Every group practice administrator knows that issues with healthcare practitioners – both physicians and non-physician practitioners – occur, if not abound, and pose a great challenge. It goes without saying that we need our medical practitioners! Without them, we can’t provide care to our patients. However, large practices, and those transitioning into large practices, may experience growing pains in establishing and enforcing certain norms.
In our experience, some common provider issues include: untimely locking of progress notes, failure to process new work (such as reviewing lab results, signing documents) in a prompt manner, tardiness and attendance issues, appointments that significantly exceed their scheduled length, and scheduling disagreements. This blog series will tackle these topics and provide suggestions from decades of experience in medical practice management.
First, let’s consider things from a policy perspective. Closing and electronically signing progress notes within 72 hours is a gold standard. Not only is the progress note a legal document, but a complete note facilitates subsequent care and allows for the timely submission of medical claims. Policies and procedures (P&P) are not a magic wand that cause employees to automatically comply, but they establish the practice’s standards, and form the basis for enforcing your guidelines. P&P must be in writing and all relevant staff members must be oriented to their contents. The issues covered under your P&P should be monitored regularly. There’s an old adage in administration, If it isn’t measured, it isn’t managed. This means that if the issue is important enough to formulate a policy about it, as an administrator, you should be monitoring compliance.
Some practices regularly post or share performance metrics and let peer pressure do some of the heavy lifting. It’s not unusual to have a few clinicians with large patient loads, who are current on all their requirements; their stats on a global report can add subliminal pressure to your non-compliant providers and stimulate a little friendly competition.
For those of us who are not so lucky, acting on issues quickly is key. If, for example, you’re running, or receiving from your billing department, regular reports that show performance metrics like open notes, you can promptly address behaviors that deviate from the norm via one-on-one interventions. When meeting with a provider, it’s important to establish that the provider knows the rule and knows he or she isn’t meeting it. The next step is to establish a short deadline to have the backlog of unsigned notes completed and locked. Some providers have a tendency to buck the system and want to do things on their own timetable; others are usually compliant but may fall behind due to extenuating circumstances. The administrator’s approach may initially be different with each group, but the bottom line is the same: notes need to be closed quickly so the practice’s revenue is not interrupted.
In an effort to encourage compliance, some administrators have been known to step on the slippery slope of reducing the patient schedule, providing more administrative time to the provider to work through the backlog. While it’s certainly important to assess whether your practice’s patient load is realistic – that means, evaluating whether it’s counterproductive to completing all work and still maintaining some semblance of a life – don’t be too quick to pare down the schedule, especially if other clinicians with similar loads get their work done on time. This may set a precedent that will be hard to discontinue and cause resentment among the medical staff.
In accordance with HR policy, all conversations and interactions must be documented by the administrator in case disciplinary actions escalate. These are also good notes to have during any bonus or contract renewal discussions. For repeat offenders, a Medical Director’s involvement may be needed with the specter of additional disciplinary action looming in the background.
Dealing with tardy work, such as unsigned labs, prior authorizations, documents, etc., should follow the same path. Monitor – most EMRs have reports that tell you the status of unsigned materials – and take prompt action.
Join us for Part 2 of this blog series where we look at another common HR issue that may be affecting your group practice: absenteeism and timeliness.