Don’t Hire a Rural Health Consultant Until You’ve Read This Article

As a rural health consultant myself with over twenty years in this profession and twelve years as a Fiscal Intermediary (MAC), I have seen what bad advice can do to a rural health clinic. Many times, I’ve been called in to pick up the pieces and help the practice get back on its feet. Let me give you some examples of the types of mistakes I have encountered and how an experienced rural health consultant would mitigate them.

Example 1

A Rural Health Clinic in central Florida had a contentious recertification by the State Agency. The surveyor was giving the business office manager a difficult time over their CLIA status and lack of Patient Care Policies. The physician intervened and the surveyor and physician got into a heated debate. The surveyor said that based on his findings, the clinic was out of compliance and he was going to recommend termination. The clinic called me and I spoke to the surveyor. He cited the discrepancies and I asked how he could recommend termination without giving the clinic the opportunity to take corrective action? When the surveyor returned 30 days later, the CLIA certificate still had not been issued and in spite of documentation that the business manager had, it was regarded as defiance. Additionally, the surveyor would not accept the adoption of the Nurse Practitioner Protocols as the clinic’s patient care policy. The surveyor again was going to recommend termination. I contacted the State Agency regional office and explained the situation but it fell on deaf ears. I contacted the CMS Ombudsman in Atlanta and furnished her with all the documentation showing that the surveyor and Regional Office were not following the State Survey Guidelines, but were, in fact, disregarding them. I assured her that the clinic was in compliance and had just received the CLIA approval. The clinic then received a visit from another surveyor and he was completely satisfied and the clinic was recertified.

Example 2

A Rural Health Clinic in west central Florida had a desk review of the prior year’s cost report and it was determined that a field audit would be warranted due to the lack of response for documentation. Apparently the office staff did not get the requests for additional information in a timely fashion. The physician contacted me and asked if I could assist the practice during the on-site field audit. A review of the case revealed that the MAC determined that the physician was well over the MD salary limits according to the MAC. The MAC used a Federal salary study by region for the basis of their determination of the reasonableness of the salary. The field audit lasted for four days and the exit conference indicated that there would be a substantial adjustment of more the half of the physician’s salary and fringe benefits. The adjustment would result in the cost-per-visit rate being sharply reduced which would impact the current year. I asked the auditor for the study which was used as the basis for the adverse determination and noticed that the study was more than 5 years old. The study was further flawed in it did not take into consideration the specialty, (this MD was an Internist) with advanced training (Board certification) and length of practice experience. I was able to secure a more current version of the study which had been updated and found that the physician was very close to the salary range when the other qualifications were taken into consideration. The result was that the adjustment was only 10% of the original determination and had no material effect on the clinic’s rate.

Example 3

A Rural Health Clinic in middle Alabama had a desk review of their prior year cost report bad debts. The MAC requested a statistically valid sample of bad debts that were in need of the EOMB (Explanation of Medicare Benefits) to justify the balances that were written off. Some of the bad debts were more than several years old and the documentation had been shredded by the clinic’s billing service. The MAC decided that without the EOMB the bad debts would be disallowed. The clinic was ordered to pay back a substantial amount resulting from the disallowances. Since the statistical sample was randomly selected, it was considered to be representative of the entire population. Unfortunately, the cases that had no EOMB were the very old ones which made up a small percentage of the entire bad debts but all were to be denied which skewed the sample. I argued that the sample was skewed and the percentage to be applied to the whole was not valid. The MAC did not agree and suggested that an appeal should be filed. The clinic would have to file a formal appeal through the PRRB. This could take up to several years and I knew this was not true so I suggested that the clinic contact Sen. Jeff Sessions, a friend of the clinic’s medical director and bring him into the case. Within three weeks the clinic was contacted by the MAC and told that most of the EOMBs had been found. The clinic was refunded most of their payback.

As you can see, hiring a rural health consultant with limited or no experienced can be just as risky as not hiring a consultant at all. In today’s market, most rural health clinics deeply depend on receiving the maximum Medicare reimbursement rate possible. One mistake by an inexperienced rural health consultant may result in an audit, and one failed audit could bring a clinic to its knees in short order. So what should you look for when hiring a rural health consultant? There are some obvious and not so obvious qualifications to consider.

First, the rural health consultant must have a detailed knowledge of all aspects of the Medicare Rural Health Program (Public Law 95-210). Technical, as well as practical knowledge of the conditions of participation, application submission, coverage issues, billing issues and most important Medicare cost reimbursement are critical to a Rural Health Consultant.

Second, an experienced rural health consultant should have a detailed knowledge of cost reporting and the factors which prompt red flags and potential desk audits. Additionally, if an audit is scheduled by the MAC, the rural health consultant should be available to the clinic to provide advice and technical assistance on a priority basis either by phone or on site.

Third, the rural health consultant must be able to engage not only the MAC staff and the State Agency staff on matters of findings and correct them when they are wrong or expressing their personal preferences even though those preferences may not be permitted in the regulations or operating instruction. The rural health consultant must be prepared to go to the CMS Regional or Home Offices to get a resolution to the problem. The rural health consultant must have contacts in higher places to present credibility of his knowledge and expertise in the areas of the issues.

By no means is this the entire list, but hopefully it will get you off to a good start. There are a number of rural health consultants in the market who have practice management experience, but zero experience when it comes to the Rural Health program. If you are having difficulty finding a tried, tested, and experienced consultant, contact me at (800) 592 – 3051.

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Marketing Your Health Clinic

It seems to be the case that many of the people who are attracted into the healing professions are not necessarily the most business-minded of people. This is a generalization, of course, but after coaching with osteopaths, chiropractors, masseurs, sports therapists, fitness trainers and many others in similar fields it would appear to be the case. The idea of selling yourself and letting the world know who you are and what you do is not appealing to everyone, but it is nonetheless vital in establishing a great, profitable business.

So what makes a successful healthcare practice? I would argue that foremost it is marketing. There, I’ve said it. Marketing. Probably one of the most disliked words I hear from colleagues and coaching clients.

What does marketing mean to you? If you are answering: adverts, yellow pages, expensive, waste of money, then you’re probably just being misled by the media portrayal of the marketing industry.

Because marketing is so much more than that…

Every time you see a patient you are engaged in marketing

Every time you speak to a friend, or an acquaintance you are marketing

Every time you even speak to a stranger about what it is that you do, you are marketing.

Sure there are the established ways of advertising and promotional activities, but there are so many more ways to market yourself and your healthcare practice.

In her book on client attraction “Get Clients Now”, CJ Hayden identifies 6 main ways to market yourself if you are a solo professional. She also lists them in terms of their effectiveness. The list looks like this:

1) direct contact
2) networking/ referral
3) public speaking
4) writing
5) promotional activity (PR)
6) advertising

What this means is that the most effective ways to attract new patients into your practice are direct contact with possible patients and a good networking/ referral scheme for patients to hear about you. In both these cases you establish not just visibility, but also credibility. When it comes to advertising and PR, you have visibility without credibility – you may say you’re the best osteopath in Europe but you would say that wouldn’t you? This isn’t to say that PR and advertising don’t work, but rather that they are perhaps not as effective as the other methods.

What does this mean to us as therapists then? Well first and foremost it means that we could adapt a marketing strategy based entirely around networking with local Doctors (for example), which may be highly cost efficient and also extremely effective. You don’t have to take out high price ads in local papers. Perhaps rather than just advertising in your paper, you could write articles for it, being a health specialist in an area of interest. Or give talks in your area of expertise to groups of people who fall into your “ideal patient” profile. The more you can expose your potential patients to your services the busier your practice will become.

Always remember that there are a variety of ways to market your healthcare business and many of them won’t cost you a single penny.

Andre Duquemin spent hundreds of hours and far too much money building his own health practice. Now he works with other health professionals to help them avoid making the same expensive mistakes he did. Andre believes in building health practices with integrity and is firmly against any hard-sell marketing methods.

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How Hospitals, Health Clinics and Doctors Offices Benefit From Virtual Waiting Rooms

Today’s hospital registration software is lacking the ability to mange the long, and sometimes frustrating, waiting periods patients have to endure to see a health care practitioner. Long waits are common for the Emergency Department, Operating Room and outpatient clinics for example. On average, Americans spend over 250 hours of their lives waiting to see a physician, either in a hospital, clinic or doctors office. Hospital registration software simply neglects this crucial point of service experience. What’s the solution?

Fostering a Positive Experience through a Virtual Waiting Room

Health care executives who are truly focused on the patient centered service are thinking out of the box when it comes to this crucial point of service experience. They are deploying queue management systems that create a virtual waiting room. Queue systems integrating SMS technology enable interaction with the patient or family member’s mobile phone. With queue mobile systems patients can enjoy a greater freedom to move around and avoid being exposed to sick people. Interactive queue mobile systems that use SMS text messaging enable hospital staff to notify a family member or patient instantly when it’s their turn. Patients or families are no longer tethered to an unpleasantly and potentially hazardous waiting area.

Today’s hospital management systems need to take into account the waiting room experience. Redesigning the hospital or clinic’s waiting room to be more soothing, less crowded and a comfortable space is a common approach that works but can be costly in terms of capital expenses. A more cost effective approach is to let the family or patient decide where in the area is the most comfortable place for them to wait. Empowering the patient or the family increases satisfaction.

Benefit to Work Flow
Staff can easy reach the patient or family with a text message or voice message directly to their cell phone. Text messaging is a very powerful communication medium with over 95% of text messages read and 85% of those read immediately. The advantages of texting is it is instant. With only 160 chacactar your message comes across concise and to the point. Interactive queue management systems can even reducing staffing costs.

How it Works for Hospital:
Traditional ED Wait Room scenario
Patient shows up at the emergency room on a busy Saturday and is triaged to the waiting room. Since the patients condition is not life threatening they are in for a long wait and potentially exposed to infectious diseases.

The interactive queue mobile ED scenario
The patient is triaged and the ED Registration staff requests permission to text or send a voice notification to the patient when the ED staff can see the patient. The patient, equipped with his mobile phone, can choose to wait anywhere he’d like (out side for fresh air, coffee shop, garden, etc) He can interact with the virtual waiting room by texting into the system specific commands such as “S” to get an updated on his status in line for instance. Although the wait time is actually not shorten the patient’s perception changes for the positive by feeling empowered he is influencing is waiting room experience.

Operating Room scenario
Patient is brought in for surgery and family is sequestered to the waiting room for 4 hours or more waiting for word on their loved one’s prognosis? The family has small children who are restless and hungry. The children want to take a walk to the cafeteria to get some food but OR staff encourages them to stay because the doctor will only have minutes to update them until his next procedure. They wait in anxiety and frustration.

The interactive queue mobile OR scenario
OR staff encourages family to take a walk to the cafeteria to get some food and burn off some anxiety. The OR staff ask for permission to text them when their loved one is out of surgery and doctor is about ready to seem them. Family goes to cafeteria to get a bit to eat. OR staff texts family, “patient is out of surgery and they can see the doctor now”. Family meets with doctor, everything is okay. Family perceives the OR staff as being extra accommodating thus increasing the family satisfaction.

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