?

For some multi-specialty practices, it may make more sense to report individually so that different quality or Improvement Activity measures may be used that will best fit each specialty. Also, in instances where individual performance may otherwise be unknown, individual reporting may be beneficial to ensure that bonuses or penalties are properly applied to individual physicians, rather than to the group as a whole.

On the other hand, reporting as a group may be easier than reporting individually. For practices that have been reporting as a group to programs such as PQRS, the transition to MIPS may be less burdensome if the practice continues to report as a group. Keep in mind, though, that bonuses or penalties will be applied to the group as a whole regardless of each individual clinician’s performance.  

5. I am a hospital-based physician, am I accountable for the same measures as outpatient clinicians?

A hospital-based physician is subject to all of the same MIPS rules as a physician practicing in other settings except that he or she is not scored on the Advancing Care Information (ACI) category. Instead, hospital-based physician’s MIPS score will be based on Quality and Improvement Activities (IA) in 2017.

6. When is the deadline to report?

March 31, 2018, but if you are reporting through your EHR then you should verify with your EHR vendor because they may have a different deadline. If you are using the claims-based reporting method, then you only have until Dec 31, 2017 to report. 

7. How can I track my performance?

CMS will provide data to help you prepare for MIPS. Many physicians have participated in the Physician Quality Reporting System (PQRS) and Value Based Modifier (VBM) programs to avoid payment penalties. CMS provides Quality and Resource Use Reports (QRURs) and feedback reports which you can obtain on the CMS website. All QRURs are available on the CMS Enterprise Portal: https://portal.cms.gov/wps/portal/unauthportal/home/. You may need to request the appropriate “role” in the system to view your QRUR.

8. Where can I find more information about the program?

Here are some great links to get started: 

·         https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html

·         https://qpp.cms.gov/

·         https://www.ama-assn.org/practice-management/understanding-medicare-s-merit-based-incentive-payment-system-mips

If you would like to download a free MIPS E-book that explains what you need to do to avoid a 4% Medicare payment decrease in 2019, as well as to earn a high MIPS score and Medicare payment increases, go here: www.lmsmips.com. You will also be able to see the payment adjustments that you may face depending on your MIPS participation level and annual Medicare revenue. 

Leading Management Solutions (www.lmshealthpro.com) provides MIPS consulting and reporting services. We will help you avoid a 4% penalty for 2017, and assist you in earning positive payment adjustments in future years. To schedule a free consultation, go here: https://calendly.com/lmshealthpro.

New Healthcare Policies/Regulations Which Affect Private Practices

Whether your private practice is in the health sector or not, it still will be affected by the health policies developed and changed. Below are some of the health regulations that affect the private practice.

No Lifetime Or Annual Limits On Coverage

There are varying health plans available for employees to take advantage of, some more generous than others. But even the most generous plans had maximum coverage limits of several million dollars prior to the passing of the health law. Some plans even feature annual coverage limits. The health law has since eliminated the coverage limits on these plans.

No Waiting Before Joining A Plan

Employers in the past could make their new employees wait for an indefinite period of time before they became eligible for coverage under the company’s plan. This is now a thing of the past. New health policies have made it that the waiting time for joining company coverage is nothing more than 90 days from the date of joining the company/business.

External Appeal Rights Are Guaranteed

Those consumers who for any reason disagree with the decision of a health plan to deny payment or benefits for their services, can proceed to appeal the said decision to an autonomous review panel. This health policy applies to new health plans without exception. This includes those that are provided by self-funding companies that cater to the claims of their workers directly and who were previously not included in the policy.

Coverage For Adult Kids Expanded

The health policy allows all workers to include their children in their health plans until they reach 26 years of age. This is irrespective of the fact that they may be married, living in a different state, or financially independent.

Standardized Plans Should Be Described

The health policy requires that all plans come with a summary of their coverage and benefits in a standardized format which allows consumers to understand the coverage and make comparisons between their plans.

These are some of the health care policies that will affect private practices. There are several but these are the main ones affecting private businesses and that to a large extent, favor consumers of health plans.

Leading Management Solutions is a healthcare management solutions company providing assistance and resources to healthcare management. Contact us today at (407) 674-1916 or visit www.lmshealthpro.com. to learn more.

About the Author:
Kristen Brady is the founder and owner of Kaboom Social Media, your social media marketing and content specialists! Follow her on Twitter: @kb54927

How Does Your Medical Practice Measure Up?

Working in a medical practice can be fun, stressful, hectic, rewarding, and draining all at the same time. After all, we are responsible for the health of our patients –they turn to us in their time of need and we in turn do our best to ensure that they are treated well and that their medical ailments are either cured or controlled. Sometimes it is hard to balance the provision of high quality medical care while also working on the growth of your practice. It is therefore important that some time is set aside specifically to analyze current operations and to do some strategic planning for the future growth of your practice. Our team at Leading Management Solutions has put together a list of questions to get you thinking and possibly identify some areas for potential improvement at your practice.

Do you have a well-known mission, vision, and values statement?

For a practice to achieve success, all employees must be on board with the practice’s overall mission and goals. It is important to instill your mission, vision, and core values in every employee, and to lead by inspiring your team to strive for greatness.

Do you have an existing strategic plan that lists your goals, actions, and identifies a responsible person and time frame for carrying out those objectives?

Until it is formally written down, your strategic plan is nothing but a set of ideas that may never come to fruition. It is important to have a written plan identifying the goals that you are trying to achieve, the actions that will get you there, who will be responsible for those actions, and by when these actions need to be completed.

Have you identified your strengths, weaknesses, opportunities, and threats?

Any organization must be self-aware in order to stay in business. It is important to know what your practice’s strengths are, as well as what areas of weakness exist that may be improved with new processes. Additionally, a practice leader must always be aware of potential opportunities or threats that may present themselves in the external environment.

Do you have a formal onboarding and ongoing training process?

A formal process for employee training is key to providing high quality services to your patients and to reducing patient frustration from avoidable mistakes. Training must begin from the first day that a new employee begins work, and must be pursued continuously to ensure that your standard of quality is held up by your whole team.

Do you utilize productivity bonuses for your staff? Your providers?

A successful productivity bonus system can help engage and motivate your employees to be more productive and more involved in their work. Additionally, a productivity bonus system for your providers can allow your practice to see more patients and increase revenue.

Do your former employees frequently file for unemployment?

All practices must deal with unemployment cases very carefully, to ensure that the practice is not paying benefits that are not their responsibility. It is important to always keep thorough documentation of any employee incidents or disciplinary actions in their files, to protect your practice from such frivolous cases.

Do you address uncomfortable issues that may be causing internal workplace tension?

Some bad habits exist within any organization, especially in employees that have been with the practice for extended periods of time and feel too comfortable or even untouchable. It is easy to turn a blind eye to such activities; however, this sets a bad example for other employees, as well as negatively affects your practice’s quality and performance.

Do you have job descriptions?

In order to hold an employee accountable for their work, detailed job descriptions must be created and signed by the employee upon hire. This prevents employees from claiming that they were unaware of a task that they were responsible for. If an employee is promoted or transferred to another department, a new job description needs to be created and signed.

These are just some of the questions that we ask when conducting a practice audit for our clients. We have found that many practices simply do not set aside enough time for formal strategic planning and reviews of current processes. Without being aware of the weaknesses that your practice may be facing, it is impossible to correct those issues, and you may be losing out on existing or potential new patients without even knowing.

For a copy of our free Practice Self-Assessment Questionnaire, email admin@lmshealthpro.com.

Leading Management Solutions is a healthcare management solutions company providing assistance and resources to healthcare management. Contact us today at (407) 674-1916 or visit www.lmshealthpro.com to learn more.

About the Author:

Sonda Eunus is the Founder and CEO of Leading Management Solutions, a healthcare management consulting company (www.lmshealthpro.com). Along with a team of experienced and knowledgeable consultants, she works with healthcare practice managers to improve practice operations, train employees, and increase practice revenue. She holds a Masters in Healthcare Management and a BA in Psychology.

Review of iHealth Clear- Talkative Blood Pressure Monitor

iHealth Clear joins the organization’s blood pressure monitoring product line with iHealth View, Sense, Ease, Feel, and Blood Pressure Dock for an affordable price of $99. This FDA-cleared tool has a smooth design and nice package. The well-crafted and light monitors with a streamlined, large 4.3-inch display come along with traditional cuffs.

As the picture above shows the numbers in big, clear fonts, its reading may be particularly comfortable for seniors. Also, I liked that its blood pressure readings are color-coded. Its range will go from dark green, which means “optimal blood pressure” until it turns red, which means “Stage 3 Hypertension. One other feature, its audible read-out also could assist the elderly in making sense of the result iHealth Clear offers an audio reading of a user’s diastolic, systolic, heart rate, and range your results fall under. That way, also individuals who have visual impairments easily can use this monitor.

iHealth Clear will measure blood pressure in 20 seconds!

Its monitor has a seamless application which is easy to use. It’ll support two users and may store around 2,000 off-line readings. Furthermore, it’ll compare your actual reading to prior measurements to aid you in making better decisions on treatment and prevention. It also informs you of the precise outdoor and indoor temperature.  

Online/offline measurement is a plus, and misleading buttons are a minus

iHealth Clear’s other benefit is that the monitor itself additionally displays the measurement; however, it may be wirelessly transmitted to a smartphone, as well. It may be vital if you consider that most digital health devices don’t display any results upon the gadget itself. Only their application transforms the raw information to digestible, little data packages. Thereby, the iHealth Clear may act as an offline and online device. It’ll build a bridge between the digital era and traditions like in the instance of EKO Core digital stethoscope.

Leading Management Solutions is a healthcare management solutions company providing assistance and resources to healthcare management. Contact us today at (407) 674-1916 or visit www.lmshealthpro.com to learn more.

About the Author:

Kristen Brady is the founder and owner of Kaboom Social Media, your social media marketing and content specialists! Follow her on Twitter: @kb54927

Could Artificial Intelligence Predict Whether You Will Die Soon?

University of Adelaide researchers have been recently experimenting with an Artificial Intelligence system which is stated to have the ability to know if you’re going to die. By reviewing CT scans from forty-eight individuals, the deep learning algorithms might predict whether they would die within 5 years with 69% accuracy.  The paper states that it’s “broadly similar” to human diagnostician scores. It’s an impressive accomplishment. The learning system was given training to assess more than 16,000 image features which would have the ability to indicate disease signs in these organs. Scientists state that their objective is for this algorithm to measure total health instead of spotting one disease.

However, this is merely the tip of the iceberg. Also, there’s an abundance of continuous research that teaches algorithms to detect a variety of diseases. IBM introduced an algorithm referred to as Medical Sieve eligible to help with clinical decisions in cardiology and radiology. This “cognitive health assistant” has the ability to assess radiology images to detect and spot issues more reliably and faster. IBM’s flagship artificial intelligence analytics platform, Watson, is also used in the industry of radiology. In 2015, after IBM bought Merge Health, Watson gained accessibility to millions of radiology studies as well as a vast quantity of existing medical record information to assist in training the AI in reviewing patient data and improve at reading imaging examinations.

Aside from IBM, other major players such as Siemens, Agfa, and Philips already have begun to integrate AI into their systems of medical imaging software as well. GE is creating a predictive analytics software utilizing components of AI for the impact upon imaging departments as somebody calls in sick, or if there is an increase in patient volumes. Vital additionally possesses a likewise work-in-progress predictive analytics software for utilization of imaging equipment.

Leading Management Solutions is a healthcare management solutions company providing assistance and resources to healthcare management. Contact us today at (407) 674-1916 or visit www.lmshealthpro.com to learn more.

About the Author:

Kristen Brady is the founder and owner of Kaboom Social Media, your social media marketing and content specialists! Follow her on Twitter: @kb54927

Cheap and Quick Medical Equipment

According to AdvaMed, (Advanced Medical Technology Association), it’s a known truth that healthcare equipment is very expensive. Overall spending upon medical devices within the United States reached around $150 billion within the year 2010, or around 5¢ of every healthcare dollar. Thereby, 3D-printing splints that healthcare facilities may utilize prior to surgeries or additional necessary healing means might result in saving large sums of money. Plus, there already are brilliant examples in the marketplace on how you can do it!

Finger splints

A Steinert High School senior, Ian McHale, crafted blueprints for generating finger splints.  One low-end three-dimensional printer may print the splint affordably and quickly, around two cents worth of plastic within roughly 10 minutes! For developing countries, in which splints often can only be ordered from overseas in bulk, it might mean the most affordable solution for poorer communities. It could easily serve personal needs at the same time.

Tumor models

Also, 3D printing may assist medical research and the results of complicated operations and particularly difficult cases. Scientists in the US and China both have three-dimensional models of cancerous tumors to help discovery of fresh anti–cancer drugs, as well as to better comprehend how tumors spread, grow, and develop.

Organ models

Also, researchers have utilized animal heart scans to develop printed models, and then added, on top of these models, stretchy electronics. This material may be peeled off a printed model and then wrapped around an actual heart for the perfect fit. Another step includes enhancing the electronics using several sensors.

How does 3D printed medical equipment save lives?

In 2011, Kaiba Gionfriddo was born prematurely. After eight months, the development of his lungs caused concerns, even though Kaiba was released to his parents when his breathing was normal. Kaiba, six weeks later, stopped breathing and turned blue. His caregivers printed a three-dimensional bioresorbable device which immediately helped him breathe.

Leading Management Solutions is a healthcare management solutions company providing assistance and resources to healthcare management. Contact us today at (407) 674-1916 or visit www.lmshealthpro.com to learn more.

About the Author:

Kristen Brady is the founder and owner of Kaboom Social Media, your social media marketing and content specialists! Follow her on Twitter: @kb54927

Diabetes Management in the Future

According to the most recent WHO estimates, 422 million individuals suffer from diabetes around the world – and that figure is steadily growing. That means that 1 person in 11 must manage the severe condition on a day-to-day basis, which may lead to amputation, kidney failure, heart attack, or stroke. Here are 3 ways diabetes will be managed in the future:

Digital Contact Lenses

Even though the search engine Google halted in the development of Google Glass, its augmented reality glass, they didn’t give up on blending technology and vision. Novartis and the search engine giant signed a contract to cooperate on the creation of the digital contact lens that was patented in the year 2014. According to their plans, through this lens, it is possible to gain more data from the digital realm plus it has the ability measure levels of blood glucose from tears as an extra benefit.

Gamification

Isn’t it more exciting to make the diabetes creature satisfied than to boringly measure levels of blood glucose? There already are companies that leverage on your inner child. These will include incredible applications for phones which may assist you in efficiently managing diabetes. An Austrian company, MySugr,  released a multitude of apps which may add a bit of gamification to traditional diabetes management applications. Watch the app in action: https://youtu.be/BTWqq1EZWFs

Artificial pancreas

Basically, the artificial or bionic pancreas will replicate a healthy version of how the organ performs on its own, and it’ll enable patients with diabetes to live a simpler life in a sustainable way. This device has the ability to constantly measure blood glucose levels and decide on the insulin delivery. Boston University engineers created a bionic pancreas system which uses continual glucose monitoring in conjunction with subcutaneous generation of both rapid-acting insulin, as well as glucagon as instructed by a computer algorithm.

Leading Management Solutions is a healthcare management solutions company providing assistance and resources to healthcare management. Contact us today at (407) 674-1916 or visit www.lmshealthpro.com to learn more.

About the Author:

Kristen Brady is the founder and owner of Kaboom Social Media, your social media marketing and content specialists! Follow her on Twitter: @kb54927

Virtual Reality Companies for Improved Pain Management

Firsthand Technology for relief of pain

Present chronic pain treatment primarily includes narcotics, the effectiveness of which is reduced over time. According to a variety of studies that were enlisted by Firsthand, virtual reality decreases the period of thinking about pain by 48%, whereas narcotics just by 10%. It’ll decrease the unpleasantness of severe pain by 38%, while this number is just 16% in the instance of opioids. In addition, the fun element of virtual reality isn’t comparable to that of painkillers: 983% boost in a “better feeling” vs. 33% reduction of joy when using narcotics.

The company based in San Francisco has been a portion of pioneering teams of researchers who’ve established the industry of virtual reality pain control and assisted in building the first virtual reality pain alleviation app, SnowWorld. Firsthand Technologies provide practical and affordable virtual reality hardware kits and their corresponding software, Cool! and Glow! Its first one will follow you on a path through changing seasons or a beautiful landscape, whereas the second allows you to draw amazing light creatures using your hands. The kits are available for single patients, and additionally for hospitals.

AppliedVR for decrease of pain in hospital settings

The start-up that was born out of Lieberman Research Worldwide, a global market research company, provides VR solutions particularly for hospitals. They perform clinical research around the effectiveness and usability of how virtual reality assists patients all throughout their healing journey, to better acquire, design, as well as make validated therapeutic virtual reality content more accessible at scale within medical settings.

They’ll brand themselves as a “Netflix” channel of validated therapeutic content. Top hospitals in virtual reality ongoing trials and research, like the Cedars-Sinai Medical Center within LA, Children Hospital in Boston or UCLA partnered up with appliedVR to test the advantages of the technology for instance in decreasing labor pain.

Leading Management Solutions is a healthcare management solutions company providing assistance and resources to healthcare management. Contact us today at (407) 674-1916 or visit www.lmshealthpro.com to learn more.

About the Author:

Kristen Brady is the founder and owner of Kaboom Social Media, your social media marketing and content specialists! Follow her on Twitter: @kb54927

Virtual Reality Companies are Changing Psychology

Here are the top 3 virtual reality companies bringing change to psychology:

Psious now treating phobias of human beings differently

The American and Spanish behavioral health technology business, Psious provides special treatment for psychological conditions like fear of needles, flying, a variety of animals, general anxiety, public speaking, or agoraphobia. With the assistance of VR, patients will get into situations that are fearful for them under the consistent control of a doctor. Their job includes facing their fears and slowly allowing them to go, while their imagination is assisted by virtual reality. So far, the results are more than encouraging!

Virtually Better provides virtual reality exposure therapy for phobias, depression, or anxiety

The pioneering virtual reality company founded in 1996, Virtually Better, provides, among others, an exposure therapy for those who suffer with anxiety disorders, PTSD, and certain phobias. The technology permits clinicians to circumvent most of the challenges related to other kinds of exposure therapy; as well as treat problematic areas which many clinicians merely lack the resources to efficiently treat. In most cases, it’s just not enough to tell a patient to imagine her or his biggest fear to resolve the problem – otherwise a patient wouldn’t actually require the intervention of an expert.

Bravemind frees soldiers from PTSD

Even though not only soldiers and war veterans experience PTSD (post-traumatic stress disorder), but also abuse or sexual assault victims, Bravemind is mostly for combat-associated PTSD.

This VR Exposure Therapy was created by a science team with the University of Southern California. It’ll permit clinicians to slowly immerse patients inside virtual environments that are representative of their traumatic experiences within a stepwise, controlled fashion. They’ll control the multi-sensory emotional stimuli that patients receive, as well as observe the intensity of a patient's stress responses through psychophysiological assessment methods and advanced brain imaging.

Leading Management Solutions is a healthcare management solutions company providing assistance and resources to healthcare management. Contact us today at (407) 674-1916 or visit www.lmshealthpro.com to learn more.

About the Author:

Kristen Brady is the founder and owner of Kaboom Social Media, your social media marketing and content specialists! Follow her on Twitter: @kb54927

How Much is Your Untrained Employee Costing You?

Your medical practice is only as strong as its weakest link—employees who lack training and make your practice look unprofessional can negate all of the effort and hard work from the rest of your team. Lack of training causes low productivity, an unsafe work environment, and increased expenses. Frequent mistakes not only cause patient frustration, but also coworker frustration: the coworkers have to clean up the messes that untrained employees create. Untrained employees can lead to serious financial and legal consequences. For example, a survey showed that 44% of the participants admitted to having shared sensitive company information because they “wanted to bounce ideas off of people”; 30% did so because they “needed to vent”, and 29% stated that they “did not see anything wrong with it.” These statistics show just how risky it is to have an untrained employee who can easily commit HIPAA violations for which you will be held responsible. When patient PHI has been compromised, the practice can face overwhelming financial penalties—and can even face criminal charges, depending on the nature and severity of the violation. A recent study shows that security breaches cost the healthcare industry $5.6 billion annually. The OCR has capped the fine for a severe HIPAA violation with no intent to correct at an annual maximum of 1.5 million dollars; however, even a fraction of this amount can seriously impact the financial stability of any practice.

Aside from HIPAA violations, untrained employees can cost you in many other ways:

Accidents or injuries while on the job: not only can an untrained employee injure himself while working, and seek financial compensation from your practice, but they can also create risky situations for other employees or even patients. Furthermore, accidents can lead to broken equipment, wasted supplies, and many other negative consequences. All such adverse incidents must be remedied and documented by the practice manager.

Bad customer service: every employee represents your practice. If an untrained employee provides bad customer service, displays a negative attitude, or is unable to answer common patient questions, it makes your whole practice look unprofessional and can cost you patients. When patients leave your practice due to subpar customer service or unknowledgeable staff, more often than not they will let their frustration be known to their friends and family, on social media and on Google reviews—leading to you losing even more patients and credibility.

Not collecting enough money from patients: If your untrained employee is a receptionist who is scared to ask patients for their co-pays or unable to explain patient balances, you will lose a significant chunk of money that should have been collected at check-in. Patient responsibility amounts have been climbing, and are now at around 23% of all A/R—and these balances are the hardest to collect if not collected at the time of service. If your untrained employee is a biller who improperly verifies a patient’s insurance—or does not verify it at all—and the patient gets seen, the practice loses money on that patient, whether by not collecting any money at all or by spending time and resources collecting it.

Not billing properly: no matter how amazing your providers are, how friendly your front desk receptionist is, or how caring your nurses are, your practice will not be able to operate if your billing department is not bringing in the revenue that you have worked so hard for. For example, an MGMA survey shows that better performing practices in primary care have an average Days in A/R of 23.54 days, as opposed to other practices who average 39.56 days. If your untrained billing staff is not following up on claims efficiently, many of your claims run the chance of being denied for untimely filing—causing you to lose large amounts of money. 

Additionally, more so than in any other field, employee mistakes in healthcare can be deadly. Medical errors have been found to be the third leading cause of death in the US, with over 250,000 deaths per year caused by such errors. Some of the most common mistakes made by untrained healthcare employees include medication errors, infection issues, and charting or documentation mistakes. As we all know in healthcare, if it was not documented, it didn’t happen. This mistake may seem minor and easy to correct—if caught. However, if an untrained nurse forgot to document an allergy that a patient had, and the patient had a severe allergic reaction to the course of treatment provided, your medical practice as well as the individual provider treating the patient is now at risk of a malpractice suit—which comes with attorney fees, incurred financial losses, a damaged reputation, and higher malpractice insurance premiums. And this is only one way in which a documentation error by an untrained employee can lead to dire consequences.   

Each of your employees directly represents your practice. The costs of not training your employees are too high for this to not be a priority for you. If you do not already have one in place, implement an onboarding and training process for all new employees—a general one for all new employees which introduces them to your practice mission, vision, core values, and goals, as well as a role-specific training process for each new employee to learn the intricacies of the position for which he or she was hired. Ensure that your training does not stop at new employees: existing employees need continuous training as well. Find a way to make it fun as well as informative—no one wants to sit through the same boring training routine over and over again. Although a new onboarding and training process may take some time and manpower to develop, the benefits of having such a program in place will be worth the effort exponentially when every employee at your practice is knowledgeable, professional, and on board with your practice’s vision and goals. 

For assistance in setting up your practice’s onboarding and training program, contact Leading Management Solutions to set up a free consultation.

About the Author:

Sonda Eunus is the Founder and CEO of Leading Management Solutions, a healthcare management consulting company (www.lmshealthpro.com). Along with a team of experienced and knowledgeable consultants, she works with healthcare practice managers to improve practice operations, train employees, increase practice revenue, and much more. She holds a Masters in Healthcare Management and a BA in Psychology.

https://www.linkedin.com/in/sonda-eunus-6895067b