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Over the last eight months, we have had a regular need to hire staff, both in Buffalo as well as in Batavia, New York. As a result of reviewing multiple resumes and conducting multiple interviews, we have witnessed a cultural change in professionalism that is not for the better. In speaking with other organizations, we have discovered that we are not alone in what we have witnessed. If you have intentions of seeking new employment, please read further, as I will detail what I have encountered, and provide you with insight on how to easily standout from other applicants.

We have been blessed with the need to expand our employee roster consistently over the last eight months. As a result of opening and/or contracting with practices, there has been a need to provide them with clinical support staff. Within Western New York, there are multiple post-secondary schools offering every clinical program you can think of from Rochester to Buffalo. Therefore, there is the potential for a large supply of candidates for recruitment. While the quantity may exist, the quality is not always as plentiful.

We typically advertise open positions on indeed, of which we also market on our social media sites, as well as our website. We make the best attempt possible, to provide specific details about the job, and what the qualifications are. So it still surprises me when we receive applicants for a nursing position, who have never gone to nursing school, and with current employment that has nothing to do with healthcare. If you apply to be a nurse, you actually have to be a nurse, as in you actually need a license registered in New York State. Immediately, those candidates are easy rejections. I wish I could tell you that I only receive one or two of these applicants for such positions, however at least 25% of the resumes are like this.

After eliminating the obvious rejections, I then look for the definite’s and then some maybe’s. The definite’s possess all that we are looking for, such as experience in that particular medical specialty; consistent loyalty to employers, not jumping from job to job, etc. And with the maybe’s, although they may not have experience with the particular specialty, if they have clinical experience that can be reasonably transitioned into the new specialty, and have not jumped from job to job, I will consider them.

Once ready to call and schedule interviews, I have learned that nobody answers the phone anymore. Or, maybe one applicant out of ten will answer the phone. And, not only do they not answer the phone, I’ve also learned the hard way that they may not return your call. So now, my protocol is to call the applicant, leave a voicemail, and then send a text message as well. The text message has never failed me. Scheduling interviews can be difficult. Applicants are eager to seek out new opportunities, but they’re not always eager about scheduling outside of their convenience. I’m willing to be flexible, especially depending on their current position, but I also have to be realistic. If they want the job badly enough, they’ll coordinate their schedule to ensure they can get to the interview. That’s if they show for the interview. Yes, you read that right. For every position that we hire for, we can expect at least one interviewee to be a no show, without a call, text, or email letting us know they won’t be there. If for whatever reason you cannot make an interview, I highly suggest you contact the company to let them know. While you may think it will go unnoticed, think again. And, there’s no saying that it won’t impact you down the road. Business owners and managers talk to fellow colleagues at other organizations all the time.

Although it is standard professional courtesy to write a thank you note in follow up to the interview, this likely occurs maybe one out of 25 interviews. If you want to stand out, send a thank you note! It can be via email. Because this happens so infrequently, when it does happen, you bet I take notice!

All of the above truly surprises me. Before becoming a business owner, when I applied for a new opportunity, I waited anxiously in hope that I may be called for an interview. If I was fortunate enough to receive a call, I didn’t expect the company to schedule around me, but rather, I would be there at whatever time they requested. In preparation to the interview, I would select a professional outfit and print out multiple copies of my resume. On the day of the interview, I would leave in plenty of time, fearful of being late; and absolutely would follow up with a thank you note, as well as likely following up if I hadn’t heard anything, to see if the position had been filled yet. I was persistent and I was eager, two qualities that don’t appear to be as prevalent anymore.

If you have been selected for an interview, your resume has demonstrated promise to the company that you could be their next employee. Let their review of your resume be an honest reflection of who you are, not only looking good on paper, but even better in person. Don’t waste the opportunity to demonstrate the best version of who you are. Even if you aren’t selected for the position, I promise you the efforts will not be wasted. It will lead to one of multiple things: 1.) Consideration for employment for a different position within the company; 2.) Recommendation to a different employer who may be able to use you; 3.) Great practice/preparation for the next interview. “Ambition is the path to success. Persistence is the vehicle you arrive in” Bill Bradley.

Last week, we started a series of blog posts, with the intention to identify positions in healthcare that may be underappreciated. Our first post was written about the “often unnoticed, medical receptionist”. This week, I decided to highlight the medical biller.

About five years ago, if asked about medical billing in a practice, I would have suggested the practice outsource the billing to a medical billing company. Within just the past three years however, my opinion has definitely changed. Through experience in practices I owned, as well as ones we have been contracted to manage, I have witnessed the consequences of outsourcing the billing. From my experience, what I’ve witnessed when outsourcing it, is the medical billing companies recruit decent billers, but then expect them to oversee a large amount of accounts. As a result, they’re unable to be efficient with any of the accounts they are working on, nor are they able to follow up on denials, or any other issues that result. I recognize there are likely some great medical billing companies out there who are not doing this, but I can say that this is what we have experienced with trying three of them.

If there’s a problem, then there must be a solution. We could not attempt trying a 4th medical billing practice. For 1.) Transferring your billing to a different company, is a significant amount of work; and 2.) time is of the essence to ensure the billing is running optimally, considering it is the life line of any medical practice. So, our solution was to hire a biller in house. Yes, technically the practices are still outsourcing it by contracting with us, but they have a person who is not overseeing too many accounts, who stays on top of any rejections and/or denials, understands all of the local insurances, and is held accountable by our leadership team. Therefore, we can guarantee positive results.

Having billing in house, has really opened my eyes to all that they do, and it is not for everyone. First, there’s the actual billing side; reviewing superbills, submitting, claims, posting payments, etc. But then, let’s face it, we all know the payers will do anything not to pay! And God forbid there’s an issue, because you have to try and get a human on the phone when you call, which is nearly impossible. And let’s not forget the constant change of how things are done. Everyone was freaking out about the introduction of ICD 10, and now I heard to expect ICD 11; understanding copays, deductibles, co-insurance, blah, blah, blah. That’s just billing. But to be successful, there’s the dealing with patients side. If you are unable to handle confrontation, this is not the job for you. Good medical billers must be able to call patients about outstanding balances and attempt to collect on those debts. There’s no guarantee you’re going to get a friendly response, and most of the time, you don’t. So, you try to stay calm, while explaining to the patient the details of what their insurance covers, despite the fact that they chose the plan, and likely knew it had a $5,000 deductible. If they didn’t, they do now!

In saying all of that, you can imagine what the personality must be like for most billers. We have an inside joke at CM Healthcare, that they’re like Roz, on the movie, Monsters Inc. I would place a bet, that our “Roz” is way cooler than yours. Stephanie O’Geen works for CM Healthcare, contracted to a couple different locations. Despite dealing with patients that may yell or curse her out, as well as having to deal with our leadership team on her back asking a thousand questions, she continues to be her graceful, and overly entertaining self. When she is in the office, there is no such thing as having a bad day. If you were having a bad day, she would certainly cheer you up, as she hits us left and right with some of the funniest things that just seem to come out of nowhere. Considering what she endures on a daily basis, you’d think we would have to be the ones to cheer her up. And if that’s not enough, if she’s not making us laugh, she’s making mugs or t-shirts for the staff, or most recently, peach pie, with peaches from one of the nurse’s trees.

I recently sat down with Stephanie to ask her a few questions about what it’s like to be a medical biller. Below are the questions and paraphrased responses.

What is the best part about being a medical biller? With her witty personality, she exclaimed, “When the payments come in…cash money!”

What is the worst part about being a medical biller? Dealing with upset patients.

Did you choose medical billing, or did it choose you? She let me know that it definitely chose her. It wasn’t something she dreamt about as a little kid.

What is something people would be surprised about? Whenever I call the insurance, it’s never just an easy call, and then everything is fixed. There’s nothing easy about dealing with insurance companies. She also said, that many would be surprised by the amount of little details that produce a large amount of work.

If you have a medical biller in your office, although they’re not likely as cool as ours, be sure to thank them. If you’re in need of one, give us a call!

Whether or not you’re employed in healthcare, one of the trends you have likely heard about, as well as the possibility of even being impacted by, is the influx of acquisition activity at all levels of the industry. From large health systems purchasing small hospitals, to hospitals purchasing physician practices, private equity firms buying large urgent care chains, etc. The new mentality in this industry is eat or be eaten. But are we truly improving healthcare delivery? Are we improving patient satisfaction? Are we reducing the costs of healthcare? I will examine each of these questions, prefacing what follows with an apology, as some may be offended by my analysis. Rather than being offensive, I hope it will encourage positive thought and reconsideration of how you are executing your strategic planning.

About five years ago, when speaking with colleagues in healthcare, I would get on my soapbox of where I proclaimed healthcare was headed. My opinion was that large health systems would become larger, through the purchase of smaller health systems, and as a result, all that would be left are these very large systems. I continued in saying that the large health systems would dominate a region; not region in the sense of Western New York, but as in the Tri-State area of New York, Pennsylvania and Ohio, for example. In the earlier part of that five years, when I said this, people thought I was crazy. Until now, when we are actually seeing that unfold. Just over the weekend, I read an article about UPMC, who is preparing to expand further into Pennsylvania and New York, as well as into Ohio and Maryland. And what about Cleveland Clinic, who already has a presence in Toronto, Florida and even Dubai!

As an entrepreneur, I completely understand the need to grow. I love the aggressiveness of UPMC, and the speed to market, of which is atypical to most health systems, who tend to move at glacier speed. And I could cite a number of initiatives by other health systems that I absolutely love, such as Cleveland’s customer service model. Another example, is what Mayo Clinic is doing in the wellness arena. Where I am struggling though, because I truly do care about the patient, is what is being done to ensure patient satisfaction is of utmost concern, and through these growth efforts, what is being done about the healthcare economic crisis. It’s no secret that a private physician who today has a reimbursement of x, if owned by a health system tomorrow, that “x” will double or trouble. And thus, rising health insurance premiums. In previous endeavors, as the owner of a private urgent care, this was one of my favorite things to market against. We were in competition with a local hospital urgent care. Something patients are unaware of, until they get a bill anyway, is they can receive the same care at either of those two urgent care locations, but the hospital location comes with a significantly higher price. If you are the patient with a high deductible plan, that’s a big deal. Not to mention, healthcare spending is already a big issue nationally, and now we’re adding to the problem.

The rising cost is one aspect of how the patient is impacted. From what I have seen locally (Western New York), the cost is only the beginning. Before elaborating on the impacts imposed on the patient as a result of acquisition, let’s talk about the healthcare staff who are effected. My staff and I hear regularly from healthcare professionals (both clinical and non-clinical) who are desperate for a new opportunity, for a new employer who is not owned by a health system. We hear stories of acquired physician practices who lose all of the former staff, because they cannot handle the newly imposed burdens of the physician being double and triple booked, not enough staff to help, and a manager they may only see once or twice per month. And if that’s not enough, this comes after losing all of their built up PTO, to be re-hired under the health system, and be put on a benefit plan that matches the hospital. So for physician practices that are closed on holidays, the staff must use PTO in order to get paid for the day off. As the physician tries to deal with these new burdens, as well as try to calm down their staff of which is dwindling, they are also arguing with the health system that promised x, y, and z before the acquisition, and only one of those promises gets delivered after the acquisition. And let’s not forget about the hospital staff, and all of their new expectations, of which despite how busy the staff becomes on their shift, they must complete everything within their designated timeframe, whether it be 8 or 12 hours, and nothing beyond that. Even the most veteran staff struggle with this, and some have given up, going somewhere else.

In saying all of this, you can’t tell me patient quality isn’t suffering. Of course it is. The staff is expected to do more with less. I’m all about operating lean and driving throughput, as long as there is a process in place that guarantees efficiency, and doesn’t overburden staff, or worse yet, create a potentially dangerous environment for the patient. Please note, I recognize that there are health systems, such as the Cleveland Clinic for example, who have all of the above down to a science. Unfortunately however, there are other health systems, who understand the need to acquire, but have no idea how to manage those acquisitions as they come in. Or, they grow quicker than they can handle. The problem with that, beyond the obvious, is the competitor is no longer just the other local health system. A looming competitor is the newly forming, private equity backed, healthcare companies. They possess many of the skill sets that don’t often exist under the health system/hospital umbrella, one being speed to market. And they absolutely grasp the need for customer service. As a member of the healthcare industry, I know these organizations are not always known for doing what’s best for the patient, or possessing the best clinicians. However, the patient does not know this! The patient is focused on their marketing ad that says they have a slushie machine in the waiting room. And speaking of ads, these organizations have millions of dollars to out-market their competitors.

Okay, a lot has been said, so I guess I should vocalize a few solutions, as well as some predictions. Health systems, you know you have to continue to acquire. As I stated in the beginning of this blog, it’s eat or be eaten. When acquiring, I would keep in mind that hospitals as we know them, are a way of the past. In saying that, it’s all about the outpatient world. You want speed to market in your secondary and tertiary markets? Stop buying old hospitals, and identify a great location for an outpatient campus, then re-purpose the old hospital building for senior living or something. Everyone loves outpatient campuses…patients, doctors, insurance companies, etc. It’ll cost you less to produce a 60,000 square foot brand new building, then to try and reinvent the old bricks and mortar. Additionally, when buying these small community hospitals, consider what you are inheriting. There’s one health system I think of in particular, that has done a lot of this. They buy these small community hospitals, get the communities excited that they’re going to send out some of their specialists, of which never happens, and they buy all of the problems. All they really do is change the sign on the door, and spend lots of time putting out fires. Also, I would consider partnering with a management company, to help properly manage the practices you acquire. If you’re looking for one, we’d love to tell you about what makes us different from our competitors.

If you grasp the need to move to an outpatient model, also grasp the need to move away from the sick model! We need to be progressive, and move into the well model. There are so many great well models out there. Akron General and Mayo Clinic are two leaders in wellness models that immediately come to mind. This is also a great way to reduce costs. With all of the knowledge of how to combat diseases such as Diabetes and High Blood Pressure, consider the reduction of cost if our first option for the patient wasn’t to prescribe them a pill.

Some predictions…these private equity backed companies are going to continue to pose a real threat to health systems. Also, local to CM Healthcare, I suspect within the next five years, there will be only one health system in Rochester, NY (currently there are two). I know one of those two health systems is working to create a presence in Buffalo, NY. They made an offer to buy one of the practices we recently opened there, as well as manage, stating they would buy it in two years, when they plan to have a strong presence there. I think Kaleida Health System has threats coming from all around. From Rochester, and I would have to assume UPMC, who has already stated publically, that they intend to move further into New York. Well, they already own WCA in Jamestown, making Buffalo the next natural progression. And we can’t forget about Cleveland, who is just up the thruway from Buffalo, and just over the border in Toronto. Actually, whenever I speak with Rochester physicians, who are interested to capture advanced cases from Buffalo, I inform them that their real competitor for these advanced cases is not Kaleida Health, but actually Cleveland Clinic.

There’s much more I could elaborate on above in the discussion of solutions and predictions. If interested to discuss further, I’d be happy to arrange a phone call or in-person meeting. CM Healthcare Innovations is an entrepreneurial healthcare consulting and management company that is prepared to ally with the right health systems, to help them compete in this new market. We have opened and manage multiple practices in New York, as well as the Greater Philadelphia Region. I have included my contact information below. Send me an email, so we can talk further!

Melissa Marsocci, MHSA

President/Owner, CM Healthcare Innovations

missymarsocci@cm-hi.com

With the decision to start a blog, I thought it would be great to highlight a couple of key positions in a medical practice that often go unnoticed. We certainly recognize the importance of the providers, however there are a couple positions within a practice that do not always gain the credit they deserve.

In this blog, I am going to talk about the front desk receptionist. Or, you may have heard this position titled by larger groups as Director of First Impressions. I love that! And how true it is! There is the customer service component of this job, in that this is the first person the patient sees, and the last. Additionally, it’s likely the voice on the other end of the line, when they call to make an appointment, or ask questions. But it’s so much more than that.

There’s no such thing as just hiring any random person off the street to manage the front desk. It’s more than a pretty face, and a nice smile. They must be able to learn how to use an Electronic Medical Record (EMR); understand health insurance, and what to collect in regard to copays and deductibles; make appointments; obtain answers to the many questions that come in via the phone; manage prior authorizations; coordinate paperwork that needs to be completed; attempt to collect past due balances; and the list goes on. The best part is they likely need to do many of these tasks all at once.

I recently sat down with Jessie Rapone, to ask her a couple questions about what it’s like to be a Medical Receptionist. Jessie is contracted to work at a pediatric office we manage in Batavia, New York, where she is a complete rock star in this position. The staff fears when Jessie needs to take time off from work, which fortunately is not too often. Each member of the ancillary staff is trained to fill in at the front desk, but no one can come close to our rock star, Jessie. There are some pretty intense days, but she never lets it get the best of her. She always has a positive attitude, to which everyone respects her for, and appreciates having her a part of the team.

Here are a couple questions I asked Jessie:

What is the worst part about being a medical receptionist? It wasn’t anything to do about the technical aspects of the job, but rather, she said it is dealing with rude people. Fortunately, there aren’t many people that are rude, that she has to deal with. But when there are, she said it is frustrating, because she always treats everyone with kindness and respect.

What is the best part about being a medical receptionist? As mentioned above, she said she is fortunate in that there is a limited amount of rude people. The best part are the lots of great people she interfaces with on a daily basis. Jessie is familiar with all of the families in the practice, and looks forward to seeing each and every one of them that comes in each day.

What is something you think people would be surprised about your job? Jessie replied by saying that people would be surprised by the amount of stuff she does. She said she feels that people often assume that her position is limited to her “just sitting behind a computer all day”. But rather, she said there are so many things she is managing, including many small tasks that really add up.

Because every ancillary staff member is trained to work the front desk, every member of our staff can certainly appreciate the type of person it takes to do that job on a daily basis, and to do it as well as Jessie. A huge thank you to all the medical receptionists, who daily play a huge role in keeping the practice alive and well, yet often go unnoticed. We appreciate you!