Do You Really Know What I Do?

I was sitting across from my physician and thinking to myself, “I am your practice manager. Do you have any idea what I do for you?” I knew the answer without even asking the question. “No, you have no idea.” My boss has no idea what I do and what it takes to be a practice manager.

As we were discussing issues within the practice, I wanted to remind him that we are both on the same side. We both want the same things. We want our patients to be cared for in a timely, efficient, respectful, and quality manner. We both are working for the success of the practice. We were both after the same things, but somehow he had different thoughts on how we can achieve our goals and be successful.

I began to feel defensive as I tried to state my viewpoint and protect the authority I should have in my position. When I disagree with him, it is not because I like arguing; it’s because I know much of what it takes to keep the practice running, and I want him to appreciate my experience.

Somehow I wondered whether he realized how early I arrived at the office. While he is rounding in the hospital, I am trying to get work done even before the office is open. I am the first to arrive and often the last to leave. Does he realize that I often come in on Saturdays just to get a handle on the coming week? It is the only time the office is quiet and I can concentrate. It is the only time I can work without constant interruptions.

This is definitely not a 40-hour work week! Sometimes it is 50 and other times 60 hours per week. But I have a job to do and I will do it to the best of my ability, no matter how long it takes. My evenings are no longer my own, as I often bring work home. It’s the work I should be doing during the day, but can’t seem to get it finished.

I truly like my job. Some days, I even love my job. I know that I play a vital role in the running of this practice. It is partly because of me that the day runs as smoothly as it does. I can’t say, though, that I loved my job last week when I had to plunge the toilet in our office. Does my doctor realize that it is I who cleans up the messes, cleans out the microwave, cleans the refrigerator, and plunges toilets because no one else wants to do it? I keep telling myself that the next time I write a job description for a new employee I am going to add these items to his or her duties.

I wonder if he appreciates what I do. How can he appreciate when he doesn’t realize what goes on in the office? What he does know is that the office is staffed and patients are seen in a fairly timely manner.

Administrative Duties

I am guessing he doesn’t even think about the bills being paid. I spend time looking for the best prices, the lowest rates, and the best deals. Does it occur to him that it is because of my tenacious ordering that the exam rooms are stocked and ready for him? Probably not, but that is not his role. His role is to care for our patients. He hired me, and I am the one who does much of the worrying about fees, bills, and expenses. He is concerned with the bottom line. How I get there is not as important.

When I ask to take time off to go to a seminar, does he think I am really going shopping? When he asks why I need to go, I wonder what he is thinking. Let me be clear: I am going for my benefit and the benefit of the practice. Gaining knowledge and sharing it with our employees allow all of us to do our jobs better and more efficiently.

There is new information and better “best practices”; and as a practice manager, it is my job to keep current on the issues and changes surrounding healthcare. Whether it is HIPAA, the Physician Quality Reporting System, new Medicaid HMOs, or new federal guidelines, our practice needs to be compliant. We need the seminars, webinars, and audio conferences to understand the changes in the healthcare field. In fact, compliance and new regulations have become huge, and affect the running of the practice more than ever before.

As a practice manager, I have pursued a certification in my field. Although the law does not require it, I want to assure my physician that I have not only the experience, but the educational background to succeed. To maintain my certification, I, like him, need continuing education units. Yes, I keep my certification up, but I bring back valuable information to the staff. I also share that information with my physician during our meetings.

Human Resources

As the practice manager, I oversee the human resources area of the practice. I am responsible for the hiring, firing, and training of staff. I schedule staff and approve days off. When an employee calls in sick, I am responsible for rearranging personnel to accommodate the empty position and make sure the necessary departments have proper coverage to ensure that the day runs smoothly and patients get seen promptly.

I am happy to be responsible for the staff. However, when I came to the practice several years ago, I inherited the employees who had been hired before me. I wonder whether my boss realizes that some of those employees are toxic to the practice. I have spoken to the physician about replacing one of these employees, but for some reason he believes that she is the “perfect employee,” and therefore I am unable to reprimand or replace her. She is demeaning to others and frequently acts as a bully. It is too bad that he can’t hear her when she is speaking to her coworkers or to patients on the telephone. I am sure he would realize that she is not the perfect employee, and she does need to be replaced. A toxic employee affects the morale of the practice. If only he would let me handle the situation and not be protective of the difficult and toxic employee.

I monitor all employees and work hard to improve care. Ongoing training is essential to the well-being of the practice, and it is my role to see that all employees are educated and coached to improve their roles in the practice.

I may not do the billing, but I know which insurance companies pay well and which ones cause us the most aggravation. I track which insurances require a referral and which patients have copayments. Although it is not my job to run all the reports, I certainly review them in an attempt to stay on top of the collections and other aspects of the practice.

I may not know much about technology, but when it comes to our network and our electronic health record system, I am a pro. Whether I am working with our IT person to make the necessary upgrades or discussing how best to fix a problem, I must be an informed consumer. I may not be the decision maker, but I definitely influence the decisions my physician makes. My input often sways his decisions.

Compliance

I know that in many practices there is a separate compliance officer who oversees several roles and monitors compliance. In my practice, I am the compliance officer. My role is to guarantee we are following all the rules and regulations set by both the government and agencies such CMS. Insurance companies are also beginning to audit practices. It is my responsibility to prevent the need for an audit. If there is an audit, it is my role to guarantee that we pass. Following the guidelines is the best way to avoid penalties.

One would think this is an easy task, but that is not always the case. Physicians have their own way of doing things, and they don’t always see the need to do the task in a particular way. It is my responsibility to explain why and how we must be compliant.

HIPAA has become an important facet in every practice. As the compliance officer, I oversee our adherence to the rules of HIPAA. One might think that staying compliant with HIPAA is simply handing out a form to each patient and having them sign it, but we all know it is so much more.

Monitoring all aspects of the practice can often alert you to a potential violation.

Practices need to train their staff in HIPAA. This is not a one-time training; rather it is ongoing. It is important to continually coach staff in what might be construed as a HIPAA violation and how to prevent it. Whether it’s on-line training, reading articles, or having discussions, I continually work with my staff to ensure that they are compliant.

Knowing what to do and how to handle a HIPAA violation is also part of the training. Monitoring all aspects of the practice can often alert you to a potential violation, which may allow you to fix the issue before it actually becomes a violation.

Patient Care

It is part of my job to calm patients who are upset, especially when the clinical staff is running late. I train my front desk personnel to have a calming influence on the patients. I role-play with them so they are comfortable with patients. I teach the staff phrases such as, “I realize you are frustrated” or “I understand how you are feeling.” I wonder if the physician realizes how hard it is on staff when the patient is rude and disrespectful to our employees and to me? I wish that my doctor would be willing to stand up for his staff and terminate a relationship with a rude and disrespectful patient. No one should have to tolerate that type of behavior.

I help staff members prioritize patient needs and help patients with acute issues get appointments sooner. After all, of all the things I do, monitoring the needs of patients is my priority. Coaching the staff to better handle patient issues is a significant part of my role.

Revenue Cycle Management

With high deductibles, large coinsurances, and patients not wanting to pay their bills, collections have become more difficult. Profitability seems to be further away, when, in fact, our goal is to become more profitable.

It is part of my duties to oversee this aspect of the practice. I verify that my biller is coding the claims correctly, submitting the claims to insurance on a timely basis, and monitoring the explanation of benefits when they are received.

To survive, our practice needs to be profitable. It is important to work with all of your staff to look for ways to increase profits. Having your front desk receptionists ask for “balance due” payments when they are face-to-face with a patient has proven to be a much more effective way to collect money. My role is to encourage staff to be more productive and efficient, thereby helping the practice be more profitable.

Another way to increase revenue is to make collection calls to patients who have outstanding balances and have not responded to the statement that was sent to them. It is not only your billers and collectors who can make these calls. Rather, train your entire staff to make calls when there are no physicians in the office seeing patients.

Benchmarking

I have begun to benchmark my own job description and the improvements I have made to the practice. I am tracking the successes of the practice for which I know I have responsibility. Monitoring the compliance regulatory changes and the impact on our practice is now on my list of benchmarking items. I track my accomplishments and the changes I have made to the practice that reflect growth. I also track the revenue collected month to month and year to year.

Here are some of the items that I now do to protect myself:

• I schedule regular meetings with my physicians to discuss the state of the office and the state of my role.

• I benchmark the revenue cycle management of the practice:

  • Running and sharing of reports allow factual data to be used to improve the accounts receivable and cash flow.

  • It is a great opportunity to address how we as a practice are doing financially.

  • Discussions on what needs to happen to improve the receivables allow us to share ideas and monitor financial successes.

  • An important question to ask is whether we are becoming more profitable. The answer affects how we move forward and what changes need to be made.

• I make sure a discussion of the human resource area of practice takes place. This allows me to benchmark my performance and accomplishments as well as the accomplishments of my staff.

• I request a short morning “huddle” with staff and physicians when they are able to attend. This allows us the opportunity to look ahead at the potential complications of the day and problem-solve potential issues.

• Whenever I attend a seminar, I follow up the session with a meeting with my physician. He needs to understand what I learned and how we can improve the practice, staff and profitability based on what I learned.

I know that someday my physician will want the answer to the questions “What is it you do all day?” and “Why does it take you so many hours to accomplish it?” When that day comes, I will be ready with my benchmarks, my own personally written job description, and my list of accomplishments. I wonder if then he will realize how valuable I am and how much I do. I love the practice I work for, and the reason I spend so many hours here is to ensure its success. Perhaps one day, my doctor will know I am on his side and have his best interest and the best interests of the practice at heart.

In my case, my physician will know what I do, simply because I continually tell him, not just in words, but in data, meetings, and frank discussions of profits, growth, and strategy.