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By Cristy Good, MPH, MBA, MGMA staff member
Meetings may take a toll on the daily work schedules of healthcare leaders, especially when the time commitment extends beyond the actual meeting.
Beyond the meeting itself, the time commitment includes deciding when to schedule the meeting, inviting the right people to the meeting, setting an agenda, following the agenda and ending it — on time, ideally — with everyone in the room aware of their responsibilities and next steps.
A May 29 MGMA Stat poll found that 39% of practice leaders say they spend zero to five hours in meetings each week, while 40% report spending six to 15 hours. On the other hand, 14% say they spend 16 to 25 hours in meetings a week and 7% say they spend more than 25 hours a week in meetings. The amount of time you spend in meetings is just as important as their effectiveness. When asked if their meetings were productive and effective, MGMA Stat poll users offered a variety of opinions:
When assessing the meetings you organize or attend in your practice, always begin by asking, “why?” In many cases, meetings are scheduled because they’ve always been part of the workflow, so they are not questioned. Imagine if you took that approach to any other part of your business.
Daniel Stover, senior leadership consultant with Integrated Leadership Systems LLC, Los Angeles, said in a recent MGMA webinar that organizations spend a lot of money on meetings that may not be productive because attendees aren’t engaged or aren’t sure why they have been invited.
Start by assessing the cost of each meeting. Consider using the Harvard Business Review meeting cost app, which estimates the true cost of meetings based on their length, number of attendees and those attendees’ salaries. For example: A 15-minute meeting of six employees who average $40,000 in annual salary has a cost of about $42.
Chances are, you have many meetings, not all of which are quick huddles, that include higher-earning members of the practice. The amount those meetings cost in salary alone may be considered even costlier if they do not result in either increased revenue generation or savings.
But before you focus too much on an estimated spend, consider how your team members view meetings. As Stover said, meetings should create alignment, accountability and trust throughout the organization — without those components, rapport is difficult to build, silos can arise between individuals and teams may head in different directions that do not serve the organization.
A good way to open each meeting is with an agenda that includes a mission statement or other method of conveying the importance of the meeting. Annual studies of workplaces by Gallup show that about half of workers do not know their organization’s goals. Stover outlined four reasons to hold a meeting:
Regardless of the meeting’s purpose, there are three pillars of a productive meeting:
Adhering to these pillars will help minimize factors that can make a meeting unproductive, such as lack of organization or side conversations. Meeting organizers and practice leaders can also develop rules about tardiness and engagement to mitigate the impact of late arrivals or attendees who spend time on their phone or other devices when they should be focused on the discussion.
As the facilitator of a meeting, you are:
Facilitator positive self-talk makes a meeting more effective. If you are confident about the value you bring to a meeting and provide a safe and supportive environment, then others will feel more empowered to speak up and the meeting will be more impactful. This encourages engagement and reduces what author Patrick Lencioni calls “sneaker time” — the hours we spend after a meeting on emails, voicemails and walking down the hall to clarify issues or decisions that should have been clear and confirmed at the meeting.1
Effective facilitators tend to:
If you create the right structure and environment, your meeting will run itself. Your job is then to listen, redirect tangents and personal discussion, call for consensus and ask for commitments before the next meeting.
Stover also recommends considering the size of your meeting. A group of 25 attendees or fewer can be facilitated by one person. Beyond 25, you need a second facilitator to keep people engaged. The more attendees, the more potential disruptions, so you need help addressing your ground rules.
As Stover mentioned, “we teach people how to treat us,” so setting expectations on how we want to do business is important. Practice leaders need to walk the talk on this issue to boost meeting productivity and limit wasted time regardless of how much time is spent in meetings each week.
Integrated Leadership Systems (ILS) group meeting ground rules
1. Lencioni P. Death by meeting: A leadership fable … about solving the most painful problem in business. San Francisco: Jossey-Bass, 2004.
Are you looking for a way to become involved in WMGMA? Consider joining the education committee!
Members of the education committee work to provide quality, cost-effective educational programs and webinars offering relevant content, enthusiastic presenters and new ideas for enhancing practice management.
They meet once per month via conference call for one hour. Outside work may include securing speakers and discussing education content with speakers. We are looking for one to two additional committee members.
Contact the WMGMA office to learn more!
Submitted by Tom Ludwig, RN, FACMPE, ACMPE Forum Rep
ACMPE Certification Exams
The next registration period to take the ACMPE certification exams will be July 23 – August 7, 2018, to take the exam in the period of September 8-22, 2018. For more information, contact the MGMA Service Center at 1-877-275-6462, ext. 1888, or at firstname.lastname@example.org.
Continuing Education Credits
Need to claim ACMPE continuing education credit or print out a transcript? Email email@example.com with details of the event(s) you attended or if you need a copy of your current transcript.
If you are requesting other types of continuing education credit for attending a national MGMA event, please log into MGMA.com, visit “My Dashboard,” select “Account Management,” and click on “Claim Education Credits.” Here you may select from a list of MGMA events to request credit.
ACMPE 2019 Program Enhancements – Bachelor’s Degree Requirement
For Nominees pursuing Certification
If you do NOT hold a bachelor’s degree or have 120 college credit hours by Dec. 31,2018 you will need to:
· Complete and pass both examinations by the Dec. 1-15 exam cycle.
· Log all 50 hours of continuing education (CE) hours under the current CE requirements, starting 30 days prior to their acceptance date. If your exams are passed, you will receive a 6 months extension to complete your 50 hours by June 31, 2019 under the 2019 continuing education requirements.
If you have a bachelor’s degree, 120 college credits or are currently in the process of completing their degree, you will remain as a nominee and will need to begin working toward the following starting on Jan. 1, 2019:
· Earn your CMPE credential within three years. If accepted before Jan. 1, 2019, you will have until Dec. 31, 2021 to complete the program.
· Log 50 hours of CE credit under the new 2019 CE requirements.
For CMPEs pursuing Fellowship
If you do NOT hold a bachelor’s degree by Dec. 31, 2018 you will need to:
· Receive approval on a business plan proposal or paper outline AND submit a final business plan or manuscript by Dec. 31, 2018.
If you have a bachelor’s degree AND seven years of healthcare management AND two years in a leadership role; OR if you have a master’s degree with five years management, AND two years in a leadership role, you will need to begin work on the following starting Jan. 1, 2019:
· Complete Fellowship within two years of your application date. If accepted before Jan. 1, 2019, you will have until Dec. 31, 2020 to complete.
· If you have a paper outline submitted and accepted prior to Jan. 1, 2019, you may continue working on your paper manuscript up until two years from your outline approval date. Starting in 2019, business plan submissions will be the only acceptable submission if no outline is previously accepted.
· Log 50 hours of continuing education (CE) every three years following the new 2019 CE requirements. These CE requirements also apply to maintain your current CMPE credential in 2019.
If you have any questions about ACMPE Certification or Fellow programs, please contact me directly at firstname.lastname@example.org.
Nominate yourself or a colleague to serve on the WMGMA Board of Directors today!
WMGMA is run by a volunteer Board of Directors. Board members develop and manage the affairs of the Association, and are supported by Committee Chairs and staff. Board members are elected annually to staggered three-year terms.
WMGMA is seeking nominations for the position of At-Large Director. At-Large Directors provide support to the Board and serve a three-year term starting January 2019. They will also be invited to attend the final Board meeting of 2018.
To be eligible, nominees must be a current WMGMA member who's membership type is individual or group.
How to Nominate
Nominating is easy, quick and simple! Nominations can be conveniently submitted online.
Submit a nomination by completing the Call for Nominations form.
The deadline to submit nominations is August 24, 2018.
By Yvette T. Doran, MBA, FACMPE, MGMA Board Chair
Amid all the competing challenges you may face in physician group practice, one of the more foundational aspects of successful leadership may not be top of mind but should be a regular consideration in your work: organizational governance.
While revenue generation, cost controls, provider recruitment and technology are all significant issues that shift at a rapid pace, medical groups require leadership that can navigate various corporate structures, board compositions and tax implications that can have a profound impact on a business.
The frenzy of mergers and acquisitions (M&A) and other partnerships across the healthcare industry in recent years is clear evidence that practice leaders should routinely consider the market realities and ownership and legal structures — whether they will enable or inhibit the type of growth desired.
While megadeals between pharmacy giants, insurers and even new players on the healthcare front (Amazon, Berkshire Hathaway and JPMorgan Chase, for example) garner headlines even if they are months and sometimes years from fruition, the reality for group practice leaders is that the decision to remain independent, merge or be acquired is immediate and has effects that reach every aspect of the practice.
As outlined in the May 2018 issue of MGMA Connection magazine, major changes are happening by way of consolidation and the rise of value-based payments and risk-sharing agreements. Large health systems are getting even larger, reaching a tipping point in which they have the means to invest in advanced EHRs and care management staff in pursuit of evolving reimbursement thresholds, as outlined by Gary W. Herschman, JD, member, Epstein Becker Green, Newark, N.J.
There is no one-size-fits-all ownership and legal structure that makes sense for today’s practices or the healthcare industry of five, 10 or 20 years from now. What is important, however, is that you possess the skills to recognize these trends, understand the implications of potential M&A activity and use that knowledge to set a strategic path for your organization — a plan that recognizes goals for growth, capital needs, and strong engagement and collaboration from both physician and administrative leaders. Those capital needs and growth can often be accomplished through a strategic partnership with a private equity firm, which is detailed by MGMA staff member Christian Green, MA.
As MGMA consultant Nick A. Fabrizio, PhD, FACMPE, FACHE, notes in his Objective Advice article, many private medical group owners have decided to sell in recent years “to relieve themselves of the burdens of running a medical group” yet “the truth is that the healthcare marketplace cannot function” without administrators building strong committees with engaged physicians to responsibly lead initiatives, whether it is population health, becoming an accountable care organization or transforming care delivery through new technology. This is an essential concept, whether your intent is maintaining a strong, independent practice or having a confident set of organizational leaders who perform their due diligence in considering a merger or acquisition.
MGMA has helpful resources — such as the M&A checklist by MGMA industry advisor Cristy Good, MPH, MBA — that outline the ramifications of looking at governance structures and ownership changes, from employee/benefit documents, financial records, claims and insurance policies to contracts, assets and facility issues.
You may be confidently leading an independent practice with healthy margins and happy physicians, but success is no reason for not keeping up with shifts in the industry and having an open mind for the opportunities that exist. As the healthcare industry continually pushes change, organizational governance models offer strategies and a directional framework for practices. Whether you remain independent or make a change through a sale or merger, it’s your awareness, preparedness and nimbleness as a leader that will directly influence the future state of your practice.
Workers’ compensation premiums for businesses are set to decline by 6.03 percent this October, according to a statement from the Department of Workforce Development.
That could result in an estimated $134 million in annual savings for businesses, the Tuesday statement noted. It’s the third year that workers’ compensation rates have declined, following an 8.46 percent decrease last year and a 3.19 percent decline in 2016.
“A safe workplace results in a more productive and profitable one for employers,” Ted Nickel, insurance commissioner, said in a statement. "Employers are recognizing the relation between their employees' safety and the savings that ensue as premiums continue to decline."
Mark Grapentine, senior vice president of government relations for the Wisconsin Medical Society, said the report shows that “good news keeps coming” for the state’s workers’ compensation program.
“We’re already a national model, with faster return to work, fantastic patient satisfaction and ready access to the highest-quality healthcare in the nation – all at a cost per claim that is below the national average,” he wrote in an email. “Another significant insurance rate reduction is just more evidence that Wisconsin’s system is win-win for both businesses and their employees.”
Grapentine added that there’s room for improvement, pointing to a need for the state’s on-the-job injury rate drop below the national average. He added that healthcare providers are “always striving to find better ways to improve care.”
Chris Reader, director of health and human resources policy, also lauded the announcement. He said the reduction follows a national trend as employers and workers have invested in and focused on safety. But he noted that costs for medical treatment for workplace injuries are on the rise.
“Had Wisconsin enacted a medical fee schedule like almost every other state, medical costs also would have been kept in check and the insurance reduction today would have been even greater," he wrote in an email.
Reader also argued that the rate reduction doesn’t mean much to fully-insured employers who don’t pay insurance costs and are left footing “incredibly high medical bills.”
Proposals to establish a fee schedule haven't gained traction with lawmakers.
The annual Wisconsin Health News CEO Roundtable is August 14 in Madison. A panel of the state’s leading health system and hospital leaders will discuss the most pressing issues facing their industry.
Register now (link).
The June 18th meeting was well attended by provider medical groups and payers. Below are some of the questions/discussions that took place at the meeting in Madison held at UW Health.
Topics of discussions:Questions submitted by Medical Groups & Network/Open Forum by Medical Groups
By Jennifer Pendleton, MS, MGMA member
Studies of occupational stress pay little attention to features of the physical environment in which the actual work is performed. Yet evidence is accumulating that the physical environment of work affects both job performance and job satisfaction.1
Provider burnout shows consistent negative relationships with perceived quality (including patient satisfaction), quality indicators and perceptions of safety.2 Conversely, nurses who perceive their work units are patient-centered were significantly more satisfied with their jobs than those who do not.3
All of these factors led to the creation of more collaborative workspaces at Concord Surgical Associates, Concord, N.H., for clinical support staff in the outpatient medical practice setting.
Press Ganey surveys all of the clinical providers and staff at Concord Surgical Associates on a biannual basis to determine the level of engagement of the overall institution and each department. The survey results to the question, “My job makes good use of my skills and abilities,” was identified as an area needing improvement in the general surgery department, which included eight surgeons, 11 advanced practitioners (APRN, PA-C), three medical assistants (MAs), three registered nurses (RNs) and five patient care coordinators (PCCs). In response, this department redesigned clinical area workstations to create a more collaborative workspace for clinical support staff and thereby improve employee engagement.
Before the office redesign, the workspace setup was not ideal for the specialized care of patients requiring clinical assessment and guidance, and was not patient-centric for care delivery (see Figure 1). The close proximity between the clinical and administrative staff led to blurred role definitions, in that MAs often provided backup to the administrative team by doing tasks that did not require clinical competency or medical decision-making: faxing documents, handling medical record requests and leave of absence paperwork, covering the check-in and checkout processes, and scanning documents into the patient medical record.
Due to their close proximity, many MAs also performed duties of a PCC, which were more administrative than clinical.
In June 2015, the office was redesigned to increase efficiency and clinical workflows (see Figure 2). As part of this process, RNs, MAs and PCCs worked with practice leadership to review the details of their job descriptions and expectations, and redefine the clinical roles of the team with more clarity. Tasks that were administrative and did not require clinical expertise were better performed by front-end users. Those tasks were systematically identified and reassigned to PCCs. MAs continued to room patients but eliminated the administrative responsibilities of scanning, answering calls and scheduling appointments, which were shifted back to the PCCs.
Workstations were renovated so that each MA was placed with an RN in the central area of the office. This workspace, referred to as the “clinical fishbowl,” has been identified as “one-stop shopping” for physicians and advanced providers looking for RN or MA help, making workflows more efficient. Clinical staff members were empowered to refer administrative responsibilities to PCCs in the front office. This change provided more time for clinical support staff to complete tasks that were within their scope and that were more professionally satisfying. For example, nurses provided pre-operative patient education and nurse office visits, which resulted in increased patient volume and revenue. This also allocated time to complete classes and required competencies for their clinical practice and development.
When expectations are clear, responsible parties are held to duties required by their certification or license, and roles are physically arranged in a space that encourages collaborative learning, coaching and mentoring. The result is an increase in employee engagement scores and increased patient volume and revenue.
Shane served for six years in the Marine Corps, three providing security for the communications of the President of the United States and three as an operator within a Recon unit. With degrees in Business Administration and Health Sciences as well as an MBA in Operations Management and Strategic Planning, Shane has spent almost 15 years in healthcare management, both in large systems as well as private clinics. Currently Shane is the Administrator of Klasinski Clinic Orthopaedics, a division of Orthopaedic Centers of Wisconsin.
Wisconsin Medical Management Group Association563 Carter Court, Suite B, Kimberly, WI 54136920-560-5621 / 800-762-8968WMGMA@Badgerbay.co
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