Seeking Direction
By Kathleen Casbarro For ICD-10 transition, It’s Essential to Choose the Right Path Should Ben start practicing the new style of documentation long, or wait until he has to do it? “It’s great that you’re not experiencing pain any longer,” Ben told his last patient of the day, “but remember to come in for regular adjustments and keep it that way.” The young woman hefted her tote bag and stepped through the door. “I know I should, but somehow if I’m not having any pain I don’t make the time.” Ben commiserated. “Let’s go ahead and make your appointment now,” he suggested. “That way you’ll have that part done. Pam, can you help Sheila?” “Of course!” Pam took over with a warm smile.Ben understood what his patient meant. He had been trying all day to get used to the new clinical documentation he’d have to be using once the shift to ICD-10 codes took place. He had tried to note which side of the body each issue involved and to write notes with the level of specificity the new system would demand. It hadn’t been hard at first, but it had been a busy day. As patients mounted up and he and Pam skillfully navigated through a day filled with surprises as well as scheduled events, it got harder to take the time for the new style of documentation — and easier to fall back on the old system he found so comfortable. After all, it really wasn’t a problem right now if he skipped the notes on laterality or wrote something with less detail. The pain wouldn’t come up till later, so it was tempting to just wait till later to make the changes. In fact, Ben mused as he moved through his end-of-day routine, making the changes now was actually causing some pain. It was slowing him down a bit, distracting him from his key priorities, and probably irritating Pam and the rest of the team. Was it better to get a head start on it now, possibly lessening the pain of the transition in October but also perhaps lengthening the amount of time there’d be pain in the office? Or should he wait till closer to the time? In fact, maybe the best solution would be to do his documentation in the usual way and pass those on to Pam and the team, but then also to produce a second set of notes that would provide enough detail for the new set of codes? But then, Pam and the rest of the team wouldn’t benefit from the head start he would be getting. Ben suddenly realized he had been standing frozen in thought, one hand holding his car keys out in front of him and the other reaching for the door, for — well, an embarrassingly long time if anyone had happened to be looking. He shook his head and got back in motion. It was hard to know the right thing to do, that was all there was to it. Should Ben start practicing the new style of documentation, or wait until he has to do it? Visit our ICD-10 page to learn how ICD-10 diagnosis codes have been built into Genesis Chiropractic Software.
Hanging In
By Reuven Lirov Office unease leaves practice owners dangling Are the problems in his practice Ben’s fault? Ben sighed contentedly and rested his chin on his wife’s head. Their son was sitting on her lap and she leaned against him on the sofa so that he could hug her and their little boy at the same time. They had a cartoon movie on the TV, but Ben wasn’t paying attention to it. At times like these, their family seemed like a perfect unit, and his life seemed as though it was completely under control. So why didn’t it feel that way at the office more frequently? Carmen had problems at the pizzeria sometimes, but it always seemed as though she could just tackle the problem and solve it, and it was over. At his practice, it felt like they no sooner solved one problem than another came up. They had high turnover in the front office, and he knew that was part of the reason things slipped through the cracks, but maybe the high turnover was a symptom of the problem. Absenteeism, too — of course that led to turnover when people had to be let go, but it also seemed as though any time one person was missing it created a bottleneck in the office. Then when absent workers returned, it took three days to recover from every one day they’d been gone. Maybe they just weren’t getting the kind of training they needed, Ben reflected. Jonathan was laughing and squealing as the cartoon characters slid down a mountainside. It was funny in the cartoon, Ben thought, but sometimes that’s how it felt at work, and then it wasn’t so funny. The cartoon characters were bouncing from one branch and outcropping to another, their eyes comically huge, and his son couldn’t stop laughing. Ben couldn’t stop thinking that this was just what his workdays were like sometimes, bouncing from one problem to another and barely having time to get one issue cleaned up before another smacked into him. Forget about building and growing the practice — he was always in crisis mode. Ben didn’t really think it was a case of having bad workers. They made every effort to hire smart, competent people. And yet those smart people made mistakes and let things slide. He knew they didn’t provide intensive training to their staff, but where would he find the time to do that? He had always figured that if he hired good people, they could pick most things up on their own. Ben shook his head and Carmen smiled up at him questioningly. He returned her smile and willed himself to get his mind back into the present. He could think about his work problems later — in fact, he’d have to. He sighed again, but this time not with contentment. Maybe it was his fault. Are the problems in his practice Ben’s fault?
Mistakes
Office errors can spill over into patient care What are the consequences of mistakes in Ben’s office? “Honey, I’m home!” Ben sang out as he stepped through the front door. His small son ran and tackled his knees, and he was relieved to see that his wife was smiling. Ben swung Jonathan up onto his shoulder and hugged Carmen. “How’d things go at work today?” he asked her. “You were right,” she said. “Once I talked honestly and respectfully with the girls about how much time there were spending on… umm… personal things…” “By which you mean the super-cute delivery guy,” Ben cut in. “Exactly,” Carmen laughed. “Anyway, they saw my point and I think it’ll be okay. It’s just hard to get a conversation like that started.” Ben thought about his own staffing issues. High staff turnover, absenteeism and errors seemed to be a constant problem, and he didn’t feel that he had time to spare to deal with the issues — even if he’d had a good plan for approaching them. Jonathan’s attempts to get down got Ben’s attention away from work, and he set the boy gently on the floor. Jonathan scampered off and Carmen said gently, “Are you worrying about work again?” Ben agreed that he was. “Maybe it’s the upcoming changes in reporting regulations that are making me notice it more,” he said, “but I feel like we make a lot of mistakes.” “Any mistakes in a medical office feel like a lot,” Carmen observed. “Oh, it’s not mistakes in treatment. It’s things like incorrect diagnosis codes, forgetting to collect copayments, incomplete documentation, delayed payments — even overpayments.” “Not things that affect the patients, then?” Carmen asked. “Actually, that kind of mistake can affect the patients,” Ben admitted. “Whether it’s a billing issue that gets uncomfortable and the patient just doesn’t come back, or a feeling that things are falling through the cracks that makes a patient feel less confident about us, we can lose patients because of office problems.” “Plus,” he went on, following his wife into the kitchen as she raced to turn off the oven timer, “Every hour I spend dealing with office SNAFUs is an hour that I’m not seeing patients.” Carmen cocked her head, a steaming pan of baked sausage and eggplant in her hands. “I think it’s always easier to change the circumstances than to change people,” she said, setting the pan onto the table. She began to gather the ingredients for a salad. Ben grabbed a tomato and began to slice it. “The circumstances are pretty settled,” he objected. “We have things we have to do, sometimes by law. There aren’t any points for originality when you’re talking about medical billing.” “I get that, but there must be things that make it easier to make mistakes, or harder. Like lines in the parking lot make it easier to park a lot of cars than it would be if everyone just did their own thing.” Jonathan raced in at that moment with a picture he had drawn, and Ben pushed thoughts of work from his mind, but Carmen’s words came back to him later. It seemed like lots of little mistakes added up to big problems. If his staff couldn’t change, how could he get past the problems? What are the consequences of mistakes in Ben’s office?
Into the Fire
Poor Communication Turns Up the Heat in the Office How do staff problems affect Ben’s chiropractic practice? “Ben? Can I talk to you about something serious?” Ben turned to his wife in surprise. Carmen was usually easygoing, taking a relaxed attitude even in serious situations. “Of course. What’s up?” “It’s the girls at the pizzeria.” Like many pizza places, Ben knew, Carmen’s had lots of part-time help, including students and musicians who needed a day job. The work tended to be fun and casual, even though Carmen ran a tight ship. She had a lot of turnover — what restaurant didn’t? — but she rarely had staffing problems. “I’m usually the one complaining about my staff,” Ben said. “You go with the flow.” “I know,” Carmen agreed. “I think we’re a happy workplace, and the systems are organized enough that the people can relax. But we have this new delivery guy…” Carmen hesitated. “Spit it out!” joked Ben. “Well, okay, he’s really cute. Whenever he’s in the shop, the girls hang out near him, flirting, instead of doing their work.” Ben couldn’t help laughing. “That’s your employee problem? Listen, I have staff absences, paperwork backing up, information silos that mean we constantly have questions that can’t be answered because the only person who knows the answer is off –” “You aren’t even listening!” Carmen objected. “I can’t bring this up with the girls without insulting them, and I can’t bring it up with the new guy at all. I can’t fire him for being too cute –” “Sorry, Carmen,” Ben insisted, “you don’t know what staff problems are if your idea of a staff problem is how to avoid hurting somebody’s feelings. My people are competent, but there doesn’t seem to be enough communication among them to keep the paperwork and billing going smoothly. We end up looking bad to the clients because their files can’t be found, or missing out on billings because the paperwork has errors. Those are staff problems.” “Maybe you’re right,” Carmen said. “Those do sound like more serious problems. Are you paying enough attention to your workers?” “That’s part of the problem, I’m sure,” Ben admitted. “I’m in with patients all day. I don’t have time to oversee the staff, and I guess they all have a lot of freedom to set up their own systems…” Carmen laughed. “If everyone just does what he or she wants, you can’t call it a system.” “Well at least I’ve got you laughing,” Ben said. “Listen, just tell your people to get back to work. You’re letting your embarrassment over the situation make it seem more difficult than it is.” As they got ready for bed, though, Ben was wondering. If that was the biggest staff problem Carmen faced in her business, why was he constantly troubled by staff problems in his? How do staff problems affect Ben’s chiropractic practice?
