Renee is not the typical PAHCOM member. She is representative of the new vanguard of small group and solo physician practice managers. What makes her so special? Well, let’s start with her credentials, Renee Mancine, MSHSA, CHM, CMM. Notice that she has a Master’s of Science in Health Services Administration. Notice also, that Renee is a Certified Medical Manager. The typical PAHCOM member in the last 24 years of the association’s existence had only a high school diploma and maybe some college. Those members sought the CMM certification to validate their knowledge of managing a physician practice. The current trend is for managers with Bachelors and Masters degrees to join PAHCOM and obtain the CMM for the same reason…to validate their knowledge of managing a physician practice.
What makes Renee so special is that she is one of a new breed of physician practice manager that has evolved as the management of medical practices of every size and specialty has grown to be spectacularly complex. Renee recognized that physicians were being challenged to specialize, sub-specialize, and then sub-specialize more in their clinical expertise. At the same time, clerical/administrative rules and regulations expanded accordingly.
As the administrator of West Coast Infectious Diseases PA, Renee is responsible for ensuring that five physicians and a nurse practitioner keep a full schedule providing clinical care to a needy community of patients. Those clinicians expect Renee to “not bother them” with paperwork that is not directly related to patient care. A sample of the scope of Renee’s responsibilities, under the umbrella of “oversee office operations” include: accounting, payroll, human resources, facilities management, development and support of computer systems, software selection and updates, and a host of other duties that would be beyond conception if they were to be fully listed.
Renee’s medical practice is not that different from many other practices facing the accelerating technological growth in both medicine and management. The organization was started as a solo practice in 2004 by Dr. Brent Laartz. It only took one year before Dr. Todd Groom was added as an employee. One more year (2006, for those of you who are counting) found Dr. Michael Phillips joining the practice. Renee was hired two weeks prior to adding the third doctor.
Naturally, the facility’s size was totally inadequate with only three exam rooms and one physician office. This situation should sound very familiar to many PAHCOM members. It is the classic “Manager, we doctors have a problem and we want you to come in here and solve it for us right now.” Renee recalls, "It was still 2006 when we opened two satellite offices. Without catching a breath, we moved the main office to a 2,500-square-foot facility in 2007 and closed one of the satellites."
In 2009, the practice added a fourth physician, Dr. Niveditha Reddy. The next year the practice expanded the main office to 4,000 square feet. Would it ever stop and give Renee a breather? Not likely! Renee coordinated the addition of a nurse practitioner, Patricia Gilliam, in 2011 followed by the addition of the fifth physician, Dr. Aurelia Schmalstieg.
Renee has relied heavily on her professional association (PAHCOM) as a resource for information and guidance. In an interview with PhysBizTech, Renee stated, “I can’t speak highly enough about the PAHCOM ListServ. All the managers come together and support one another. And in this day and age, quite frankly, we need all the support we can get.” The PAHCOM ListServ is a member communication system that allows each PAHCOM member to post a question on any topic related to medical management. The question receives responses within minutes from experienced professional medical managers that have personal knowledge of the topic. Best news of all: It is free with PAHCOM membership.
Renee observed, “I’ve been in healthcare for 25 years, and I’ve seen a lot of transition. And it’s not getting any easier. I think whether you are a doctor or an office manager or someone else within the healthcare field, it’s getting more difficult to practice medicine.” With PAHCOM membership, Renee is networked with more than 3,000 members throughout the country. From her office in Safety Harbor, Fla., Renee has “…picked up the phone and called other managers all the way out in California for advice. Everyone’s experience is valuable. You may get an e-mail and find out about something that you never really considered.”
Renee added: “I’ll give you an example with the 5010 conversion that took effect in January. Historically December is a low month for getting payments. It seems like everybody from the insurance companies is on vacation. So reimbursement slows down. This year it was worse than usual. It seems that the 5010 conversion gave the insurance companies another reason to withhold payments.
With our payments, we were able to get them in by the middle January, but I know of providers who were having trouble getting paid. I even heard locally of an office manager being fired because of the whole situation.
Using the PAHCOM ListServ, I was able to go to our doctors, reference other practices, and say, ‘Look, we’re not the only ones in this boat. Others are experiencing the same thing.’ So the ListServ is not only a support tool as far as knowledge, but it also backs me up in discussions with the physicians”.
Renee also attends the Annual National PAHCOM Conference. She has attended for the last two years and says “The speakers are leaders in our field, so I get a lot of good information. It’s also valuable to talk to the vendors who exhibit at the conference, because you just never know when you’re going to want to look for another vendor.”
When asked by PhysBizTech how she feels about her position, Renee responded, “I wear many different hats every day. I’m sure any office manager will tell you the same thing. I handle everything except the clinical side of the practice. I handle payroll and all the managed care negotiations -- and that’s getting more difficult, too. So it’s a lot of work, but I have the autonomy to look for ways to improve operations."
Meeting the EMR challenge
The following story about implementation of the EMR system in her practice should sound very familiar to a lot of readers. In her own words, "We had a billing company, but we had been trying for years to bring billing into the office to do it directly. We probably reviewed about five systems, and it came down to three of them. Then we went through further review and eliminated two more. We had negotiated the contract and basically had implemented it on our servers and were getting ready to go live. We signed the contract in June 2008, but then in October 2008 we found out that our vendor had been purchased by a larger company – and our system was no longer going to be supported.
"We went back to the vendor and said…We’re a growing practice. No support means no upgrades, no improvements. We need something that will grow with us. The acquiring company came back and offered one of their products.
"We put the go-live on hold in October, negotiated the contract for the new system, and signed it on December 23. But there was one little caveat: We had given notice to our billing company back in September that, as of January 1, we would no longer use their services. So here it was December 23, we had signed the contract with no system up and running, and January 1 was right around the corner. Talk about pressure!
"We were very aggressive. Our staff worked long hours and weekends, but we got the payments in. We knew we had to do it because the doctors’ livelihood was at stake. By January 9, we had the software on the server, and by Jan. 25 we had the systems built and were using it. We had charges and payments turned around by the end of January 2009."
PhysBizTech asked what the key was in being able to make that quick transition. True to form, Renee gave credit to others that helped... "The billing manager was knowledgeable in claims billing. We also had a support person from another company called Doctors Administration Solutions who was knowledgeable in the specific system. She was always available. I could call or text her and she would answer me, even if it was 10:00 at night."
When asked if the practice was a meaningful user of an EHR? Renee responded, “Yes we are. We have received our incentive payments and are just waiting for our new doctor who started last year. She didn’t certify until January, so we’re waiting for her incentive payment, but we have received the payments for the other doctors. In addition, we do PQRI on top of that."
If that is not enough, the practice has expanded beyond the typical clinical treatment of infectious diseases.
The practice runs a travel medicine business called West Coast Travel Consultants. It’s a separate business from West Coast Infectious Diseases. They treat “clients” (rather than patients) that travel all over the world. The business provides information on the country they are traveling to…ranging from travel warnings to advisories on disease outbreaks, such as the cholera outbreak in Haiti. The doctor talks to the client about those types of concerns and prescribes what the client needs medically. If the client needs vaccinations, he or she can get them done in the office. For example, certain countries won’t allow entry without a yellow fever vaccination.
A third business, Galileo Real Estate, is the holding company for the satellite office. In September 2011 they opened a separate practice in St. Croix, Caribe ID. It is just getting up and running.
Renee also told PhysBizTech that she is involved in all of the above operations as well as the West Coast AIDS Foundation. It is a non-profit foundation that provides case management services to clients. Renee stated, "They’re not always our patients. We provide PAC waiver [Project AIDS Care] services for the state of Florida. It may be as simple as providing a gas card because the client may be running out of money and can’t pay for gas that month. We help clients navigate the healthcare system. Our workers are liaisons for the clients, but we call them case managers.”
Like many medical managers, Renee has a full plate but being networked with other professionals is key to staying organized and informed. That's how leaders like Renee work smarter and are able to do so much more for their practices, their communities and their patients.
We appreciate Renee taking time to share her knowledge and welcome you to participate in the conversation as well. PAHCOM members interested in telling their story should contact PhysBizTech Editor Frank Irving at .