Faber Healthcare Solutions

If you want to get the best out of your staff, you have to motivate them all, every single day. Only a well motivated staff will achieve at its peak performance.

Daniel Yankelovich and John Immerwahr wrote a wonderful article for the Public Agenda Foundation in 1983 titled Putting the Work Ethic to Work. In this study, the authors found that among the top ten items employees find most rewarding about their work are working for people who treat them respectfully, recognition for a job well done, and being well-versed about office happenings. What’s wonderful about these three points – and most of the items in Yankelovich and Immerwahr’s report – is that they are absolutely free!

Employees do not become invested in your practice simply because you issue their paychecks. First, you have to show them respect, as people and as professionals. If all you offer is the paycheck, all they will offer is their attendance. To get their best work out of them, you have to respect the work they do, let them know they are appreciated, and give them praise.

The flip side, of course, is reprimanding your employees who step out of line. But this too can be done with respect and dignity. Do not dress down employees in front of their peers, and when you apply the rules they should be applied fairly and equitably across the board.

Motivation goes beyond nice words. You will have to knuckle under and spend a little money, but it is well worth it. Employees need incentives. That doesn’t mean you need to engage in profit-sharing with your office manager. But, for example, if business is slow you can set patient volume goals for your schedulers, or you can incentivize your billers’ accuracy with a bonus for limited billing errors. Provide your dedicated employees with training so that they can better their positions. Throw a holiday party plus a semi-annual dinner as morale boosters. Buy flowers for the medical assistants on Nurses’ Day. Think outside the box too; something as simple as shamrock brooches on Saint Patrick’s Day can generate smiles all around.

Show your staff that you value them, and they answer in kind. If you show your staff that you will go the extra mile for them, they will respond in kind and go the extra mile for you.

Unfettered internet access in the workplace is nearly uniformly available in electronic practices today – that is, practices with computer systems and some form of electronic billing. Employees usually feel that unlimited, unmonitored access to the web is their entitlement. After all, it is an indispensable tool in everyday life today, from banking to messaging to shopping. And (pardon the ungrammatical use of the ‘and’ to start the sentence – I am using literary license here) it certainly can serve as a very useful office tool. But in the workplace, these are all distractions, wasting the practice’s money and drastically affecting employee productivity.

So what can you, the owner, do to strike a reasonable balance between granting employees limitless internet access and banishing them to the electronic dark ages?

The first step is determining what access employees need for legitimate work-related purposes, what access would make employees happy without seriously interfering with the office’s work flow or security, and what access requires outright proscription. Once you have determined that, it is time to have your IT staff (or consultants) properly program your firewall.

[A firewall is a piece of hardware, a gatekeeper of sorts, which sits between the nasty virus- and hacker-filled world of the internet, and your naïve and homely office server and computers. It is an absolutely essential piece of hardware; if you have IT staff in place that has not already cajoled you into purchasing a firewall, you have a problem.]

The firewall can, in most cases, be programmed with what types of internet services to allow (such as web surfing and email), what services to forbid (such as instant messaging and VOIP calls), and what services to limit (such as certain websites or classes of websites, such as pornography or shopping). What capabilities your firewall will have will depend on the model and how much you are willing to spend on it. It is worth noting, when you compile this list, that some pornography firewall settings may actually prevent you the clinician from accessing legitimate medical websites – if your firewall can be programmed to exempt you from its settings, that is a good workaround for this limitation.

Just before having your IT staff program your firewall, have a frank heart-to-heart with your staff to discuss the changes you are planning to make. Explain yourself well. Bear in mind that your younger employees may react as if you are planning to amputate a limb, and will require smooth handling.

It may serve you well, for your relationship with the staff, to share your new internet access policies with them without putting all of them into play in the firewall programming (possibly with some exceptions, such as pornography or myspace and facebook), asking them to police themselves. Some firewalls allow you to monitor the employees’ access, either as individuals or in the aggregate, and you can determine if self-policing is working. If you do plan to monitor your employees, let them know (including in writing, in your employee handbook), and share your findings with them should you decide to curtail their access in the future.

With the costs of health care on the rise, and the number of uninsured Americans larger than ever, both major presidential candidates have plans in place to reform the system. Unfortunately, both their plans are seriously flawed, and, as I have said before, until we as a society are willing to reconsider what our expectations are from a comprehensive health coverage plan, we will never be happy.

The candidates’ plans are presented in no particular order. Full disclosure: I am registered as non-partisan, belonging to no political party.

Senator Obama’s plan, in his own words, “begins by covering every American.” However, despite this assertion, details listed further down his web page, make it clear that he is offering availability to everyone, but not necessarily coverage.

In addition, Mr. Obama writes that everyone will have access to the same plan as federal employees and that they would have “affordable premiums.” One has to wonder who can afford such premiums. Reviewing the 2008 premiums for these plans, which vary by state and within states, the plans are hardly cheap. Lower cost individual plan premiums run $3,939/year, and family plans are $9,060/year. More expensive plans run $6,522/year for premiums, and families pay $15,081/year. Hard to call that affordable.

Of course, we forget that when employers pay for plans, that money is really coming out of the employee’s pocket, because it is the total compensation package that the employer pays for, and truth be told, if health coverage were not offered, that additional money would be available in the form of salary. But most people don’t think that way.

Senator McCain, on the other hand, clearly offers a plan with universal access, not universal coverage, saying “access to health care for every American.” His program relies on private enterprise to provide coverage to all Americans instead of implementing a government controlled plan. This, however, is simply not realistic. Health plans, despite what they want the world to think, are in the business of making money, and have no interest in covering the sickest (read: most expensive) patients. The Senator writes about his GAP program – Guaranteed Access Plans – but details are conspicuously absent.

To make matters worse, Senator McCain’s program offers tax rebates to employees who opt out of employer-offered health plans, with the intention that those people would use the rebate money to purchase their own health plan. Alas, he appear to have ignored the rule of unintended consequences: as young, healthy people, who can purchase cheap health coverage, opt out of employer-offered plans, and the sicker people remain with the ‘more affordable’ plan, the employer plans will become more expensive with each iteration as the plans find their members costing more each year, and ultimately the gap between those who do and do not need comprehensive care will grow wider yet. (The irony of gap v. GAP is not missed.)

Lastly, it is worth bearing in mind that foreign governmental plans that provide comprehensive coverage for all citizens (i) have special, usually high, taxes that pay for those plans, and (ii) have many coverage limitations that would shock most Americans. It is hard to imagine a universally accepted national health program in this land of opportunity that would have coverage limitations such as no dialysis over the age of 65, or no pacemakers over the age of 70. On the other hand, if such limitations, which are not unheard of overseas, would be absent in a national American program, the costs of our national health care would certainly exceed today’s 16% of GDP by a large margin, and that money would have to come from somewhere.

Our Federal government has expended an enormous (if unnecessarily complicated and hopelessly difficult) effort attempting to ensure the privacy of our medical records.

And yet …

On the front of every Medicare card (and a few holdout health plans), prominently displayed, is the patient’s Social Security Number. How reassuring.

Since the government is not taking steps to protect these patients, providers can. Patients can be taught a simple step to protect their identity; not carrying their actual Medicare card, but rather a photocopy with some of the digits blacked-out (although, naturally, they will need to provide those numbers at the first service). This can help protect them from pickpockets looking to steal their identities.

It would be a lovely trust-building step for your office to undertake in providing this service to patients. The copy will cost you pennies, but the trust built with patients is priceless.

Health costs rose around 10% in the past year for smaller businesses, and coupled with increasing costs for transportation, energy and supplies, they have been cutting back on health coverage for employees.

A survey conducted by the NJ Business & Industry Association found:

- While 4 years ago 92% of the smallest companies provided coverage, today only 77% do.

- 76% of the companies who dropped health coverage said that they did so because of costs.

- 52% of the companies who do provide coverage require employees to pay part of the premiums.

Premiums are expected to rise about 10% this year again. If it were because health costs went up, and health plans made only a modest profit, this would be a difficult but understandable reality. But as the AMA reports, the health plans are making a big buck at our expense (and force physicians to spend money fighting claims unnecessarily), and would rather lose members than lose profits.

What will next year hold?

On April 8th of this year, I wrote “Prepare to apologize. Lawyers cringe at this advice, but doctors who admit their errors, particularly the little ones, and treat the patient with respect and apologize, tend to get sued less frequently. Some organizations, such as the VA, have adopted this guideline as policy, and the number of suits has fallen since its implementation.”

It looks like the New York Times agrees. I recommend this article as a good read.