The Cultural Leadership effect -- it starts with you

The leadership team is responsible for strategy. It is a major portion of our many meeting agendas. We have all seen or created the list of items and our strategy focus may vary from how to enhance our service line growth, to retaining and recruiting more nurses, or focusing on the improvement necessary to boost the patient scores and much, much more: however, as leaders we all know what must always be forefront on our strategic agenda, taking care of our employees.

How many times have you seen where the Administrative Team gets together, decides they are all going to Round together, and their assistants (with repetitive internal mirth) agonizingly make the schedule, coordinating whereby everyone can Round together. It lasts for a few months, weeks or even never gets completely off the ground despite the many studies showing its benefit. It is not out of leadership neglect, but the daily re-prioritization battle that necessitates our lives. Nevertheless, the focus on your employees must always take precedence.

The questions must then be asked: How is this precedence displayed? How do you show you care about your employees? Read Full Article.

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

14 Hits
0 Comments

Decision Making Traps: Decider Beware

Leadership Transformation Series

This is Part 4A in this Four-part Leadership Transformation Series (LTS); 4B will follow.

Transformation in healthcare is personal: it requires the transformation of health system leaders. The LTS begins to speak to key differences in some of the fundamentals of transformational vs traditional leadership in healthcare.

This article focuses on how we make decisions: 4A Reviews decision-making errors.

4B Addresses how to mitigate decision-making errors

Leaders – and their organizations - succeed or fail based on their decisions. Yet the evidence is clear that our decision making is perilously fraught with biases and irrational behaviors of which we are not even aware. These biases are so ingrained in our psyche that, like water to fish, we cannot imagine that they are even there, much less clouding our view – regardless of how “well-intended and objective” we believe we are. In short, bad decision-making is largely hard-wired.’ Just as many medical errors are associated with unexplained variation in medical decision-making (How Doctors Think), so too are many leadership errors are associated with unexplained variation in management decision making.

Traditional change is oriented in the past; it involves more, faster, better, but not different (Daniel Prosser). Transformation is future-oriented; it requires the creation of something from nothing, i.e., letting go and giving up something in the past to create something new. This means that, to do transformation well, it is even more important that our hidden decision biases be flushed out and made explicit. Leaders on a transformation journey are at higher risk for decision making traps and consequences than in traditional change. Said differently, leadership decision making in transformation is less forgiving.

A brief review of categories and types of decision and judgement errors include the following: (Read Full Article)

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

40 Hits
0 Comments

Five things every CEO needs to do

It is a truth. As CEOs, we are pulled in many directions. The incessant priorities, though seemingly always valuable, will consistently distract us from our most meaningful impact. How does a CEO maintain their focus and discipline on what is important when everything is significant? They must focus on what is central to the organization’s success. The following five imperatives will aid in this journey:

1) Visible Listener:

The CEO must be a good listener who spends time greeting, listening and positively interacting with the individuals on the floors and in the clinics. Ninety-Five percent of your time should be spent listening. Hearing from the people doing the work who can keep you informed of the issues they are solving through the work-around of their own ingenuity. You have an opportunity to develop relationships, listen for trends, solve problems and gain credibility as a CEO who cares about the people enough to make them a priority in your busy day. Read Full Article.https://www.rodneyreider.com/blog/2019/2/7/five-things-every-ceo-needs-to-do

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

52 Hits
0 Comments

The Operating Model: Closing the Strategy-Execution Gap

Leadership Transformation Series

The Operating Model: Closing the Strategy-Execution Gap

This is Part 3 of a Four-Part Leadership Transformation Series (LTS).

Read Part 1 and Part 2.

Transformation in healthcare is personal: it requires the transformation of health system leaders. This LTS begins to speak to key differences in some of the fundamentals of transformational vs traditional leadership in healthcare.

This article focuses on how leaders operate.

You have a strategy. How do you rate your organization’s execution of that strategy on a 1-10 scale? For most, it is not high – or as high as they would like. Closing the strategy-implementation (aka, the knowing-doing or what-how) gap is the leadership Achilles heel of any business, but especially for hospitals, a business recognized by Drucker as the most complex organization to lead. Given that his observation pre-dated some of today’s larger and more evolved and blended academic-community healthcare systems, the complexity he referred to then has only increased. Across industries, the results of studies consistently identify unsuccessful execution for the vast majority of strategies; and the results of CEO surveys cite execution as the biggest current challenge, but reasons for such failure and concern vary widely. A sampling of HBR articles on the topic cite too much of an internal focus, poor CEO preparation in both strategy AND execution, “a people problem.” (Read Full Article)

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

73 Hits
0 Comments

The Power of Simplicity

My father taught us, “If you want to be happy, simplify, simplify, simplify.” He loved the quote from the movie, Amadeus, in which the Austrian emperor told Mozart that his music had “too many notes.” My father did not agree with the criticism of Mozart’s music, but felt the quote was great for describing anything from cluttered architecture and art to overly complex solutions to problems. His house that he built from steel is pictured with this article. It is an expression of his design and artistic philosophy: clean, smooth, uncluttered, simple lines.

Albert Einstein said, “The definition of genius is taking the complex and making it simple.” Steve Jobs surely met this definition as he brought us the power and complexity of computing through as simple a user interface as possible. He took the complex and made it simple.

We often find that we cannot complete all of the tasks that are already on our “to do” lists let alone other tasks and goals we should be adding. We can choose what is most important to us and drop some good things from our list that are standing in the way of our accomplishing better. Advice I received from the book, Scrum: The Art of Doing Twice the Work in Half the Time by Jeff Sutherland and JJ Sutherland, helped a lot. Give yourself a short deadline. I needed to write an application to the Texas Medical Board to start a hospitalist fellowship. It seemed to me like this should take several weeks to complete which I did not have so I kept pushing it down on my to do list. I gave one of my hospitalists and me two hours to complete the application. We were done, and the application was accepted. My inner OCD wanted to overly complicate the task. I needed to simplify. Read Full Article.

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

75 Hits
0 Comments

Rural Health's Specialty Lies in the Special Care

It was my first time back to a rural hospital. Though I had practically grown-up in rural health – both with frequent visits as a volunteer and as a support services employee – I had not been within the walls of a rural hospital in many years. And never had I been in one as a healthcare executive.

I arrived early, intending to look around and meet a few staff to better prepare me for a meeting with the Critical Access Hospital’s Board of Directors.

One of my first interactions was with a nurse coming out of a patient room. She was clearly emotional. Practically crying. I had seen the impact of caring for patients over the years. But this was not that. No, it was not simply a nurse and patient, but something much more. Even with my many years of experience, I didn’t yet know what I didn’t know – or regrettably, perhaps had forgotten. (Read Full Article)

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

72 Hits
0 Comments

How to ‘Stop the Insanity’ and Pave the Way to Real Achievements

I am sure you have heard the old adage “the definition of insanity is to keep doing the same thing over and over again expecting a different result.” I would like to expand to that definition “and doing something without appropriate planning and expecting a better outcome.” Have you ever witnessed an unexpected result or outcome followed by a flurry of activity which is expected to positively impact the outcome? The danger of this reactionary activity is the false sense that the problem is being solved. Reactionary activity may address the fringe of the problem, but the root cause remains festering and aggravating the organization. To help with the risk of confusing activity with root cause problem solving, I suggest the Four Steps to Achievement, or what I like to call P8. Read the Full Article

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

73 Hits
0 Comments

Systemizing Healthcare: The Integrator Role

This is Part 2 of a Four-part Leadership Transformation Series (LTS). (Read Part 1 Here)

Transformation in healthcare is personal: it requires the transformation of health system leaders. This LTS begins to speak to key differences in some of the fundamentals of transformational vs traditional leadership in healthcare.

This article focuses on the changing role delineation of leaders.

The leadership need for ‘the Integrator’ is re-shaping traditional CEO and COO roles.

A few decades ago, the role of ‘the Integrator’ in healthcare leadership did not exist – at least not in the form needed today. Unlike roles with new names – CTO, CMIO, CPHMO, etc. - the same titles of CEO or COO may be used for a healthcare system, yet the shapes of these roles bear little resemblance to those with the same titles used in a hospital or other ‘vertical.’

While a hospital administrator/CEO is expected to stay close to the pulse of acute care operations, the system CEO is expected to transcend operations to assure an aerial view/perspective, i.e., to become more visionary and system-focused. The transition from hospital to system requires a view that is less entrenched with how we have run hospitals and more focused on the population served. Despite use of the same title for both roles, it is the difference between being ‘tied down’ and ‘freed up.’ (REAd Full Article)

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

88 Hits
0 Comments

When is achieving all your goals not good enough?

We’ve closed the books on another year, and it’s time to review your performance. Maybe you’ve completed all your goals -- congratulations you’ve failed. Failed? How could that be, I’ve completed all my goals? And therein lies the problem, you didn’t set your goals (or the bar) high enough for your own performance. Goals by definition are aspirations and should be set high enough to stretch the organization and yourself in new directions. If you are constantly beating your goals, you’re not stretching enough.

But why don’t we set our goals high enough? Well, it’s complicated. It has a lot to do with you, and with equal parts of your companies’ culture and goal setting process.

Take this simple test: Read Full Article

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

82 Hits
0 Comments

Patient Care Experience Beyond the Medicine

INTEGRATING SUPPORT SERVICES AND FAMILIES FOR PSYCHOSOCIAL CARE.

He is that family member we all know, regrettably often looked upon as bothersome, annoying or cantankerous. Throughout my career in home health, skilled nursing and acute care, these family members are at every level – anywhere that involves caring for vulnerable patients.

One doesn’t even have to be in patient care – simply working in healthcare means each of us will likely deal with these troublesome family members at one time or another.

I was still a teenager when I first encountered “the husband” as we came to know him. Little did I know that those few days with him would have an impact upon my entire future, and that of my very role as a healthcare leader.

Interacting with patients’ families while working both in dietary as a dishwasher/server and facilities as housekeeping/maintenance taught me the importance of both support services and family members within the patient care experience – beyond the medicine. Read Full Article

89 Hits
0 Comments

Focus on Culture for Patient and Family Care: Beyond the Medicine

As healthcare (including acute care, nursing homes, home health and all downstream providers) moves towards a greater focus on patient/family satisfaction, the model of healthcare must also evolve, for both the government and patients/families will be closely reviewing these in determining healthcare provider(s) of choice. A satisfied patient is a more compliant patient, making for a more engaged patient. Providers at every level must now move beyond the patient centered approach, into an understanding of the patient/family perspective and be willing and able to convert input to action and measurable goals, benefiting staff, patients and families. Read Full Article

125 Hits
0 Comments

Healthcare Integration: Ship-to-Shore Work and the Ultimate Weapon

Veterans Day reminds me of my father. In WWII, he landed on Omaha Beach on D-Day.

As Steven Ambrose details in his book “D-Day,” the Allies planned the Normandy invasion for three years, but as soon as our troops hit the beaches, the plans went out the window. To the ‘man on the ground,’ NOTHING was as planned. And on the beaches, formal leaders were dead or not available. Survival and progress to save the free world depended on rapid learning and action, i.e., adaptive leadership. Our troops felt empowered to act, German forces felt compelled to wait for Hitler’s direction. The rest of this leadership story, as they say, is history.

Despite asserting to my Dad, in my youth, the growing impact of technology, e.g., pilotless planes, long-range capabilities, etc., he remained convicted of the mantra “the ultimate weapon is the man on the ground.”* My Dad and his colleagues, some of whom made it past D-Day, are heroes. I have since learned that there were others “on the ground” back in the U.S. who heroically enabled these heroes. During the planning for the largest invasion in modern history, a significant challenge was figuring out how to get our troops from ‘ship-to-shore.’ The U.S. federal government knew how make large ships to get our troops across the English Channel, but they could not get our troops to the shore. Enter Andrew Jackson Higgins, who was described by Dwight D. Eisenhower in 1964 as “the man who won the war for us.” (Read Full Article)

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

151 Hits
0 Comments

Congrats you got the job! Read before you sign.

A physician who I greatly admire and respect once took a job as a hospitalist in a small town. She was told that she would have a guaranteed salary. But she did not read the fine print in her employment contract. The guarantee was actually an advance against future production, or collections. She was required to meet a certain level of collections to support her salary. If she did not meet that level of collections, she had to pay back the deficit. There was a hospitalist outside of and competing with her group. One of the emergency department physicians really liked this hospitalist. If he determined that the patient had good insurance, he called the outside hospitalist to do the admission. If he determined that the patient did not have good insurance, he called my friend’s hospitalist group. They were providing a tremendous amount of care to the patients in the hospital. They were just not getting paid. The longer she worked there, the deeper in debt she was getting. One of her partners did the math and simply left. My friend stayed out of a sense of integrity and fairness to give them time to find her replacement. She was not repaid in kind. And who was going to come and take over for such a terrible deal? She ended up in court and had to pay everything that the hospital was demanding of her. The judge said that it was a terrible contract, but a legally binding one and that she was a big girl and should have read the contract. Her partner who left early made the right decision in that she paid much less to the hospital.

When I was in medical school, we had a medical legal course which consisted of about 10 hours of lectures. One of the things that we were told was to read very carefully anything that we put our signature to. We were particularly cautioned to read employment contracts. I have followed this advice, and it has served me very well. I know of some stories where physicians were badly injured for not having read their employment contracts.

The first question is, “Will I be paid as an employee or as a contractor?” If an employee, then the employer pays half of the Social Security and Medicare taxes. If a contractor, then you pay all of the Social Security and Medicare taxes. If paid a salary, you will get a set amount of money, usually every two weeks or every month. Most people who are paid a salary are expected to work significantly more than 40 hours per week, because there is no additional cost to the employer for extra hours that you work. Many job offers will sound like salaried positions, but close examination of the contract will reveal that all or a significant portion of the payment offered is contingent upon one or more performance metrics. These metrics may include collections, relative value units (RVU’s), quality & efficiency. These may be based on individual performance, group performance or some combination of both. Collections is how much was actually paid for the care you delivered. Usually, a percentage of your collections is paid to the group or hospital for overhead. RVU payment is based not on collections, but on billing. This system is often used by organizations that serve the underserved as it encourages physicians to deliver care regardless of an individual’s ability to pay. Increasingly large portions of physicians’ compensation packages are only paid if the individual and/or group meet certain quality and efficiency metrics. Whether you are actually in control of a metric, the manner in which the metric is tracked & calculated and the thresholds to qualify for the metric all can have significant impact on your actual compensation. Benefit packages can also have significant impact.

In such a short article, I cannot tell you everything to look for. I would advise you to look closely at the exit clauses. When you go to work for a new employer, you have great hopes and even expectations that things are going to go very well. But they may not. I heard of a physician who, within two months of joining a new group, learned that his partners were engaged in and engaging him in activity of questionable legality. The exit clauses in his contract were onerous, and it was very costly for him to leave so early. Issues that may hit you with early separation can include repayment of sign-on bonuses, repayment of moving stipends and noncompete clauses. I was once invited to sign a contract that said I could not work for two years in any hospital anywhere in the United States owned by any company or organization that had a contract with this large physician staffing company (which had hospital contracts in many states).

So how do you go about reading an employment contract? Of course, you are not going to receive a copy of the contract until after you have been given an offer of employment. The contract is usually sent as a PDF. You can either print it out and use a highlighter and an ink pen or, if you can get it into an editable format on your computer, you can go through the document using track changes. You are now going to sit down and read every single word of the document: slowly, carefully and thoughtfully. You will go online and look up the definitions of any legal terms that you do not understand. You can write those definitions in the margins. You can make notes about things that you understand and want addressed and about things that you do not understand. After fully digesting the document, you will either decide to walk away from this job or you will think that this might be doable if the potential employer is agreeable to reasonable changes.

If you wish to go forward, you will now hire an experienced physician employment attorney and will send him or her a copy of your highlighted document with all its notations. You will discuss your concerns. Your attorney will review your document and schedule a follow-up discussion. Your attorney may advise you simply to walk away. Or he may give you a list of items that need clarification or correction. Some issues you identify and some of your attorney’s recommendations will be deal breakers meaning either these changes are made, or you refuse the offer of employment. Others may be that it would be nice if you could get them, but are not that important. With the help of your attorney and your spouse or significant other, if there is one, you will formulate a plan for seeking necessary and desired changes in your employment contract that are reasonable and fair to both parties. Your attorney will help you express your concerns in a language that resonates with the attorney working for your potential employer who will have to give the final approval on any changes to the employment contract.

I will walk you through how I approach these negotiations. I schedule a phone meeting with the individual designated by the potential employer to be their face for the negotiations. My tone is very pleasant and reasonable. I start by saying that my wife and I have carefully read the contract. I have sought the advice of a very competent attorney experienced in physician employment contracts. From these discussions, the following concerns have arisen. If the concern is coming from me, I do not hesitate to say so, but I consider it a good strategy to point out when the concern is coming from my wife or from the advice of my attorney. This is called an appeal to higher authority. It may seem like weakness, but it is a very powerful tool. Used properly, it can tremendously strengthen your position as nothing they say to persuade me will have any impact on how my wife feels about it, especially when it is an issue that is recognized as a reasonable concern for the employee’s wife. When appropriate, I ask for clarification of language in the contract rather than outright changes. Everything that I am asking for needs to be laid out in this first meeting. If you keep coming back with new demands, they may tire very quickly and look for another candidate.

You likely will not get everything you ask for. Just make sure that you get everything you need.

You likely will not get everything you ask for. Just make sure that you get everything you need.

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

187 Hits
0 Comments

Where’s your sweet spot? The balance between confidence and arrogance.

Why is it that too much of something becomes a bad thing? We have all heard that phrase, “too much of a good thing.” And while we might not like to admit it, it is true. I have a weakness for sugar, but if I eat it too often, I gain weight. This causes a chain reaction because being fit is also important to me. So, I compensate for this love of sugar by increasing my hours in the gym. As I increase my hours in the gym, I forgo time at home with my wife and family. Life is full of balancing acts like this one.

Another such balancing act is needed between confidence and arrogance. As an executive transition coach, I work with clients on confidence frequently. Although, it should be noted that even though I have been in the healthcare business for 30 years, I can name only 10 people I thought were truly arrogant. Most people in healthcare seem to be somewhat humble, but when that is overstated it too can become a negative.

What is arrogance? Somebody once said to me “confidence becomes arrogance when performance dips.” At what point does confidence become too much? When does arrogance come into play, and how can you strike a balance between the two? The answer lies in humility ...or rather in your ability to be humble.

Urban Dictionary states that, “To be humble is to have a realistic appreciation of your great strengths, but also of your weaknesses.”

Your confidence level is absolutely essential in securing your next position. Sometimes the client is overly afraid of coming across as cocky, other times the client is already so cocky, we have to work on humility and self-awareness. Whatever side of the spectrum the client falls on, we talk about ways to meet in the middle and find their sweet spot.

How to find your confidence sweet spot:

  1. Take an inventory of your professional accomplishments. Be honest with yourself. Be proud of yourself. Self-awareness is the first step in identifying whether you fall on the arrogant or the self-deprecatory side of the spectrum.
  2. Record yourself talking about your accomplishments. Then play it back so you can hear how you are coming across. Does it sound like bragging to you? Or perhaps you are actually downplaying the work you put into a project? Neither scenario is ideal, but if you are able to identify it, you can modify your message and practice a new approach to telling your story. One that is genuine and strikes a healthy balance between what you accomplished, while giving credit where due.
  3. Observe others. Seek out and observe people with the right level of confidence and write down your observations. It always helps in defining what the right level of confidence is for you.
  4. Ask a friend or two to be candid with you. Look at yourself through their eyes. Put your pride to the side and take note of any areas they identify where you could make improvements. This is sometimes very difficult and hard to hear, but if you really listen, it can be invaluable feedback.
  5. Be willing to take responsibility, but not too much. Arrogant people don’t like to take any responsibility, while confident people admit their error, and create an action plan to remedy the error.

Above all, be genuine and honest with not only everyone else, but perhaps most importantly -- to yourself. When you are able to see yourself objectively, both the positive and the negative, then you can speak confidently -- and with the right amount of humility -- during your next interview or conversation with a recruiter.

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

304 Hits
0 Comments

Coding: Inpatient or Outpatient, Risks (and Benefits) Are Increasing E&M, DRG, APC, Risk Adjusted, CDI, and Hospice … It All Matters

“This article originally appeared on www.stout.com.

Ensure accurate coding and billing by reviewing the coding and compliance policies woven into a health system’s revenue cycle.

Because coding can be confusing and laborious it can often be overlooked and potentially not recognized as part of the revenue cycle process. Now more than ever before, coding reviews are an important component of a health system’s overall "value”-based payment continuum, due to continued scrutiny by Medicare/Medicaid and commercial payers. Health system executives are tasked with optimizing performance of and maximizing efficiency of the coding stage in the revenue cycle. Accurate coding leads to clean claims, which results in prompt reimbursement, and that’s why coding has a direct impact on the bottom line.

Coding is a moving target for many providers. Omnipresent and at times inconvenient and confusing, the ever-changing demands coupled with the risk of inaccuracy constantly challenges providers. With severity of care levels and clinical outcomes increasingly tied to “value,” reimbursements will inextricably link with accurate disease-state coding and documentation. Also, with provider compensation woven tightly to provider production (with emerging compensation models embracing quality and efficiency components, as well), accurate coding confirms both proper reimbursement to the system and accurate compensation for those providers on productivity models.

Educating providers mitigates downside risk to health systems and hospitals and offers leadership (the C-suite along with the physician executive team) the prophylactic of ongoing monitoring ensuring that the administrative/physician partnerships are cemented in a compliant manner.

Coding Compliance

A successful coding review and compliance plan should be crafted to define the hospital or health system’s investment and belief in coding compliance. A memorialization of the processes and procedures undertaken in a coding review enshrines that all constituents clearly understand the goals, objectives, and expectations of the hospital/system. Coding/compliance plans cannot be one-dimensional relying solely on documentation of services or an information technology solution. For instance, in a vacuum a provider can “pass” a coding assessment with proper documentation which generates work relative value units (wRVU). However, sometimes that productivity can be overly, and erroneously, robust given clinic hours, patient facing time, provider schedules, etc. Since most employed providers have a component of their compensation driven, at least in part, from a wRVU model, ensuring precise claim level of billing (e.g. a level 3 versus a level 5) offers physicians and health system leadership peace in the knowledge that claims, charges, and subsequent revenue are accurate.

Additionally, until block chain, “machine learning,” and other IT initiatives like artificial intelligence (AI) have firmly taken hold to “solve” coding and compliance issues, human-intervention will be required to certify that coding documentation aligns with patient facing time, required coding elements, and charting. EHRs can be dangerous when a user simply hap-hazardly “carries forward” a note which can offer a false sense of accuracy. Providers (physicians and APPs) must fully understand the rules and regulations of coding, especially in the critical nature of pay for value initiatives that are evolving over time. Additionally, and tangentially, carrying notes forward has potential med/mal exposure. All of that said, accurate coding is essential relative to severity of disease state, etc.

A Coding and Compliance Program - The "3 F's"

Frequency

Delineate a program of ongoing review and analysis. It should have well-defined expectations. The program should be structured with defined timelines, be diligent, and guarantee random sampling and a rotating sequence of providers (depending on group size) for review. In program development “acceptable” parameters should be constructed indicating varying rates of post-review monitoring and education. The program should be “owned” by a staff member (with backup) to ensure it is perpetual and robust.

Feedback

After reviews are performed, an expedient and concise feedback loop should be deployed displaying to providers deficiencies and providing education. For instance, if a provider “fails” 80% of his or her coding reviews for accuracy, he or she should be placed on a more frequent review process (every quarter?) as defined in the compliance plan to document a remediation process and catalogue improvement in accuracy.

The feedback loop should contain educational opportunities that celebrate successes and elucidate challenges. Providers should be counseled and offered “real time” assistance if coding issues or questions arise during the day.

Follow-up

The coding review should carry with it a robust follow-up plan ensuring that team members (from front desk to providers) understand that the plan is deployed and in force infusing into the culture a sense that the system or hospital takes, and will continue to take, coding compliance seriously. That is not to say that staff members should know that Dr. X failed his or her coding review. Instead, the message to staff should be that the system views coding compliance as a system-wide obligation and focus.

Stout’s coding/compliance leadership ties coding together with one point of contact to manage all aspects of review and education. Our seamless coding and compliance team delivers a variety of solutions based on client need. Stout associates manage outpatient, “pro fee” evaluation and management (E&M) and risk adjusted coding assessments and education, while deftly handling Ambulatory Payment Classification (APC), Diagnosis Resource Group (DRG), and Clinical Documentation Improvement (CDI) coding initiatives for inpatient coding. Additionally, we are adept at hospice and home care coding analyses. Our “borderless” approach empowers our team to rapidly address client needs by removing artificial “silos” that inhibit fluidity on multi-faceted projects running between health system, inpatient work and ambulatory reviews. Stout associates understand the congruency of in and outpatient facilities and can deliver reviews and offer a coding/compliance partner.

* To read more about Stout’s experience and how we provided a 15 to 1 return on a client’s initial investment by helping them improve on their revenuecycle, download our case study now.

Physician Compensation Value-Based Care Initiatives Bring Disruption

a href=http://www.wiederholdassoc.com/blog/2018/10/19/physician-executives-are-you-utilizing-their-talent>Physician Executives – Are You Utilizing Their Talent?

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

575 Hits
0 Comments

Your Healthcare Marketing Plan: What’s Missing?

Everyone knows that the foundation of a good healthcare marketing plan is a focus on where an organization is trying to maintain and grow market share, and where the opportunities lie for expanding reach and volume. And, hopefully, it is based on a solid strategic plan with immediate and long-term goals. But often, there are a number of key sections that are left out—overlooked elements that can move a good marketing plan to excellence, taking advantage of all the layers of outreach in a healthcare marketer’s virtual toolkit. I offer six to consider below.

Six Sections Often Left Out of a Healthcare Marketing Plan

  1. Internal Communications. First off, internal audiences can help reinforce your key messages and themes. But only if you take the time to engage them. Employees, physicians, and volunteers want to “get it” and be included. Include a section that focuses on doing just that.
  2. Media Relations. Why not strategically incorporate earned media into your plan to help reinforce your key themes in an instantly credible way? Take control of your media outreach so that it supports what you’re working to achieve through paid channels.
  3. Community Outreach and Sponsorships. Your organization probably does a lot to give back to the community and support important local initiatives. Some of this can be incorporated into your plan to support service line and program messaging. Think about how to promote your outreach while promoting your key marketing goals, without being too self-serving. It can be very powerful.
  4. Payer Strategy. Healthcare marketers don’t often think about payers, but we should. As the major conduit for reimbursement, you want payers to know your organization has a positive reputation and strong consumer demand. This can be leveraged during contract negotiations. Consider how to target payers with your messaging in ways that are relevant and memorable.
  5. Niche Targeting. Depending on your market, you may have the opportunity to message to a number of cultural niche audiences—Hispanic, African American, Asian, etc. Where appropriate, in-language marketing can be very favorably received. Experiential marketing can be incorporated to engage these audiences in ways that are meaningful to them, bringing them closer to your brand.
  6. Consumer Engagement. Lastly, think of how you can engage consumers when they aren’t in need of your services. Done well, these efforts can actually build your brand much more effectively than a multi-media service line or image campaign. Think of how you can interact with consumers in ways that support your brand and provide value—outside the typical provider-patient relationship.

Take out your marketing plan and reflect on whether any of these sections are missing, and how you might incorporate them to bring greater value to your organization. As marketers, that’s our responsibility. I’d love to hear from you on how you utilize these ideas, as well as any additional thoughts you might have.

Read other posts by Janice:

Process Transformation: a Way to Reduce Cost, Improve Quality, etc. etc. etc.

Your Healthcare Marketing Plan: What’s Missing?

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

850 Hits
0 Comments

The recipe for creating value

When I was in college, the church that I attended had a booth every year at the local fair. We made a pastry called an elephant ear. I have seen at fairs funnel cakes which are made by pouring a liquid batter into hot oil and frying it. The elephant ear dough was mixed in a huge mixer. It had eggs in it. The dough was allowed to rise. It was then punched down, weighed out into balls and set on large cookie sheets to rise again. Volunteers sitting at tables would pat the balls into flat disks. These were fried in hot peanut oil and then covered with cinnamon sugar or powdered sugar. In the mid-1980s we sold these for two dollars apiece. They sold like, well, hotcakes. Many people would pay to get in the fair solely to buy elephant ears. There was always a line. If people saw that the line had gotten short, they would run to get in the line. We could sell as many as we could make.

I was in the booth one Saturday morning patting out elephant ears when I noticed Brother “Jones” handling sales. He was a very kind and pleasant man but age was upon him, and he was absolutely overwhelmed with the task. He had before him a line of people who were eager to get elephant ears and behind him stacks of elephant ears growing cold. I spoke to the team leader and asked him if he could arrange for Brother “Jones” and I to exchange positions, of course, handling it in a way that was not hurtful to Brother “Jones’s” feelings. The team leader declined to have us exchange positions but asked me to assist Brother “Jones” with sales.

We began to quickly make sales, and the stacks of unsold elephant ears got much shorter. Soon Brother “Jones” was at one of the tables patting out elephant ears. This was not a terrible place to be. There was always lively and pleasant conversation at the tables, and the task was ideally suited to his capabilities. I now had helping me another brother who was young, like I was, and energetic. We found ourselves waiting for elephant ears to be produced so we could sell them.

A new problem became apparent. The elephant ears were coming out of the vat and were stacking up waiting to have cinnamon sugar or powdered sugar applied. I spoke to the team leader who moved someone to assist with this task. Each time product piled up at a certain point in the process, I would ask the team leader to add or exchange human resources to speed the flow of product through the production chain.

The following day was Sunday. It was announced in church that the elephant ear booth averaged about $11,000 per year in sales, yet the day before we had sold $4000 in elephant ears. The fair would run each year for 11 days. We were not open on Sundays so we would run our booth for nine days each year. This gives us a daily average just over $1200. While Saturdays had more people at the fair than weekdays, demand always exceeded supply even on weekdays. We had tripled our sales that day by simply using our available resources more efficiently.

Several years later while in college, I read The Goal by Eliyahu M. Goldratt and Jeff Cox. This book is a business novel that describes the same process I did in the elephant ear booth but done in an air conditioner manufacturing plant. The protagonist identifies bottlenecks in the production stream by where product in process piles up and then eliminates the bottleneck by moving resources to that step. I highly recommend this book for business leaders.

The ideal value strategy requires no additional investment of resources but uses the current resources more efficiently to deliver quantity and quality, such as: a faster moving line delivering more and hotter elephant ears. We must not be afraid to make small investments when we know that there will be substantial return on investment. Large investments may be necessary and wise, but the larger the investment, the greater we risk, and the higher returns that are necessary to create a value result.

Read previous articles related to this topic:

Article 1: Your business’ future lies in an abundant strategy – not in scarcity

Article 2: Maximum Wow Strategies Lead to Scarcity

Article 3: Fat cutting from an organization can be taken too far – Are you starving your organization?

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

1116 Hits
0 Comments

Fat cutting from an organization can be taken too far – Are you starving your organization?

A maximum value strategy may involve cutting the fat from an organization, but a maximum economy strategy will cut the meat and bone. A maximum economy strategy has an excessive emphasis on cost-cutting so that it starves the organization of the resources it needs to sustain and thrive.

I will tell you the true story of the only hospital in a town of less than 100,000 people. I will not tell you the name of the hospital or the town to protect the innocent and the guilty. This hospital was sold to a national, for-profit hospital chain. Their emphasis was to pull out as much of the hospital’s gross income for corporate profits as possible. This left very little operating capital to run the hospital. They underpaid their doctors and treated them with contempt. They did not buy necessary equipment and supplies. Deferred maintenance on the building piled up. Many of the doctors moved away including surgeons who were very important to the hospital’s revenue. People in the community began driving to other towns to use the hospitals there. The average number of patients in the hospital each day fell from 75 to less than 10. They wanted it all and slowly they killed the goose that was laying the golden eggs. They wanted everything and ended up with a little bit higher percentage of much, much less.

They saw their market as static and limited. They saw increasing profit opportunities in decreasing their investments in people, operations and infrastructure. They took on a scarcity mindset. They starved the hospital of the resources it needed to thrive or even sustain itself. The hospital wasted away under this neglect and abuse.

Stephen Covey told a similar story in The Seven Habits of Highly Successful People. A restaurant sold a delicious clam chowder that people lined up to buy. The restaurant was sold. The new owners were given all the recipes. They decided that they could make more money if they used cheaper ingredients. Over time people realized that the clam chowder was no longer as good. The lines got shorter and shorter. When the new owners realized their mistake, they tried to go back to the original recipe, but it was too late. The restaurant closed. They bought a maximum value organization and tried to convert it into a maximum economy organization. They shifted from abundance to scarcity and failed.

I am not saying that cost savings and efficiency are bad. If the restaurant owners were paying $3/pound for butter and found the same quality butter for $2/pound from a supplier who was just as reliable, that would be value neutral for the customers and value positive for the owners. But if they instead bought margarine for $1.50/pound, that would be value negative for the customers who are still paying the same price for a bowl of clam chowder. Now the question is, “How would buying cheaper margarine affect the value equation for the owners?” The new owners thought it would be value positive. They figured that they would pay less for margarine and get the same price for a bowl of clam chowder. But the customers stopped buying the clam chowder. The little bit extra profit they made buying cheaper ingredients was small compared to the income they lost from reduced sales. It was also value negative from the owners.

Here is an important take away. Be very careful about changes that you suppose will increase your value results while reducing the value results for your customers and other stakeholders. That is seeing your customers and important stakeholders as members of the opposing team instead of being on your team. And when they realize that you are not on their team, they will abandon you as soon as a viable alternative presents itself. Where the value equation really counts is in what you deliver to your customers and other important stakeholders.

A maximum economy strategy is a scarcity strategy. It is driven by pessimism and lacks vision. It is excessively focused on cost reduction without weighing the impact on quality. It will fail to deliver value (quality divided by cost) and will likely lead to weakness and failure.

Read previous articles related to this topic:

Article #1: Maximum Wow Strategies Lead to Scarcity

Article #2: Your business’ future lies in an abundant strategy – not in scarcity

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

954 Hits
0 Comments

How to find 3-7% more Net Revenue at your Hospital

A recent survey of 146 CEOs by the Advisory Board (1), the CEOs voted that “sustainable cost control” was the number one priority. This is an imperative that every hospital in America must be doing in the current health care environment. Net revenue is tightening up. Smaller and smaller increases from government programs are the trend and health plans are taking the position that any new net revenue be tied to improving quality or costs. The routine annual increases are not routine anymore.

What CEOs should be focusing on is collecting all net revenue. What is the best that can be expected in net revenue collections from the revenue cycle area? Is it 90% of expected? 93%? 96%? What is preventing your organization from collecting closer to 100% of expected revenue?

We know that nothing ever happens at 100% in any field, endeavor or undertaking. Asking the question of “why not 100%” is the start of reviewing what is preventing your organization from improving on net collections. If your organization is at 91% net collections (including vendor fees, etc. from handing off old accounts), that’s pretty good. But can your organization get to 95%? Or 97%? Or 98%? What steps can be taken internally to earn an extra 3-7% of net revenue? That extra money could be the difference in meeting budget or bond market targets.

How to find your 3-7% extra net revenue:

  1. Adoption of a new attitude. Policies and procedures have been adopted over time that balance the effort and expense of collecting versus the return. Making policies that allow for write offs of cases under $500 or $300 creates the mindset that it is ok to “just write it off.” If $500 is ok to write off, then why not the $15 co-pay? The concept is to reinforce the attitude that NOTHING is written off without a “good” reason. Hospital revenue cycle leaders get under pressure to lower A/R and it is too easy to compromise on small amounts that can add up. But when its ok to write off $15 it becomes easier to write off larger amounts. Additionally, reinforcing the attitude of no write off without a good reason helps support collection efforts of the front offices as well as in the back end
  2. Trend analysis needs to be refined and acted upon more quickly. The new analysis is one plus one equals a trend. Reporting in revenue cycle often trends towards financial statistics and contractuals. Reporting needs to get more granular and specific to highlight trends in more real time. The best way to get real time information is to educate and empower your skilled staff.
  3. The staff need to understand that when they see something happen twice – sound the alarm. Getting a denial or a rejection you don’t understand once happens. But twice is a trend. You do not need to wait until 10 or 50 or 100 examples occur to request an investigation, create a report and send to a payer. Health plan payment systems are very precise and anything unusual needs to be acted upon immediately.
  4. Get better at reporting and documentation – fast. To support the staff, create rigor in the documentation of issues with plans. Nothing helps contract discussions for the managed care lead than starting off with how difficult the health plan is administratively. Reporting also needs to be detailed and refined in new ways to spot trends and support the managed care staff.
  5. Establish new interactions with payers – set expectations and standards. Monthly meetings with payers need to reframed. The managed care lead needs to get agreement on performance and service expectations of the health plan. Simple expectations of responsiveness, service turnaround, etc. is imperative and needs to be enforced with the health plans.
  6. Use process improvement techniques – be rigorous. Collecting the last few percentage points of revenue requires focus and discipline. Using process improvement techniques and their rigor is a must to gain and sustain results.

Hospitals need to ask the question: what more can be done to gain net revenue? Re-evaluating the revenue cycle and creating a “need attitude” is key. Adding a new focus and training for staff will create the ability to approach payers in a new way for new results.

(1) 2018 Advisory Board Research Annual Health Care CEO Survey conducted between December 2017 and March 2018.

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

1094 Hits
0 Comments

Your business’ future lies in an abundant strategy – not in scarcity

In Abundance: The Future is Better Than You Think by Peter H. Diamandis and Steven Kotler, the authors make the point that technological developments and continuing innovation will bring to the world a future of abundance rather than scarcity, of increasing prosperity rather than increasing poverty. I believe that they are right so long as we can maintain freedom in general, free markets in particular, reasonable levels of taxation and relative peace throughout the world. As I pondered on the ideas they presented, it occurred to me that a business leader needs to have an abundance mindset in strategic development. An overall scarcity strategy cannot bring a strong and bright future to an organization. We cannot simply cut and slash our way into growth and prosperity. Nor can we simply spend our way into growth and prosperity. An abundance strategy is one of tremendous value generation.

My wife and I built a home using a general contractor who builds custom, luxury homes. I commented to him one day that it had occurred to me that there are three types of people who buy a custom home:

  1. Maximum WOW! These buyers do not care how much it cost. They want to upstage everyone else at any cost.
  2. Maximum value. Value is defined as quality divided by cost. These buyers are willing to spend more money if they get a good return on their investment relative to their experience living in the home and to their resale value.
  3. Maximum value. Value is defined as quality divided by cost. These buyers are willing to spend more money if they get a good return on their investment relative to their experience living in the home and to their resale value.

I told him that I thought that he could build homes for wow buyers and value buyers, but he could not build a home for an economy buyer to which he agreed.

At first glance we may be tempted to see a maximum wow strategy as an abundance strategy, but maximum wow and maximum economy are both scarcity strategies. Both strategies are low value generation strategies, and low value generation will sooner or later lead to scarcity. In maximum wow the cost is too high relative to the quality generated. In maximum economy the cost is low, but the quality generated is too low relative to that cost. The abundance future is in high value generation that comes in a maximum value strategy.

Connect with us on LinkedIn, join our Active Network Program and look at the other areas of connection we offer.

1250 Hits
0 Comments