Top 5 Posts for 2009

As 2009 nears its close, I thought it might be useful to recap the top five posts from PrimoroBlog. I have enjoyed getting Primoro, Inc. and the PrimoroBlog up and running this year. I look forward to continuing this blog and providing medical providers useful information and insight to better medical practice management.

Review of the various analytics reports presents valuable information about which topics are of most interested to you. As such, stay connected in 2010 for more detail on the most popular topics. Without further ado, here are the top five!

1. Empowering Others to Act - This blog touched on one the aspects of leadership excellence. Leaders set the agenda and provide the circumstances by which others take ownership of their tasks.
2. Practice Performance Surveys - Practice Performance Surveys are the single best way to learn how your practice performs and is viewed by your customer. This topic always rates high on the interest scale. Most practices are truly interested in providing good service, but simply may not know how to get started. Also, some third party payers require performance surveys to established reimbursements.
3. First Impressions - This blog also discusses Practice Performance Surveys. I wrote this blog in response to an example of poor customer service I received. Business owners, doctors included, should realize that referrals come many sources. These sources include: patients, staff, delivery people, drug reps, etc. A bad first impression is hard to overcome.
4. Connect Questions - Medical providers are very interested in taking advantage of Web 2.0 capabilities. Primoro, Inc. offers medical practices CONNECT, a patient communication tool that utilizes social networking sites as a distribution method of the practice's message. Using social network sites can be confusing and misunderstood. Using CONNECT and other Web 2.0 technologies maximizes your marketing and advertising budget, requires much less personal time than you might think, provides timely patient communication and produces improved bottom line results.
5. Medical Practice Patient Flow Improvement - The title speaks for itself. Improving patient flow provides greater patient satisfaction, happier staff, and better bottom line results. If you think about it, patients want to get in and get out in a timely manner, and, your staff wants to finish on time each day. Taking steps to improve your flow helps you achieve these goals and produces improved financial results from increased revenues and by reducing per patient fixed overhead costs.

That's it for the top five. Thank you for spending a bit of your time with PrimoroBlog. From all of us at Primoro, Inc., have a very Happy (and safe) New Year!

Medical Office Design and Architecture

Over the past weeks, I have blogged about improving efficiency within the medical practice. Most offices are adequate, yet there is always a way to improve the flow. I commented in my last blog about an office with poor distinction between check-in and check-out. Their solution was to install a check-in kiosk that created a defined check-in space and better enhanced the check-out flow. This solution was relatively simple, others may not be.

For those of us in Georgia, we are fortunate to have several architectural firms that specialize in medical office design. While these firms are located in Georgia, they do work nationwide. It is of extra benefit that they are located in our part of the country.

So, as you are considering your plans for 2010, and if you are considering new office space or an office remodel, consider bringing in the experts in design that can truly benefit you patient flow.

Medical Practice Patient Flow Improvement

Improving your general operational processes can lead to greater patient satisfaction, happier staff and financial benefits.

Many medical practices are aware of the symptoms of inefficiency as it relates to patient flow. Inefficiency is best observed by patients not being seen at their scheduled appointment time and the back office staff rushing to complete the morning or afternoon clinic sessions on time. There are a number of factors that contribute to these inefficiencies and every office is different. One this is for sure, failure to address patient flow inefficiencies leads to poor patient retention and makes getting referrals more challenging. I have said many times in this blog that delivering excellence in customer service is always good for business. As such, improving your patient flow is a key metric of customer service.

The three key elements that have the greatest impact on your patient flow and efficiency are:

• Physician capacity
• Staff capacity
• Physical space and layout

Making sure you have these elements optimized will improve your efficiency. A client of Primoro recently conducted a Practice Performance Survey. The patients reported that the check-in/check-out area was confusing. In their case, check-in and check-out areas were poorly marked and patients did not easily recognize which area did what. This is a good example of how a less than optimal physical space hampers efficiency. It also created a less than optimal customer service impression. A simple, and relatively inexpensive, fix was to construct a new welcome station kiosk to check-in patients. This solution afforded better flow, and, improved patient privacy. I suspect, it also provided a better customer service impression.

Take a look at your office from your patients' point of view. Does the flow really work? Sometimes a simple fix is all it takes!

If you need more information on this topic, please contact Primoro, Inc.

CONNECT Questions

Over the past weeks I have been asked about Primoro, Inc.'s product CONNECT. The most common questions deal with,

1. How much time does it take each week to managed a blog and the social network distribution?
2. How comfortable should you be when connecting your business to your favorite social network?

Time required to manage the CONNECT product is relatively little. That's quite a surprise to most clients. After you learn the system, and that's very easy, the time spent each week can be as little as 10-15 minutes. In fact, writing blogs is where the bulk of that time is spent. Remember, blogs are intended to be short and concise information that most customers can digest in about 60 seconds. That converts to about 250-300 words.

The second question may be concerning to some, but it shouldn't. CONNECT provides for "business sites" on the social networks. And it is these business sites where your message is found by your patients. Facebook is the one exception. Yes, you still have the business site, but your blog message also appears on your personal site. Frankly, that is probably a good thing as it doubles your presence on Facebook.

The biggest benefit of using CONNECT is the ease at which your message is delivered. For you, it is as simple as a word processor and clicking the "publish now" button.

Lastly, a side benefit of CONNECT is the increase in your internet presence. Instead of having only one presence, your website, you now have your blog, Facebook, Twitter and LinkedIn, all reaching your patients and potential patients.

First Impression

Making a good first impression is good for business. One of the best ways to measure your first impression is to ask you patients about their office experience, e.g., a Practice Performance Survey. Most offices find that by asking patients about their appointment experience, through an anonymous survey, results in frank commentary .

Most surveys offer a combination of numeric scores and comments. While the numeric scores are telling, especially when compared to known national benchmarks, I have always found the comments the most valuable component of the survey. Patients very often reward their surveyor with good scores, but offer honest critique with their comments.

It is important to realize that the respondents fall into two categories; those that had a wonderful experience, and those that had a less than desirable experience. Generally speaking, patients with an average visit almost never complete the survey. The two extreme groups though is what offer the best insight as to what you are doing well and what is not going well relative to the customer service your office is providing.

Changes in our healthcare system may create a requirement for practices to conduct routine patient satisfaction surveys. These changes may also create a financial penalty for practices that fall below some established benchmark. I know of one healthcare association today that does in fact financially penalize those individual physicians that rank poorly relative to other association members.

The fact is, excellence in customer service is just good for business. While there may be some upfront costs to improve your customer service, these costs will more than pay for themselves with increased patient retention and new referrals.

Surveying your patients is the first step in developing the habit of providing quality customer service. There are many surveys available, so take advantage of them. If you have any questions about conducting a survey, Primoro, Inc. is here to help.

Was It Cyber Monday, or Cyber Month?

If you paid attention to the news this week, you probably heard the term "Cyber Monday." This is the name given to the Monday following the Friday after Thanksgiving, "Black Friday," that loosely defines the date that most retailers' businesses move into the black. "Cyber Monday" is the term associated with "e-retailers" that loosely marks their increase in sales leading up to the December Holidays.

This is all very interesting, but what does it have to do with medical practices. Well, a new development in "Cyber Monday" is e-retailers use of social networks to reach their customers. In fact, Facebook and Twitter appear to be the social networks of choice when communicating to customers about sales. Thus, social networks represent a key way that consumers learn about the businesses they frequent and use.

As such, social networks offer a tremendous opportunity for medical practices to reach their existing patients and to touch potential patients. If you are using social networking as part of your overall marketing mix you are ahead of the game. If not, you might consider getting involved.

Primoro, Inc. offers medical practices "CONNECT." "CONNECT" utilizes a blog site as the primary communication tool, then distributes the message via the big three social networks: Twitter, Facebook, and LinkedIn. Each of these social networks has their place and reaches their own defined demographic.

For more information about social networks and "CONNECT," please feel free to contact PRIMORO, INC.

Don't Be Uneasy

Experience has shown me that most office staff members are uneasy when a business consultant is working at their practice. They may fear that the consultant may find something that is not being processes correctly, fearful of losing their job, or, at the very least, is going to create additional work to be done. Well, nothing could be further from the truth!

It is fact that consultants do review current business processes and make recommendations for improvement. It is also a fact that most of these recommendations result in better efficiency and an office that runs more smoothly and on time.

My consulting practice works in many areas of medical practice management, but specializes in office flow and efficiency. This aspect of practice management affords benefits for physicians, staff, and patients.

• Physicians benefit from improved patient flow that very often results in more patients being served in the same time period. That means more revenue for the practice.

• Staff personnel benefit by having an office that finishes on time at the end of the day. They also benefit from having an advocate for their issues.

• Patients benefit by not having extended "wait time" in the reception area. Most patients appreciate the "get in/get out" when comes to seeing their doctor.

Lastly, the best value a good consultant brings is the visibility of the best operations of the best practices in the area. Having someone to advise you on how to better compete, provide better customer service, train and develop your personnel, provide the support for tasks your staff does not have time for, are all good reasons not to be hesitant when a consultant calls on your office.

Vision - Imagine Your Design

I had lunch today with a financial advisor friend, and we got to talking about business - his and mine. What we discovered is that our businesses are not all that different from each other. Our discussion moved from general topics to the one of "vision." In his case, he deals with client's vision of their financial futures, looking at all the various financial instruments from insurance of all types to estate planning and retirement assets. In my case, Primoro focuses on your vision for your business.

The question is, "Do you have a vision?" You probably are looking for financial security for now and the future. You also want to have a successful and well respected practice within your community. But the questions still remains, "Do you have a vision?"

Developing a vision first requires you to look inwardly discovering your goal. And yes, that's singular. What is the singular goal you have for your practice? To help you get started with discovery, considered these factors:

• What challenges do you face in reaching your goal?
• What opportunities exist that will help me reach my goal?
• What relationships do I currently have, or, need to establish to aide in reaching my goal?
• What experiences do I have that puts me in the best position to reach my goal?

I have long been an advocate for medical practices to develop and institute a strategic plan. Conduction a strategic planning session in your practice goes a long way in ensuring your goal is aligned with your partners. If you are a solo physician, a strategic planning session can aid you in teasing out your real objective. In any case, a strategic planning session forces the development of a Vision Statement. This statement then becomes the overarching tenant on how you, and your staff, function with everyone reaching for the established goal.

New Client Offer

Primoro, Inc. offers new clients a complimentary one hour consultation. To take advantage of this offer, simply click here and fill in your contact information.

Patient Communication via Web 2.0

Many of us are using the internet to present to the community information about ourselves and our businesses. In recent years the term Web 2.0 has come on the scene. Though the term suggests a new version of internet programming, it really suggests the changes by which software programmers and users of the internet interact with "the web." In short, Web 2.0 is associated with programs that enable interaction, e.g. information sharing. Some examples of Web 2.0 include social networking sites (Twitter, Facebook and others) pod casts, blogs, video sharing, etc. In contrast to static websites, which most of us use, Web 2.0 enabled websites allow for users to interact with the website, or in our case, our businesses via the internet.

Internet marketing seems to change and modify every day. As such, it is important for business owners to stay on top of these updates and to take advantage of internet marketing. Using social networks is just good business today. In this blog, is a form of Web 2.0 as it can be reached through Twitter, Facebook and LinkedIn, social network sites. And it is done with a single press of the "Publish" button. The programming feeds do the rest.

Using social networks in a 1 by 1 fashion is time consuming. Instead, using existing Web 2.0 programming makes it a breeze. I have long been an advocate for blog production instead of newsletter (paper or email) production. In a blog, you are writing only 250-300 words per blog, and composing separate blogs 1-2 times per week. This method of customer communication creates the constant contact that most businesses are looking for. As a side benefit, utilizing blogs, and other Web 2.0 capabilities, increases your overall web presence. And that what most of us are looking for.

For more information about Web 2.0 capabilities and CONNECT (a Web 2.0 blogging system), simply contact Primoro, Inc. to set up an appointment.

Practice Performance Data

Data collected from the Practice Performance Survey is very revealing. Medical practices are served well when they receive feedback from their patients.

Medical providers typically view the quality of medical care they provide as the only metric used by patients in evaluating their doctor. In contrast, most patients use a variety of metrics in the evaluation. Components such as price, access and quality are the metrics patients use to determine the value of the service provided.

Conducting a Practice Performance Survey gives us insight to the patient experience. For example, in survey that Primoro, Inc. is conducting, patients report that they use the telephone to make their appointments. The physician recently installed a telephone system to help direct patient inquiries. The system, one of those "Press 1 for this, Press 2 for that," has now created a sense of frustration for patients. The fact is, most patients, and the generally population, hate these systems. Customers much prefer to talk with a live person than to some machine.

With this survey data in hand, the practice is now positioned to create an alternative, more customer focused, telephone system. I generally recommend physicians hire an telephone operator to manage inbound calls. Most practices shutter at the overhead expense. This decision now becomes a choice between true customer service vs. an expense line on the P&L. I would argue that providing true customer service is always beneficial to the P&L.

Of course, all practices are different, with different needs. Thus, don't go out an hire a telephone operator without an office evaluation or Practice Performance Survey. Instead, consider conducting a survey to get your patient's feedback about your practice as your first step in providing better patient/customer service.

Patient Flow and Efficiency

Few medical practices have a scheduling strategy that maximizes the hours spent in the practice. Developing and implementing a strategy for your schedule provides the opportunity to operate in a fashion that produces better patient satisfaction, happier staff, and provides you, the business owner, a better quality in your professional life and better bottom line results.

I written on this topic in prior blogs, but bears repeating. In the current economic environment, physicians are looking to increase their patient load to help offset changes in reimbursement. Most do this without regard to their office's capacity to accommodate the extra flow. Capacity is defined as a physician's patient-time requirement, the staff's ability and talent, and the physical layout of your office.

You can locate any number of consultants skilled in evaluating your current schedule and staff competencies. You can also find architectural firms, such as Practice Flow Solutions, that specialize in medical office design.

In brief,

• Define roles and responsibilities with accurate job descriptions.
• Perform annual evaluations of your staff's performance ensures they are fulfilling the job requirements.
• Training, training, training. Too many practices pay too little attention to staff training.
• Train your reception staff to the extent you train your back office staff. Remember, they are setting your schedule. It is important for them to understand the time requirement for new patients vs. post-op checks, vs. more complex patient issues.
• Evaluate your own performance. Check your patient encounter count for the first six months of this year. How many patients did you see?
• How often did you end each patient session on time? Be honest. If you are comfortable seeing four patients per hour, don't schedule six without regard to your overall capacity.
• Consult a specialist. Don't underestimate the value a good consultant can bring. Good consultants more than pay for themselves with improved patient flow.

Here's a simple formula for you. Take your net collections for the first six months of 2009. Now divide that number by the total number of patient encounters. This gives you net collections per patient encounter. Or, in other words, this is the value to the practice every patient represents when they see you. Now, if a consultant can help you see one extra patient in the morning session and one extra patient in the afternoon session, well you do the math. Over the course of one year, the added income could and should more than pay for the consultant and any additional overhead.

All the Best.

Consultants, Consultants, Consultants Everywhere!

These days you are liable to run into consultants everywhere. In fact, I recently visited an office and the office manager's response to my introduction was "Been there, done that." Upon inquiring to her response, she explained they had used a consultant in the past and were not happy.

I do not want to debate whether or not her prior consulting experience was good or bad, but consultants are like others in the workforce. There are good ones and bad ones. A fundamental skill for a good consultant is their ability to listen and to distinguish the salient points of the discovery process. Often times business owners tell a long story of their perceived issue; it is the consultant's role to assist the business owner in separating the true issue from extraneous supportive arguments.

Finding a good consultant for your business is not necessarily the easiest thing to do. Consultants come with diverse backgrounds and experience. Consultants very often specialize in one business area or another, e.g., human resources or financials.

I have used consultant myself. My preference is to find a local consultant; someone who is available when I need them, not when is is convenient for the consultant. Also, beware of the consultant with motives other than you best interest at heart. Look for a true professional consultant without biases. I understand that large corporations have started to offer consulting services. These services are often "free," but we all know there is no "free" lunch. There is always a string attached.

Consider hiring a fee for service consultant. In most cases you will be pleased you did and your bottom line will show it.

I Just Had to Write About It

I had a meeting scheduled today with a client and while waiting, I overheard the receptionist/business manager tell a vendor, "Well, Dr. X can't see you today, he's too busy!" While the physician may be running late in the schedule, it struck me odd that the vendor was the recipient of the outburst...in front of waiting patients no less. I asked this person, "What gives?" Her response was, "Well, he's just a salesman!" Her response to me makes me wonder two things:

• Where does customer service begin and end? Is customer service excellence reserved only for paying customers and not for other business contacts with the ability to refer new business to the practice, and
• Is this the response the physician would expect of his/her receptionist? I suspect not.

Most medical practices provide good customer service, but too often, they overlook the referral opportunities that happen nearly every day. Think about it, vendors and sales people live and work in your community. Why would you ever choose to treat them so curtly and with little respect? Believe it or not, medical salespeople are always asked for a referral by a family member or friend, and believe me, they do make recommendations to these acquaintances.

There are times that salespeople come to your office when you simply do not have time to see them. That is understandable. Extending solid customer service to salespeople and other vendors is not that hard. In fact, it's simple. A smile and kind word, a simple explanation of the day's circumstances is all any vendor needs. Demonstrating the courtesy they deserve is no more than what we would expect. Extending your customer service efforts to paying customers and other business contacts is just good business.

Office Efficiency

This week a client asked me, "Robert, just how do you make an office more efficient?" Well the answer is my favorite answer, "It depends." That sound like a flippant answer, but it is so true.

Every medical practice operates in differently and, thus, recommendations to improve one office's efficiency differ from the next. The most common cause of inefficiency and area to improve is the physician's patient schedule.

First, is the physician's scheduled based on seeing a given number of patients per hour? If so, you probably are not taking into consideration the reason for the patient visit. We all know that a new patient requires a bit more physician time and should therefore be schedule for a longer appointment. A general rule of thumb is have three distinct time slots for the schedule. For now let's call them brief, intermediate and long time slots. By establishing this type of schedule, you can better take advantage of the physician's time while respecting the patient wait time.

There is a catch. Implementing a variable time schedule requires training for your schedulers. It becomes their responsibility to properly triage patients as they schedule the appointment. Some of you may be thinking, "this is impossible," but believe me, with proper development and training; your staff can become quite adept at properly scheduling patients in the proper time slot.

Secondly, I am a big believer in arranging the schedule with two "brief" appoints at the top of each hour in any given clinic session. This is particularly important for the first appointments at the start of the day and first appointments after lunch. Having these brief appoints at these times aides the staff in getting into the swing of that session.

Thirdly, NEVER, NEVER, NEVER schedule two "long" appointments back-to-back. This is usually a recipe of behind in the overall clinic session. Instead, to the extent possible, limit "long" appointments to only one per given clinic hour.

Depending on the physician capacity, your staff's capacity and the physical layout of your office, there are scheduling templates available to assist you in getting started with this strategy. Implementing a variable time slot appointment schedule can go a long way into improving your productivity. This in turn is beneficial to your patients and your bottom line.

The Tale of Two Businesses

Last week, two business demonstrated the best and the worst in customer service.

In the first experience, I was leaving a client's office and managed to get about 200 yards down the road before the fan belt on my car went...somewhere. Realizing I had lost the air conditioning and power steering, I made my way to the closest auto repair shop. The mechanic diagnosed the problem as actually being a broken serpentine belt idler pulley. In any case, I was stuck. I was advised that it would only take about 1 hour repair, but they had to order the parts. By now, I am not only counting how much this is going to cost, but also how I was going to reschedule the afternoon's appointments and potential loss of business. Much to my surprise and delight, the repair to my car was completed in a mere 35 minutes.

The second experience was a visit to a physician's office. In this case, I had never met this doctor, but was hoping to simply introduce myself and my services. What occurred next is almost inexplicable to me. The office manager greeted me with such a curt tone it verged on being rude. Now, I have been in sales for many years and can accept rejection, but this was beyond anything I have ever experienced. But, it got me to thinking. Perhaps the person was simply having a bad day; but is that an excuse? I suggest not. Businesses, including medical practices, need to know that your staff IS the public face of your business or practice.

So the question is this, "Which business are you more likely to recommend to friends and family?" The business that under promises and over delivers (the auto shop), or, the practice where the staff demonstrate near-rude behavior?

Now you are thinking, well, in the first case you were a customer spending money. In the second case, you were a vendor selling something. That is true, but does it really matter? Again, I suggest it does not. In the first experience, as a customer, I will recommend that auto repair shop. In the second experience, as the vendor, I will not. Clearly, had the auto repair shop done a poor job that took too long and was too expensive, how could I recommend them to a friend? Likewise, though a vendor, how could you recommend the medical practice?

We all need to remember, that most of us live and work in our communities. Our businesses are forever linked to the people, customers or vendors, which visit our offices. It is important to treat everyone as a potential customer, or, can provide the referral for future customers.

Running On Time?

Do you measure whether or not you are on time based on finishing your clinic at 5:00? If so, you are an inwardly focused business. Now, how many of your patients would say you are on time? Results for many patients surveys nationwide report that "wait time" is their number 1 complaint about their doctor. In fact, of all the various metrics used to measure patient satisfaction, wait time rates the poorest....consistently. Most service industries strive to be outwardly focused. That is to say, these businesses are focused on providing the best in customer service possible to ensure customer retention and future sales. Medical practices should be doing the same.

There are many tactics you may choose to improve your overall efficiency, but simply implementing without first knowing the cause is like doing surgery when the patient presents with a cough. Surgery may be indicated, but it probably is a decisions reached by first understanding the cause of the cough.

Medical practices, like many businesses, look to improve revenues by adding patients to the schedule. Certainly this is a reasonable solution, provided you have the capacity in terms of physical space, adequate staff and proper provider scheduling to execute that plan. I would suggest you first invest in a professional flow and efficiency evaluation. This evaluation reveals efficiency leaks that rob you of productivity and potential practice revenue.

About a year ago, I was asked to conduct such an evaluation for a fairly busy dermatology practice. While the evaluation revealed several areas for improvement, their biggest inefficiency came from medical assistants answering patient phone call regarding biopsy reports, blood tests, etc. Here, the recommendation was to hire another staff position, preferably an RN, as the phone nurse. Her responsibility was to field patient's phone calls and to add an extra level of expertise in the back office. At first the physician felt that adding another staff position, an RN no less, was a budget breaker. After determining the improved efficiency that allowed the doctor to see 2 extra patients per day, AND, improve overall wait time, the practice realized a cost pay back in just a few months. All revenue after that fell straight to the bottom line. In this case, the practice realized an additional $75,000 in revenue after expenses. Not bad!

More than anything else, you have the opportunity to improve your patients experience when they visit your practice. You also have the opportunity to begin and finish your day with greater satisfaction. Your patients and staff will appreciate it.

Customer Service

Over the years I have worked with many medical practices conducting surveys and efficiency studies. Oftentimes physicians fail to recognize that their patients, dare I say customers, measure the customer service from a single perspective...their own. That is to say that your patient's customer service quotient is the same for all business. From the local coffee shop to the mega department store to your office, the quotient is the same. So what does that tell us?

In short, you the physician owner, is competing not only with other doctors, but also every other business in your community. Question: How many of us would tolerate a restaurant telling us there is an hour wait before seating even though we have a reservation? I suspect very few of us would wait. I also suspect most of us would have something to say to the management. Yet, too often, this is common, or even expected, when we have a doctor appointment.

Most people are really not looking forward to their next doctor appointment. Partly because of what the doctor might tell them, but also because of undue wait time which the patient interprets as poor customer service. Taking steps to improve overall patient flow, realistic scheduling and a welcoming smile and hello go a long way in providing good customer service.

Here are few additional tips your patients will appreciate:

• Doctors, please introduce yourself. It is not enough for patients to assume you are the doctor. Remember, patients are already nervous. Make sure they know who you are.
• HIPAA already requires patient privacy. Make sure your receptionist is conversing with your patient in a secure fashion regarding reason for visit, insurance verification, co-payments. Believe it or not, I have observed the receptionist calling out across the reception area verifying this information.
• When patients are escorted to the exam room, protect the privacy of other patients. Make sure doors are closed. When entering a room, make sure other cannot peek in.
• Knock before entering an exam room. This holds true for all back office personnel.
• Schedule accordingly! If you are comfortable seeing 4, 6, or 8 patients an hour, then schedule that way. There is no reason to book, or double book, patients. It serves no one's best interest.
• And for the last tip - BE ON TIME! If you clinic starts at 8:00am, you and your staff should be seeing you first patient. Tardiness to the office only makes you run late, it also says something to your patients about your practice. And it is probably not very good.

Delivering superior customer service is really not hard. Here's an exercise for you. The next time you are in your local coffee shop, your favorite restaurant or department store, check out their customer service. Imitate those activities you observe; your patients, and your balance sheet, will appreciate it.

Primer on Patient Flow

Improving your efficiency with patient flow increases your patients' overall satisfaction. Let's face it, no one wants to go to the doctor. To the extent we can improve the patient's office visit experience, the more likely you'll have better patient satisfaction. You will also improve your patient retention and gain more referrals...and that's good for business.

There are many traps in patient flow and efficiency. Too often physicians automatically think consultants suggest, "Book more patients." Nothing could be further from the truth. There are cases where more patients make sense, but only after fully understanding the capacity of the practice. That is to say,

• How many patients does the doctor feel comfortable seeing each hour?
• Is the staff adequately trained to manage the patients?
• Is your staff allocated correctly?
• Is your office layout optimized for improved flow?

These are but a few of the areas a good flow and efficiency analyst will observe in an on-site study.

Labor Day Best Wishes

It is Labor Day weekend any many of us are enjoying a long weekend with friends and family. It is important that we take a moment to think about all the women and men in military service. These Americans take upon themselves to serve on the front line protecting you and me. It is also important to remember their families. Everyone knows a friend or family who's loved one is overseas. Thank them for their service and sacrifices.

Best Wishes on this Labor Day!

Is It Time To Move On?

A prospective client asked me this week, "How do you know it's time to let an employee go?" Well the answer is, it depends.

Making a decision about dismissing an employee can have an emotional, and, potentially legal, implication. Depending on your state's employment law, you may be faced with a formalized disciplinary process prior to the dismissal.

I have long been an advocate for holding employees accountable to their actions. And this includes accountability to their job description. Thus, here is the point. Do you have adequate and up to date job descriptions for your employee staff? If not, then dismissing an employee for failure to perform job duties becomes cloudier.

Good job descriptions become the basis for your relationship with your employees. This document describes what the employee's job function is, and, directs their daily activities. For employees who fail at their job duties, disciplinary actions are in order.

First, you must communicate, both verbally and in writing, your dissatisfaction with the employee's inadequacies. Second, you are well served to provide the non-performing employee some measure of time to improve their performance. If their performance improves, you are better off as you have now developed the employee. If their performance does not improve, then dismissal may be appropriate.

It is important to ensure that each of your employees is fully trained to perform their job duties. And this is your responsibility. Too often, employers dismiss poor performing employees because the employee was poorly trained. If you establish a relevant training period for your new employees, you will benefit from better performance.

The dismissal of an employee is never pleasant. It is expensive and time consuming when you consider having to replace this employee. Having a quality interviewing process will help you avoid making hiring decisions that ultimately lead to poor employee performance and potential dismissals.

Are You Ready to Interview?

Many physicians and administrators dread the day they have to start recruiting and interviewing. Let me suggest to you that recruiting for a replacement employee is a opportunity to upgrade the departing staff member. Yes, that's right...upgrade. That is not to say the departing employee was a bad employee, though that might be the case, embracing the attitude that you are striving to upgrade will lead you exactly down that path.

Finding qualified candidates in the current economic environment is not that tough. What is tough is finding the right candidate for your situation. Ensuring the new employee meets all of your expectations and fits in your culture is the crux of the recruiting and intervi9ew process.

The interview process need not be cumbersome. Taking a few steps to properly prepare yourself will make the process run smoothly.

First, have you identified the "core competencies" you look for in a new employee? If not, you should. If you do not know what you are looking for, then you cannot adequately evaluate one candidate from another. Examples of core competencies might include:

• Initiative
• Adaptability
• Resilience/Tenacity
• Work Ethic
• Customer Service
• Motivation Fit
• Judgment
• Oral Communication

Secondly, have you clearly defined the job descriptions for your employees? Again, how can you evaluate the core competencies as they relate to the candidates job responsibilities. Having solid job descriptions also play a large role in your employees' annual review process.

Thirdly, prior to seeing any candidate in your office, you should conduct phone interviews to identify 4-6 potential new employees. Phone screening interviews should take no more than 30 minutes each. Here you are looking for basic educational background and to determine if their prior work experience will satisfy your requirement. Look for direct answers to direct questions. If the candidate leads down long tangents, move on. It is likely this candidate cannot, or will not, meet your requirements.

Fourthly, conduct the face to face interviews. Since you have identified 4-6 candidates, you should plan to see all of the candidates back-to-back, with a 15 minute break in between. This allows you properly evaluate each candidate compared to each other. Be sure to ask them the exact same questions. Again, you are looking for comparisons between candidates. During the interview, ask questions to focus the candidate on their past experience and how their behaviors controlled the outcome. Candidates that speak to "the ideal" or "what I would have done" are speaking in theories. You want real experiences and real behaviors.

Lastly, from the 4-6 candidates, select 2 candidates for a final interview. If you have executed the interview process correctly, either of these candidates would do. In the final interview, you are really looking for the motivational fit the candidates bring to the table. After your final interviews, review your notes and pay particular attention to how the candidates met your list of core competencies. Identify your best choice, and then make the offer.

One last thing, be sure to follow-up with the candidates you did not hire. That's just common courtesy. You want to make sure the candidates at least walk away feeling they were treated with respect.

Recruiting and interviewing need not be the dreaded task. With a little preparation, you can make recruiting and interviewing a smooth and pleasant experience.

What Consultants can Help You With

My last blog asked a simple question, "Do you use a business consultant?" Since then, I compiled a list of items I routinely work on with practices. I am sure other consultants can add or take away from the list, but you can see there are many things consultants can help you with.

• Business Planning
• Strategic Planning
• Overall financial performance
• Understanding revenues sources
• Physician collections
• Hourly collection rates, and their influences
• Mid-level provider collection rates
• Ancillary resources collection rates
• Key metrics to your practice's financial health
• Budgeting
• Account receivables management
• Check-in processes
• Back office processes
• Check out processes
• Patient flow and efficiency
• Telephone skills
• Patient Scheduling
• Staff management
• Patient/physician interaction
• Patient/staff interaction\
• Super bill management
• Cash management
• Insurance co-pays
• Job descriptions
• Employee work performance reviews
• Handling discipline issues
• Staff surveys
• Quality improvement
• Internal marketing
• External marketing
• Physician referral processes

The Consultant Advantage

Are you working with a consultant? Maybe you should be. Consultants are a wealth of information and can help you navigate issues that may arise in your practice.

Most consultants come from business backgrounds, either from running their own business, or from corporate America. In either case, they have the business knowledge and experience, most physician do not have. I've met some really sharp physicians who happen to be really good business people, but sadly, most of their learning comes from the school of hard knocks.

Business consultants have resources that most physician owners would love to tap in to. For example, consultants have access to financial benchmark data that can be so important to doctors. Yes, physicians can, and should, conduct their own benchmarking, comparing financial data from quarter to quarter, year to year. But how many physicians have access to broad range benchmark data to measure themselves compared to other like practices?

Consultants can also serve as your contract employee should you have the need to implement a new initiative or conduct a special project. Projects such as practice performance surveys, staff surveys, annual review processes are good examples. Your staff may simply not have the time to conduct these projects, or may not know just how to get started. Consultants can help you in these environments.

Fee structures for consultants vary, but generally fall into one, or a combination, of these structures:

• Hourly rate
• Project rate
• Retainer

Hourly rates are good if you need is simple and need only a few hours time. Project rates work well if you a sure of a specific project you want to conduct, e.g., practice performance survey. Lastly, the retainer affords you the best option. With a retainer, you can use the consultant as much or as little without the worry or inconvenience of frequent billings. Retainers can also be budgeted much more easily. And I would suggest you discuss any fee questions with your consultant prior to any commitments. As a final note regarding fees, there are a lot of consultants who will talk with you about your issue at no charge. Take advantage of that.

At Primoro, Inc. our philosophy is "thought medical practice consulting." We are here to assist you where we can and to offer solutions or other resources where needed. Be assured that at your consultation, Primoro, Inc. will have your best interest at heart.

Leadership and the Grocery Store

My wife and I celebrated our 26th wedding anniversary yesterday by having lunch at our favorite Mexican restaurant. On the way home, we stopped by a local grocery to pick up a few things and my wife said, "I hate this store." Of course, I was curious and asked why. She went on to tell me they have very poor customer service and the employees are not very friendly. She finished her story by saying, "I am not sure why this is, other grocery stores are much friendlier." As you might imagine, being a consultant, I have an answer.

Clear and simple, poor customer service is the result of poor leadership. For years customers of a leading computer manufacturer enjoyed some of the best customer service; that is, until the founder retired. Sadly, today, this company is struggling because their product quality has slipped and their customer service is poor. But, how does this happen?

As I stated, poor customer service is the result of poor leadership. Simply put, if the owner or senior management doesn't put customer service as a priority, nobody else in the organization will. And, it goes further. Simply stating the goal does not make it so. Owners and senior managers have to live it! You have to know what is going on in your business - Inspect What You Expect!

Living and breathing excellence in customer service is everyone's responsibility, but it begins with the owner. Make sure you are delivering your very best every day. Train your staff properly. Inspect what you expect. Conduct a practice performance survey to find your weak areas and improve them. Enhance and broaden those aspects of your practice's customer service that already excels. Think about the businesses you like doing business with and emulate their level of customer service.

Delivering good customer service to your patients should be an expectation. Believe me, your patients expect it.

Strings Attached

No matter what your need is, or what you think your need is, there is always strings attached. Consulting is an interesting business. There are many consultants out there ready to sell you their service or product. And I am no different.

Business owners too often "self-diagnose" there issue and hire the services of a consulting group to solve the problem. I suggest beware. Self-diagnosis can become expensive, and in the end, may not solve your true issue.

I used to work for a organization that provided its customers complimentary consulting services. Not a bad thing, except the client was too often offered a very biased recommendation based on the product the company was trying to sell. While their recommendations perhaps would provide for increased revenue for the client, it was always to the benefit of the organization's product offering. Therein lies the rub.

As a business owner, physicians must make the choice between "free" consulting vs. "fee for service" consulting. We all know that there really is no free lunch and strings are always attached.

I am particularly fond of consulting generalists. The consulting generalist is very much like the family doctor. While not the specialist, we know which specialist the client really needs and can help the client ask the right questions, focused on the real issue. I once had a physician who just could not wait to purchase and install a new practice management software system. After spending nearly $100K, he found the software did not really solve his issue. Had the doctor consulted a consulting generalist, he could have achieved a better result by spending a few thousand dollars on staff training on his old system.

Primoro, Inc., like other consulting generalists, is in business to make a living. Businesses hire outside consultants to help them see their business with fresh eyes. Paying for their services is almost always a wise decision. The old adage still holds true..."You get what you pay for."

Planting Trees

Years ago, a good friend planted a row of beauty ornamental trees along her driveway. In the years following, she enjoyed watching these trees grow and display their beautiful flowers and foliage every spring. One day, upon returning home, she was shocked to see that her neighbors had sheared the limbs that protruded beyond the property line. The trees once beautiful now looked horrible.

I was surprised to see my friend's response to this action. Instead of reacting to the insult, though the neighbors were within their rights legally, my friend looked at the event in a philosophical way. The next day all the trees were removed, the following day, new trees were planted...well within her property line. She told me she was "planting trees." That was her way of saying she was investing in her property, and, I suspect, in her soul.

How many of you are "planting trees?" Planting tree can be as easy as taking an extra minute with each patient. Make sure you have answered all their questions and that there is no doubt in their mind about the treatment you propose.

Benchmark data would suggest that your new patient ratio should be about 33% of you total patient schedule. If it isn't, perhaps you might consider "planting trees" for your business.

Writing a Blog Is Not Hard - Think Simple

Many of you are interested in setting up a blog for your practice, and now, you are wondering "How do I write a blog?" My experience shows that it should not be an arduous task; instead it should be simple. When I work with clients in setting up their social networking/blog project, I generally also offer some critique on a few of their initial blogs. For doctors, I always have the same critique - KEEP IT SIMPLE.

Doctors are smart people, but too often they let their knowledge on their area of expertise get in the way of good communication with their patient. I always tell doctors to keep it simple and in terms their patients, and prospective patients, can understand. In the case of a plastic surgeon I have worked with, I had to tell him to be cautious about how he described the liposuction process. In his blog, he continued to reference liposuction as a "de-bulking" procedure. While technically correct, I know few patients who would want to be considered "bulky."

There are some wonderful blogs on how to write effective blogs. I am particularly fond of the ProBlogger at www.problogger.net. Here you will find some very straight forward talk about what makes a good blog, and how to make yours better. Check it out.

On a second note, you may have heard that Twitter crashed today. While inconvenient, it does demonstrate the overall utilization of social networking sites. Get involved - TODAY!

How is Your Practice Doing?

Knowing how your practice is doing, from the eyes of your patients, is critical to success. Having done countless Practice Performance Surveys, I can tell you there are things happening in your practice that do not necessarily spell overall quality. While I readily admit that most physicians are providing high quality medical care, how does the overall quality of the patient visit rate?

Remember, in previous blogs I have touched on the patients' perspective of "value." Value is the emotional aspects your patients feel when they compare price, access and quality to virtually any other business they use. Yes that's right; you are competing for high quality and value to every other business in your community.

It is important to recognize that patients can only compare their perspective when comparing their experience with your office as compared to other business. That is to say to their local Wal-Mart, Target or Publics. They look at the overall experience. Do the sales people or clerks treat them with respect? How about real interest?

In a recent Practice Performance Survey, the practice rated pretty well in all categories. Funny, the physician was concerned that perhaps his fees were too high for the community. The survey revealed that price was not an issue. Instead, patients reported that certain staff members and departments were less than customer oriented. Patients love the doctor, but had pointed comments about the staff. Of course, the doctor is taking corrective action. Without the survey, he may well have gone on for some time before knowing what his patients really think about his practice.

If you are getting complaints, or even suspect there is something not quite right, do a survey. Ask you patients what they think of the practice, ranging from getting an appointment, seeing the medical assistants, seeing the doctor and finally checking out. You may find new opportunities to improve your patients' perception of a quality practice.

Advertising and Marketing Budget

Financial benchmark data suggests your advertising and marketing expenditure should be 1-5% of your collected revenue. There are circumstances where you might spend more or less. Examples might include a well established practice not interested in attracting new patients, or, the brand new doctor looking to build a practice. In any case, you should spend your money wisely and be able to track your return on investment (ROI).

Over the years, physicians have dedicated resources to attracting new patients to their practices. This is considered "external" marketing. But your best ROI for you marketing dollar comes from "internal" marketing. That is, advertising and marketing to your existing patients about new services, technologies, or products you offer.

If you have followed these blogs, you'll quickly recognize my bias towards internal marketing and, my interest in social networking. During a visit last week, a client asked me to review a print ad she was considering. This was an 1/8 page ad in one of those community advertising magazines. The ad looked good. When I asked about the cost, the doctor said, "About $299/month, and I'm not really sure if we get much from it." Well, you can probably guess my response. As we know, very few of these advertising magazines, or, advertising mailers ever get read, and more importantly, ever get acted upon. Most of these types of advertising vehicles end up in the landfill.

Blogs and social networking are just the opposite. Your message is enduring, distribution is free, and is always available to your audience. And, unlike the advertising magazines, your social networking efforts can be tracked and your return on investment measured. The internet provides some really interesting analytical tools to help you see which message is most popular with your audience, and, the key words your audience used to find you. How powerful is that?

At the end of the day, you have many choices to advertise and market your practice. You should approach your advertising and marketing efforts with a variety of channels. Please do consider social networking as an extension of your website marketing.

Atlanta IS # 1

Well, Atlanta is #1 again. Yes, we have a great climate, the restaurants are fantastic, Atlantans are some of the friendliest people in the country, and, of course, we have the Braves. AND, we are #1 in Facebook use.

In fact, data shows that the demographics of new Facebook users is the 35-49 age range. Just the age range cosmetic physicians are trying to attract. So, are you embracing social networking as part of your marketing and advertising effort? If not, you should be.

When you combine the power of internet distribution with a blog site, you maximize your message penetration. And it is nearly free. I have long been a supporter of internet marketing, particularly in aiding practices internal marketing efforts. Connecting with existing patients in a consistent and frequent basis simply makes good sense for you and your patient.

Primoro, Inc. introduced its new offering CONNECT several weeks ago and response to this product has been inspiring. Many practices want to use social networking tools, but are simply not knowledgeable about it. In simple terms, using social networking is merely a distribution method for your patient communication. This communication arrives to the patient in the form they prefer, whether it be Facebook, Twitter, LinkedIn or other social network site they use.

For those of you who have established a Facebook or Twitter site, congratulations. It is now time to maximize your current efforts with CONNECT. Call Primoro, Inc., to learn more.

* Data from Neilson Online, Global Index

It Happened This Weekend

Well, it happened. Once again, our household received another hardcopy medical newsletter. Normally, these items would make it to the trashcan, but my wife saved it to show what a waste of money this newsletter represented. And I agree.

Paper newsletters are expensive to produce and mail. It is difficult to measure any return of investment as most medical practices have bought some mailing list from an expert marketing firm. Most of these efforts are termed "external marketing." While not a bad idea, it's not great either. Most marketing efforts are geared towards finding new users for products or services. It is far more practical to fully mine your patient database in search of patients that might benefit from other services you offer. It's also cheaper too.

There is a lot of data out there that suggests that most medical practices should budget 1-5% of their net collected revenue for advertising and marketing. As such, it makes sense to use those dollars as efficiently as possible. External marketing is expensive, newsletters are expensive, using the internet is NOT.

Social Networking Tools are a wonderful new addition to the marketing world. Here, you can choose your message and distribute to your patients in the format they choose. I am a big fan of blogging. It is quick, easy and provides for more frequent patient connection. If you are wondering what you might blog about, well, I suspect there is not a day where you don't see some condition, make some diagnoses, or recommend some treatment, more of your patients might have interest.

Concerned About Price?

Many times over the years, physicians have asked me whether or not their fees might be too high, especially for cosmetic services. My answer has nearly always been the same, "It depends." Certainly, patients seeking cosmetic services are concerned about price, but what I've found is that patients are much more interest in finding "value" for their dollar.

Value is one of those attributes that can be confounding because so much in the purchasing process is emotional. The three attributes that describe a good value are, price, access and quality. The combination of these attributes is interpreted by your patients as value.

Price represents the cost to deliver a service, plus a reasonable profit. Clearly, if you are charging 50% more than the community norm, then your fee may be too high. There are always exceptions to price, and those exceptions are due in part to the access and quality the patient receives. For example, I know of two medical providers that charge vastly different from each other for BOTOX Cosmetic. One practice charges $8/unit, while the other charges $18/unit. Believe it or not, both practices conduct very healthy BOTOX Cosmetic businesses. The patient that visits the $8/unit practice receives their injections and good care. The patient that visits the $18/unit practice receives their injections and good care, AND, a perceived better patient experience. It's the same mentality for the consumer who shops at Nordstrom. The level of customer service at Nordstrom typically ranks much higher than other clothing retailers.

Access to care is the second attribute that defines value. If you find your practice cannot accommodate a new patient for 4 or more weeks, then your patient's perception of high value is diminished. The classic benchmark ratio for new patients is about one-third of your overall schedule. In other words, every provider in your practice should reserve 33% or so of all appointment slots for new patients. If you can achieve this goal, your access is further aiding the patient's perception of value.

Lastly, deliver high quality. For most practices, high quality medical care is a given. Quality for the overall patient experience may vary widely. It is important that the physician-owner be responsive to the need of their patients in term of quality medical care and patient/customer service. Schooling your team in terms of high quality patient/customer service is your responsibility, and, your responsibility to inspect. Practice Performance Surveys that measure your staff's responsiveness to patient expectations, can aid you in determining your practice's strengths and weaknesses as it relates to quality.

So, you can see, price is not everything. It is one component of the attributes that patients use to arrive at their perception of value. If we are all providing value to our patients/customers and clients, we can effectively minimize patient "shopping" and develop loyal patient advocates.

Happy 4th of July

I've had a good week. I hope you had one too! It is a somewhat shortened week with many of us taking Friday off. It is well deserved.

For me, the 4th of July causes reflection for all the sacrifices our founders and women and men in uniform created and preserved for the rest of us. To all of those who serve our country, I tip my hat and say thank you.

I hope each of you will take a moment during all the festivities to take a moment and reflect.

Have a Wonderful and Safe 4th of July!

Practice Performance Surveys

Understanding your patient's views of your practice, particularly in today's economic environment, is an essential need for the physician-owner. While, most of us think we are providing solid customer service, in all likelyhood, customers/patients may have a different opinion.

Over the years, most business assume that because they have operated a successful business, then, we will always run a successful business. In other words, the attitude, "If it isn't broken, don't fix it" can lead us down a declining path. It is the business owner's responsibility to continually challenge the business process, to ensure excellent customer service is delivered.

A friend of mine asked my to edit his manuscript about the business of medicine. Through the pages I continued to see references to good customer service. And he's right. My favorite concept in the writing was, "Inspect, what you Expect." That's great advice and sounds an awful lot like one of the tenets of Leadership. Inspecting your staff's work, how they interact with patients, check-in/check-out, how your medical assistants escort patients and take patient histories, etc.. are all elements of "inspect what you expect."

Another tool to gain knowledge about the patient experience is to conduct a survey. I have conducted many over the years. There has never been an occasion where the survey revealed no improvement opportunities. Measuring the patient experience from the moment your patient makes the appointment, till the moment they check out, is vital to your delivering the patient experience you hope to deliver.

Primoro, Inc. conducts "Practice Performance Surveys" and can benchmark your results year-to-year. Continually improving your practice's performace, both in terms of medical care and customer service, is simply good business.

Data Supporting Social Networking

Yes, I know the list is small to see, but it illustrates the reach social networking sites have. For example, FaceBook is the most popular with 68+ million unique visitors and nearly 1.2 billion monthly visits. Twitter comes in third with nearly 6 million unique visitors and 54 million monthly visits. By the way this data is as of January 2009.

So, if you are considering how to better allocate your marketing and advertising budget, think about social networking.

Data from Compete.com. The full article can be seen at Social Networking Optimization.

Compete.com

Blog Sites and PhotoShop

I've spent the past few hours working on a client's social networking capabilties, that is, I have built various boards and blogsite functionality. Interesting, I've learned some new skills. While I am quite adept to building these boards and sites, I have not spent too much time with the photography portion of the project. Generally, I've left that to my photographer wife, Donna, a.k.a The Barefoot Photographer. It is amazing to watch her manipulate a photograph to just the right tome, texture, contrast and brightness. And that's just the beginning.

I bring this up because I know many of you, like me, are busy business owners, with other things on your mind besides photograph editing. I too, thought this skill was beyond my interest, but today, I found myself, without my teacher...Donna.

Before she left for her photography class (she's the instructor) she gave me some basics and said, "See you later." Horror came upon me. What am I to do? Well, I buckled up, cranked up the computer and grabbed the PhotoShop manual. Well, I am here to tell you, it wasn't that bad. I learned to convert color to black and white, producing reverse images, pixel colorization, and on and on.

Some of you are quite avid photographers and many of you use digital equipment. I would encourage you to explore the fun, yes I said fun, in experimenting with digital photography editing. This could be the skill that produces photographs you add to your social networking sites.

A Case for Social Networking

If you are considering adding a newsletter to your patient marketing plan, I would suggest you consider the power of social networking instead. The internet marketing opportunity that exists today with tools like Twitter and FaceBook are much too powerful to ignore. And frankly, looking at the cost, internet marketing is far more cost effective in terms of time and dollars as compared to the tired old printed newsletters.

Consider this, if you have produced printed newsletters in the past, at best you produced one on a quarterly basis. You probably cringed at having to sit down to produce a four page copy. The design is next, then the trip to the print shop. Once they have it, they print a proof to be reviewed and edited. Finally, you are ready to go and the final print run is underway. Now you get the final newsletter and it is time to stuff envelopes. Did you buy enough postage? How about patient addresses? When all is said and done you finally get the bill and the newsletter goes out just in time to start the process all over again. WOW!

Now consider the social networking opportunity. You hire someone to set the network up. Prinoro, Inc. charges a one time charge of $800 for this service. Now all that's left is to produce the blog. My experience shows that a blog takes only about 15 minutes to produce. Once your done, you simple click the "publish" button and the blog automatically goes out to your social networking foll0wers. The very nature of blogs is to produce quick, but relevant, information for your patients. I bet a day does not go by that you exam a patient and think, "more of my patients need to be aware of this condition." If this is you, and it probably is, then sit down for 15 minutes and tell your patients about it. If you can do this at least once per week, you are connecting with existing patients, relating to them and providing the consistent patient outreach most of you would like to have.

Today, patients are using the internet for all kinds of information. And, they do it on their timetable. Take advantage of this opportunity. I know your patients will appreciate it.

Employee Incentive Plans

Creating and implementing an incentive compensation program provides the mechanism your staff needs to focus on specific and targeted product sales or cosmetic services. The result is a positive impact on your practice’s ability to achieve the goal, staff morale, and bottom line performance.

In review, the key elements to an overall staff compensation package is comprised of three key elements: a fair and equitable hourly or salaried wage, the ability to earn merit increases based on yearly performance compared to their job description, and an incentive compensation package. This article discusses the strategy and implementation of the staff incentive plan.

Several key decisions need to be made in preparing and developing the staff incentive compensation plan. These include,

· which staff members are eligible to participate in the program,

· what services or products you want to include as part of the plan and

· setting appropriate and reasonable goal(s).

Staff Member Eligibility

Deciding which staff members can participate does have some real considerations. Are all full-time employees eligible, probably so, but what about part-time? Are part-time employees eligible at all, or, at some reduced amount? How about aestheticians, or, other non-physician providers, such as physician assistants, nurse practitioners, or nurse injectors? These must be answered prior to implementing any incentive compensation plan.

Deciding who participates in the incentive plan is purely subjective. Many consultants have their own opinion and I certainly have mine. I consider an incentive plan as a goal for the practice. To achieve this goal requires everyone in the practice to be engaged and educated about the products or services highlighted in the plan. As such, I believe everyone, including part-time employees and aestheticians, should participate equally in the plan. This sounds odd, but experience demonstrates tremendous buy-in to the plan and success in achieving the goal. Remember the premise for an incentive compensation plan. That is, to motivate your staff to go above and beyond their typical job duties and to engage patients in these products or services, create demand for these products or services and to create value for the practice.

Non-physician providers, PA-Cs and NPCs, may be another story. Since most of these employees are already on some type of production compensation package, you may choose not to include them as part of the staff compensation plan. In the case of these non-physician providers, they generally benefit from the staff incentive plan through increase overall service delivery production.

Services or Products to Include

Selecting which products or services to include in the staff incentive compensation plan is subjective. However, selecting those products or services that return the greatest value to the practice and patient are the most attractive. From a practical matter and from a medical-legal perspective, selecting cash services make the most sense. It is important that you have the ability to track sales of the products or services through your practice management software. This provides the real-time data comparing performance to goal, and the necessary data to assist you in developing a realistic sales goal.

Incentive Compensation Plan

The most effective plans are those that benefit the staff and the physician-owner as well. The successful plan also puts some of the responsibility and accountability back on the practice personnel. I have seen some incentive plans based on overall practice growth. While not a terrible design, this type of plan generally puts most of the responsibility for achieving the goal on the providers. I have seen one example where the surgeon finds himself in surgery late on a Friday afternoon while the staff has already begun enjoying the weekend. After a few sessions like this the surgeon quickly abandoned the incentive compensation plan for the staff.

While there is no question that the provider(s) must do their part, it’s a matter of selecting those products or services that maximize the provider productivity time.

In overview, your plan should be based on historical data and be sensitive to the “seasonality” of those products or services. For example, some cosmetic services have some seasonality. Similarly, most plastic surgeons see a decline in their surgical load just before and just after school begins. As such, your compensation plan needs to be reflective of these seasonal variations.

Understanding prior performance on your targeted products or services is critical. These data elements help us establish the upcoming compensation period goal. The staff incentive compensation plan that seems to work best follows this design:

Establish the sales goal for this period’s targeted products and services, minus, the prior periods products and services sales. The difference represents the growth of the targeted product and service, and establishes the basis for the total incentive compensation plan pool of dollars.

$150,000 – Sales Goal

$100,000 – prior periods sales

$ 50,000- basis for incentive plan pool.

Next, as the business owner you must decide the portion of this basis pool you wish to share with your team. Common percentages range for 10-25%, depending on the current status of the targeted product or service at your practice. Thus,

$ 50,000 -Basis for incentive plan pool

X 10% -Percentage you elect to share with your team

$ 5,000 – Total dollars available to the team, if they hit the sales goal target at 100%

Most offices use a sliding scale to determine actual payout. That is, should the team over-achieve, more money is funded by the basis. If the team under-achieve, there is less money available in the incentive pool. Most practices implement their plan at a minimum of 80% achievement and top out at 120% of achievement. This should be enough of a spread to reward behavior while at the same time protecting the staff and the practice from potential errors in goal development.

Goal Development

This is probably the most difficult element to implementing a fair staff incentive compensation plan at your office. You may be offering selected services, but have seen a decline in overall performance. This is a great scenario to implementing a incentive plan. Historical sales data for your practice is critical in goal development. Also, if you can get national sales growth numbers from your suppliers, that too, is a help. You also need to have a good understanding of your current market and competitive nature of your area.

Implementation

Implementation of a staff incentive compensation plan is probably the most enjoyable part of the process, aside from handing out money for a job well done. The plan should be presented at a staff meeting where there is ample time for questions. It should be in a written document, complete with examples. Your staff should know what their individual opportunity is and what role they play in achieving it.

Education is key. You must invest in your staff’s education of the products or services you are including in the plan. As the physician-owner it is your responsibility to ensure everyone on your team is knowledgeable about the products and services highlighted. As part of this process, be sure to ask your vendors for assistance. I suspect most of them would be delighted to assist, especially since you have included their product as part of the incentive plan.

Well constructed incentive compensation plans have many positive benefits. It certainly benefits the staff and the practice with increased financial reward. Somewhat secondary, but equally beneficial is the teamwork the plan helps establish. Improving teamwork and improving staff work satisfaction have benefits well beyond the incentive compensation plan. I hope you will give one a try.