Unqualified employees who have embellished their applications can also lead to a higher employee turnaround when they are not able to meet the requirements and expectations you require.  This can also result in loss of revenue spent on training and effect employee moral by placing more duties and responsibilities on your current employees.

Studies show:

• One in every 32 adults has a criminal record, according to the US Department of Justice.
• Employers found liable by a jury face up to $1.6 million in damages and $20 billion annually is lost by US businesses due to negligent hiring costs.
• Information given on a resume is false or exaggerated an estimate of 45% of the time.
• The average turnover expense for an $8.00 per hour employee is $5,000.
• Employee theft results in 30% of all new business failures.

If an employee drives your company vehicle or uses their own vehicle for your company’s business, a motor vehicle record should be procured from the state in which they hold their license.  Insurance companies will usually give a business discount for performing background and motor vehicle record checks.

Some examples of how a background check could have prevented negligent hiring in an Arizona county:

1. Albert Robbs was not given a background screening when he was hired by the county recorder’s office in 2003.  He was ultimately arrested for theft and identity theft of another individual by accessing the county files.  His prior arrest record and 3-year prison sentence would have been discovered had a background check been performed.
2. A bailiff in the same county had previously spent 9 years in prison for theft and drug possession/distribution, but his arrest record was not discovered until after he was arrested on suspicion of bribery and offering to exert improper influence on a public officer.
   This county has since required background screenings on any new hires as well as for all existing employees in 2009.  The expense of the screening will cost less that that was spent for the above-referenced incidents.

Some basic screenings to be completed on potential employees include:

• Social Security Number search.  This will allow you to verify any and all aliases and other names used for the past 7 years in any and all counties and states.
• 7-year county/state criminal record search.  All county and state records will be searched for criminal records for any and all aliases and names used.
• Credit history. This will show any bankruptcies, liens, judgments, collections and other financial history.
• Motor Vehicle record. This will provide a detail of the person’s driving record and any citations, suspensions, revocations, etc.
• Education verification. This will allow you to verify the dates, diploma or degree earned and the highest level attended.
• Employment verification. This will provide verification of employment dates, reason for departure, rehire status, job title and performance.
• Professional license verification. This will provide verification of any state licensing and status.
• Sex offender registry. This will list any past sexual offenses.

“The best offense is a good defense” isn’t just a saying, it’s good practice.  The cost involved in performing these background screenings could potentially save your company thousands of dollars as well as showing your current employees, customers and insurance providers that you are a reputable company.

• Are you accomplishing less?  If you are and you aren’t sure why, you may need to head back to the office for a few days each week.  If you know why, implement solutions quickly. 
• Is your staff accomplishing less?  If the mice play when the cat is away, decide how you can address this with your staff.  Perhaps an in-office staff member should be promoted to a supervisory position to keep the rest of the staff working as efficiently as possible. 
• Are you “out of the loop?”  If you’re being left out of meetings, key decisions, and major changes in the office, telecommuting isn’t working. 
• Does your staff resent you?  Misconceptions about working from home abound.  If your colleagues think you’re not pulling your weight, you’ll need to put methods of showing them otherwise in place. 
• Are the bosses satisfied?  If you sense discomfort with the current setup, schedule an in-person meeting to determine how to make the necessary corrections.  
• Do patients and vendors know you telecommute?  This is a huge no-no in the virtual office world.  No one outside the practice should know that you’re not in the office during working hours. 
• Are you having technical problems?  Telecommuting can offer technical challenges, such as inconsistent internet connectivity, that are both frustrating and difficult to solve.  If you can’t seem to get past them, heading back to the office may be best. 
• Is your home life suffering?  Though telecommuting theoretically makes work easier, in practice it often results in a confusing and conflicted home-work life.  You may feel isolated or struggle with how to integrate your efforts into team objectives and goals.  You may work too much because your office is “right there” and easy to access after dinner or when you can’t sleep.  Telecommuting is a wonderful opportunity, but it’s not for everyone.         

If the answer to each of these questions is “no” or is “yes” but easily correctable and you and your practice’s physicians/owners are satisfied with the arrangement, congratulations!  You have successfully transitioned to life as a telecommuting practice manager.  Be sure to reevaluate your policies and procedures every three to six months to ensure that telecommuting continues to work well for your practice. 

One option for accomplishing the task of appointment reminders without using up staff resources is to use an automated telephone reminder service.  These services are increasing in popularity because they can accommodate a large volume of calls, as well as provide helpful data in easy-to-compile reports.  Here’s how automated appointment reminders work:

At the beginning of the calling session, a staff member starts the process by preparing a calling list (call reminder services are built to be compatible with practice management systems) and selecting a pre-recorded message.  The information is uploaded to a “call center” that has access to thousands of phone lines.  The large number of phone lines means that appointment lists can be completed within a few minutes rather than in the hours it takes for one person to dial each number.  Typically, patients press one key to confirm the appointment and another if they need to cancel and reschedule (the patient can either be called back to reschedule or the system can automatically route patients who press this key to a scheduler).  After the calling session, the staff member receives a report with the results of the session.  The call list can be re-run several times per day to increase the probability of reaching every patient on the list.  Telephone appointment reminders cut the cost of using a staff member to make the calls in half and are far less expensive than postcard reminders.

Though some patients may be uncomfortable initially with the use of a machine for their appointment reminders, practices can ease the transition by posting notifications around the office.  Many patients grow to appreciate the convenience of the reminder system, and practices do too; studies show that no-shows can be reduced by up to 30% with automated appointment reminder systems.  Reminders also allow patients to cancel appointments they might otherwise have been no-shows for, which often means that the practice can fill that spot with another patient to avoid the loss of revenue.

Appointment reminder services can also be used to make phone calls for other purposes, including:

• Reminders to schedule check-ups, follow-up appointments, and screenings
• Notifications of lab results
• Pre-op and post-op instructions
• Collection calls
• Special issues, such as when the office is closed due to weather

Issue #1: Remaining engaged with internal top-level executives, co-workers, and subordinates. Solutions include:

• Conduct weekly scheduled telephone meetings with key personnel to determine and document weekly goals and objectives, stay up-to-date about ongoing projects, and anticipate upcoming deadlines.
• Telephone subordinates at least twice per week to check in and offer assistance. Schedule in-person meetings for introducing new projects, conducting employee reviews, and other significant issues.
• Demonstrate loyalty to the practice and support its image by participating in morale-boosting and branding efforts, such as holiday parties and charitable events.

Issue #2: Losing track of or getting confused about your own projects due to lack of face-to-face interaction with superiors. Solutions include:

• Clarify project details via email and retain responses for future reference.
• Take notes on conference calls and submit them for review to participants within 24 hours.
• Maintain project details and timelines on Google Docs – you can specify individuals who are allowed to view and/or edit the documents.

Issue #3: Making it obvious that you are “working from home.” Solutions include:

• Maintain a fully-equipped home office with a landline phone with voicemail, a high-speed internet connection, a printer/copier, a fax machine and any other equipment that you have in your office at work. Your home office should be a duplicate of your work office.
• Maintain a cell phone used only for work.
• Return client and client-related calls immediately, from your home office (never your kitchen phone or personal cell phone as you pick up your children from soccer practice).

Issue #4: Maintaining a productivity level comparable to or exceeding that of in-office employees – and showing it. Solutions include:

• Maintain regular office hours.
• Avoid personal phone calls and interruptions during office hours.
• Stay easily accessible to colleagues via phone and email during work hours.
• Avoid extended “water-cooler” chat on days in the office. Catch up at lunch or with an after-hours get-together.
• Complete all assigned projects on time and under budget.
• Email bulleted to-do lists to direct supervisors at the start of each week; email bulleted lists of accomplishments, measured against to-do lists, at the end of each week.

• Written telecommuting schedule, distributed to all interested parties.  If you are working from home part-time, keep to your schedule – switching days and/or times will be confusing to physicians and staff and will make it appear that you are abusing the opportunity. 
• With your supervisor, determine how you will sign in and out each day.  Options include completing a daily timesheet, logging in and out on the computer, and calling in at the beginning and end of each workday.  Include provisions for when you will take your breaks (again, a set schedule is best) and how you will notify your supervisor and staff.
• With your supervisor and staff, determine methods of communication.  Consider email, chat, Skype, and phone. Make a commitment to check email and messages no less than once every two hours.
• Create a system for signing equipment and files, if applicable, in and out of the office.  You may need to invest in a lockbox for your home office.  Be sure your home office desk drawers lock and that you have the keys.  Lock a second set of keys in the office safe.
• Ensure that your home office is set up well in advance of the telecommuting start date.  You will look very unprofessional if your first day of virtual employment is spent waiting for the cable guy.  Your remote office must have a computer with the ability to access the practice’s server and email, broadband internet access, and antiviral software that updates automatically, as well as a telephone with voicemail, printer, fax machine, and copier.  If you’ll be using Skype, be sure you have a webcam and headset – and remember, this means working in your pajamas isn’t an option!
• Your home office should have ergonomically correct furniture, good lighting, and a door that closes.  A doorknob “do not disturb” sign is helpful if anyone else will be in the house during your working hours.  Be sure your home office is stocked with a range of office supplies.  A small office refrigerator stocked with water and soda is helpful for busy days or long conference calls.        

• Be sure you’ve conducted as much research as possible and can spell out for the owner/physician exactly how your job will work as a virtual position.  Doing this in writing will help you get your thoughts in order; you’ll also be able to refer to your notes as you discuss the option.  Be specific as to what type or work you will be doing; things that generate income will be received more favorably.  Indicate WHY you want this as a solution.  Will you be promoting a green-friendly practice?   Will you be forcing cross-training to allow freedom of employees to take allotted time-off without affecting the practice?  How will this benefit the practice?  (encourages company loyalty, etc.)  Give stats as to how you will be more productive (productivity increases an average of 40%), i.e. getting to projects that you haven’t been able to complete – list examples that are near and dear to the physician’s heart. You can also leave the report behind so the owner/doctor has time to review it and think about your proposal.  She or he is not likely to be receptive to telecommuting if you put her or him on the spot and expect an answer right away.   Suggest assigning an office liaison that your doctor can go to when you are not around.
• It probably goes without saying, but try to select a time when the owner/physician is in a good mood to make your case for telecommuting.  Make an appointment for the least busy day at the office.  You’re probably a good judge of what time of day will be best and how long the presentation should be to give the physician/owner an understanding of what you want without being pushy.  You’re likely to meet with resistance, so be prepared to table the discussion, leave your written report for review, and review the matter at a later date.  An argument, or even a long, drawn-out discussion, will tire your listener and hurt your case.
• Be prepared to compromise.  You may want to telecommute three days per week but only get approval for one; you may want the trial period to last 90 days but only be granted 60.  Accept your losses gracefully and show appreciation for what you’ve been given.  Remember that many owners/physicians are unfamiliar with the concept of telecommuting or, if they are familiar with it, have many misconceptions about it.  All you need, for now, is a foot in the door of your home office and a chance to prove that telecommuting works.
• Be prepared to assume all costs associated with your home office, such as the cost of broadband internet service.  It’s possible to negotiate these expenses at a later date, but asking your employer to cover them during the trial period may net you a ”no” on working virtually at all.
• Let the owners/physicians know that if at anytime they feel the telecommuting arrangement is not working, they can back out of the trial with no hard feelings.  They aren’t likely to exercise it, but an escape clause can help your employer feel more secure.
• If your practice’s owner/physician flatly refuses to conduct even a telecommuting trial period, accept defeat without animosity or bitterness.  Resolve to revisit the issue at a later date, such as at your annual review.    

Telecommuting, also known as working from home or from a virtual office, is an attractive prospect to many practice managers. Avoiding a lengthy and irritating commute is a top motivator for practice managers who work in large, crowded cities with heavy rush-hour traffic. And working from home often raises productivity by offering blocks of uninterrupted time for completing projects. This series of articles will explore the concept of telecommuting for practice managers.

If the concept of telecommuting is new to your practice, you will probably have to invest significant time and effort in helping your practice’s owner/physician see the value of working from home. Here are some things to consider before making your case.

• Have you been working for this practice long enough to have proven yourself to be a dependable, honest employee? Do you have a track record that makes you all but indispensible? The owner/physician must know you well enough and want to keep you enough to be motivated to consider a change to the status quo.
• Are you willing to work during regular office hours? Many employees like the idea of telecommuting because they want to work flexible hours, but many practices will not support that. Decide which home-office hours will most benefit the practice, not your lifestyle.
• Is there a day or are there days when the practice is less busy than others? If full-time telecommuting is not an option, consider asking to work from home one to three days per week.
• Are you comfortable working independently? Working from home can be isolating. The enhanced productivity typically associated with telecommuting comes at least partially from a lack of opportunity to socialize with other employees.
• Are you interested in telecommuting for a trial period of, for example, 90 days? This may allow your supervisor/physician to evaluate the option of telecommuting without making a commitment.
• Do you have trusted staff members to whom you can delegate escalated patient service problems and other in-office issues? You must be able to solve most office crises over the phone or via email to work from a virtual office.
• Do you have space for a home office? If someone else will be at home during your work hours, will she or he respect your work time and space? Does your virtual office have a computer with fast internet access and the ability to access the practice’s server and email, a printer, a fax machine, and a phone with its own number (separate from the household number)?

The next article in this series will offer tips on how to pose the idea of telecommuting to the owner/physician of your practice.

1. Provide training.  When a new staff member starts, take the time to show them the ropes. Even if they’ve done the job before, it may be valuable for them to “shadow” someone for a day or two to learn the policies and procedures specific to your practice. But don’t stop the training there. Providing employees with opportunities to grow can make them feel their career is moving forward. Check out seminars, trade shows, and other learning opportunities in your area. If you can’t afford formal classes, consider having employees within the company share their knowledge with the rest of the staff.

2. Show your appreciation.  Make a point to praise your employees at least once a day. You’ll be surprised how much of a difference it makes when people feel recognized for their efforts. Bonuses, parties, and other special perks are other ways to show your appreciation. You can award the staff for referring new patients or doing well on the job.

3. Communicate with your staff.  If they don’t get their information from you, they’ll get it from the practice’s rumor mill. Keep such speculation at bay by being open and honest about what’s happening in the practice. You should also hold regular staff meetings to promote problem solving, share news, and recognize accomplishments. Make it clear year-round that you have an “open door” policy, so employees feel like they can come to you with problems or their ideas for improving things.

4. Conduct evaluations.  Twice a year is a good rule of thumb. In your feedback, be sure to point to the areas where the worker is excelling. If an employee has problem areas, be constructive in your criticism: provide advice on how to improve. It’s also a good idea to let the staff evaluate you, so you can find new ways to meet their needs and help the practice run more smoothly.

5. Follow your own policies.  If you set a rule, stick to it – for yourself and others. This will help others to take you more seriously, and cut down on resentment about preferential treatment.

6. Be positive.  Don’t complain about patients or other workers in front of your staff. Doing so can foster a negative environment. Need to vent? Save it for your friends and family. If you have a problem with someone’s work, speak to them in private.

7. Socialize.  If you have a personal relationship with someone, it’s easier to communicate with them. Throw company parties to foster this environment. They don’t need to be fancy. You can even make it a potluck!

8. Be flexible.  If you respect the fact that your staff has a life outside of the office, your practice will be more likely to retain employees. It doesn’t mean you have to give in to every request made by a staff member, but within reason, make compromises to ensure that they are able to comfortably balance their home and work life. Avoid asking your staff to put in long hours or overtime when possible.

Enter facial recognition software.  Though it may sound like something out of a science-fiction movie, this type of security has been refined to the point that many medical practices are using it to keep data secure by controlling the “faces” allowed to access data.  Here’s how it works and why you should consider it for your practice.

Biometric facial recognition software “learns” a person’s facial features and matches them to a particular username and password during an initial “getting to know you” period.  Then, when a staff member sits down at a computer, a webcam sends information about the person’s facial features to the software, which logs the individual into the system.  When the “face” moves out of range of the camera, the user is logged out so an unknown user can’t simply walk up to and use the computer.  Other biometric security systems include fingerprint, voiceprint, and eye (iris) recognition programs.  Facial recognition software is used:

• In law enforcement
• In banks
• In casinos (to locate banned individuals)
• In hospitals and medical practices
• At special events where large crowds will be present (to find wanted criminals)
• During elections (to verify that each person has only one vote)
• In information technology departments     

Biometric facial recognition software decreases the need to memorize passwords (to reduce the security risk, users are periodically required to verify their usernames and passwords), which is especially helpful given that current computer security guidelines mandate changing passwords at least once every 90 days.  It facilitates work flow because it can be programmed to log users in and out in a manner that is conducive to practice efficiency.  Patients are impressed with the technology and appreciate that up-to-date methods are being utilized to keep their data secure.  Microsoft’s Windows 8 will include My PC Knows Me technology that promises to make this a reality.  Thus facial recognition software is a valid and valuable choice for many medical practices.

House Democratic leaders said yesterday they will not vote on the Senate’s six-month fix to the sustainable growth rate (SGR) formula until the Senate passes jobs legislation, according to the Congressional Quarterly.

The Senate passed its latest version of an SGR fix, S 3962, on June 18. The bill would postpone for six months a 21.2% cut in reimbursement under the Medicare Physician Fee Schedule. The U.S. Centers for Medicare and Medicaid Services (CMS) has already started paying claims at the lower rate.

The Senate hoped the House would approve the measure quickly. But political wrangling is getting in the way, and the legislation may be held hostage to the House’s efforts to pass a jobs bill, according to the Congressional Quarterly.

Speaker of the House Nancy Pelosi (D-CA) called the Senate’s bill “inadequate,” saying that the House has repeatedly sent job-creating bills to the Senate since December, but Senate Republicans continue to block approval of the legislation.

“I see no reason to pass this inadequate bill until we see jobs legislation coming out of the Senate,” Pelosi said in a statement. “House Democrats are saying to Republicans in the Senate: Show us the jobs!”

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