As providers continue to reel from the announcement of the Round 2 competitive bid prices, many are preparing for their plan A, B or C in reaction. This is to say that they are beginning to implement their alternate business plans, many drafted prior to receiving the appalling news of Round 2 pricing. Simultaneously, they are clarifying for their legislatures the impending disastrous outcome of the program as they make a final attempt to abolish competitive bidding in favor of the Market Pricing Program (MPP). While all of this is logical and a natural and critically important reaction, regardless of what happens in Round 2 there is one thing over which every provider has control: their operational efficiencies.
As I visit many providers throughout the country I notice familiar weaknesses, such as staff that runs the show rather than managers. Examples:
- One provider allowed CPAP patients to schedule mask refits as often as they wanted, starting immediately after the patient receives their first mask.
- Another provider with almost all manual processes (despite being automated) had their staff pull me aside to beg me not to make too many changes to the manual systems for fear of losing their job.
- One more provider accepts all special orders, regardless of price and profitability. I witnessed a transaction for an $11 item that the retail salesperson offered three times to deliver to the patient since they didn’t stock it.
The common thread in all three examples is that staff is running amok with their own version of how they’d like to run a company. As these three examples show, providers should be focusing on internal operations while they prepare their next move. Hone in on that which you can control. Below are some suggestions to counteract the three examples listed above:
CPAP Masks—If the patient has trouble adjusting to sleeping with a CPAP, counsel them by telephone first, using clinical staff as needed. Give them adjustment suggestions/options before inviting them to trade it in for a different mask. Also allow them time to get used to the CPAP. Finally, inform the patient of how often their insurance pays for replacement masks when they are first set up with the equipment. If they insist on a new mask, have the patient sign an ABN and pay cash for the mask if you are providing it prior to when they are allowed a new one (unless the manufacturer gives it to you for free or pays for the replacement, and even then it should be done sparingly as it is still a costly process).
Manual Systems—Walk around the office and look in drawers, on desks and on clipboards for manual processes. Watch staff that copies and faxes excessively. In some cases, they are actually creating the extra work as a way to look busy and get up from their seats. With e-fax and e-mail you should be able to curtail this activity. Further, to print a scanned image only to fax and rescan it seems senseless. Eliminate this type of work as it wastes time and paper. Ultimately, a fully automated and paperless environment is the key to process improvement and efficiency, something we should strive for in the coming years.
Special Orders—In today’s environment, the ability to accept orders for items outside the norm is getting tougher. Although exceptions are warranted on occasion, you will find that the work spent on special orders takes more time than the actual bread and butter items you so desperately need to provide. While you might say that it is the special ordered equipment that feeds the bread and butter referrals, it is time to educate the referral sources on the need to perform only those services that are profitable for sustainability. Desperate times warrant desperate moves and for some of you, furloughs and bare bones staffing have been the answer.
Whether you implement plan A, B or C as your next move, remember that a walk around the operation is helpful and allows you to regain some sense of control. You will find ways to improve efficiencies, whether through small or big initiatives. Regardless of your plan, you should be able to hone in on your internal operations for better business control.
