The True Cost of A Doctor Appointment

The medical service your patient receives is only part of the patient's overall visit experience. Patients use many metrics to "score" the customer service, AND, the overall value they receive.

Value is the result of three components: Price, Access and Quality. Price goes beyond the cost of the professional services. If one considers the time element incurred by patients, the overall cost rises.

Consider the average patient:

• First they have to take time away from work in transportation time, 30-45 minutes one-way,
• Second, most patients find themselves waiting too long in the waiting room, then the exam room, before actually seeing their doctor, 45-90 minutes,
• Next comes the check-out process that may include making a follow-up appointment, 15 minutes,
• Lastly, their commute back to work, 30-45 minutes.

All totaled, and in the best case scenario, the patient loses 2 hours at work. Depending on their hourly wage, the cost to the patient is certainly more than the professional fee they pay to the practice.

Being sensitive to the patient's time is an under-appreciated aspect of customer service and the overall value patient's perceive when they see their doctor. Creating a patient oriented attitude in your office, including expectations to run on time are key elements to providing customer service your patients will appreciate.

Providing exceptional customer service is always good for business!

Is HealthCare Reform Dead?

It has certainly been in interesting political week! With Scott Brown's from Massachusetts election to the U.S. Senate, many a political pundit, both right and left, is guessing what comes next. Speaker of the House Nancy Pelosi says there are not enough votes in the House to pass the Senate's bill. Cap and Trade legislation appears to be questionable. And, President Obama focused his attention to banking regulation reform, much to the displeasure of Wall Street; the markets dropped about 5% in just three days. So what does all this mean for the physician-owner?

While Washington politicians scramble for cover, physicians may be feeling a sigh of relief. I, too, feel somewhat relieved, but I do believe reform in one form or another is in our future, both as a country, a small business owner and for the practicing physician.

The best defense to the changing political and business environment is to have solid business processes in place within your practice. Ensuring your business is fiscally sound, fully trained and competent staffs, as well as a patient outreach program should be your focus for 2010. When healthcare reform occurs, and I believe we will see some type of reform, proactively managing your business always makes good sense.

While we are still in early 2010, consider taking actions to improve your profitability now. Some of these actions are:

• Schedule a financial review meeting with your office manager/administrator,
• Develop a working budget for your practice,
• Develop training events for your staff; clinical, customer service, business process,
• Create a patient communication outreach program. Review you current marketing, advertising and communication plans. Consider revamping your internet presence.

Mr. Rosser has been a featured speaker for a variety medical societies and organizations. He received his Bachelor of Science degree in life sciences from North Carolina State University in Raleigh, North Carolina and has completed numerous management and industry courses offered at University of California, Irvine, and the American Management Association. He is an active member of the Medical Group Management Association and is an Advisory Board Member of the Association of Dermatology Administrators and Managers. Mr. Rosser received the Consultant of the Year, the highest recognition award, from Allergan.

An Interesting CONNECT Week

I have blogged several times about Primoro, Inc.'s CONNECT offering and this week was no exception. Primoro, Inc. installed CONNECT systems for two of Fayette County's non-profit organizations, Fayette Care Clinic, Inc. and Fayette Youth Protection Homes, Inc.*. Fayette Care Clinic provides medical care for the working poor in our county and Fayette Youth Protection Homes provides shelter for neglected and abused children. Both organizations provide needed services, have many volunteers and needed a way to more effectively and inexpensively communicate activities, programs and fund-raising events for their organization.

CONNECT represents a wonderful opportunity for businesses to use new internet technology, commonly called WEB 2.0, to house, host and create an outreach through the internet. Using tools such as blogs, video and social networking sites (e.g., Twitter and Facebook) provides businesses the affordable and nearly instant communication they are looking for. And best of all, once connected, your businesses can, and do, use these tools at no ongoing costs. Some businesses choose to use for-fee services to help maintain the system, usually a monthly fee that runs about $99 per month. In any case, using these technologies should be part of your annual advertising and marketing budget.

Ten years ago, a business could barely get by without a web presence. Today, having just a website is just not enough. Consider getting involved with what internet technologies can help you maintain and grow your customer base.

* The CONNECT systems were donated by Primoro, Inc.

Employee Work Performance Evaluations

Do you conduct employee work performance evaluations (WPEs)? If you don't, you should. For those of you who do conduct WPEs, when do you conduct these evaluations; on the employees hire date anniversary, or do you conduct WPEs for all of your employees at the same time each year?

Conducting employee WPEs is a crucial component to staff management, AND, serves as a building block for overall practice performance enhancement. In short, if your employees are not evaluated, they tend to perform at "meets expectation" levels or below. If they are evaluated as compared to their job description, and as compared to other employees, you create the sense of urgency for them to create and maintain the level of performance your patients expect.

Conducting employee reviews at the employee's hire date anniversary is used by many medical offices. While this represents a better option as compared to not doing one at all, most medical practices would benefit from conducting WPEs for all employees at the same point in time. The

rational is both practical and has sound financial considerations.

From a practical perspective, conducting annual WPEs for all employees a the same time insures no employee is overlooked in the process. It also ensures all employees are evaluated over the same time frame. Lastly, as the evaluation date should be publicized, your employees are never caught off guard and can participate in the overall evaluation process.

From a financial perspective, the physician-owner can avoid "wage creep." Wage creep occurs when the employee receives a merit increase where no basis exists, and, the percentage or dollar increase decision is made in a vacuum. Conducting annual evaluations for all employees at the same point in time each year provides comparisons to other employee performance. Further, I always recommend the medical practice conduct these reviews in February, or early March. Why? Well, first, early in the year sets the stage for employee performance improvement. Secondly, you should have your prior year's financial results to help you determine what percentage increase in wages is reasonable as compared to the practice's financial performance.

Conducting WPEs is an owner's opportunity to reward an employee's performance. It is also a time that you can help your struggling employees with their development. It is a key management responsibility and one that should not be taken lightly.

As a reminder, Primoro, Inc. offers clients comprehensive management consultation, including job descriptions and employee work performance evaluations strategies.

Job Descriptions 2010 Update

With the new year here, it is a good time to update your job descriptions and start preparation for your staff annual reviews.

Relevant and current job descriptions are the basis for developing employee accountability and the foundation for all aspects of employee evaluations, e.g., promotions, dismissals, etc. Having good job descriptions just make good business sense. Steps to designing, writing or updating job descriptions can be a time consuming chore for your office manager. There are some good job descriptions available to medical providers through various vendors, but they can be expensive. One internet vendor is charging upwards of $400 for a CD of various medical office job descriptions.

Steps to creating relevant job descriptions are:

• Careful consideration to the actual job function requirements, and not necessarily what your employee does.
• Establish 3-4 key measurement areas and the activities required in each of these areas.
• Determine the relative importance of each measurement area and assign a percentage weighting to that area, e.g., Medical Assisting, 80% weight.
• Gather input from employees to the functions performed each day. If an employee reports a function they perform, but is not truly their responsibility, reassign that function to the proper job description.
• Once you job descriptions are complete, make sure you employees review their own job description and sign off that they have read and understand their daily job function.

Primoro, Inc. provides its clients with complimentary job descriptions as part of the comprehensive consultation process. In addition, Primoro, Inc. works with medical practices on establishing employee annual review processes that meet the needs of individual clients. Should you have questions about job descriptions, or are interested in implementing a formalized employee annual review process, please give Primoro, Inc. a call.

Welcome to 2K10!

Well, 2009 is past and 2010 is here. I for one am looking forward to a very good year filled with challenges and successes. Year 2009 ended with the US Senate passing their version of healthcare reform. Now, the two houses of government are set to merge both the Senate and House of Representatives versions of healthcare reform into one singular piece of legislation. The final outcome is yet to be determined. In any case, you the physician-owner is challenged with providing medical care in an environment of uncertainty.

It is safe to assume that physicians, hospitals and other healthcare related outlets will bear to brunt of reform. Whether that brunt is reimbursement related, or, new regulations complete with inordinate paperwork, the physician-owner must be efficient. Taking advantage of services that can help you with that endeavor is paramount in light of this upcoming legislative change.

Sadly, since most of the healthcare reform changes, aside from taxation, will be several years off, most providers will begin 2010 with a "business as usual" attitude. The successful practices will instead start planning and implementing business practices that maximize their opportunities for success in future years. Here are few things to keep in mind as you plan your business activities in 2010:

1. How efficient is your practice in serving your existing patient base, including your capacity to see patients, your staff's capacity and your physical space?
2. Have you conducted a SWOT (Strengths, Weaknesses, Opportunities & Threats) analysis for your practice?
3. Have you established your strategic plan for the upcoming 5 year period?
4. Have you updated your Vision and Mission Statements?
5. Does your staff live up to the Vision Statement and execute your Mission Statement?
6. Have you started evaluating 2009 financial performance? If not, get the final P&L and Balance Sheet statements before the end of January!
7. Schedule a meeting with your advisors, legal, accounting, marketing, and other consultants. Conduct your own strategic planning session with all key practice stakeholders.
8. Lastly, spend some time alone thinking about your long range goals, personal and professional.

Wishing you a very successful and fulfilling New Year!