1. The Nitty-Gritty of Office Operations: Policy and Procedures Manual David Kolva, MD Practice Management Seminar

2. Seminar Learning Objectives Understand Why Most FP’s Offices are INEFFICIENT and CHAOTIC Understand Why Most FP’s Offices are INEFFICIENT and CHAOTIC Advantages in Using a Well-Planned Manual and Job Descriptions Advantages in Using a Well-Planned Manual and Job Descriptions Develop a “User-Friendly” Policy and Procedures Manual and Stimulate Use of Same. Develop a “User-Friendly” Policy and Procedures Manual and Stimulate Use of Same.

3. What do BABIES and Office Staff Members have in Common? They both Learn VERBALLY! They both Learn VERBALLY! Is This the Most Efficient Method Is This the Most Efficient Method - or - - or - Just the Most Convenient at the Moment?

4. Problems with Verbal Teaching (Folklore Approach) Inconsistent Content between Teachers Inconsistent Content between Teachers (i.e. preceptor’s room) (i.e. preceptor’s room) Teacher’s Tendency to Forget or Misinterpret Policy (“put own spin”) Teacher’s Tendency to Forget or Misinterpret Policy (“put own spin”) Dependent on Teacher’s Presence Dependent on Teacher’s Presence The Person Most to Gain (Owner) is LEAST Likely to be the Teacher! The Person Most to Gain (Owner) is LEAST Likely to be the Teacher!

5. Purpose of Policy Manual Greatest TASK of Leader = articulate the vision. Greatest TASK of Leader = articulate the vision. The Manager creates the road map so everyone knows their role and expectations. The Manager creates the road map so everyone knows their role and expectations. Without a clear policy manual, mistakes are made repeatedly - consumes an inordinate amount of time and energy to remedy. Without a clear policy manual, mistakes are made repeatedly - consumes an inordinate amount of time and energy to remedy.

6. Glossary POLICY - Making a recurring decision just once. POLICY - Making a recurring decision just once. PROCEDURE – EXPLICIT set of instructions about how to carry out the policy. PROCEDURE – EXPLICIT set of instructions about how to carry out the policy.

7. Advantages of P & P Manual Save TIME : no need to debate what to do! If situation fits, do the procedure! Save TIME : no need to debate what to do! If situation fits, do the procedure! Decrease Chance of Misunderstanding/Resentment: Each staffer is treated the same each time. Decrease Chance of Misunderstanding/Resentment: Each staffer is treated the same each time. Quick Quality Decision-Making Quick Quality Decision-Making Staff gets to OWN policy & procedure if they are part of formulation = better compliance Staff gets to OWN policy & procedure if they are part of formulation = better compliance

8. Advantages of P & P Manual Decreased Training-Time of NEW Employees and Encourage Cross-Training of Positions Decreased Training-Time of NEW Employees and Encourage Cross-Training of Positions Reduce Variations in Patient Care Reduce Variations in Patient Care Improved Risk Management: Comprehensive P & P establishes “Usual Practices” and Averts Carelessness Improved Risk Management: Comprehensive P & P establishes “Usual Practices” and Averts Carelessness

9. Job Descriptions Absolutely Essential! Most Failing Practices DO NOT have Job Descriptions. Absolutely Essential! Most Failing Practices DO NOT have Job Descriptions. Explicit Outline of Duties for each employee. Explicit Outline of Duties for each employee. –Specificity directly predicts performance. –Teamwork improves if everyone knows what is expected of them!

10. Policy Manuals Paper-Based Book: Paper-Based Book: –Looks nice, but less utility & hard to update! –Loose-leaf cheaper and easier to update, –Each employee & work station needs own copy –Many existing templates Computer Based: Computer Based: –Better utility and easy to update! –Requires computer literacy –Security issues –CREATE YOUR OWN PRACTICE INTRANET!! HTML

11. As A New Employee……… If joining an established practice, perfect opportunity to create or update the practice’s P & P manual. If joining an established practice, perfect opportunity to create or update the practice’s P & P manual.  You are probably more computer literate  Forced learning of ALL practice’s details  Your suggestions more likely to be accepted if you are doing the work

12. Manual Essential Elements *Front Office* Reception/Check-in: Script Greeting Reception/Check-in: Script Greeting Demographic Information Gathering Demographic Information Gathering Patient Insurance Registration and Method of Payment for Services. Credit Cards. Co- Pays. Patient Insurance Registration and Method of Payment for Services. Credit Cards. Co- Pays. PRACTICE NOTICE OF PRIVACY PRACTICES and HIPAA Acknowledgement PRACTICE NOTICE OF PRIVACY PRACTICES and HIPAA Acknowledgement PHONE ETIQUETTE and TRIAGE. PHONE ETIQUETTE and TRIAGE.

13. *Front Office* Appointments and Scheduling, Walk- ins, Sales Reps Appointments and Scheduling, Walk- ins, Sales Reps Filing Insurance Claims. Medicaid. Professional Courtesy Filing Insurance Claims. Medicaid. Professional Courtesy Bad debt and Past due accounts. Bad debt and Past due accounts. Photocopies. Photocopies. Completion of Forms. Completion of Forms.

14. *Front Office* Referral Specialist. Prior authorization requests. Referral Specialist. Prior authorization requests. ABUSIVE PATIENTS ABUSIVE PATIENTS EMERGENCIES [Basic CPR certif.] EMERGENCIES [Basic CPR certif.] REMEMBER: The quality of the practice is mirrored and represented by the front office staff! REMEMBER: The quality of the practice is mirrored and represented by the front office staff!

15. Manual Essential Elements *Clinical/Nursing* Telephone Advice and Triage. Get Standardized Manuals and Rehearse! Telephone Advice and Triage. Get Standardized Manuals and Rehearse! Prescription Refills Prescription Refills Patient Visit Preparation. Vital signs. Patient Visit Preparation. Vital signs. Lab/Test results. Recording History. Lab/Test results. Recording History. Nurse-Only visits Nurse-Only visits Medical Supplies Inventory Medical Supplies Inventory Chaperones Chaperones

16. *Clinical/Nursing* Medical Emergencies Medical Emergencies Employees as Patients in Practice Employees as Patients in Practice Controlled Substances. Storage and Dispensing. Controlled Substances. Storage and Dispensing. State Vaccine Program State Vaccine Program In-Services and Conferences In-Services and Conferences

17. SPECIAL MANUALS H.I.P.A.A. = Document training of Employees H.I.P.A.A. = Document training of Employees O.S.H.A = Specific Infection Control Procedures and Documentation of Training O.S.H.A = Specific Infection Control Procedures and Documentation of Training C.L.I.A. = Specific Laboratory Procedures, Quality Control and Proficiency Training C.L.I.A. = Specific Laboratory Procedures, Quality Control and Proficiency Training

18. Manual Essential Elements *Personnel* Type of Employment “at will” Type of Employment “at will” Confidentiality of Personnel Files Confidentiality of Personnel Files Dress Code Dress Code Conduct – Immediate Termination Conduct – Immediate Termination Personal phone calls and family visits Personal phone calls and family visits Compensation Compensation Benefits Package Benefits Package Work Schedules/Vacations/Holidays Work Schedules/Vacations/Holidays

19. Manual Essential Elements *Personnel* Schedule of Performance Appraisal and Feedback Method Schedule of Performance Appraisal and Feedback Method Sexual Harassment policy Sexual Harassment policy Some States consider personnel manuals as implied contracts …… Some States consider personnel manuals as implied contracts …… need ATTORNEY REVIEW! need ATTORNEY REVIEW! Some national firms now provide personnel management services and printed P & P manuals. Some national firms now provide personnel management services and printed P & P manuals.

20. General Principles Clear and concise. Clear and concise. Good policy and procedure manuals create: Good policy and procedure manuals create: – good quality care – teamwork – enhanced patient safety – lowered legal RISK Use Constantly and Consistently Use Constantly and Consistently