Not the right question That can be answered in 3 minutes The real question is complex and is really asking "How to run an Efficient Medical Practice where staff learn, perform, and grow to create a dynamic environment for patient satisfaction, employee satisfaction, and physician satisfaction, while growing revenue." I altered the topic

(Opening the Door to Revenue)

Building a Practice and a Life (The Efficient Practice)

Student, Intern, Resident, Fellow Learning by Immersion ("Drowning") Focus on understanding the facts, processes, data, understanding science, your role in it all Minds are fresh, open, curious, exploring, and protected. (Academic Setting) "I don't care about making any money, I just want to treat and help my patients"

Employed What does my contract say? What do I have to do? How do I get paid? Am I satisfied? Am I happy? What can I control? Are there any other options? Am I enjoying my life outside of my job?

Private Practice- small, medium, large Are my patients satisfied? Are my employees satisfied? Am I satisfied? Am I happy? Am I in control? How do I control my destiny? Insurance Companies, Government plans and regulations Can I survive out here?

Never stop learning after "official training" Be open to ideas outside of the medical field Keep medicine as a big part of your life, but not your LIFE ! Discover your purpose and your dream and go after it with all that you have. Always work on yourself more than you work on your job

Our current financial challenge in medical practice Overview of my practice - Oliver Family Healthcare,P.C. New Paradigm - Think Twice (White Coat / Dark Suit) White Coat Thinking Dark Suit Thinking EHR – The Centerpiece of Profit Growth Putting technologies together - Laddering technologies Results – The profitable practice Future enhancements and efficiencies for additional profit See the possibilities for growth in my own practice. Can I really still be in charge of my destiny?

"If you don't work for your own dreams, You'll work for someone else's"

Sharing my journey as an illustration Your path will be much different It will be of your choosing, or of your not choosing If you gain one bit of information today that helps you in your future, then my purpose will have been served.

Attitude Quality Care Right Staff Servant Service Systematized Business

Physician First Office will reflect Drs attitude If Dr. treats staff coldly, staff treats patients coldly Work to develop functional team Avoid Hierarchy in the office Direct physician communication with staff

Patients dont care how much you know, until they know how much you care ! Always put patient care first My mentor: Dr. Steve Young, Cardiology If you take great care of the patient, youll never have to worry about the money

I choose attitude and personality over skill Must have good skills, but skills can be taught… attitude and personality cannot Attitude: Team, caring, ambitious, industrious, fast paced, teachable Interview, screen, ½ day workview I get input from current staff If you make mistake, admit it, fire fast Hire slow, fire fast Eliminate Deadwood, Trim the plant

Entire office should be servant trained Patients dont want to feel like objects We smile, use patients names often Ask how we can help Ask if everything was handled today Dr. asks patient if any problems with office or staff to let him/her know personally No automated attendants!!! Call patients with every lab, test, procedure f/u

Have systems in place for everything System for how to greet patient, phones, scheduling, check-in, collections, insurance, settlement protocols, financial task redundancy, deposits, time off, every aspect of business. Every team member must understand Takes time, education, positive reinforcement Morning Huddles Monthly executive review Annual strategic planning

Declining Reimbursements from 3 rd party Escalating Costs- rent, supplies, equip Govt / Insur oversight / decision mgmt. Performance initiatives – Pay 4 Perform Consumer demands – patient pays more Pressure to be clinically / tech up to date "Healthcare Reform" is changing landscape I believe we are moving toward "cookbook mediocrity"

Family Medicine for 28 years ER Physician during first 7 years Started with 2 other Drs Developed a 4 location, 15 Dr. Group Developed and operated 5 urgent cares Sold entire group to Hospital Was Medical Director of the hospital group After contract up, bought back current practice Last 9 years focused on small, efficient, profitable practice

1Dr., 1FNP, 2 PA-C 20 total staff Family Medicine with modified open access model Use Allscripts Professional EHR and PM system Wireless tablets for providers, laptops for nursing, desktops for administrative and reception staff Onsite x-ray, dispensary, ancillary services No hospital, nursing home care, I use hospitalists On staff at two local community hospitals 75,000 charts on system Average 2300 patient visits per month

Medical practice has two independent mindsets operating My clinical practice and my medical business Decisions require Think Twice evaluations White Coat Thinking – Whats best for the patient Dark Suit Thinking – Whats best for my practice Strategic Planning – Plan, Do, Review Physician ownership mentality is required Physician buy-in is imperative for greater profits Learning the power of the EHR and partner technologies will create greater rewards for practice and Dr. A resource ! Michael Gerbers The E-Myth Revisited, and The E- Myth Physician

Patient Care Enhancement Diagnosis and Treatment Quality of Care Issues Safety for patients Risk reduction Continuing Education Preventive Care implementation Follow-up Care obligations Results reporting to patients

The business of our practices Focusing on revenue expansion New services Greater efficiency in managing patient care Controlling costs – transcription, employees, supplies Schedule management Intra office communication Office – patient communication Bringing it all to the bottom line - Greater profits

Schedule management and visit expansion Enhanced intra – office communication Correct coding – E/M calculator Test results reporting efficiency Preventive care and visit outreach In House service expansion - In House Dispensary E-script efficiency Patient follow-up reminders and tracking Vendor interfaces – Lab, Hospital, Ancillary Equipment Patient feels that Dr. is better, technology = quality

Correct Coding E & M Calculator Schedule Management Visit # Expansion Service Expansion First Fill (EKG, PFT, Holter) EHR Enhanced Intra-office Communication Preventive Care & Disease Management Outreach E-script Efficiency Patient Follow-Up Reminders & Tracking Vendor Interfaces Lab, Hospital

Establish independent parameters for each Dr. / Provider Establish appointment times for ancillaries in office Track No-shows Keep lists to fill appointment cancellations Set up appointments for disease states or insurance types Color coded patient appointment management

Messaging between phone intake and nursing staff Messaging between Dr. and nursing staff Messaging among nursing staff Consult passing between Dr.s and midlevels Sending charts for work to appropriate staff member Sending dated reminders to staff regarding patient care Create shared message boxes for general work In exam room contact between Dr. and Nursing, EHR communication and voice command contact

Most physicians undercode E & M codes A review of our coding practiced showed following $61,000 undercoding loss in 2005 Captured this revenue following year with E&M calc. $39,000 undercoding on New Patient Visits in 2006 Captured this revenue in 2007 with E&M calculator and have continued to improve annually Continue to enhance coding at point of care Physician must take control of practice financial destiny

Lab tests come overnight into patient chart Single test review site in EHR. Physician reports all tests by voic to each patient Patients feel that personal call came from Dr. Nursing staff use voic to notify patients also EHR allows rapid movement to multiple patient charts Medvoice is the technology we use, others available

Automatic search of EHR for preventive protocol Automatic search of EHR for disease management protocol Automated phone calls and confirmation of appointments Patients can cancel appointments electronically Open appointments can be filled immediately First month revenue increase $ 13,500, continues to grow Patients think service is incredible – they dont have to think 2008 start of program - Revenue increase of $300, consistent revenue enhancement of $400,000

A-S Dispensing program On premises medication dispensary ½ of sales are cash, ½ of sales through insurance Can order prescription in exam room – Checks inventory Verifies patients medication insurance coverage level Patient picks up RX at front office on check out First 4 weeks profit = $2,600, continues to grow Expansion of in office formulary easy Inventory control easy Automated reorder of medications 2008 Dispensary revenues of $35, Dispensary revenues of $51,000

Scripts sent to any State Pharmacy from exam room Patient satisfaction high. No wait at pharmacy Rapid refills from E-Script requests from pharmacies Enormous time savings = more time for revenue production All of prescriptions are legible Can send prescriptions electronically, by fax, to printer Script management by nursing staff via grants

Send future reminders to staff for patient care Track referrals as reports return Send future action plans for patient tests or procedures Automatic reminders about specific patient needs or desires Eg: 32 y/o patient with breast lump, tender, freely moveable. Recommended 1 month of conservative care and observation. Patient advised to follow up in 4 weeks. Left a 6 week dated reminder to notify patient if she hadnt returned. Patient had not returned, we called, she came in, got mammogram after re- evaluation. Lump was malignant and was removed early.

Bi-directional interface with Lab, overnight lab results to chart Pull electronic data and put in chart from local hospital network, Docs for Docs Incoming fax reports directed to patient charts for review

Weve had hundreds of patients enter our practice after friends, family members, and co-workers have experienced some of our technologic services. In a time where patients will pay more out of pocket for primary care services, the office that provides the best service and care will have the most good patients.

Immediate results when we went live on EHR 1. $39,000 reduction in transcription costs Our transcription bill from year prior 2. $60,000 reduction in employee costs Two employees left, didnt want to learn computers Did not need to replace them due to less paper handling 3. Loss of expenses related to charts, filing, space requirements for files 4. Employee satisfaction and lower turnover 5. Our EHR was paid for with this immediate cost savings

9 years 50 patients a day to over 115 patients a day 250 new patients a month Patient satisfaction surveys average 95% in all categories Increased Employee benefits every year – Dental, vision, 80% of health insurance cost, 100% matching 401K, profit sharing plan for all employees, monthly bonus plan for all employees, extremely low employee turnover, only 1 person has left in 6 years. 25% + profit growth annually Quadrupled revenues in 9 years –measured from year prior to renewed private practice implementation 2008 with 27% increase revenue over previous year 2009 provider time off expanded with same profitability 2010, 2011 increased revenue with preventive business

EHR and Mgmt. software integrated Point of care Charges input by provider Clean claims submission within 24 hours Navicure real time claims interaction Automated payment posting from insurers Active in house collection management Patient training for up front payment, discounts and deposits up front. Accounts Receivable > 90 = 2.75%

Use fully integrated EHR / PM Chart connect Labs, Hosp., Pharms Chart connect in-house ancillaries Data mining software Point of service E/M coding Intra-office and patient communication Point of service quality care protocols In-house profitable ancillaries patients want

Increased Employee Benefits Dental, vision, 80% of healthcare costs 100% matching 401K Profit sharing plan for all employees 15-25% profit growth annually for 9 yrs Increased provider time off Able to add new ancillaries / update equipment Employee Monthly Bonus Plan Adequate profit to fund outside investment opportunities 2009 – Added Preventive company –Cash Business Recruiting second physician actively

2002, employed Dr. + NP $ 625, , Private Practice Dr. + NP $ 875, , Private Practice Dr.+NP+PA $ 1,250, , Private Practice Dr.+NP+PA $ 1,635, , Private Practice Dr.+NP+PA $ 1,975, , Private Practice Dr.+NP+2PA $ 2,300, , Private Practice Dr.+NP+2PA $ 2,715, , Private Practice Dr.+NP+2PA $ 3,060, , Private Practice Dr.+NP+2PA $ 3,390, , Private Practice Dr.+NP+2PA $ 3,705,000

Morning huddles to future-face any problems of the day Train staff to high level to off-load work of Dr./NP/PA Always explore new technologies for possible benefits as time savers or revenue enhancers. Get started now – review current status and write plan for improvement. Always Think Twice

Implement and understand your EHR Mine and act on data acquired Use automated systems for non complex actions Train your patients to understand systems Add profitable, necessary ancillaries Make every staff member a patient advocate and revenue producer Establish monthly and annual plan, do, review Spend time working on your practice, not just in your practice

Strategically plan implementation of laddering technologies Stay up to date with upgrades, new technologies Take advantage of training modules Always think twice / White Coat and Dark Suit paradigm Be a high quality, high profit practice Focus on your patients and practice, not outside influences Attitude is EVERYTHING, Take charge of it ! Discover or remember your purpose in life. Write down and take action on your dreams, goals, plans Work on self-improvement Understand it's OK to make a profit Make every year Your Best Year Yet !!

Opportunity: Searching for a D.O. to join me in my practice in Entrepreneurial minded physician who would enjoy working in a small fast-growing private practice. To be part of a team that values working hard, playing hard, and deciding and taking actions on ideas that make our patients healthier, our employees satisfied, and our personal lives rich and rewarding.