Managing Your Practice

Promises, promises


For many, the making and breaking of New Year’s resolutions have become a humorless cliché. Still, the beginning of a new year is as good a time as any for reflection and inspiration; and if you restrict your fix-it list to a few realistic promises that can actually be kept, resolution time does not have to remain an exercise in futility.

I can’t presume to know what needs improving in your practice, but I do know the issues I get the most questions about. Perhaps the following Top Ten list will inspire you to create a realistic list of your own.

1. Do a HIPAA risk assessment. The new HIPAA rules are now in effect, as I discussed a few months ago. Is your office up to speed? Review every procedure that involves confidential information; make sure there are no violations. Penalties for carelessness are much stiffer now.

2. Encrypt your mobile devices. This is a subset of item 1. The biggest HIPAA vulnerability in many practices is laptops and tablets that carry confidential patient information; losing one could be a disaster. Encryption software is cheap and readily available, and a lost or stolen mobile device will probably not be treated as a HIPAA breach if it is properly encrypted.

3. Reduce your accounts receivable by keeping a credit card number on file for each patient, and charging patient-owed balances as they come in. A series of my past columns in the archives at explains exactly how to do it. Every hotel in the world does this, and you should too.

4. Review your coding habits. For example, are you billing for 99213 each and every time your evaluation and treatment meet the criteria for that code? If not, you’re leaving money on the table; and that will become a more and more significant issue if reimbursements tighten up in the next few years – as they almost surely will.

5. Clear your "horizontal file cabinet." That’s the mess on your desk, all the paperwork you never seem to get to (probably because you’re tweeting or answering e-mail). Set aside an hour or two and get it all done. You’ll find some interesting stuff in there. Then, for every piece of paper that arrives on your desk from now on, follow the DDD Rule: Do it, Delegate it, or Destroy it. Don’t start a new mess.

6. Keep a closer eye on your office finances. Most physicians delegate the bookkeeping, and that’s fine. But ignoring the financial side creates an atmosphere that facilitates embezzlement. Set aside a few hours each month to review the books personally. And make sure your employees know you’re doing it.

7. Make sure your long-range financial planning is on track. This is another task physicians tend to "set and forget," but the Great Recession was an eye-opener for many of us. Once a year, sit down with your accountant and planner and make sure your investments are well diversified and all other aspects of your finances – budgets, credit ratings, insurance coverage, tax situations, college savings, estate plans, and retirement accounts – are in the best shape possible. Now would be a good time.

8. Back up your data. Now is also an excellent time to verify that the information on your office and personal computers is being backed up – locally and online – on a regular schedule. Don’t wait until something crashes.

9. Take more vacations. Remember Eastern’s First Law: Your last words will not be, "I wish I had spent more time in the office." This is the year to start spending more time enjoying your life, your friends and family, and the world. As John Lennon said, "Life is what happens to you while you’re busy making other plans."

10. Look at yourself. A private practice lives or dies on the personalities of its physicians, and your staff copies your personality and style. Take a hard, honest look at yourself. Identify your negative personality traits and work to eliminate them. If you have any difficulty finding the things that need changing ... ask your spouse. He or she will be happy to outline them for you in great detail.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is a clinical associate professor of dermatology at Seton Hall University School of Graduate Medical Education in South Orange, N.J. Dr. Eastern is a two-time past president of the Dermatological Society of New Jersey, and currently serves on its executive board. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

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