Staff management in an ophthalmology office is a monumental task -- sometimes overlooked by overworked surgeons until it's too late. In this article, I'll list 10 common areas in which staff shortcomings could damage your practice's functioning and reputation, and how you, as the practice leader, should monitor these areas and approach problem-solving.
Problems and solutions
Problem:
Unpleasantness. Patients' visits to your office can be fraught with anxiety. Often they're asking themselves, "Do I have a problem? Am I going blind?" Therefore, when a patient actually makes contact with your office, it's essential that the staff members make him feel welcome and comfortable. A smile over the phone and in person goes a long way in putting the patient at ease.
Too often a receptionist is short with patients, making them feel as if they're imposing on the doctor or that the receptionist is doing the patient a favor by "allowing" him to come to the office. Speaking with a staff member who isn't pleasant makes patients reluctant to provide important information and leaves them wanting to get out of the unfriendly environment.
Solution:
Start by hiring the right people. Someone with no personality and no enthusiasm will not suddenly become a smiling dynamo just because you hired her. Let new employees know what's expected and ask them if they can provide the attitude that you desire. Smiles should be sincere and related to a face and facial motions that convey the employee's concern for the patient and happiness about being in the office.
It's your job to make the staff aware of how important it is to be pleasant. Also, you must stay alert for any signs of employees not being nice. Keep your ears open when you call into the office and when you walk around the office and hear staff members answering phones, talking to patients, performing tests, etc. And finally, set a good example. If you don't treat patients properly, your staff members won't either.
Problem:
"Protecting" the doctor. Staff members often believe that they have an obligation to protect you from phone calls, vendor representatives, mail, etc. This often antagonizes people. Making you inaccessible to a patient who has a concern about his eyes encourages him to seek a more sympathetic practice. I've called physicians about important matters only to be ignored by their staff members to the point that I left the physician out and went elsewhere for what I needed.
The patient is often told that someone will get back to him. When he asks when, a typical response is "The doctor is very busy so I can't tell you when you will be called back." In other words, the caller isn't busy and should sit near the phone all day so he doesn't miss the call.
Recognize that when someone calls your office, he has a concern. He has a question of importance even though it may seem trivial to the person who takes the message. Obviously this doesn't apply to the numerous "cold" calls that we all get from "boiler room" types of operations.
Solution:
Explain to your staff how to handle calls and which calls you want to take immediately. Determine which types of calls you'll return later and set up certain times when you'll follow through, such as between noon and 12:30 or between 4:00 and 5:30 p.m. today, tomorrow etc.
Problem:
Inaccessibility of the office by phone. Many practices take too much time to answer the phone or they keep patients on hold for an inordinate length of time. This can happen if you don't have enough phone lines, or if everyone wants to go out to lunch at the same time, switching the phones to the answering service.
Solution:
Have the phone company do a busy survey or simply pay attention to how long the phone rings or that you are put on hold when you call the office. Have enough lines and rotate staff so that someone answers the phone at all times.
Problem:
Billing. This entails a number of factors, including poor coding (which is easier than figuring out the right codes), not sending out bills fast enough, not sending out bills when it's perceived as difficult, not filling out insurance forms properly and not following up on denials or incorrect payments. These problems decrease your revenue dramatically.
Solution:
Evaluate and observe your billing system on a regular basis to avoid any of the situations listed above. It's the responsibility of you and your office manager to be alert and vigilant in these areas.
Problem:
Keeping information from you. Often, patients call about problems and the office staff member who took the call doesn't tell the doctor. It's also not uncommon for a staff member to give a patient advice without the doctor knowing it. At other times, staff may want to protect themselves from criticism by failing to pass on complaints from patients.
Solution:
Establish a protocol under which every phone call or patient encounter is documented on the chart. This should include the reason the patient contacted the office and what the patient was told. You should review and sign these notes. Any patient complaint should be passed on to the doctor or appropriate person for evaluation and resolution. This is an important issue from the standpoint of risk management.
Solution:
You must constantly evaluate the schedule through meetings with the appropriate scheduling staff so that you can detect this problem.
Problem:
Poor interoffice relations. Any source of unhappiness among staff members could lead to their criticizing one another, ganging up on certain individuals, criticizing one another in front of patients or shifting work onto someone else.
Solution:
Vigilance by you, your office manager or administrator should detect these problems. It's essential to nip them in the bud. Someone with experience in staff morale must serve as a diplomat to analyze such situations and correct them as soon as possible.
Problem:
Lack of referral authorization. This has probably happened to you: You've evaluated a patient, treated him and sent him home only to learn later that the insurance company is refusing to pay you because referral from the gatekeeper was required. This creates a bottleneck. Now, a staff person must contact the patient's physician for permission. Then the patient must wait for the permission. It can take a while to reach the referring physician, who's hopefully not on vacation by this time. In addition, you may have to work this patient into a later time slot when permission is finally obtained. Usually, your office is the one this patient will be angry with.
Solution:
Your staff should anticipate this when scheduling appointments over the phone. They should explain the situation to the patient so he understands the requirements of his health plan. They should ask the patient to call his doctor for the referral before coming to your office. If a patient does arrive in your office without the referral, your staff should try to obtain authorization before you see the patient.
Problem:
Lack of pre-authorization for care. Your staff should never end up having to say, "Mrs. Jones, we performed "x" test on your last visit and your insurance company won't pay. Therefore, you're responsible for the cost, which is $200."
Solution:
Unless you want the patient to faint from shock or yell that he wouldn't have had the test knowing he had to pay for it, your staff must know how to prevent this problem. It's difficult to keep track of what's covered, especially if you participate in several plans, but your staff members must have at least some idea of what might require pre-authorization.
When they're not sure, they must know to call the referring physician or insurance entity to check -- prior to your performing the test or procedure. Under Medicare and many other plans, you may not be able to charge the patient for services not covered unless you give the patient information as to the test and its cost. Then the patient must sign this to accept responsibility for payment if the company doesn't pay.
Satisfaction guaranteed
You must be sufficiently aware of the potential for all 9 of these problems to arise, provide sufficient guidelines for your staff members and monitor these areas frequently enough so that you're able to detect any shortcomings. Your practice will run more smoothly and your patients as well as your staff members will appreciate your efforts.
How to Fire an Employee Without Getting Burned
By Jeffrey D. Weinstock, Esq.
Boca Raton, Fla
One of the most difficult tasks that doctors and their practice administrators encounter is the termination of employees. Furthermore, firing an employee carries with it the potential for significant liability. Although many employees are employed "at will" and may be fired for any reason that's not legally prohibited, terminated employees file lawsuits every day claiming that they were wrongfully terminated.
To avoid liability and losing a lawsuit, you must not only fire the employee properly, but also make sure his entire tenure with your practice was handled properly. Below are guidelines to follow, some of which come into play as early as the employee interview.
Documentation
Proper documentation is the key to defending yourself in a wrongful termination case. Without a documented history of employment that begins at the interviewing and hiring stage and includes problems and discipline administered, you'll have a much more difficult time proving that you acted properly.
Although each situation is unique and requires consultation with an employment law attorney, you can consider this list of general suggestions for documenting employees' records:
- Handbooks. Adopt an employee handbook that document regulations, procedures and expectations. A handbook is evidence that you advised the employee of your expectations and what would happen if he didn't meet those expectations.
- Handbook vs. application. Make sure that the employee handbook is consistent with any employment application or other policy statement given to employees when they start employment. If the handbook contradicts the application, the employee could argue that he relied on the application, and a court could find that the application governed. Overall, make sure that if an employee is "at will" nothing is said or done to contradict that status. Make sure the employee handbook is regularly updated and reflects the way things are actually done.
- Supervisor training. Office administrators and supervisors should be informed of the proper manner in which to discipline employees and manage the day-to-day operations of a practice in a way that doesn't create liability issues.
- Evaluations. The performance of all employees (including administrators) should be candidly reviewed and evaluated on a regular basis (every 6 months to 1 year). The reviewer must give an honest assessment of the employee's abilities and work ethic. Although human nature is to be forgiving on evaluation forms for a well-liked employee, failing to accurately disclose bad points, such as poor work habits, poor attendance or inability to get along with other staff members or patients, could leave the practice open to the accusation that the employee was not discharged for legitimate reasons.
- Consistency. Enforce your employment policies consistently. For example, if your reason for firing an employee is habitual late arrival for work, you must be able to show that all employees who arrive late for work are disciplined in the same way. Document all personnel matters consistently. Personnel files should indicate that when a problem arose, you addressed the problem with the employee, and the employee was given an opportunity to correct the unacceptable behavior. Obviously, very serious incidents may necessitate that you take immediate action.
- Consider resignation. Depending on the situation, it may be a good idea to give an employee the option of resigning instead of firing him. This will remove some of an employee's argument that he or she was wrongfully discharged.
- Post-termination. Immediately after an employee is terminated, you must document the factors surrounding the termination in detail. If an employee sues you later, you'll need this record to respond to the allegations. This step is also important in case the person who executed the termination no longer works at your practice when the lawsuit is filed. Also:
- To minimize confusion, present the terminated employee with a brief explanation of office procedures for the way he can continue receiving benefits. Designate one contact person at the office to answer the employee's questions concerning the way benefits or final pay will be handled. The contact person should be advised which specific inquiries he can answer and which he should direct to the practice's attorney.
- Agree on a time the employee can remove personal belongings from his work area, preferably after hours with supervision. Make sure he turns in his key.
- It may be appropriate to agree with the employee on how the office manager will respond if contacted by potential employers. A response to a potential future employer about a terminated employee should also be handled carefully, as it can be a source of liability.
- If you discharge an employee for performance-related reasons, don't provide remaining employees with unnecessary details. A firing can place additional stress on the entire staff. Take steps to make sure that each situation is handled in the least disruptive manner and with the utmost dignity. This is important not only to minimize disturbances that may occur as an employee is being fired, but also to maintain morale for the future.
The book should contain job descriptions, personnel and grievance procedures and a clear statement that employment is "at will." Employees should be given the handbook immediately when they begin working for you. They should sign a receipt stating that they received the handbook and acknowledging that they understand that they're employed at will. The acknowledgment should also state that the employee has reviewed the policies, understands the policies and agrees to abide by them.
Better safe than sorry
Even in a clear-cut situation where you've taken the proper steps leading up to firing an employee, you should consult with an attorney specializing in employment law prior to a termination. If you suspect that discharging an employee will lead to conflict, contacting an employment law attorney is a must to ensure that potential actions leading to a lawsuit are minimized. Moreover, an attorney will help you to avoid liability from complex federal laws, such as the Americans With Disabilities Act, which carry significant penalties.
There is no way to fire an employee without creating potential liability for your practice. But if you take the steps discussed in this article, your risk of losing a lawsuit will be significantly minimized.
Dr. Weinstock is a private practitioner with Canton Ophthalmology Associates and a professor at the Northeastern Ohio Universities College of Medicine. He's also the vice president of Medical Infosystems, a medical adviser for Frontier Healthcare and an Ophthalmology Management editorial board member.
Jeffrey Weinstock, Esq., is an attorney practicing in the healthcare/corporate law department at Sachs, Sax & Klein, P.A. in Boca Raton, Fla.
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