A few days ago, I was watching an interview on ‘Mad Money’ with the CEO of Salesforce.com, Marc Benioff.  Mr. Benioff was introducing Salesforce’s new social medium platform for businesses, Chatter – just like Facebook for business. 

This idea of using a “Facebook” type of application for a small company is brilliant, it’s a great way to communicate with all employees, or specific employee groups, and even more brilliant as a way for management to get information that they might not necessarily see.  Using a social networking site will all for instant collaboration, give a real time “snap shot” of the company, and allow management to gain valuable insight.

Today, NY SportsMed is launching Yammer, similar software to Salesforce’s Chatter, but free.  Yammer sells upgraded Silver and Gold packages for a few dollars per user. Yammer is set up just like Facebook, but it is a closed group to just people with company email addresses.  (I am reluctant to endorse products here, but this one is very cool and free).

Some of the features that I look forward to using:

Profiles – employees can share important information on their profiles

Status Updates – Share insight or a tip of the day, front-of-the-house staff and back-of-the-house staff can collaborate.

Groups – work groups can share information and work together across different locations

Document Handling – we can post important documents, such as the employee manual so people know where to go to find it.

App updates– employees (and managers) can get updates via sms or an iPhone app.

NY SportsMed will be testing Yammer our today, I will keep you posted.

AdamBanks

I am taking my co-op billing idea to the next step; I am going to propose some real world numbers!

The below budget is based on NYC prices; rent, salary’s and electricity are significantly more expensive in this town than the rest of the US – I am sure some of you will laugh at these numbers.  If we use these higher numbers for assumptions, certainly there will be room to reduce expenses in the future.

For simple assumptions, I have added an additional biller for each 3 practices and divided the expenses equally by practice.  In reality a practice would have to “pay for what they use”.  A small practice may actually use only a portion of 1 biller – a small practice could get all of the benefits of a large billing company for a portion of 1 salary and overhead.  A large practice would pay a larger portion of several billers and a larger portion of the overhead.

It would be easy to see that a smaller practice could get the full services of the cooperative for less than $2,000 per month.

AdamBanks

I am so sick of wasting so much money on collecting from insurance companies.  Each and every practice is wasting its profits on “back-of-the house” operations.  NY SportsMed runs a large “in-house” billing department – this is a very expensive operation – but I have found it better (most likely not cheaper though) than out-sourcing. 

To do billing in-house NY SportsMed spends 10’s of thousands of dollars to keep up on the ever changing environment of billing.  We bring in billing consultants quarterly.  Our company is lucky in that we can afford this investment; most small practices (and small billing companies) could never make this investment. We are very good at billing, but we spend so much money to be good at it (right now our billing department is 6 full time employees – all located in Manhattan on the most expensive square footage in the country).

Our company is not only waste money on billing, we all waste money on other information that we could share, like calls to our attorneys.  It drives me crazy to think that we are paying our attorney $300 per hour to answer a question and the practice down the street is paying their attorney $300 an hour to get the same answer to the same question.

I propose the creation of a billing “cooperative”.  I don’t feel that there is “competition” among our practices, why don’t we agree to share back-of-the-house resources? 

The basic idea of the billing co-operative is that we will create a billing company that we all can own (member-owned and operated, an alternative to commercial profit-orientated medical billing company).  As members, we will work together to build the most efficient and knowledgeable and ethical billing company.  Only members may use the resources, we will share in the expenses based on actual use / actual expenses.

By combining resources we will eliminate duplicity of billing departments, and eliminate the third-party-for-profit billing companies.  Members will share information on a real-time basis to help all member companies become more profitable.

I propose the following principles:

1st Principle: Voluntary and Open Membership

The Billing cooperative would be a voluntary organizations, open to all physical therapists willing to accept the responsibilities of membership, to use the services of stated co-op.

2nd Principle: Democratic Member Control

The billing cooperative will be a democratic organization controlled by their members, who actively participate in setting their policies and making decisions. Elected representatives are accountable to the membership.

 3rd Principle: Member Economic Participation

Members contribute equitably to, and democratically control, the capital of their cooperative. At least part of that capital is usually the common property of the cooperative. Members usually receive limited compensation, if any, on capital subscribed as a condition of membership. Members allocate surpluses for any or all of the following purposes: developing their cooperative, possibly by setting up reserves, part of which at least would be indivisible; benefiting members in proportion to their transactions with the cooperative; and supporting other activities approved by the membership.

 4th Principle: Autonomy and Independence

The billing cooperative would be an autonomous, self-help organization, controlled by the members. If the co-op were to enter to agreements with other organizations, including governments, or raise capital from external sources, it would do so on terms that ensure democratic control by their members and maintain the co-operative autonomy.

5th Principle: Education, Training and Information

The billing co-op will provide education and training for their members, elected representatives, managers, and employees so they can contribute effectively to the development of the billing co-operative.  Members will share billing related information to other member’s of the co-op, individuals working in the co-op will be educated to provide the highest level of service to the members.

6^th Principle: Level of Service

The billing cooperative will provide a higher level of service to members by sharing information among practices.  Billing standards will be increased; practices revenues will increase as all practices will share in real-time information.  

Let’s start the conversation, email me if you are interested: abanks@nysportsmed.com

AdamBanks

In a majority vote during Tuesday’s primary elections, the voters of Missouri chose to invalidate a mandate of the new health care bill which presses for individuals without healthcare to purchase healthcare.  The overwhelming 71% support of this referendum, Proposition C, was the first of its kind to be passed before the 2014 law goes into effect.   Due to alot of uncertainty with the new healthcare bill, there will likely be many court decisions on how the bill will be interpreted and if states will be able to pass such measures.  We will have to simply sit back and see how things weigh out. To read more about Missouri’s decision, read a recent post in the New York Times.

JosephBrence

Are your notes compliant?  PT’s are running into trouble with Medicare because their notes are not properly signed.  CMS requires all notes contain (1) date, (2) time, (3) authentication and (4) legibility.

Below are key excerpts from the CMS manual. Read the entire text of the here.

All entries in the medical record must be dated, timed, and authenticated, in written or electronic form, by the person responsible for providing or evaluating the service provided.

• The time and date of each entry (orders, reports, notes, etc.) must be accurately documented. Timing establishes when an order was given, when an activity happened or when an activity is to take place. Timing and dating entries is necessary for patient safety and quality of care. Timing and dating of entries establishes a baseline for future actions or assessments and establishes a timeline of events. Many patient interventions or assessments are based on time intervals or timelines of various signs, symptoms, or events. (71 FR 68687)
• The hospital must have a method to establish the identity of the author of each entry. This would include verification of the author of faxed orders/entries or computer entries.
• The hospital must have a method to require that each author takes a specific action to verify that the entry being authenticated is his/her entry or that he/she is responsible for the entry, and that the entry is accurate.

AdamBanks

We are launching IPads for medical notes in our practices.  From the second that I first held an IPad, I knew it was a game changer for medical notes.

As a practice administrator I am always fighting to get “good” notes done on time.  I fully understand that from a PTs perspective doing notes is tedious work however, it is my job as the administrator to make this as easy as possible for the PT, while producing a compliant note.  Note “burn-out” is very expensive to the practice, bad notes don’t get paid, and they clog the billing process with denials and appeals (possibly adding an additional staff member to handle).

I see that the IPad as a “Game Changer” in the way providers interact with the EMR system.   I envision all providers being able to get notes done, real time, in front of the patient in a non – intrusive way.  Notes can be done on the IPad very quickly, almost at a conversational rate.  Patients are quick to adapt to the interaction of a PT talking and clicking away on the Ipad.  PTs can be “heads-up” and still complete a note.

Our practices has tested everything to make note taking easier; dictations (didn’t work as there was so much back and forth with India, Tablet PCs (too heavy and too slow), Assistants (too expensive and burn-out was high), and different software’s (long on promises and short on delivery).

At $500, I am finding that the IPads are actually cheaper than PCs, too.  A fully loaded PC always seems to end up around $1,200 – no matter the teaser price.  The maintenance on PCs is a very real expense, our practice has hired a 3^rd party computer “geek” company, is always upgrading our anti-virus software, and I frequently walk by an employee that isn’t doing anything because their computer “doesn’t work”.

I have asked a few of our PTs to post their experience with the transition to IPads.   FYI, we are buying the “cheapest” Ipads, we have Wi-Fi set up in the office and I don’t see that we need 3G.  We have been testing an external keyboard, and so far everyone likes the option of using it.

I am not in the pracitce of endorsing a product, however I am very impressed with these two EMRs, www.forcetherapeutics.com and www.WebPt.com for the high quality note that they produce in “real time” and both are IPad capable.

AdamBanks

The most trafficked pages on our practices web-site are the provider profiles. Patients read these profiles, before they come in and after. Here are three things you can do to improve your profile

1. Keep it Fresh: Content that is not update has a tendency to feel stale. Update your profile often, keep dates current (ie, the last thing you mention should not have happened 5 years ago).

2. Buy the Race Photos: If you are an athlete, buy the $30 professional photos that are sold after races. Your patients want to know that you are active; the sweaty pictures with bib numbers are great marketing tools and they make your bio look more interesting and credible.

3. Build an expertise. Choose an event, running, soccer, baseball, golf – and comment on it in your bio regularly.

4. Make exercise sheets. Just like in all of the fitness magazines, people respond to short “lists”. Be creative. Some that we like, 5 tips to better abs, 5 tips to safer running, 5 ways to relieve back pain. Post yours exercises adjacent to your bio.

AdamBanks

The PT Project servers have lost data from June 24th forward.  If you have registered for a seminar, the newsletter, or otherwise tried to contact us, please do so again. 

Please resend any communications to The PT Project directly to jon@theptproject.com.

AdamBanks

The Federal Trade Commission (FTC) delayed enforcement of the “Red Flags” Rule until December 31, 2010.

 The delay comes at the request of several Members of Congress, who are being urged to pass legislation that will resolve any questions as to which entities are covered by the Rule.

Read more

AdamBanks

Our products have arrived!  We now have a decent inventory of foam rollers, polo shirts, water bottles, high quality tapes, orthotics, TENS units, and we are even trying out waterproof sunscreen.  With the distributors that we chose, we have been able to price all of our products at just about double our costs.

We have already set up a few small display racks for our “retail store”.  What have we learned so far from this process?  A lot of time goes into setting up and stocking the store, as well as warehousing the extra inventory.  We have had to make up small price tags for each product, and have to rearrange and restock our displays throughout the day in order to keep them looking good and well stocked.  And this all takes time away from other tasks that our employees can be doing.

Another issue we are trying to work out is how to track inventory.  This has been our biggest obstacle so far (other than the fact that everyone wants something for free!), but we’re considering a few options to make this easier.  Is it enough for the front desk to just write down what is sold on a piece of paper each day?  This didn’t work so well for us in the past.  We are looking into iPhone applications that should make tracking inventory easier.

Our second major issue is how to handle sales tax.  We have to either build the cost of the sales tax into the price that is charged for the product or we have to charge for sales tax separately.  If we charge it to the patient on top of the product price, then the dollar amount of the sale is not nice and “clean”, so we have to keep more change at the front desk.  Also, our billing software is not set up for tracking the sale of retail products and figuring out sales tax collection, so we end up doing it by hand (or we wind up forgetting to collect the tax).  

Since calculating sales tax by hand is a pain and having to hand out change is kind of lame, on top of the fact that I really don’t want to have a cash register or a drawer filled with lots of change at the front desk, I’m leaning towards just including the sales tax in the purchase price of each product.

Oh, and by the way, our best seller so far?  The short length foam rollers (aka “the baby roller”).  I’ll continue to keep you posted on how our “store” is doing…

AdamBanks

1. Fatigue from cycling…is it in your head?
2. Wii-hab Increasing Rehab Potential
3. Barefoot Running: Separating Facts From Myth
4. A Brief Review
5. Tight Hip Fexors . . . A Pain In the Neck?