Each day brought a new offering of courses taught by PCC staff as well as guest speakers. Topics ranged from updates about new features coming to PCC's software, to various practice management techniques, to informing pediatricians about how to meet the latest regulations, or how to add new services to their practice.
Here are just a few examples of the many kinds of sessions that took place, with key highlights from each:
Dr. Todd Wolynn from KidsPlus Pediatrics spoke about creative ways to build your practice through Community Education.
Opportunities for Relationships
Dr. Wolynn urged us to think about our practices as more than just well care and sick care. He said, "Parents are bringing you their babies and trusting you... don't squander it. Power it up, make it richer, make it more connected." He spoke of this connection as an opportunity to have a "Sacred Relationship" that goes deeper; a relationship that involves getting to know patients and their families in a more thorough way, and making the effort to engage them in your practice via creative educational offerings.
Regarding how to decide what to add to your practice he said, "Parents come to pediatricians with a yearning. Can you identify that yearning? If they come to YOU for that, great."
Some of the ways in which Dr. Wolynn's practice has increased patient education and involvement are:
Being willing and able to talk to new parents about subjects that are not in the "normal" pediatric book. Here are some examples: Potty Training, Nutrition, Childcare, Education, Discipline, Sleep, Feeding Issues, Self-Esteem, Sexuality, and Technology
Offer classes. This is a way to go more in-depth with topics you don't have the time to fully cover during an appointment. It also shows people why you are special and stand out as an independent pediatrician. Some examples of the kinds of classes KidsPlus offers are:
- Expectant Parent Orientation
- Expectant Breastfeeding
- New Mom's Coffee Series
- Not-So-New Mom's Coffee Series
- The Sleep Class
- Things You Can't Control (i.e. Sibling Rivalry, Potty Training)
- Parenting as a Full-Time Working Parent
Make your space multi-modal. You can offer classes, events, and services at your practice. You can use one room and continually re-purpose it for whatever is happening at the moment. Or, if you have the luxury of excess space, you can set up different spaces to accomodate each thing you offer. Here are some ideas:
- Add a dedicated breastfeeding center
- Create a fitness space where you offer exercise and movement classes to kids and adults
- Have an multi-purpose event space where you hold a kids' music series, classes, family fairs, or a holiday party
Get creative with your Virtual Space. Amp up your online presence. Many new parents are young Millennials, and they are from a generation that wants and expects your practice to be onboard with technology. Your website will often determine their impression of you more than your list of credentials will. They will want to engage with your practice on social media. This is a relatively low cost way for you to educate and interact with your patients and their families.
- Get an informative, straightforward website with a modern look. This is money well spent. Make sure is works on multiple platforms, i.e. desktop, laptop, mobile devices.
- Set up Facebook or Twitter and post regularly. Share educational tools, videos, photos, articles–anything that will get the engagement going online. Tell your story.
- Maintain a private Facebook group for the members of your classes. For example, create an online forum where members of your New Moms class can chat and share in a safe and nonjudgmental environment.
These are just a few of the many great examples of what KidsPlus is doing. As Dr. Wolynn said, "Change your practice from a place for well and sick visits to a DESTINATION." You will create a place your patients will want to go to. By doing so, it will become a place he says, "that they know for connected, real reasons... and that bond leads to better care."
Incorporating Patient Education Services
A key highlight of this talk was about ways to incorporate patient education services into your practice. This is a great way to create a sense of community within your practice, increase your services, and connect patients to the resources they need.
One way to do this is to add classes or clinics taught by providers, trained staff, or independent contractors. Examples of clinics include:
- Asthma Clinics
- Nutrition Clinics
- Lactation Clinics
- Travel Clinics
- Sports Medicine Clinics
- ADHD Clinics
- Adolescent Clinics
Consider developing an entirely new business, either under your own tax ID or as a separate entity. An example of this would be adding a Lactation or Breastfeeding Center. Another idea would be to include a Behavioral Health Center. You could house these in a separate building, or as a designated space within your current office. There could be full-time offerings if you have room, or you could use a shared multi-use space and offer these services during slower hours, such as early morning, end of day, or over the lunch hour. You can utilize a trained employee or an independently contracted agent to provide these services, and you can schedule them to coincide with your newborn or one-month visits, or any other time the services are requested.
Connect to local community resources. This is a great way to network and add resources to refer your patients to. You can approach these venues and offer to give a pediatrics-related talk or class. Conversely, you can find volunteers from these places to come to your practice and share their knowledge with your patients. Examples of community resources to connect with are:
- Multicultural Centers
- Local YMCA
- Yoga Studios
- Local Schools
Become an advocate for your patients and your community. Susanne spoke of many ways to become an advocate. One key idea to incorporate into your practice is to have a "Do You Know?" bulletin board in your waiting room with information that will help the uninsured and under-insured patients in your practice. It could contain information about:
- Prescription Assistance
- Local Non-Profits
- Insurance Coverage and Medicaid Qualification Information
- State Health and Human Services Information
Protecting Practices Against Theft
Paul Vanchiere, MBA, from the Pediatric Management Institute taught ways that practices can protect against theft.
Paul opened his class by driving home the fact that external threats to your practice are real. For example, a thief can sell the information from a stolen electronic patient health record and average about $61 per record. If your practice has 4,000 patients, that is $244,000 that a thief stands to make off your practice. These figures show why people are so motivated to steal, and why your practice needs to be vigilant about protecting electronic health information.
Theft does not always happen via an anonymous, external source however. Unfortunately, many times the people right in your office are the culprits. Paul spoke about the "Fraud Triangle" where Pressure, Opportunity, and Rationalization come together to form the perfect opening for a crime to occur at your practice. He gave examples of the motivators behind employee theft. Some of these include:
- Financial hardship
Paul told many stories of ways he has seen employees steal from the practices they work for.
Mobile apps to deposit checks are a big opportunity for theft via loose checks from patients that come in the mail. The employee writes off the patient's balance, reconciles the accounts receivable, uses the app to take a photo of the check and deposit it into their own personal account, then destroys the original check. All this can happen in minutes at the front desk, with the provider never realizing what happened.
Employees have been known to swipe patient credit cards with a swipe device that stores the credit card number for them to use later. Other times, they will use a mobile swipe device like the Square, tell the patient standing in front of them that this is what the office is using to run cards, when really, the payment from the transaction is going straight into the employee's personal account.
After getting us to realize how very easy it can be for theft to occur in our practices, Paul gave some great advice on how to protect against it. Here are some of his ideas:
Lock down all the technology (i.e. laptops, iPads) in your office so that someone cannot walk out with it.
Decommission your old computers in the right way. Wipe the hard drives. Know when the computer was taken out of use and where it is being stored. It is easy for an employee to "borrow" (i.e. steal) an old computer and never return it. By the time you realize, it is long gone, having been converted to cash.
Control your environment. Make sure all patient credit cards are swiped in plain view. Make sure the cash drawer reconciles every night before your staff leave. Money received via mail and over the counter should equal what is posted in the billing system and also on the bank deposit sheet. Segregate staff duties. For example, people who collect money should be separate from people who deposit it and from those who do the reconciliation. That way one person does not have access to all phases of money handling, thereby reducing the opportunity to alter the books.
Take steps to prevent theft in the first place. When hiring new employees, call all references, run criminal background checks, and possibly even run credit checks to determine if there is financial strain that could motivate someone to steal. Have clear job descriptions and hold all employees fully accountable for their actions. Create an environment where it is clear that theft is not tolerated.
Monitor your practice. Review the cash handling, check for "missed" copays (i.e. the patient did pay but the employee took the cash and said the copay was never collected), review EOBs and look for patterns of suspicious adjustments in the patient accounts.
Consider having multiple checking accounts. This is a way to mitigate risk. If an employee finds a way to access and drain one account, you will be protected from having all your money taken since it is in multiple locations. Think about only allowing necessary staff to have access to account and routing numbers, and all other staff are given view-only access. You could have a lockbox for cash or checks that come in over the counter, along with separate bank accounts for:
- Patient Insurance Checks
- Operating Expenses
Paul's class gave many ideas of ways all practices can take steps to keep theft from internal and external sources at bay.
Added Screenings for Developmental and Mental Health
Dr. Barbara J. Howard of Johns Hopkins University School of Medicine and CHADIS relayed great information about how and why to add Developmental and Mental Health Screening to pediatric practices.
Dr. Howard is a pediatrician who specializes in developmental and behavioral pediatrics. She noticed that most pediatricians are undertrained in this area, thus contributing to a gap in how children's needs are met. She helped to create CHADIS, a screening, decision support and patient engagement system in order to address this gap.
Dr. Howard shared that 12-22% of kids have developmental or behavioral disorders, and 40-50% of primary care visits involve behavioral, psychosocial, or developmental issues. These issues make up a significant portion of what pediatricians deal with, yet they are often underprepared for it. Increasing the use of developmental and mental health screening tools in your practice can help to identify issues early on, creating better patient outcomes and lower societal costs in the long run. According to Dr. Howard, when these disorders are detected and treated early, it leads to:
- Increased rates of high school graduation
- Increased employment rates
- Lower rates of teen pregnancy
- Lower rates of violent crime
Some pediatricians resist the use of screening tools, arguing that:
- There is not enough time to add these screens into the appointment
- Lack of payment
- Language barriers
- Fear of negative labeling of the child
- Lack of agreement between different screening tools
- Cultural Bias
- They don't trust the screening tools to be accurate
- They don't think it is the role of pediatricians to do these screens
Arguments for adding these screens include:
- A screening tool takes much less time than all the talking involved in parent "reassurance"
- The results can be used as data for referrals to appropriate providers
- They can be used as a baseline tool to track progress over time
Developmental screens can be used an a standardized instrument to detect a problem whether or not one is currently suspected. Dr. Howard shared that informal clinical assessment only detects 30% of kids with developmental disorders. Only 20-30% of developmental disorders are identified before a child enters school. Often, a provider will only use a screening tool when there is a suspicion that something is wrong, but Dr. Howard shared that the AAP recommends surveillance happen at all visits, and actual screens for young children occur at 9, 18, and 24 or 30 months of age.
Other reasons to include these screening tools into your regular services include:
- Parents often "know" something is off and having these results will help to clarify the issue for them.
- A parent who does not realize anything is amiss could worsen the situation by pushing a child too hard, when they truly are not able to do what the parent is asking.
- Siblings may be born with the same issues, so it is good to identify what is happening now.
- It will help families to cope and find support.
- When you acknowledge what is happening as the pediatrician, it will increase the family's trust in you.
Dr. Howard suggested that if you only add three screening tools into your practice, they should be screens for:
- Developmental Health
- Mental Health
If you were to add Behavioral Health screening tools, you could consider tools that address:
- Substance Use
There are many types and sources for screening tools, and it is up to each pediatrician to find the tool that works best for them. CHADIS has over 300 questionnaires, and it selects and scores them for you. From there, you can add the results to your patient's chart. Patients can fill these questionnaires out in the office during the appointment, or at home outside of visit time. In fact, this is often preferable as it allows the doctor to review the results prior to the next appointment, and develop a plan.
Screening tools are a valuable way to increase the quality of care you provide for your patients.
Creating Consistent Recall Techniques
Chip Hart from PCC gave an engaging class on Patient Recall Techniques.
Chip made a strong case for taking the time to make patient recalls a regular activity at your practice.
With the average well visit paying $211, and the average sick visit paying $80, it makes sense to recall your long-lost patients for their overdue well visits. Even though well visits take longer to perform, eating up precious space in your schedule, you will generate more income over the course of a day despite taking more time per visit due to the fact that they bring in more money.
Money is not the only reason to recall patients for well visits, nor should it be. It's also really good for your patients. Well visits check for scoliosis, hearing issues, vision issues, eating disorders, family violence, and developmental issues to name a few. As Chip says, "How many times have you spotted something and said to yourself, 'I wish they had come in last year.'" When patients drop off the calendar and miss annual well visits, you miss the opportunity to provide them with exceptional and necessary care. Recalling them benefits both of you.
Recalling is a misnomer in a way. There are more ways to get your patients back on the schedule than simply picking up the phone and calling them, although that certainly does work. Here are some examples:
Make use of electronic options. Use a program where you can "set it and forget it." On a regular schedule, the program will send out secure texts or emails to your patients, reminding them it is time to schedule a visit.
Use your reporting tools to run various reports like patients who are the most overdue, or patients who have the worst chronic conditions. You can use the results to determine who will be recalled first.
Don't forget about good old-fashioned letters. Send out personalized patient letters that are name, age, sex, and language specific. Tell them what you will do for them at a well visit for their age range. Create a sense of urgency by telling them how much they need to come in to see you.
Train your staff to think about the big picture. If someone calls for a sick visit, make sure your staff automatically checks for the last time they were in for a well visit while they are on the phone. If the patient is overdue, consider having your staff schedule them for a sick visit and a well visit at the same time.
Pick up the phone. Call parents at home. If you get them on the line, encourage them to set up an appointment for their child as soon as possible. Consider hiring a staff member to spend a few evening hours a week making these calls. The expense of paying them will be worth it even if they only get a couple of appointments scheduled...and odds are, they will do more than that over the course of a few hours.
These are just a handful of highlights from the many great ideas Chip brought to the class. The takeaway? It is well worth your time and effort to start making patient recalls on a regular basis.
A Look at Medsinc
We also heard from ThinkMD about an exciting new project PCC is partnering with them on called Medsinc.
On the telemedicine front, we heard a presentation from Barry Finette, M.D., Ph.D., one of the creators of an exciting new mobile health app called Medsinc, from ThinkMD.
Dr. Finette and his team created this tool as a way to increase access to healthcare globally, and particularly in underdeveloped countries and rural areas. He shared with us that 99% of children who die under the age of 5 are in low and underdeveloped countries and that they die of completely preventable illnesses such as:
- Acute Respiratory Infections
- Systemic Infections
Medsinc is a mobile health platform that can be used in these areas to help treat these childhood illnesses before they become fatal. It is a tool that the layperson can be trained to use, thus filling the void of physician shortages in underdeveloped countries. Minimally skilled workers can take this tool into rural areas and use it to assess, diagnose, and offer treatment guidelines to sick children.
The key features of Medsinc are:
- It is simple to use
- It can be used on any mobile device
- It can work independently of any internet or cellular connection, so once it is on the device it is fully functional
- It includes training videos
- It allows for SMS texting
- It is a "medical hub" meaning it can take data and use it to make an interpretation
- It is highly accurate. There is an 85-95% correlation in the diagnosis that community health workers arrive at through using it and the diagnosis a trained health care professional arrives at.
Medsinc currently assesses clinical severity in 4 key areas:
- Respiratory Distress
It also assess conditions such as:
- Urinary Tract Infections
- Skin Infections
- Ear Infections
It does over 20 clinical assessments, and provides triage, treatment, and follow-up instructions.
Medsinc has the potential to decrease deaths and long-term disabilities that occur due to preventable illnesses, and will increase global healthcare capacity.
Not only can Medsinc be used in underdeveloped areas, in partnership with PCC, a U.S. version is being developed for use in family homes to assist with children's healthcare. A family will be able to use it, then send the information directly to the pediatrician via the EHR, thus improving triage and streamlining care. A positive outcome from this type of tool will be that a patient can stay home and avoid the emergency room if it is not really necessary due to the fact that telemedicine allowed them to connect with their pediatrician from home.
We are excited to see the positive impact Medsinc will make in healthcare over the coming years.
In conclusion, the PCC 2016 Users' Conference was a great success.
These highlights illustrate just a handful of the many incredible courses that took place over the week. The educational opportunities paired with the social and networking events made for a an experience we all look forward to having again next year.