Recruiting a New Doctor? Offer a Student Loan Repayment Program

New Doctor Associate

Student debt has become a major financial factor for new medical and dental graduates.  Your new associate doctor is likely to have student debt in the range of $260,000 or more. Rather than looking for a position that offers the benefits of ownership with an independent practice, younger doctors are seeking positions with a secure paycheck.  Adding a student loan repayment assistance program to your compensation offering will put you one step ahead of your competitors seeking to hire the same candidate.

New recruits offered this benefit are more likely to accept a position.  They are also less likely to leave, if it means leaving their student loan repayment assistance program behind.  Hospitals and larger corporate employers, in the dental profession, have been offering these benefits for years. Independent practices that address their potential associates’ concerns about student debt when making an initial offer of employment, stand a better chance to successfully hire their desired candidate.

To make your offer even more attractive, get creative with your benefits.  Consider offering a salary amount along with an upfront low-interest loan that can be used to jump-start the reduction of the student debt.  You can structure increased contributions to be made based upon determined factors that align with your business goals.  Your goals might include a vesting schedule based upon length of employment, taking on new business, or becoming a business partner.

The tuition assistance payment that is made on behalf of your employee is a taxable benefit. However, the company contribution, or the “jump-start” loan, will provide a favorable interest savings to your new doctor employee.

Mike DeVries is a CERTIFIED FINANCIAL PLANNER ™, Enrolled Agent,  and a Certified Healthcare Business Consultant focusing on helping healthcare professionals. If you would like to learn more about becoming a client, contact Mike at www.vmde.com.

Build an Exceptional Team – Start with Position Descriptions

Free Position Description Templates

Having clearly defined Position Descriptions is the first step in the process building the right team for your office.  I often receive questions from clients related to staffing issues in their office. And, I often answer their question with a question – What does your position descriptions say?

Position Description

Providing Staff Evalutions for Your Office Staff

Any conscientious healthcare business practitioner for various reasons can easily overlook evaluating office staff. Two basic reasons are: one, it is extra work; and second, many doctors simply believe that all is working well in their offices and do not want to “rock the boat”.  Yet, it is very important for you to know that your office is operating as efficiently as it can, and with a well-planned, routinely conducted staff evaluation program, you can achieve several advantages.

Accurately Evaluating Your Office Staff

Overtime Changes – Fair Labor Standards Act

3 Action Steps to Take Now

On July 6th, the Department of Labor announced a proposed rule that would extend overtime protections to nearly 5 million white-collar workers within the first year of its implementation. What impact might this have on a medical or dental practice?

Filling the weekly time sheet for payroll

Creating Excellence in Your Office

Aerial View of People and Excellence ConceptsIn his book, Hardwiring Excellence, Quint Studer indicated that 27% of employees leave their employer within the first 90 days because they give up on their healthcare employer. Turn over of personnel is expensive and should be avoided by maintaining a good recruiting and training process. Keeping your staff working as a team and cultivating loyalty is also important for maintaining a smooth running office. As a leader of your business, here are some ways to work with your team members to create excellence in your office.

  • Recognition – be sure to let your staff know you appreciate them. Address them by name and thank them.
  • Equip your team – provide them with the tools and equipment they need to do their job. Ask them, what could you use to do your job better? Or even, I want to make this a great place to work – what can I do for you?
  • Praise – Acknowledge employees’ achievements in front of their peers. I have had clients provide awards and dinners for special achievements. You can certainly establish a non-taxable employee awards program, but you don’t have to – a simple word of praise can go a long way.
  • Purpose – Communicate your vision for your practice and make sure employees see how their particular tasks affect the big picture.
  • Meaningful work –  Eliminate “busy work” and maximize your employees’ effectiveness. Sometimes this means that we need to look beyond the way things have always been done and do something that is hard for most everyone – change.
  • Decision autonomy –  Provide the training, skills and authority for employees to fix problems on their own.
  • Participation –  Encourage staff opinions at regular staff meetings. You will be surprised by the creativity and resourcefulness of your employees when you ask them what they like and don’t like about the way the office is run and what suggestions they have for improving it.
  • Flexibility   Consider creative scheduling and job sharing. For example, have a staff member come in at noon and stay later into the evening so that another member might be able to leave the office on time.
  • Diverse experience – Allow for and provide training so your staff members know what is expected of them and realize that their professional growth is important to you. Encourage cross training so they learn skills beyond their usual job description.
  • Measure progress – establish common goals or benchmarks that can be measured each month, quarter, or annually supports the alignment of behavior and recognized behavior is repeated. But don’t get too stuck on the numbers; rather than catching people meeting the criteria for recognition, work towards mobilizing the entire organization to recognize individuals that perform acts of excellence.

Team members that work in healthcare desire to feel a part of something worthwhile. As the leader of your team and business, you have the ability to foster and encourage this desire by growing as a leader and creating employee engagement, which will contribute to memorable patient kindness, profitability, sustainability and patients telling others about your office – an office of excellence.

A Method for Setting Pay and Budgeting for Raises

iStock_000011030526XSmall[1]I have helped my doctor clients review the compensation levels of their team members.  I have also assisted in establishing a “right wage” when hiring a new member to their healthcare team.  The process for doing this is built upon both internal and external data. It’s not only important to compare wage data to other similar paid positions externally; I believe that it is also important to have a wage scale within the office that is relative to the position being filled and the responsibility that goes along with the needed position in the office.

Establishing a pay scale for your office begins with the job description.  Each paid position in your office should have a position description that describes the duties and the requirements of job.   This description will also provide you with a tool needed to assess the position from time to time as well as evaluate the person doing the work. Along with each job description I recommend you assign a salary range – a minimum pay amount and a maximum pay amount that will attract the desired team members and provide a fair compensation.  Having this detail and structure will provide the communications needed to keep understandings and expectations very clear.

Once you have a base range for each position, then you are ready to take the next step towards your pay raises, which involves an overall pay “raise budget” for the year. This is typically set as a percentage and applied to your entire team pay amounts.  If you have team members that are paid a salary, convert them to an hourly rate for this computation. For example, and to keep things simple, let’s assume you employ three people – one person at $10 per hour, a second at $15 per hour, and the third at $20 per hour.  Let’s also assume that all your employees fall into the range of pay set in their job descriptions.  To establish the raise budget for the year, add the hourly pay amounts together, which, in this example, would equal $45 per hour.  Now, multiply this by a raise percentage.  This raise percentage will vary from office to office based upon factors such as the annual cost of living increase during the past year, how well your practice prospered in the prior year, and based upon the cost of other benefits you are providing your employees.  During high inflationary periods I have seen this percentage in the 8 – 12% range, but we haven’t seen that in years.  Today, and over the past many years I would say that the range would be more in the range of 1.5 – 5%.  Let’s use 5% for our example.  Applying this percentage to the combined hourly rate, the result is $2.25 ($45 X 5%).  Armed with your annual “raise budget” of $2.25, you are ready to move to the third and final step.

Some doctors prefer giving team members a cost-of-living adjustments or simply applying the same percentage increase, in our example 5%, across the board to all team members to avoid confrontations over employee performance.  This negates your responsibility as the manager and leader in the office.  Pay-oriented evaluation sessions are essential to good supervision.  Instead consider the following method as a recommendation for applying pay raises.  Based upon your evaluation of the person and the job performed, provide each employee with a portion of the “raise budget”.  Back to our example, let’s say that employee one did an outstanding job this past year and exceeded your expectations.  Employee two, well, let’s just say you have had a few conversations about missing the mark, but not to the point of terminating the relationship.  Employee three has been with you for a long time.  This team member continues to meet your expectation and provide a good experience for your patients.  Her current pay rate is within the current pay range for her job description, but it is getting close to the top.  The following table is an example of how you might divide the $2,25 among your personnel based upon your evaluation.

PayRaiseTable

Note that not all team members received the same percentage increase, but you have kept the overall raise amounts within the 5% budgeted amount.  If by chance, in allocating the raises, you come up short of your initial determined budgeted amount, you can either increase an employee’s raise amount or simply lower the overall percentage based upon your final evaluation. Whatever your final decision is, remember this – people will have difficulty accepting low pay increases.  If your overall increase will be lower than what you have done historically, you can pave the way for lower salary increases specifically by informing your employees via general office team meetings before salaries are reviewed.  Indicate that the cost-of-living is rising so slowly that pay raises will be lower than in the past.  But do this over time – several weeks or months – depending on when you schedule evaluations and reviews.  By allowing the idea of a lower pay raise to sink in over a period of time, the lower increase will more likely be understood when granted. Whether it’s good news are not so good, having the discussions with your team members will enhance better personnel relations and help raise the expectations of your team.  A team member’s compensation should be a positive incentive for good work performance.  An additional merit increase, such as reflected with Employee 1, would be paid only on a basis of merit, i.e., because the employee deserves it and not because external forces dictate it.

Using this method of establishing pay raises will keep your overall costs in check.  It does involve more evaluation than simply giving everyone an established percentage raise, but remember, each employee is an excellent resource for your practice and worth the extra effort.  If you have a large amount of personnel and the option of meeting with each of them in one time-frame will not work with your schedule, consider staggering when you actually conduct employee’s salary reviews and increases to coincide with each person’s anniversary date with the practice.  By using their date of hire as the time when you conduct their evaluation and then grant pay increases, you reduce the financial impact on you r practice of everyone getting a pay increase at the same time.  For some larger practices, this could be a real plus.  Using an employee’s anniversary date also distributes the “evaluation workload” for you because everyone does not have to be evaluated at the same time.  One caution, however–(depending on the size of the practice) it may be easy to overlook someone’s anniversary date.  If this happens, you could lose a valuable employee just because of an oversight.  Guard against just such a situation occurring.

How do you establish pay raises? (Reply Here)

Mike DeVries is a CERTIFIED FINANCIAL PLANNER ™ and a Certified Healthcare Business Consultant focusing on helping healthcare professionals. If you would like to learn more about becoming a client of Mike’s, contact him at www.vmde.com

Employee Notice Regarding Health Insurance Options

Many provisions of the Affordable Care Act that will expand access to health coverage become effective beginning in 2014.  Included in these provisions is health insurance coverage that will be offered through a Health Insurance Marketplace. Open enrollment for this “Marketplace” health insurance coverage, available for Individuals and employers of small businesses, will begin October 1, 2013.

This past May, the Department of Labor issued regulations that you provide your employees with a 2 page notice informing them of their health insurance options by October 1, 2013.  I suspect that many independent physician and dental offices are not ready to meet this obligation with their employees.  To assist you with this, I have provided an executive summary, copies of model notices provided by the Department of Labor, and the technical notice issued by the DOL in the following link:

http://dld.bz/EmployeeHealthInsuranceNotice

I suspect that being a healthcare provider and offering good medical or dental care to your patients is your goal each day when you arrive at your office.  Taking the business hassles out of Healthcare and keeping you in the business of caring for your patients is mine.

Keep Practicing on Purpose.

A 15 Point Front Office Check-up!

Checking patients in and out of their appointments in a friendly and efficient way is a complex process that leaves a deep impression – for better or worse – of your practice. Because first impressions are often lasting ones, leaving this process up to chance is not a risk you want to take.

When patients enter your office, are they seeing the image of your practice you want to convey?

If not, educate your staff about the specific image you want to convey and provide the standards to support it. By establishing high standards, you eliminate mixed messages patients might get if they see another patient getting more personal attention or courteous, discrete service. While all office staff has a role to play in achieving high standards, the office receptionist is the first contact a patient makes when he walks through the door. Her efforts to maintain those standards need to be supported by the rest of the office team.

Here are some “check-up” tips to consider for your check-in and check-out procedures that will assist you in making that first impression a good one.

  1. A clean, well-organized front desk and reception area will go a long way toward creating a positive impression and making patients feel comfortable.
  2. Desks and work areas visible to patients should be neat and organized. Establish rules about eating and drinking in the reception area. Ensure that confidential phone calls to insurance companies by your billing personnel be made outside of earshot of the waiting room.
  3. The front desk should be configured to help the receptionist efficiently perform her duties. For example, have a copy machine available to copy insurance cards, driver’s licenses, and referral or pre-authorization information. Some practices let receptionists lose valuable time by requiring them to walk to the back office to perform these simple tasks.
  4. Consider using “cheat sheets” to assist staff in answering questions about insurance co-pays, hospital/lab phone numbers or directions to your office. The station responsible for collecting payments should have a cash drawer and credit card machine available.
  5. A good receptionist has a demanding position that requires she courteously deal with difficult patients, scheduling delays and other problems. Making small improvements in the working conditions lets her know her skills are valued. For instance, consider providing a telephone headset that allows her to handle calls and appointment changes without getting a cramp in her neck.
  6. Staff should arrive at the office before the first scheduled appointment. This would be a good time to hold an informal staff meeting to discuss the upcoming day’s appointments, open slots, potential problems, and other short timely topics.
  7. Unless you have implemented an electronic charting system, patient charts should have been pulled or created for new patients the night before or prior to the day’s first appointment. A list of the scheduled patients and appointment times should be prepared and ready for the receptionist as each patient arrives.  This will allow for proper greeting of the patient along with an efficient means to follow-up with the patient through-out the visit.
  8. A friendly, attentive receptionist can reduce the anxiety of a doctor’s appointment. Does your receptionist make eye contact when speaking with patients? Does she listen and respond rather than spout rote phrases? Standard scripts can be helpful in ensuring that office policies are followed, but they must be flexible to accommodate individual situations.
  9. To assure confidentiality, patients should be signed in on a list that’s kept next to the receptionist instead of on the counter. Patients requiring special assistance should be escorted to a seat in the reception area and then to the examination room.
  10. New patients should be pre-qualified during the appointment scheduling and reminder calls. Before the patient arrives at the office, you should know what type of insurance coverage the patient has; whether you are a participating provider in that plan, and if your practice provides the services needed. All such information should be in the patient’s chart and verified upon arrival.
  11. Be sure to verify the patient’s address, employer and insurance plan at the check-in time. It is better to ask the patient to provide this information than to assume that “everything is the same”, which could create billing or reimbursement delays.  This is also a great opportunity for specialists to obtain the patient’s referral and/or authorization form.
  12. Whether a practice collects co-payments and deductibles at check-in and check-out depends on the practice’s philosophy and type of services offered. For all practices, however, it is important that the patient be aware that payments for which the patient is responsible are expected at the time of the visit.  Providing patients with a copy of your written financial policy as part of a welcome packet or prior to their visit with you can be helpful for having this discussion.
  13. If a follow-up appointment or referral letter is needed, handle it immediately. If the patient will be sent to the hospital, a lab for tests, or to another practice, provide directions and a phone number along with the appropriate forms. If necessary, make the appointment for the patient.
  14. The receptionist should know the co-payment, deductible and other fees due for the visit and politely request the payment. Here’s a courteous way to phrase that request: “Mrs. Smith, your co-payment for today’s visit is $30.  Will you be paying by cash, check or credit card today?” If the patient has forgotten her checkbook, provide a stamped, self-addressed envelope so that the check can be mailed as soon as she arrives home.  By not expecting appropriate payment for your services, you are implying to the patient that your knowledge, skill and care are not worth the fee you are charging.
  15. Before the patient leaves, ask if there is anything else you can do. Conclude the visit by thanking the patient and, if appropriate, relaying your concern for his or her well-being.

You will need to modify your procedures from time to time. Regularly schedule discussions at your staff meeting about how to handle a difficult patient; resolve scheduling problems, adapt to changes in insurance information; doctor delays, and the like. As new problems arise, the entire staff can work on providing a solution.

“Raising” Expectations of your Team

The cost of living from December 2010 to December 2011 was 3% as defined by Table 1 of the Consumers Price Index for all Urban Consumers (CPI-U): US city average, by expenditure category and commodity and service group.  I suggest that when you look at raising your team member’s pay, you do so with more of a focus towards “merit” raises.  Rewarding your employees that have performed well or exceeded your expectations makes good business sense, but make sure you communicate this to your employees as well.  The best way to do this is in person, but I would suggest that you also send them a note – here is an example:

Dear Valerie:

This notice serves to advise you of an increase in your wage that is equal to 5% of your current hourly rate.  The effective date of this increase is March 1, 2012 and the increase in pay will appear in the payroll check you receive on March 9, 2012.

We are pleased to award this increase based upon your performance over the last review period and believe it will serve as an incentive for you to continue to strive to meet our business goals and objectives in the future.

As the leader of your business, be sure to continually communicate the mission and objectives of your practice to your employees so they know what is expected of them.  Dealing with poor performance can be time consuming, but don’t let it go unchecked or it will send a clear message to the rest of your team that you don’t care, which can be an infectious attitude.  Poor performance usually only gets worse over a period of time and rarely corrects itself without some form of intervention.  So, as soon as it is noted, take the necessary time to address the matter, note it in your personnel files, and then reinforce this during the review with your employee.  At the time you give raises, you should address the change in compensation with those for whom you are giving a lower or no raise as well.  In additional to speaking with them in person, you should also include a notice – here is an example:

Dear Gertrude:

This notice serves to advise you of an increase in your wage that is equal to 2% of your current hourly rate.  The effective date of this increase is March 1, 2012 and the increase in pay will appear in the payroll check you receive on March 9, 2012.

This increase is reflective of your performance over the last review period.  We will review this and the goals set for you again in six months.

Among a medical or dental practice’s most valuable assets are its employees.  Most desire to meet or exceed your expectations.  So, as their employer, be sure to communicate, train, develop and treat your employees in a manner that wins confidence and raises expectations and your practice will run smoothly.