Rheumatology Practice Management February 2014 Vol 2 No 1 — February 28, 2014

San Diego, CA—A major goal of human resource management is to help the medical practice establish a sustainable competitive advantage. Linda L. D’Spain, CMPE, CMCO, CMC, CMIS, CMOM, faculty consultant at the Practice Management Institute in San Antonio, TX, provided tips for successful human resource management at the 2013 meeting of the American College of Rheumatology.
Among the functions of human resource management are providing support and advice to line management, ensuring that competent employees are identified and selected, and affording employees with up-to-date knowledge to do their jobs.

“Your employees are your greatest asset,” she said. “A strong human resource management team provides strong leadership to our greatest asset.”

Because the front desk is the first and most lasting impression of your practice, the personnel must receive support not only with respect to customer service but also for compliance in all areas of healthcare, including the Health Insurance Portability and Accountability Act (HIPAA), Occupational Safety and Health Administration (OSHA), and the prevention of fraud and abuse.
Various tools can be used in the selection process. Performance tests are becoming more common. Online personality tests can help to determine if candidates can assert themselves when the need arises, “especially in that front desk role, because they truly are the front line in the battlefield,” said Ms D’Spain. “They are the line of defense for patients who may be getting upset because of wait times or having to pay a copayment or fill out paperwork.” These tests may also indicate whether the candidates are well suited for a team environment.

Practical performance tests are also valuable. Candidates for the front desk can be tested on their ability to check a patient in and gather the patient’s information. “If we’re hiring a coder, I would give them a coding test. It could be available online but it could be something that the practice actually wants to create,” she said. “I would give coding scenarios based on rheumatology to see if they can actually code medical records to extrapolate proper diagnostic codes, proper modifiers, and proper procedure codes in order to see if they would be an appropriate biller/coder.”

Potential collectors may be tested on their ability to appeal a claim. “I would give them an example of a denial and ask how they would fix it,” Ms D’Spain advised.

The Interview Process
She also advises spending an adequate amount of time with the applicant when interviewing him or her, and suggests structuring a fixed set of interview questions for all applicants and providing detailed information about the specific jobs for which the applicants are interviewing. “Ask behavioral questions that require applicants to give detailed accounts of actual job behaviors,” she said. Short interviews that encourage premature decision-making should be avoided.

The 80/20 rule is a rule in business that also can be applied to the interview process. The 80/20 rule assumes that the top 20 procedures will generate 80% of a practice’s revenue. “It’s important for a manager or a human resources person to listen 80% of the time,” Ms D’Spain said. “Ask open-ended questions and listen very carefully to the answer, and extrapolate more questions from the answers. This will help in making the right hiring decision.”

“To be compliant with all of the labor laws involved, there are many questions we cannot ask during the interview,” she warned. “Some people go into an interview with their ears open, just waiting for someone to ask an illegal question. They can go back and sue the practice and they can win the suit.”

It is illegal to ask a candidate how old he or she is; what his or her marital status is and/or whether he or she plans to have a family; whether the candidate has ever been arrested; and what his or her native language is. Instead, you can ask if the applicant is willing to relocate, is authorized to work in the United States, or has ever been convicted of a crime that is reasonably related to the performance of the job.

A good job description is the cornerstone for recruiting employees, Ms D’Spain said. An up-to-date job description will help a manager understand exactly what is expected of a potential candidate. “As we’re interviewing staff, we need to keep the job description in front of us and in our minds,” she said. “The interview should be conducted with the thought ‘can this person do this job?’”

Training Methods
New employees must be oriented to the job. The employee handbook, which should be given to all employees on their first day, sets the guidelines on office policies, including the obligations of the employee and the obligations of the employer.
On-the-job training should ideally come from a person in the same department or a mentor. That mentor or coach should serve as a “go-to” person for the new employee.

Technology-based training methods can be added to the traditional training methods. One that Ms D’Spain prefers is webinars. “They can help in all areas of practice management, from customer service to compliance,” she said. “It’s also important to send employees out to live classes so that there’s a bit more networking. Questions might be asked that the employee may not think of or might be afraid to ask, so it stimulates good discussion.”

Performance Appraisal
The performance appraisal provides managers with the information they need to make good human resources decisions about how to train, motivate, and reward organizational members. Performance appraisals must be conducted solely to appraise performance and not discuss salary increases, Ms D’Spain noted.

“The manager should have taken the time to go back and read the job description, see what is expected of the employee, find out the employee’s strengths, and determine the opportunities to improve,” she said. An opportunity for employee feedback should be provided.
Expectations, goals, and timelines to improve on areas where improvement is needed should be provided at the performance appraisal. Employees should be given a reasonable amount of time to improve before another evaluation, perhaps 3 months or up to 6 months if additional education or training is needed. At the follow-up evaluation, compensation can be discussed.

The management by objective performance appraisal method is one that Ms D’Spain favors. It is a results-oriented method that focuses on specific behaviors and end goals. Although comprehensive, the disadvantage is that it is time-consuming. The management by objective  approach offers potential solutions to correctable problems. For example, if an employee is consistently late because he or she has to drop a child off at school at a certain time, changing the arrival and departure time could be an option to explore. “Our goal is to salvage the employee, not drop him or her,” she said.

Entice with Good Compensation
Those employees who show superior skills should be enticed to remain with good compensation and benefits, in addition to career development, Ms D’Spain said. As important as money, “people want feedback and recognition for their performance,” she said.
Remind employees that their compensation includes not only their salaries but their benefits as well. Some practices may be able to compensate for lower salaries by offering better health insurance plans or offering both a defined contribution plan and a profit-sharing plan.

“It’s important to educate employees that they don’t get a raise just for working there. They need to meet all of the expectations and bring something to the table instead of throwing a dollar at them on their anniversary date,” she said.

Dismissal and Downsizing
Employees who do not meet expectations should undergo immediate verbal counseling followed by written counseling signed by the employee if he or she continues to fail to meet expectations. The written counseling should lay out the steps that will be taken if the employee continues to lag in performance. Termination should be immediate for certain infractions such as stealing, drug abuse, or fraud.

Some practices with declining reimbursement may find it necessary to downsize. In the event of downsizing, every employee will feel threatened. “The best thing that a manager or physician can do for their staffs is to be honest,” Ms D’Spain advised. “Tell them up front that you have to eliminate positions.” Good human resource management in this case involves offering assistance to downsized employees, such as services that will help update their resumes and recruiters who can help with job searches.

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