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Practice Pointers: Get your office software out of first gear


You can't improve efficiency and boost income unless your staff uses the system properly. Here's how to help them do that.




Get your office software out of first gear

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Choose article section... Are you missing out on these functions? Without reports, you can't manage Off-site training may be the best bet Learn from your vendor, and lean on him Cultivate a climate of information sharing

You can't improve efficiency and boost income unless your staff uses the system properly. Here's how to help them do that.

By Robert Lowes
Senior Editor

A 17-doctor ob/gyn group in Florida discovered two keystrokes in its practice management software that helped boost revenue by $600,000 a year.

The group had struggled to collect from patients in the office. Staffers knew only one way to determine what somebody owed—looking up balances from past visits and services recorded in their program from IDX Systems, and adding them on a calculator. The process took so long that on hectic days, staffers gave up and let patients leave without paying, says Vic Arnold, a professional services manager for IDX.

IDX representatives showed the group how to produce a grand-total patient balance on the computer screen by hitting "F4" on the keyboard while pressing "Alt." Suddenly, collecting from patients became immensely easier.

Arnold's story illustrates a common scenario: Physicians pay thousands of dollars for practice management software, but staffers don't use the most basic features. It's like buying a $225,000 Ferrari and driving it only in first gear.

Curtis Mayse, a St. Louis consultant with LarsonAllen Health Care Group, sees this problem all too often. Before he visits a physician's office, Mayse requests routine reports such as year-end summaries of overall finances, accounts receivable, and physician productivity by CPT code, all documents that the average program is designed to spit out. "Nine times out of 10, they can't produce some of them," he says. "Three times out of 10, they can't produce any." Without such documents, Mayse says, doctors fly by the seat of their pants, risking financial disaster.

Why the ignorance about software capability? Usually it's because cost-conscious physicians don't spend enough on training. Even when initial training is picture-perfect, doctors blow it when it comes to teaching new hires about the software or getting the staff educated about upgrades.

Short-term thinking also contributes to undercomputing. Employees caught in the daily grind don't take the time to master software functions beyond scheduling patients, entering charges, and posting payments. Another problem is sheer inertia, which caused a primary care practice in New Jersey to enter charges in its sophisticated software program but post payments on an ancient, hard-copy "pegboard" system. "They used the pegboard because they had always used the pegboard," says Kathryn Kocevar, a consultant with The Health Care Group in Plymouth Meeting, PA.

In an era of shrinking reimbursements, you can't afford to waste the firepower of your practice management software. The following advice from consultants and vendors—focusing on features that are standard on virtually all products—will help you get your money's worth from the technology.

Are you missing out on these functions?

Do you feel limited by an appointment schedule that's an endless series of 15-minute blocks? Some programs come with a default template that consists of 15-minute visits, but you can create templates that better suit your workflow. You can reserve Monday mornings for new patients, giving each a 30-minute time slot, or block out every Thursday from 4 to 5 p.m. for a committee meeting.

Jennifer Bever, a consultant with KarenZupko & Associates in Chicago, recalls how a Georgia surgical group made more work for itself by not learning how to customize its scheduling template. Staffers made appointments with their computer but scheduled surgeries on paper. "They didn't want to fill in eight 15-minute slots on the computer screen for a two-hour surgery," says Bever. As a result, staffers had to share a single scheduling book, which wasn't always at their fingertips. And they couldn't automatically monitor whether a bill went out after a hand-scheduled surgery.

Electronic claims submission dramatically speeds up payments, but consultants say that many doctors use this only for one or two big payers, such as Medicare. Of course, not all payers accept e-claims yet, but whenever one begins to offer that option, physicians are slow to switch over, says Belleville, IL, consultant Jerri Weith. Sometimes that happens because staffers don't update payer profiles in their systems to indicate that they accept electronic claims. Without an updated payer profile, the system will continue to print paper bills, says Weith. She advises doctors to review these profiles every six months to keep them current.

A similar story plays out with line-item payment posting, a function that breaks down a lump-sum payment into dollar amounts for individual CPT codes on a claim. To use this function in IDX software, you must activate it for each payer with a few keystrokes, says Peter Butler, a consultant with Hayes Management Consulting in Redmond, WA. "Many practices don't take the time to turn it on."

Is the payment you post the amount you expected to receive? The best software programs can tell if you're being shorted. They'll compare the dollar amounts listed on the explanation-of-benefits form to the fees that the insurer agreed to fork over for the CPT codes. The trick is, you first have to enter these fee schedules into your computer, says Butler. "I hear office managers say they're too busy to load the fee schedules," he says. "So they don't catch a lot of underpayments."

Without reports, you can't manage

Insurers that take three or four months to pay claims will dry up your cash flow. The typical practice management program can identify these laggards so you can take remedial action. One basic tool is a report that "ages" accounts receivable in increments of 0 to 30 days, 31 to 60 days, and so on. That's not enough detail, though. You need a report showing aged A/R receivable by payer. Slowpokes will stand out like the sore thumbs they are.

Some physician offices don't generate aged A/R reports by payer, even though their software lets them. Tammy Swanson, a product manager with medical software vendor Misys Healthcare Systems (formerly Medic), encountered such a practice. "They knew they had lots of receivables older than 90 days, but they didn't know what payers to concentrate on," says Swanson. The former office manager knew how to create these reports; her replacement didn't.

The ability to slice and dice data is one reason they call it practice management software. The popular Medical Manager program can spit out more than 150 standard reports in addition to custom jobs. All this information can overwhelm a staff and induce paralysis, says Jennifer Bever. "We help clients sort through the stack and choose 10 reports that they need to show their doctors each month."

Some reports reflect how well employees use the software, says Rosemarie Nelson, a computer consultant in Syracuse, NY. A monthly report showing what percentage of claims went out on paper can alert you to foul-ups in submitting electronic claims. Likewise, a report tracking the dollar amount of patient balances turned over to an outside collection agency is a gauge of your in-house collection efforts, says Nelson. An increase in A/R referred to an outside agency may indicate that staffers aren't fully harnessing your software's collection features.

Off-site training may be the best bet

Wasted software capabilities usually point to subpar training. Sometimes it's the vendor's fault. "Trainers may not give practical examples of why a practice needs a particular report," says Jerri Weith. By all accounts, though, the blame for software illiteracy falls mostly on doctors.

Vendors commonly prescribe five days or so of training at about $1,250 a day when they install their product. Doctors often negotiate to shave off a day or two, arguing that they're smart enough to teach themselves and their staff, says Jerry Schulz, director of sales and marketing at NextGen Healthcare Information Systems. "I tell them they're buying more than a billing machine."

Tammy Swanson of Misys says her company once scaled back training for bargain-seeking doctors, but now resists these requests. "We realized that we did clients a disservice when we reduced training. They'd get frustrated and say the system didn't work."

Doctors also shoot themselves in the foot by holding computer classes during office hours. "Employees become distracted because they still have to deal with patients," says Curtis Mayse. He advocates training office staff on weeknights or weekends—and paying them for their time.

New employees need to go to software school, too. The in-house approach—letting old-timers teach rookies—makes sense, consultants say, only if the software vendor has trained a key employee, like the office manager, to teach others. Even then, you should limit in-house training to lower-level employees and cover only rudimentary tasks such as scheduling appointments, says Jennifer Bever.

Vendor training is a must when you hire a new office manager or billing department chief, says Bever. She recalls one ENT group that did it right. The group sent a new office manager out of town for two days of vendor training before he reported for work. And the practice made sure his first two weeks overlapped the last two of the outgoing office manager, who showed her replacement more about the system.

Software upgrades also require physicians to invest in ongoing staff training. The pace of upgrades will quicken as the Health Insurance Portability and Accountability Act standardizes how health care information is transmitted electronically, making such transactions more commonplace, predicts Bever.*

"The question is, will employees be prepared to use the features that come with these upgrades?" she says.

Continuing education from vendors isn't cheap. Misys and IDX charge $1,250 a day—plus expenses—to send a trainer to your office. NextGen gets $1,520 a day. Training at a vendor site may shrink your bill considerably. A day of classes at NextGen's facilities in Atlanta, Philadelphia, and Newport, CA, costs $760.

You also can trim costs by dispatching employees to national and regional meetings sponsored by software vendors. Misys, for example, charges a standard fee of $900 for someone to attend its three-day national user conference. Regional meetings for Misys customers are more of a bargain: Attendees pay only for food and any hotel costs they incur; the training itself is free.

To accommodate doctors who don't want their staff to travel, more and more vendors offer Internet-based training. Once a month, NextGen holds a two-hour, live "Webinar" in which a trainer—heard but not seen—demonstrates software features on customers' computers by remote control and answers questions. These online classes are free for customers who pay for annual software support, says Jerry Shultz.

Learn from your vendor, and lean on him

If you believe that your staff isn't taking full advantage of your practice management software, contact your vendor. Software companies have internal consultants who can assess how well you're using their products. These analysts can be just as pricey as on-site trainers, but if you let them know that you're unhappy with the software, the vendor may not charge for a visit, says Rosemarie Nelson. "They'd rather help you than lose a customer."

You can also request an evaluation from a local practice management consultant who has expertise in the software product you use. You may get not only a smaller bill (you probably won't pay for an airline ticket and hotel room) but also a more objective opinion. A consultant won't try to sell you extra software and support services to earn a commission, explains Curtis Mayse.

While vendors can help you find the treasures of your computer system, sometimes you have to hound them to do so. "I've seen medical offices give up on their software because they got poor response from the vendor when they asked for help," says Terri Fischer, another LarsonAllen consultant in St. Louis. "Sometimes the company will blow them off by saying, 'You're the only practice I know that has this problem.' "

Persistence is even more critical if you encounter a serious program flaw. Fischer recalls one practice that was submitting paper claims to a major insurer because its computer system couldn't supply the provider number needed for an electronic submission. "The office manager asked the vendor to fix the problem, but she was pretty low on the totem pole of needs in the vendor's eyes," says Fischer. "I got involved, kept pressing, and within 48 hours, we had the problem fixed."

Sometimes such glitches in practice management software are flukes, but other times they stem from how the system was originally set up for an individual office, says Fischer. No matter why your software doesn't perform as advertised, don't let up on the vendor, she says. "It takes perseverance to get them to make the system work."

*See "Breaking through the HIPAA hype," Sept. 9, 2002.

Cultivate a climate of information sharing

Training on practice management software goes to waste if office staffers don't freely share what they know. Consultants and vendors routinely see a secretive climate in medical practices.

"Some employees have a protective attitude about what they learn," says Tammy Swanson, a product manager with medical software vendor Misys Healthcare Systems (formerly Medic). "They want to be the special people with the special knowledge. They seem to think that that gives them more job security."

One way to disseminate software know-how is compiling an in-house manual that explains step by step how your practice schedules an appointment, posts a payment, or generates A/R reports. Not only must the manual answer questions that might stump even an old-timer, but it should be required reading for a new recruit. If creating this handbook sounds like more work than your staff can handle, hire a consultant to do it.

Robert Lowes. Practice Pointers: Get your office software out of first gear.

Medical Economics


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