Program · 2018-11-27 · Danna Gracey *2013 Office Administrator Program Chair FACULTY Sherri L....

www.ophmasters.com

Sponsored by the Florida Society of Ophthalmology

June 29, 2013 The Breakers | Palm Beach, Florida

Program

S Y L L A B U S

Saturday, June 29 7:00‒8:00 AM BREAKFAST Ponce de Leon IV-VI 8:00 AM WELCOME

Steven R. Robinson, FASOA, COE 8:00–8:45 AM Social Networking for the Medical Practice‒

Five Effective Ways to Engage in the Conversation Cindi Green, RN, BA, AS 8:45–9:30 AM Risk Prevention for the Electronic Age‒

EMR, E-Mail, Texting, Social Media and the Internet Sandra C. Strickland, RN, MSN, LHRM, CPHRM 9:30–10:15 AM Flow and Efficiency Considerations‒

What You Can Do to Enhance Productivity and Profitability Sherri L. Boston, MBA, COE, OCS 10:15‒10:45 AM BREAK Ponce de Leon IV-VI

10:45‒11:00 AM Comments from the American Academy of Ophthalmology EVP/CEO

David W. Parke, II, MD 11:00 AM–12:00 PM ICD-10 Update E. Ann Rose

12:00–1:00 PM LUNCH Gulfstream 4 1:00–1:30 PM Worker’s Compensation Update Tom Murphy 1:30‒2:00 PM 401K Updates Wes Caldwell 2:00–3:00 PM Risk Management Strategies for the Ophthalmic Practice Steven I. Rosenfeld, MD, FACS 3:00‒4:00 PM Organizational Management

Steven R. Robinson, FASOA, COE

4:00‒4:15 PM QUESTIONS AND ANSWERS 4:15 PM ADJOURN

ACCREDITATION This program has been approved for 5.75 COE Category “A” credit hours by the National Board for the Certification of Ophthalmic Executives. You must sign in at the beginning of the program to receive credit.

AGENDA

*2013 Office Administrator Program Chair

FACULTY Sherri L. Boston, MBA, COE, OCS Eye Care Business Advisor Allergan Tampa, FL Cindi Green, RN, BA, AS Director of Community Relations Florida Eye Institute Vero Beach, FL Wes Caldwell Danna Gracey Delray Beach, FL Tom Murphy Danna Gracey Delray Beach, FL Steven R. Robinson, FASOA, COE* Senior Consultant S&R Consulting Chattanooga, TN

E. Ann Rose Owner/President Rose and Associates Duncanville, TX Steven I. Rosenfeld, MD, FACS Voluntary Professor University of Miami Miller School of Medicine Bascom Palmer Eye Institute Delray Eye Associates Delray Beach, FL Sandra C. Strickland, RN, MSN, LHRM, CPHRM Director of Patient Safety-SE Region The Doctors Company Jacksonville, FL

Cindi Green, RN, BA, AS

Cindi Green, RN, BA, BS has been Director of Community Relations for Florida Eye Institute in Vero Beach since 2010. Her self-made title, Protector of the Brand, describes her ongoing mission to enhance the reputation of the growing practice through the mediums of advertising, public relations, charity events, physician outreach, customer service, and social media.

Cindi attended Randolph-Macon Woman’s College, a small liberal arts school in Lynchburg Virginia, where she majored in theater and was puzzled about a career direction. During an interview for her first ‘real job’, she was told - “Cindi, I have never heard anyone describe Waitressing Experience in quite the same way before!” – and realized she might have a future in marketing.

After beginning her career in retail management with companies like The Gap, Cindi advanced to direct media sales and became an account executive for an advertising agency specializing in healthcare. She was then recruited to a plastic surgery practice as Marketing Manager where she began nursing school, received her RN, and progressed to patient care coordinator. She continued her studies and additionally became a licensed healthcare risk manager for the plastic surgery practice.

Cindi moved to Vero Beach in 2001 and has served her local medical community as Director of Business Development for HealthSouth Treasure Coast Rehab Hospital and as Physician Liaison with the Visiting Nurse Association. She has been an enthusiastic supporter of Toastmasters, an international public speaking and leadership association, where she served as Vice President of Education from 2009-2010.

1

Social Networking for the Medical Practice

Cindi Green, Director of Community Relations

Florida Eye Institute

[email protected]

Let’s introduce ourselves

Why should I use social media?

2

Why should I use social media?

Social Media Revolution 2013

What is the conversation all about?

The Social Media Revolution

Video Clip

3

Where do I

begin?

Step One

Secure your Band across all platforms

Don’t forget about these!

Secure your Band across all platforms

4

Step Two

Plan your strategy and create guidelines

According to a survey by Symantec and Applied Research, the cost of public relations disasters, lawsuits, security breaches and other risks associated with social media blunders averages $4.3 million. The survey also reports that after a social media mishap, 28% of companies have reported damage to their brand, or a loss of customer trust averaging a cost of over $638,000. So to avoid putting our businesses and ourselves on the virtual chopping block, let’s get our social media etiquette on and learn from the missteps of others.

Why do you need a plan?

What does your Social Brand say about you?

Who are you?

What do you talk about?

Where can people find you?

How quickly can you respond to others?

5

What does your brand bring to the Social Media party?

Are you this guy?

Personalize the face of your business

Personalize the face of your business

6

Assign a spokesperson

Who is the face of your Practice?

Step Three

Create unique and engaging content

What should I

talk about?

7

Personalize

Our most popular post *1,300 people saw this post

Personalize

https://www.facebook.com/fleye?ref=tn_tnmn

https://www.facebook.com/fleye?ref=tn_tnmn

8

Testimonials

Educate

Educate

9

Educate

Engage

Ask patients to share positive thoughts

10

Patients are finding their voice in Social Media

The Future of Patients - Kru Research (2:41)

The Future of Patients - Kru Research

Video Clip

What are patients saying about you?

11

“I will write 1 well researched

review and post it to Google

Places for $5.”

Step Four

Understand the benefits

12

Brand: What’s your name?

Secure your name across all platforms.

Create rules: Who. What. Where. When.

Choose a Platform: Stop. Look. Listen.

Update your status. Link an article. Upload a video. Post a photo. Make some comments. Share a Like. Write a blog.

Count your fans. Check your ranking. Know your ratings. Monitor inbound calls & email.

Social Media Hierarchy of Needs

Step Five

Don’t take it too seriously- go ahead & make mistakes

But don’t be despised

The 15 Most Frustrating Companies in America

By Max Nisen | Business Insider – Thu, May 23, 2013 10:52 AM EDT

13

The 15 Most Frustrating Companies in America By Max Nisen | Business Insider – Thu, May 23,

2013 10:52 AM EDT

7 (tie) Twitter Rated 64/100 — This is the first year it has been rated Though it's the first year many social networks have been included in the survey, as a category, social media is rated poorly. Increasing worry about the sharing and use of personal data, the sheer omnipresence of these sites, and increased advertising might be behind the extremely low scores.


2013 10:52 AM EDT

#6 LinkedIn

Rated 63/100 — The second-lowest-rated social network LinkedIn's inaugural rating puts it near the bottom, along with other social networks like Twitter. ACSI finds that "Monetizing schemes appear to be at the core of user dissatisfaction with both sites." In LinkedIn's case that could possibly mean its "Recruiter" platform, which gives companies that subscribe access to account information.


2013 10:52 AM EDT

#3 Facebook Rated 61/100 — A five-point decline from last year — The lowest-rated social network Facebook comes in at the very bottom of the social media pile after a turbulent year. Customers were dissatisfied with the forced change to the "Timeline" style profile, and a particularly messy IPO in May couldn't have helped. It remains by far the largest social network.

14

Research Tools:

Allergan Access

PhysiciansPractice.com

PewInternet.org

Blogs:

symplur.com

amednews.com

E-Tools:

Hubspot.com

HootSuite.com

[email protected]

Resources

Sandra C. Strickland, RN, MSN, LHRM, CPHRM

Sandra Strickland is Director of Risk Management Services for The Doctors Company. She earned a Master in Nursing degree from Medical University of South Carolina and her Bachelor of Nursing degree from Barton College in Wilson, North Carolina. Mrs. Strickland is a Licensed Health Care Risk Manager, Certified Professional Healthcare Risk Manager, and a Registered Nurse with over twenty years of experience in the healthcare and over fifteen years in healthcare risk management. She is a member of the American Society of Health Care Risk Managers and the Florida Society of Health Care Risk Managers.

1

06.01.06

A Risk Management Seminar

Presented by

Sandra Strickland, RN, MSN, LHRM, CPHRM

Director of Patient Safety Services – SE Region

Risk Management

in the

Ophthalmology Practice

COURSE OBJECTIVES

Recognize current liability and patient safety issues in an

ophthalmology practice;

Identify high-risk clinical and administrative exposures in the

ophthalmology practice; and

Describe risk management strategies to reduce loss exposure

and increase patient safety.

At the conclusion of this Risk Management

Seminar, the participant will be able to:

What is your risk?

Duty

Breach

Injury

Causation

2

How Often Do Medical Errors Occur?

If death from medical errors was a disease–it

would be the third leading cause of death in the

U.S. (cancer, heart disease)

During the next hour of this presentation, 11

people in the U.S. will die as a result of medical

errors

1 in 12 ophthalmologists will experience a claim

U.S. Department of Health and Human Services,

National Center for Health Statistics, Health, United States, 2002, Table 33, p.132

Risk Exposures

Communication factors

Unclear lines of authority

Variability

Time pressured environment

System deficiencies

Human fallibility

National Patient Safety Foundation

3

Swiss Cheese Model

Ophthalmologist

fails to examine

eye

Wrong eye

blocked

Patient HOH

Breach in Universal

Protocol

Teamwork/

Leadership

Failures

Risk Management Strategies

PRACTICES AND PROCEDURES

PATIENT RELATIONS/COMMUNICATIONS

DOCUMENTATION

Risk Management Pearls

Scheduling &

coverage

Non-compliance

Tracking & Follow-up

• Wait times

• Practitioner present

• Call coverage

• Document & manage

• Assign and oversee

4

Case Study

65 y/o male. Reduced vision. Age related cataracts OU.

OS cataract extraction in May.

Pre-op CXR: Abnormal – Nodular density L hilum…not reviewed by

ophthalmologist.

4 months later - OD cataract extraction

2nd pre-op CXR: enlarging hilum with significantly enlarged lobulated mass.

Ophthalmologist notified after induction.

CT confirmed lung mass. L thoracotomy & pneumonectomy. Poorly

differentiated adenocarcinoma w/ 4 of 8 hilar lymph nodes positive for

metastasis.


Medications

Diagnostics

• 5 Rs

• LASA – Storage

• Concentrations

• Reconcile

• Allergies

• Quality Controls

• Calibration

LASA Medications

5

Case Study

37 y/o male with c/o L lower lid swelling x 3 days. PCN allergy –

currently on no medications.

DX: Hordelum Rx: Ampicillin 250 mg tid X 5 days. Warm

compress to L lid.

After 2 doses, patient called office with c/o skin rash and itching.

Ampicillin d/c’d. Tetracycline 500 mg tid x 5 days rx’d.

Treated with Benadryl and Medrol Dose-Pak.

Three days later patient admitted w/ confluent, erythematous

rash over entire trunk and extremities. Treated with IV

steroids, H1 & H2 blockers and topical steroids. Discharged

after 3 days to continue oral and topical steroids and

Benadryl.


Emergencies

Triage/Calls/Advice

• Training

• Kit

• Response drills

• Training

• Protocols

• Responsive

• Document


Universal Protocol

Consent

Training

Checklists

Specific

Forms

Checklists

6

Case Study

• 59 y/o female – c/o glare, decreased visual acuity – OS

• Corrected VA 20/20 OD and 20/25 OS.

• Glare testing VA 20/80 OD and 20/100 OS.

• Uncomplicated cataract surgery OS

• PO day 1: VA w/ pinhole 20/150 OS. Anterior chamber 2+ cells. Tobradex gtts 4x/day. Return 1 wk.

• Informed by OR nurse of wrong IOL = 17.0 diopter vs. 20.5

• Patient informed. Lens exchange planned.

• Mishap during lens exchange – VA remained 20/150 after 2 months. Referred to corneal specialist for corneal transplant.

• Post transplant – VA w/ refraction of 20/25 OS, with continued c/o residual cloudiness d/t posterior capsule haze


HIPAA

OSHA/Infection

Control

P&P, training,

documentation,

oversee

Training, P&P,

inspections

PPE, Hepatitis B

vaccine,

Handwashing

Autoclaving


Scheduling

Coverage

Non-Compliance

Tracking & Follow Up

Medications

Emergency Preparedness

Universal Protocols

Diagnostics

Consent

Telephone Triage

Returning Calls

Medical Advice

HIPAA

OSHA/Infection

Control

Medical Records

PRACTICES & PROCEDURES

7

The most prevalent root cause of medical errors is

Communication

Fact: The diagnostic interview, evaluation or consultation is

the most prevalent procedure resulting in malpractice claims.

PIAA Data Sharing

2000

Staff Communication: Liability or Asset?

Impression

Information

Reflection

"

8

Communication Challenges

Diversity

Language

Medical Jargon

Knowledge Deficits

Physical & Emotional Stressors

Internal Communication Issues

“And would you be performing the actual surgery?”

Low Health Literacy

90 million people have literacy related health

risks

1 out of 5 read at _______ grade level

50%–Understand directions for taking

medications correctly

www.npsf.org

http://www.npsf.org/

9

Ocean Spray

“Save the two”

once

Yale University School of Medicine

Techniques for High Impact Contact

Review the chart

Eye Contact

Pleasant Expression

Patient Name

Personal Comment

Inquire

Handshake

Listen

Verify – Buy In

Summarize-Confirm

First and Last 1 - 4 MINUTES

Trouble Areas

Telephone

Ignoring

Waiting

Patient’s Name

Waiting

Interruptions

Explanations

Expectations

Talking around

Routines

Complaints

Apologies

10

Managing Complaints

Acknowledge

Apologize

Amend

Documentation of Telephone Calls

• Date and time of call

• Person making the call

• Patient’s name

• Chief complaint or concern

• Brief history

• Assessment – P/A Symptoms

• Any advice given

• Symptoms which require a call back

• Identity of advice-giver

• Date and time call is returned to the patient

11

Problematic E-Communications

Sensitive test results

Requests for narcotics

Facetime/Photo diagnosing

Information from family members

J Gen Intern Med. 2005 October; 20(10): 959–963 Preventing Communication Errors in

Telephone Medicine–A Case-Based Approach, Anna B. Reisman, MD and Karen E. Brown, MD

Case Study

E-mail on Friday afternoon:

CC: Poor vision. “Spots.”

Response: Follow up with optometrist on Monday.

Outcome: Retinal Detachment. Vision loss.

What would have prevented this?

Handoff communication

Triage training

Auto-reply

Risk Exposures

• Creation of professional relationship

• Response delays

• Lost or incomplete communications

• Misinterpretation

• Questionable receipt & understanding

• Privacy breach

• Abandonment

12


Patientcentric

culture

Awareness

Team building

Training Protocols–

checklists

Eye contact

Slow down

Listen

Language

Visual aids

Limit and repeat

Ask Me 3

Verify with teach

back

Documentation

• A pivotal factor in pursuing litigation

• Most important piece of evidence in a medical

malpractice defense

“She has no rigors or shaking chills, but her husband states

she was very hot in bed last night”

Bad Medical Records = Bad Medical Care

13

Good or Bad Documentation?

• Patient was hostile and threatening

• Continue same medications

• Systems review remains unchanged

• Follow-up visit

• Consent obtained

• Pt. non-compliant

• Patient c/o sharp stabbing eye pain

• Patient difficult and argumentative.

• Patient screaming and pounding fist on exam table. States “You’re going

to be sorry you ever met me. I’ll get you for this.” Points at abdominal

incision line and states “You’re going to have one of these when I’m done

with you.”

• Complains of sharp, stabbing pain in R eye after sun exposure and reading

for 20 minutes. No c/o floaters or flashers.

Documentation Deficiencies

• Generic – lack detail

• Inconsistency

• Status of conditions not

noted

• Unclear medication orders

• Unclear instructions

• No evidence of medical

decision making

• Diagnostic results not

incorporated

• Lack objectivity

• No evidence of resolution

• Communications not noted

• Unable to ID author

• Patient non-compliance not

addressed

• Errors/omissions/blanks not

addressed

• Patient’s progress not noted

Documentation Concerns

• Follow-up

• Diagnostic reports

• Referrals

• Telephone care

• No-show & non-compliance

• Termination of care

• Consents and refusals

• Non-FDA approved prescriptions

• Non-standard care

14

Visit Preparation

Review chart

Problem list

Diagnostic/Referral results

Telephone communications

Previous visit notes

Alerts

Documentation Pearls

Assessments

Admission Data

Demographics

HT/WT/BMI/VS

Past Histories

Medical/Surgical – Family

Social – Medications & Allergies

Chief Complaint

Documentation

P Patient’s concerns

Q Quality & Quantity

R Response

S Signs & Symptoms

T Timing

Current Medications/ Allergies

Current Treatments - Compliance

15

Documentation

Medications

• Allergies

• Samples

• Instructions/Cautions

• Side Effects

• Refills

• RECONCILE

DID I WRITE THAT?

“By the time he was admitted, his rapid heart had stopped, and he was feeling better”

“Healthy appearing decrepit 69 year old male, mentally alert but forgetful”

“Patient left hospital feeling much better except for her original complaints”

“She has no rigors or shaking chills, but her husband states she was very hot in bed last night”

“Patient may increase her meds, unless we decrease her meds”

“Between all of us, we should be able to get her pregnant”

“Patient has been depressed since she began seeing me in 1999.”

“The patient has no history of suicides.”

“She is numb from her toes down.”

“Patient has chest pain if she lies on her left side for over a year.”

“She slipped on ice and apparently her legs went in separate directions early in December.”

Medical Record Pearls

• Train

• Audit

• Accurate & complete

• Reflect medical decision making

• Reconcile

• CC = Evaluation (ROS/Exam Findings) = Diagnosis = Plan of Care = Response

• Pertinent + and –

• Communications

16

Their Trust Is In You

Click to edit Master title style

Click to edit Master text styles

Second level

Third level

– Fourth level

» Fifth level

48

“The pessimist complains about the wind; the optimist expects it to change;

the realist adjusts the sails.”

--William Arthur Ward

Prevention of Medical Errors /

17

Thank You for Attending this

Risk Management Presentation

Sherri L. Boston, MBA, COE, OCS

Sherri Boston is a business advisor with the Eye Care Business Advisory Group of Allergan, Inc., an eye care company based in Irvine, California. She has worked for Allergan since 1989. Ms. Boston advises medical practices, physician networks, and ambulatory surgery centers. Her advisory expertise includes leadership training, team building, sales training, marketing, business development, strategic planning, clinical operations, financial management, and overall practice efficiency. Other responsibilities include training and support for internal Allergan customers. Ms. Boston has more than 23 years of experience in the health care industry, working with a variety of providers and health plans. Before joining the Eye Care Business Advisory Group, Ms. Boston worked as a senior sales executive with the Eye Care Team at Allergan, where she gained expertise in strategic planning, financial analysis, and creating high-performance teams. Ms. Boston received her MBA from the University of Rhode Island and a Bachelor of Science degree in medical technology from St. Joseph College in Connecticut. She holds certifications through the American Society of Ophthalmic Administrators and the Joint Commission of Allied Health Personnel in Ophthalmology as a Certified Ophthalmic Executive (COE) and as an Ophthalmic Coding Specialist (OCS).

1

FLOW AND EFFICIENCY CONSIDERATIONS

Presented by:

Sherri L. Boston, MBA, COE, OCSEye Care Business Advisor

Masters in Ophthalmology 2013Administrator Program

Disclosures

Eye Care Business Advisor, Allergan, Inc.

Scientific Advisory Board Member, y ,Hawaiian Eye Foundation

Session Objectives

Enhance knowledge base on the subject matter of patient flow and efficiency.

Review practice resources availableReview practice resources available.

Recognize when to triage and invest in outside resources.

2

What is the primary concern when it comes to patient flow?

Survey says …

Patient Flow and Efficiency

Wait Time

Wait Time

Wait Time

The most frequent complaint on patient satisfaction surveys.

The most frequent complaint from physicians.

“No lunch time and have to stay late” complaints from staff.

What is the practice’s chief complaint?

Extensive wait times.

Competency of technical staff.

The need to increase productivity and revenue.

3 Areas of Focus

Physical capacity

Space

MD/OD

T h i l

Staff Deployment/Delegation

Template design

Scheduling

capacity

Flow design (circular, linear, in/out)

Technical design

MD/Tech

3

Patient Flow and Efficiency Assessment:3 Areas of Focus

Space

Evaluate Room Allocation:

2 lanes per provider

1 lane per technician

Dedicated room for each test or groups of tests

Dedicated procedure room

Look for:

Technicians waiting for rooms

Patients occupying rooms to dilate (versus seated in designated dilating areas)


Staff

Are they interrupting each other or other providers with questions?

Protocol book

Training opportunitya g oppo tu ty

Are patients waiting for testing?

Need proper staff allocation

Who is the technical supervisor?

Working Clinic Manager

Clinical Director

Lead Technician


Schedule

Is there a consistency in appointments per hour?

Even distribution per hour

Look for “clumping” of appointment types:

Too many new patients or long exams per hourToo many new patients or long exams per hour

Where are emergency patients or “add-ons” booked?

Are they triaged appropriately?End of session?

Diagnostic Testing

Ordered and scheduled in advance (same day or different day? On the fly?)

Procedures, lasers, injection and special clinics

4

Differential Diagnoses of the 3 Areas

Build-out or relocation

Reallocation of resources

Space

Staff

Competency assessment and provide re-training

Delegation of tasks

S a

Facility being used to its maximum?

Predictable: Specific return to office or generic reference (“4-month IOP check” versus “follow-up”)

Schedule

Re-design of facility/schedule

Review of findings based

Process Review

Space / Facility layout

Assessment Analysis Recommendation

Staff training opportunity and accountability

MD commitment

d gs basedon assessmentsStaff

assignments/ benchmarks

Scheduling template

Time-study

Clinic capacity worksheet

Summary

Proper flow and efficiency is based on the building blocks of:

Space

Staff

Schedules

When all else fails……

Invest in outside resources.

APC33SQ12

E. Ann Rose

Ann Rose, owner and president of Rose & Associates, is a Medicare reimbursement and compliance consultant who has been associated with the health care industry for 30+ years. Rose & Associates specializes in Medicare coding, billing, documentation, and training for physician practices with medical record auditing being their main focus. Ann’s professional experience began as a member of the Medicare acquisition team at Blue Cross and Blue Shield of Texas shortly after they were awarded the Medicare contract in 1966. She was instrumental in helping develop the HCFA 1500 claim form (now known as the CMS-1500 claim form) and served as a team member in developing the paperless claims processing system known today as electronic billing. For the past 30 years Ann has been devoted to assisting ophthalmologists with coding and reimbursement issues for maintaining compliance with government regulations. She is a member of the American Society of Ophthalmic Administrators (ASOA), the Medical Group Management Association, the American Academy of Ophthalmic Executives (AAOE), and the American Academy of Professional Coders. She is also editor and publisher of The Messenger, a newsletter written and developed specifically for the specialty of ophthalmology and serves on the editorial board of the reimbursement section of Ocular Surgery News.

Rose & Associates 1-800-720-9667 1

ICD–10 Update

Masters in Ophthalmology 2013

Office Administrators Program

Palm Beach, Florida

June 29, 2013

Presented by: E. Ann Rose

Financial Interest

E. Ann Rose is President of Rose & Associates and a consultant for:

Alcon Surgical, Inc.

Heidelberg Engineering

Implementation

• October 1, 2014 – go live date

– Per CMS – implementation date is firm and

not subject to change • There will be no delays

• There will be no grace period

• ICD-10 not accepted prior to 10/1/14

• ICD-9 diagnosis not accepted on or after

10/1/14

• Planning must start now!!

3


Background

• ICD-9 is current diagnosis code set used in

the U.S.

– ICD-10 updated diagnosis code set moving

away from 30 year-old ICD-9 code set

• Technology and medicine has changed

• ICD-9 has outgrown level of specificity

– Many ICD-9 codes don’t accurately describe

the diagnosis they are assigned to represent

4

Who is Affected?

• All Healthcare

• Providers (including nurses & technicians)

• Payers

• Software vendors

• Clearinghouses

• Third-party billers

5

Why The Change?

• Patient benefits

– Enhance healthcare by tracking and trending

diseases

– Will precisely identify diagnoses and

procedures

• Payer benefits

– Will enhance accurate payments for services

rendered

6


Why The Change?

– Improved care coordination

– More effective case management

– Improved utilization management

• Provider Benefits

– Will enhance accurate payments for services

rendered

– Improved care coordination

– More effective case management

– Improved utilization management

7

What You Should be Doing

• Creating an implementation team

– Project manager

– Steering committee

• Evaluating effects of ICD-10 on other

projects

– Quality reporting

– Meaningful Use

– Improvement in chart documentation

8


• Implement strategies to address areas

lacking or weak

– Particularly in coding injuries

– Determine top 80% of your diagnosis codes

and devise cross-walks

– What are your most frequently denied ICD-9

codes?

9



– Periodically address staff knowledge

• Coders, billers, EOMB denial teams

– Determine any potential for lost revenue

10

Know What Vendors are Doing

• Know what your vendors are doing

– Do they have a readiness plan in place

– Will they provide any training on ICD-10

– Any additional configurations needs to practice

management system or software

– What are the testing plans of your vendors

• Currently no framework for testing between payers

and provider

• To be announced at a later date

11

Learn about ICD-10 Differences

• Specificity and detail have been greatly

expanded

– Expanded codes

• Injuries

• Diabetes

• Post-operative complications

• Alcohol/substance abuse

– Includes more combination codes

12



– Injuries grouped by anatomical site rather than

type of injury

– Additional characters allow for identifying:

• Body system

• Root operation

• Body part

• Approach

• Device involved in a procedure

13


– Majority of primary ophthalmology codes now

in one chapter (Chapter 7)

• Eye codes no longer combined with ear codes

– There are a lot more ICD-10 codes than ICD-9

• 17,000 ICD-9 codes

• Now over 70,000 ICD-10 codes

14


Differences

ICD-9-CM ICD-10-CM

3 - 5 Characters 3 - 7 Characters

All Characters are Numeric

No laterality

Character 1 is alpha (A-Z, not case sensitive)

Character 2 is numeric

Characters 3-7 are alpha or numeric

Laterality

Supplemental chapters:

Alpha and numeric characters

-----

366.22 - Total Traumatic Cataract H26.131 - Total Traumatic Cataract, Right Eye

H26.132 - Total Traumatic Cataract, Left Eye

H26.133 - Total Traumatic Cataract, Bilateral Eye

H26.139 - Total Traumatic Cataract, Unspecified eye

15



ICD-10 Features

Combination Codes Expanded Ambulatory and managed

Care Encounter Details

Added Laterality Timeframes Added

Episodes of Care Added External Cause Codes – no longer

supplementary classification

Expanded codes (diabetes, post-

operative complications) Greater Specificity

Addition of Placeholder “X” – allows for

future expansion Enhanced Quality Reporting

16

What Changes Need to be Made

• Policies and

Procedures

• Forms and superbills

• Health Plan and

Payer Policies

• Systems

• Prior Authorizations

• Clinical Knowledge

• Clinical

Documentation

• Training

17

Policies and Procedures

• Any policy or procedure involving a

diagnosis code, disease management,

tracking or PWRS must be reviewed and

revised

• If Privacy Policies are revised, patients will

need to sign new forms

• Vendor/payer contracts

18


Forms and Superbills

• Review all forms for any needed updates

– Advance Beneficiary Notice (ABN)

– Superbill/Encounter Form

– Consult letters/templates

– HIPAA notifications

– Lab, DME orders

– Clinical notes

19

Payers and Health Plans

• Patient Coverage

• Payer Reimbursement

• Reporting Requirements

• Ordering Requirements

• Prior Authorization Policies

20

Clinical Documentation

• Will need to be more comprehensive due

to ICD-10 level of specificity

• Documentation in chart must be able to

translate to the proper ICD-10 code

– Remember, if it isn’t in the chart, it wasn’t done

(according to Medicare). If it wasn’t done, it

can’t be billed.

21


Clinical Documentation

• Documentation must address:

– Story of what was performed and what is

diagnosed accurately

– Must thoroughly reflect the condition of the

patient

– What services were rendered

– What is the severity of the condition

– Key work for documentation is SPECIFICITY

22

Documentation

• ICD-10 will require more (or improved)

chart documentation

– Has more unique, precise diagnosis codes

• Substantiates medical necessity

– ICD-10 will impact how you do your job

• How you deal with patients

– More questions specific to patient’s complaint or condition

• How you interact with staff

– ICD-10 will require more specificity

23

Documentation

• Documentation becomes critical with

trauma or injuries

– You may need to ask more questions specific

to the patient’s complaint

• What were you doing at the time of the injury?

• Where were you?

• Was this the first injury of this type?

24


Documentation

• Will be required to collect more information

in more detail when documenting chart • Will permit coders to select the right ICD-10 for

symptom, disease, or provided service

• In the past, diagnoses were general

– In ICD-10, there’s a diagnosis for just about

everything

• If chart not documented properly, could lead to

denials

25

Documentation

• New documentation to consider

– Laterality plays a big part in ICD-10

• Assessment must be specific to each eye or each

eyelid

– Specificity is more important than ever

• Impression must be as specific as it can be for that

particular complaint or condition

– Particularly important for injuries

– Manifestation is critical where applicable

• Must list disease and manifestation

26

Documentation

Documentation Differences

Current New

Chalazion OS Chalazion LLL

Cataract NS cataract, OS, floppy iris syndrome

CME CME OS after cataract surgery

Eyelid laceration Laceration, left eyelid, hit in eye with tree

branch

Diabetic Type II diabetes using insulin

Myopia Myopia OU; regular astigmatism OD

27


Documentation

Documentation Differences

Current New

Corneal Foreign body

FB in cornea, OD, initial encounter, subsequent

encounter, or sequela (condition that is

consequence of previous disease or injury)

Ptosis Mechanical ptosis OU

BDR, OU Type II diabetes w/mild NPDR w/o macular

edema; on insulin

28

Documentation

• Other documentation impacts on ICD-10

– Acuity of disease

– Supporting diagnostic test results

– Causative agents, drugs, diseases, genetics

– Specific site of disease or disorder

• Eyelid, retina, globe, iris, pupil

– Alcohol, drugs, and tobacco use

29

Documentation

• Glaucoma

– Must assign as many codes from Glaucoma

category H40 as needed to identify type of

glaucoma, the affected eye, and the glaucoma

stage • Expanded chart documentation will be required

– In some cases, even laterally will apply

• Nurses/technicians/physicians will need to be more

specific particularly as it relates to glaucoma stage – Coder won’t be able to code claim unless chart is properly

documented

30


Documentation

• Cataract

– Some descriptors are different requiring better

chart documentation • Age-related cataract

– Senile

• Age-related nuclear cataract – Cataracta brunescens/nuclear sclerosis cataract

• Complicated cataract – Cataract with neovascularization

– Laterality will also play very important part in

cataract documentation

31

Documentation

• Blindness and low vision

– Some of the descriptors are different • ICD-10 – Blindness & low vision

• ICD-9 – Profound impairment

– Moderate impairment

– Severe impairment

– Blindness

– ICD-10 will have manual to define blindness

and low vision • Again laterality critical

32

Documentation

• Diabetes

– 5 Categories in ICD-10

• E08 – Diabetes mellitus due to underlying condition

• E09 – Drug or chemical induced diabetes mellitus

• E10 – Type 1 diabetes mellitus

• E11 – Type 2 diabetes mellitus

• E13 – Other specified diabetes mellitus

– Chart documentation will have to be specific to

these categories

33


Documentation

– Combination codes will be important

• Three character category shows type of diabetes

• Fourth character shows underlying conditions with

specific complications

• Fifth character defines specific manifestation

– Diabetic retinopathy

• Nonproliferative: mild/moderate/severe

• Proliferative & unspecified

• With/without macular edema

– Diabetic cataract

34

TRAINING

Training

• Everyone in practice will need to be trained

– Create training plan

– Topics

• Codes

• New updated policies and procedures

• New computer systems/software

• Clinical knowledge – anatomy and medical

terminology

• Clinical Documentation

36


Training

• Training should focus heavily on clinical

documentation excellence

• Need to correctly and sufficiently provide clinical

details to support coding in ICD-10

– Will be critical in conversion process to avoid

claim denials

37

Training

• ICD-10 will require more engagement with

physician

– Physician input may be key to proper

documentation

– Suggest physicians/nurses/technicians get

same training at same time

• That way everyone will be on board with same

information

38

Training

• Prepare listing of the most frequent

conditions treated with ICD-9 codes

– Compare chart documentation to

corresponding ICD-10 codes

• Does documentation allow selection of ICD-10

code at highest level of specificity?

• If yes, move on to next code

• If not, discuss with doctors and allied staff what

documentation will help code that level of service in

the new ICD-10 codes

39


Training

– Train, train, and re-train on the new ICD-10

codes

• Discuss how your chart documentation will be

impacted

• Additional information that may be required

– Train on additional codes that may be required

for specific conditions

• Diabetes

• Glaucoma stage diagnoses

• Type of injury or where it occurred

40

Training

• Time needed to train personnel

– Initially, 4 to 10 hours recommended

– Other studies suggest:

• 16 hours for experienced coding

• 24 hours for less experienced staff

• Learning curve might not be as steep for

ophthalmology

• Limited number of codes to deal with

41

Training

• May want to take refresher on-line

anatomy course

– Eye anatomy becomes important in ICD-10

• Is not required in ICD-9

• Understanding the differences between

ICD-9 and ICD-10 will be key

– Also the impact it will have on the practice

42


Training

• Staff training crucial to successful transition

– The train has left the station

• No time to put it off

• Train 6 months prior to implementation

– 9 months for larger practices

– Need to get involved in the process now

• Taking baby steps a little each month is better than

no progress at all

43

Case Scenarios

Case Scenario

• A 68-year old male patient experiences

sudden vision loss with the sensation of a

veil over his right eye

• Seen by ophthalmologist the same day

• Ophthalmologist examines patient and diagnoses

him with proliferative vitreo-retinopathy with retinal

detachment

– Patient is scheduled for laser therapy to be performed

that afternoon

45


Case Scenario

• Alphabetic index:

• Detachment retina serous traction

H33.4-

• Tabular list:

• H33.4 Traction detachment of the retina, right

eye H33.41

• Correct code:

• H33.41

46

Case Scenario

• A 67-year old patient has had type 2

diabetes mellitus for 10 years • On insulin for blood sugar control for past 3 months

– Blood sugar doing well on insulin and diet

• Family doctor referred her to ophthalmologist with

suspected condition related to the diabetes

• Ophthalmologist examines patient and finds

diabetic retinopathy that is nonproliferative, with

macular edema – condition is moderate

– Physician recommends surgery same day

47

Case Scenario

• Alphabetic index: • Diabetes Type 2 diabetic retinopathy

nonproliferative moderate with macular

edema E11.331

• Tabular list: • E11.331 Type 2 diabetes mellitus with moderate

nonproliferative diabetic retinopathy with macular

edema (must use addt’l code to identify insulin use) – Z79.4 Long term insulin use

• Correct code sequence: • E11.331, Z79.4

48


Case Scenario

• A patient who had cataract surgery on the

right eye two days ago now experiencing

pain in right eye • Following a slit lamp exam of affected eye,

physician discovered lens fragments in right eye

– Returned patient to OR to remove fragments

• Alphabetic Index: • Complications Postprocedural Following

Cataract Surgery Cataract (lens) fragments

H59.02

49

Case Scenario

• Tabular List:

• H59.021 - Cataract (lens) fragments in eye

following cataract surgery, right eye

• Correct Code Sequence:

• H59.021

• H57.11 – Ocular Pain

– Chapter 7 (Eye and Adnexa) includes instructional note to

use external cause code following code for eye condition,

if applicable, to identify cause of eye condition

50

Case Scenario

• 67 year old male jet skiing at South Beach

– Was driving recklessly and fell off jet ski • Hit in left eye with handle bar before entering water

– Does not recall accident and admits to

drinking too many beers before getting on jet

ski • Presented to office next day with complaint of eye

swelling when he blows his nose

• Diagnosed with orbital floor fracture

51


Case Scenario

• Alphabetic index: • Fracture, traumaticorbitfloor (blow out) – S02.3

• Tabular list: • S02.3 – Fracture of orbital floor

• Correct code sequence: • x7th - S02.3XXB – Fracture of orbital floor

– No 5th & 6th digits available

– “X” place holder must fill empty spaces

– “B” is 7th digit for initial encounter for open fracture

• V93.33XA – Fall on board jet ski – Injury also requires secondary code for external cause

– “X” is place holder – diagnosis requires 7 digits

– “A” is for initial encounter [for injury]

52

Websites to Know

• CMS

– http://www.cms.gov/Medicare/Coding/ICD10/L

atest_News.html

• AAPC

– www.aapc.com/ICD10/

• AHIMA

– www.ahima.org/ICD10/

53

Overcome Obstacles

• ICD-10 is not an option

– Required by HIPAA

• ALL HIPAA covered entities must convert to ICD-10

– Does not affect CPT or HCPCS codes

• ICD-9 codes based on date of service will

continue to be sent and received for some

time • Will need to file claims/appeals after

implementation of ICD-10 for earlier dates of

service

54

http://www.cms.gov/Medicare/Coding/ICD10/Latest_News.html

http://www.cms.gov/Medicare/Coding/ICD10/Latest_News.html

http://www.aapc.com/ICD10/

http://www.ahima.org/ICD10/


Overcome Obstacles

• Anticipate problems!

– Possible delays in payment from carriers until

everyone is fully trained

– Inaccurate coding, reporting, and processing

increasing delays in payment

• Denials, and/or rejections

• Biggest obstacle to overcome may be

resistance to change • May have some staff turnover during transition

55

Questions

Rose & Associates

1-800-720-9667

[email protected]

www.roseandassociates.com

56

http://www.roseandassociates.com/

Tom Murphy

As an agent with Danna-Gracey, Inc., Tom Murphy is a frequent guest lecturer for numerous medical societies, sharing his expertise with the medical community while gaining additional insight into the business of medicine. Prior to joining Danna-Gracey, Tom worked at FCCI, RAB, and Allstate where he developed extensive experience in claims and risk management, giving him a unique ability to understand his clients’ true needs and exposures. He holds a bachelor’s degree in marketing and management from Florida State University. Tom and the Danna-Gracey team focus on medical professional liability insurance, workers’ compensation coverage, and employee benefits. They educate clients about their insurance options and tailor coverage’s and benefits to meet specific needs. By building strong relationships with his clients, Tom is able to provide service that’s unmatched elsewhere in the industry.

1

Workers’ Compensation

FAQs

Who needs Workers'

Compensation coverage?

• If you are in an industry, other than construction, and have four (4) or more

employees, full-time or part-time, you are required to carry workers'

compensation coverage (an exempted corporate officer does not count as an

employee).

• If you are in the construction industry, and have one (1) or more employees

(including yourself), you are required to carry workers' compensation coverage

(an exempted corporate officer or member of a limited liability company does not

count as an employee).

• If you are a state or local government, you are required to carry workers'

compensation coverage.

• If you are a farmer, and have more than five (5) regular employees and/or twelve

(12) or more other workers for seasonal agricultural labor lasting thirty (30) days

or more, you are required to carry workers' compensation coverage.

How does an employer obtain

workers' compensation insurance?

You have several options:

• By purchasing a policy from an insurance agent that represents

approved insurance companies.

• From the Joint Underwriting Association (JUA), http://www.fwcjua.com

• By qualifying as an individual self-insured; for additional information,

contact the Division of Workers' Compensation at (850)413-1784.

• Or, an employer may contract with a professional employer organization

(employee leasing) that has secured workers' compensation coverage.

2

Where do I get a supply of the injury

report forms that I am required to

complete when one of my employees

is injured?

• Your insurance carrier is required to provide you a

supply of the Form DWC-1 First Report of Injury or

Illness. Forms can also be downloaded from the Florida

Workers' Compensation web site Rules & Forms page,

located at:

http://www.myfloridacfo.com/wc/forms.html.

Who can I contact with questions or

concerns regarding risk classification

codes and premium amounts?

• Call your insurance carrier or service representative. If you

have a dispute regarding the risk classification codes, you

can call the National Council on Compensation Insurance

(NCCI) at 1-800-622-4123.

Does the injured worker pay any

part of my workers' compensation

insurance premium?

• The law is very specific on this point. It is the

employer's responsibility to pay the entire

premium for workers' compensation

insurance coverage.

3

What kinds of employee

injuries are covered?

The law covers all accidental injuries and occupational

diseases arising out of and in the course and scope of

employment. This includes diseases or infections resulting

from such injuries. The law also covers death resulting

from such injuries within specified periods of time. Even if

you do not think an injury is covered, you must still file the

First Report of Injury or Illness (DWC-1) with your

insurance carrier for determination of responsibility within

7 days of your first knowledge of the accident/injury.

What injuries are not covered? The law does not provide compensation for the following conditions:

• a mental or nervous injury due to stress, fright, or excitement;

• a work related condition that causes an employee to have fear or dislike for another individual because of the individual's race, color, religion, sex, national origin, age, or handicap;

• "pain and suffering" has never been compensable in Florida, nor is it compensable in any other state. The employer may not sue an injured worker for causing a catastrophe nor can the injured worker sue the employer for their injury. This trade-off makes it possible for injured workers to receive immediate medical care, at no cost to the injured worker, without any consideration for who was at fault, the employer or the employee. In civil law, negligence must be established through litigation before any compensation is awarded.

• Reference: Section 440.02(1), Florida Statutes

Compensation will not be paid in several other instances:

• if the injury is caused by the employee's willful intention to injure or kill himself or another;

• if the injury is caused primarily because the employee is intoxicated or under the influence of drugs;

• if the injury or death of the employee is covered by the Federal Employer's Liability Act, the Longshore and Harbor Workers' Compensation Act, or the Jones Act (if the injured worker is a "seaman" or member of a crew).

Can an employer be liable for

double compensation?

An employer can be liable for double compensation if a

minor child is injured while employed in violation of any of

the conditions of the child labor laws of Florida. The

employer alone, not the insurance carrier, is liable for up to

double the normal compensation as provided by the

Workers' Compensation Law. To receive further

information regarding the Child Labor Law, call the Child

Labor Office at (800)226-2536.

4

As a small business owner, I fail to see how I can

be sued by an injured worker if I provide all the

necessary care, light duty work, and offer to

retrain the employee.

Under the provisions of Chapter 440, Florida Statutes, an injured

worker has two years from the date of the accident to file a petition for

benefits with the Division of Administrative Hearings. If an employer is

providing benefits and return to work options, that should be sufficient

to meet the ultimate goal of returning an injured worker to gainful

employment. However, an employer/carrier's definition of "necessary

care" and that of an injured worker may differ. When that happens, the

injured worker has no remedy except to file a petition for benefits and

have a judge of compensation claims determine whether the benefits

that are being provided are sufficient, or if additional benefits not being

provided are required by Florida law. If the employer is providing

benefits, all expenditures must be reported to the employer's workers'

compensation insurance carrier for statistical purposes.

If I suspect an employer should have Workers'

Compensation insurance coverage, but does not,

or if I suspect fraudulent activity in a workers'

compensation claim, where do I report this?

Suspected workers' compensation fraud can be reported directly to the

Department of Financial Services, Bureau of Workers' Compensation

Fraud, 200 E. Gadsden Street, Suite 100A, Tallahassee, Florida

32301, or to the bureau's toll free hotline number at 1-800-378-0445.

Suspected fraud can also be reported to the Florida Workers'

Compensation, Bureau of Compliance's toll free hotline at 1-800-742-

2214. Anonymous calls are accepted. You can also fill out the Non-

Compliance Referral Form to report employer's who do not have

workers' compensation insurance coverage. This form can be

accessed at the Division's website at:

www.myfloridacfo.com/wc/databases.html.

What in the system would prevent an injured

worker, who wanted to leave his employer anyway,

from claiming to be hurt, waiting out the treatment,

still claiming to be hurt and then trying to settle? It

would not cost him anything but a few hours to do

this and he would have nothing to lose.

By law, pain or other subjective complaints alone, in the

absence of objective relevant medical findings, are not

compensable. However, sometimes these types of claims do

occur and they are sometimes settled by insurance carriers for a

nominal amount of money to rid the employer/carrier of a

nuisance case.

5

Is compensation payable if an

employee refuses to use a safety

appliance like a hard hat, safety

goggles or observe a safety rule?

Compensation will still be paid, but indemnity benefits

(partial wage replacement) may be reduced by 25 percent

if the employee knew about the safety rule prior to the

accident and failed to observe the rule, or if the employee

knowingly chooses not to use a safety appliance which the

employer has directed him to use.

Will becoming a drug-free

workplace save me money on

my insurance premiums?

If you implement a drug-free workplace program in accordance with the criteria set forth in s.440.102, Florida Statutes, you may be eligible for a 5 percent premium credit from your insurance carrier to your workers' compensation insurance premium. In addition to the premium credit, having a Workers' Compensation Drug-Free Workplace Program may make your workplace safer, resulting in fewer accidents, which may reduce your workers' compensation costs.

Am I required to become a

carrier certified drug-free

workplace?

Becoming a carrier certified drug-free workplace is voluntary. However, without the certification, you would not be eligible for any of the benefits provided under this program.

6

Under the Workers' Compensation

Drug-Free Workplace Program,

can I conduct random drug testing

of my employees?

In addition to the situations in which testing is mandatory, the law does not prohibit a private employer from conducting random testing or any other lawful testing of employees. A public employer may institute random testing of employees in "safety sensitive" or "special risk" occupations.

Can I use a breathalyzer as a

valid drug testing method?

Under the Workers' Compensation Drug-Free Workplace Program, the use of a breathalyzer cannot be used as a testing method for initial or confirmation tests.

What if an employee refuses to

take a drug test?

If an injured worker refuses to submit to a test for drugs or alcohol, the employee may forfeit eligibility for medical and indemnity benefits. If an employee or job applicant refuses to submit to a drug test, the employer is permitted to discharge or discipline the employee or may refuse to hire the applicant (if specified in the written Drug-Free Workplace Policy), since, by law, refusal to submit to a drug test is presumed to be a positive test result.

7

If a terminated employee files for

unemployment compensation benefits, may I

inform the adjudicator that the employee was

terminated as a result of a positive drug test?

The adjudicator is bound to maintain this information confidential under s.443.1715(3)(b), Florida Statutes, until introduced into the public record pursuant to a hearing conducted under s.443.151(4), Florida Statutes. Under all other instances employers may not release any information concerning drug test results obtained pursuant to section s.440.102(8), Florida Statutes, unless such release is compelled by an administrative law judge, a hearing officer, or a court of competent jurisdiction or is deemed appropriate by a professional or occupational licensing board in a related disciplinary proceeding.

Can I post the results of my

employees' drug tests?

All information, interviews, reports, statements, memoranda and drug test results, written or otherwise, received by the employer through a drug testing program is confidential and cannot be posted in any public manner.

Am I responsible for payment for services

when my employee participates in an

Employee Assistance Program (EAP)?

No, but if you choose to pay for an Employee Assistance Program, you have the right to choose the facility providing treatment. If an employee does participate in an Employee Assistance Program, you, the employer, are required to extend the same considerations as reflected under the federal guidelines established for the Americans with Disabilities Act and the Family and Medical Leave Act.

8

How many days does the employee have

to re-test the specimen if he or she

wishes to contest a positive test result?

During the 180 day period after written notification of a positive test result, the employee who has provided the specimen shall be permitted by the employer to have a portion of the specimen re-tested, at the employee's expense, an Agency for Health Care Administration (AHCA) licensed or a USHHS certified laboratory of his or her choice.

Who pays for the drug test?

The employer is responsible for payment of all drug tests they may require. However, if an employee wishes to have the specimen re-tested at a laboratory certified by the Agency for Healthcare Administration (AHCA), it will be at the employee's expense. If the workers' compensation insurance carrier uses a positive test result to determine the compensability of a claim, the carrier would be responsible to cover the costs of the test.

Delray Beach • Jacksonville • Miami • Orlando • Pensacola

At Danna-Gracey, it is our privilege

to be a partner with

9

Did you receive money back on your workers’ comp insurance premium last year?

Many doctors have through the Florida Society of Ophthalmology

Workers’ Compensation Program.

The rates for workers’ compensation insurance are set by the State of Florida. Your practice will pay the

same price no matter where you choose to secure coverage. However, under the OptaComp program,

you may be eligible for a potential dividend of up to 24.8%:

･ $10K premium has returned an average dividend of 20%, or $2,000.

･ $5K premium has returned an average dividend of $1,000.

･ $2K premium has returned an average dividend of $400.

Your membership with the Florida Society of Ophthalmology (FSO) can provide savings that can be paid

back in dividends. OptaComp has returned a dividend for 12 straight years, with over $4 million over

the past six years to medical societies’ members in Florida. The OptaComp (rated “A” by A.M. Best)

program is endorsed by the FSO and is offered by Danna-Gracey, Inc.

For more information on the workers’ compensation insurance program through OptaComp, call the

experts at Danna-Gracey.

Delray Beach ･ Orlando • Miam • Jacksonville • Pensacola

800.966.2120 • [email protected] • www.dannagracey.com

mailto:[email protected]

Wes Caldwell

Wes currently heads up the benefits division for Danna-Gracey, a leading medical malpractice provider with offices in Delray Beach, Orlando, Miami and Jacksonville. He has spent the last 28 years in the insurance industry working with professionals in the areas of health, life disability and non-qualified retirement plans. Wes is a native of Delray Beach, Florida and holds a Bachelor’s Degree from Florida Atlantic University. He is Past President of the Sunrise Kiwanis Club of Delray Beach and the Juvenile Diabetes Research Foundation of North Florida. He has served on the boards of the Rotary Club of Mandarin, San Jose Country Club and the National Board of the Juvenile Diabetes Research Foundation where he was a Liaison for the State of Florida. Wes lives in Jacksonville Florida where he enjoys singing, cooking and serving his church.

1

www.dannagracey.com

FRF 401(k) Advantage

Wes Caldwell June 2013

Introducing…

Since ERISA (Employee Retirement Income Security

Act) was enacted in 1974, there has been an

amendment or regulation almost every year which

affects the compliance and operation of your Qualified

Retirement Plan.

Why is FRF Advantage a solution for my company’s

retirement plan needs and responsibilities?

2

• 1,000+ new audit/enforcement agents

• 25% increase in plans audited

• Litigation, required money restorations, fees and penalties

FRF Advantage

Beginning in 2009 - 2010, the Department Of Labors

focus changed from voluntary compliance to

mandatory enforcement.

• Most employers who sponsor retirement plans do not fully

comprehend the extent of their fiduciary liability.

• Product Providers have an inherent conflict

• Most Plan Sponsors do not know that they can delegate their

responsibility.

The SEC and DOL independent investigations have

confirmed that:

FRF Advantage

Why do I, as a Plan Sponsor of my Company’s Retirement Plan

need Fiduciary protection?

FRF Advantage

• ERISA Sec 409 makes a Fiduciary personally liable for any breach of responsibility that he

commits either by act or omission.

• “Any person who is a Fiduciary with respect to a plan who breaches any of the responsibilities,

obligations or duties imposed upon Fiduciaries shall be personally liable to make good to such

plan any losses to the plan resulting from each such breachﾉ”

• “The Law and Courts encourage those in control of the plan to delegate the responsibility to

“skilled professionals” who are familiar with such matters . US Court of Appeals - Katsaros v.

Cody 744F2d at 270.”

• “A fiduciaryﾉ.will be liable for responsibilities delegated to him.” ERISA 405 (c) (2) Bulletin 75-8,

FR-13 and FR-14

3

• Becomes Named Fiduciary

• Plan Governance Review

• Maintain Plan Fiduciary File

• Managed Plan Calendar

• Benchmarking Costs/Fees

• Provide 404(c) Compliance

• Supervise and Manage Annual Notices

• Annual Audit

• Help on Demand: Provide One-Point of Contact for all Questions/Needs

• Review Plan Design

How We Do It

401(k) Levels of Responsibility

The FRF 401(k) Advantage EMPOWERS SUCCESS through a proactive

ongoing process, which:

• Effectively manages your plan, its vendors, and the costs your

participants pay.

• Ensures that your plan offers only the highest quality investment

options.

• Guides your participants to save.

• Guides your participants to invest wisely.

• Constantly reviews your plan design to ensure it remains effective.

• Employer Controlled ﾐ Each adopting employer can maintain their

unique plan.

• Provisions and plan design.

• Individualized for your participants ﾐ Investment options chosen for

your plan/participants.

• Employee Education ﾐ Communication Network available to participants.

• NO 5500 to File.

• NO Plan Audit.

In Summary

4

“..401(k) MEPs are one of the few options available for most

employers that wish to comprehensively mitigate their fiduciary

responsibilities and exposire to liability, and outsource their

administrative compliance burden..”

- A White Paper by C. Frederick Reish, Esq.; Bruce L. Ashton, Esq.;

Joshua L. Waldbeser, Esq.; September 2011, Drinker Biddle

What They are Saying


800.966.2120 • www.dannagracey.com • [email protected]


http://www.dannagracey.com

Steven I. Rosenfeld, MD, FACS

Dr. Steven I. Rosenfeld is a board-certified, fellowship-trained ophthalmologist who specializes in medical and surgical treatments of corneal conditions, infectious and inflammatory eye diseases, refractive surgery, and cataract surgery. Dr. Rosenfeld has been in private practice with Delray Eye Associates, PA since 1985. He is a Fellow of the American College of Surgeons and the American Academy of Ophthalmology, and an Associate Examiner for the American Board of Ophthalmology. Dr. Rosenfeld currently serves as a Voluntary Professor on the clinical faculty at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, where he has been on the faculty since completing his fellowship. Dr. Rosenfeld has been a Committee Member on the Board of OMIC since 2010.

Dr. Rosenfeld has authored dozens of textbook chapters and scientific articles on the topics of cataract surgery, PRK and LASIK surgery, corneal transplant surgery, and ocular infections. He has co-authored two recent textbooks — one on Lens and Cataract Surgery and one on Refractive Surgery — under the auspices of the American Academy of Ophthalmology. He is on the editorial review boards of EyeNet magazine and Focal Points Clinical Modules and is a reviewer for Ophthalmology and the American Journal of Ophthalmology. Dr. Rosenfeld has been honored with numerous awards from the American Academy of Ophthalmology, including the Achievement Award, Senior Achievement Award, Secretariat for Education Award and Lifelong Education for the Ophthalmologist Award. He is also a recipient of the Physician's Recognition Award from the American Medical Association and is listed as one of the best doctors in Best Doctors in America, Who's Who in America, Who's Who in the World, Top Doctors, and Florida Super Doctors, just to name a few. Dr. Rosenfeld frequently lectures at ophthalmic meetings nationwide.

Dr. Rosenfeld earned his undergraduate degree with honors at the Johns Hopkins University and was elected Phi Beta Kappa. He obtained his medical degree at the Yale University School of Medicine, where he was elected into the Alpha Omega Alpha Honor Medical Society. He completed his medical internship at Yale/New Haven Hospital and his ophthalmology residency at Barnes Jewish Hospital at Washington University School of Medicine in St. Louis. Dr. Rosenfeld continued his extensive training with a Heed Foundation Fellowship in Cornea and External Diseases at the Bascom Palmer Eye Institute in Miami.

Dr. Rosenfeld is a member of numerous professional associations, including the American Academy of Ophthalmology, the American Society for Cataract and Refractive Surgery, the Association for Research in Vision and Ophthalmology, the Ocular Microbiology and Immunology Group, the Cornea Society, the Society of Heed Fellows, the Eye Bank Association of America, the Paton Society, the International Society of Refractive Surgery, the Florida Medical Association, the Florida Society of Ophthalmology, the Palm Beach County Ophthalmology Society and the Palm Beach County Medical Society.

1

Risk Management Strategies for the Ophthalmic Practice

Steven I. Rosenfeld, MD

OMIC Board Member

Practice

Administrators

June 29, 2013

Course Objectives

• Provide information that will aid the practice

in implementing successful telephone

screening procedures and protocols

• Help you organize your practice to minimize

patient injury and decrease risk of

malpractice claims

Course Outline

• Review roles and responsibilities of staff and

ophthalmologists

• Review delegation of services

• Review in-office protocols

• Review after hours protocols

2

Handout Material

• “Telephone Screening of Ophthalmic

Problems” at www.omic.com for:

– Sample screening guidelines

– Patient telephone screening form

– Complaint categories: emergent, urgent and

routine

– Office telephone assessment form

– After-hours/On-call Telephone Contact

– Patient Care Phone Call Record Pad

Introduction

• Patients call their ophthalmologist to report

problems and seek advice

• Physicians rely upon their office staff to

screen these calls and schedule

appointments

• After hours:

– ophthalmologists themselves field many of these

calls

– cover other physicians’ patients as well as for the

Emergency Department

The “Risk” Challenge

• The health care team does not have access to

information obtained from face-to-face

contact

• Patient may be a poor historian or may not

want to inconvenience the physician

• Patient may be unknown to the

ophthalmologist and medical records may

not be available

3

Roles and Responsibilities

• Practice is made up of physicians, techs,

administrators, front and back office

• Each has specific roles and responsibilities

• Every practice needs written guidelines for

telephone screening

OVERVIEW

• Exercise same care over telephone as you

would during office visit

1. Gather information

2. Communicate assessment and plan to the

patient

3. Document the encounter and decision

making process

OVERVIEW

• Safely enlist your staff’s assistance in

gathering information

1. Develop and implement written protocols for

telephone screening (approved by physician)

2. All delegated duties are part of employee’s

written job description

3. Should be specific to your patient population,

subspecialty and staff

http://www.omic.com/






4

Polling Question – Show of Hands

• Do you have a written protocol for telephone

screening?

• Yes

• No

• I don’t know

OVERVIEW

• Physician and Administrators must

supervise staff members who screen calls

1. Train and verify competency

2. Staff must feel authorized to consult with an

ophthalmologist as needed

3. Ideally, daily review of telephone calls by

physician

4. Periodic review of the screening protocols

themselves. When you update guidelines, note

the new revised date, and keep a copy

Practice of Medicine

• Do not delegate tasks that require

independent medical judgment

• Practice of medicine is defined by state law in

Medical Practice Acts

• Only physicians can

– diagnose mental and physical conditions

– use drugs in or upon human beings

– sever or penetrate tissues of human beings

– use other methods in treatment of diseases





5

Scope of Practice

• All medical diagnoses must be made by the

ophthalmologist to promote patient safety

and avoid allegations of practicing medicine

without a license

• You should respect staff members scope of

practice and service

• If in doubt what services can be delegated to

non-physicians, contact your state licensing

boards

Screening Training

ROLE OF STAFF

• Staff members are limited to gathering

information and the assignment of an

appointment category

• Important:

– All contact forms must be filed in the patient’s

medical record. (Ideally) The physician will initial

and date forms.

– No independent decision making can be made by

your staff

Instruct Staff

• Medical advice should only come from a

physician

• Instruct non-physician staff members not to

give their opinion.

• When properly trained, staff can

communicate instructions and information to

the patient

EXAMPLE:

“Instruct patient on how to rinse eye with sterile

saline solution”







6

Instruct Staff

• Staff should not minimize patient complaints

or provide false reassurance

• Juries are not sympathetic when a

receptionist tells a patient that nothing is

wrong

Screening Training

• Non-physicians follow written policies and

procedures under the supervision of an

ophthalmologist

• Written guidelines should be in place that

prompt your staff to ask questions

• Staff ask questions and follows these written

guidelines to ascertain the patient’s level of

distress

Polling Question

• Do you have a written guidelines in place that

prompt staff to ask questions?

• Yes

• No

• I don’t know





7

Instruct Staff

• Post the guidelines by the phones of all staff

members who answer calls

• Staff members may be concerned about the

amount of time required to screen calls

• Not every phone call will require asking every

question. The patient’s complaint will

determine how many questions should be

asked

• Important: Time spent carefully screening calls is

time well spent if it preserves a patient’s vision

Categories of Complaint

• Vision Loss Vision Changes

• Pain Flashes/Floaters

• Burn Foreign Body

• Trauma (Injury) Redness/Discharge

• Other Eye Complaints



8

Categories of Complaint

• If patient falls into one or more category,

always consider assigning the category

where the patient will be seen soonest

• Important: If the patient has any complaint

that falls into the emergent category, give

him/her an emergent appointment

Polling Question

• Do you have staff training reviewing category

of complaints?

• Yes

• No

• I don’t know

9

Interrupting Physician

• Your protocol should indicate if your

physicians want to be notified of emergent

appointments or other situations

• Staff should be instructed what to do if the

patient requests to speak with the physician

Patient “same day” requests

• Ask staff to inform physician when a patient’s

request to be seen the same day can’t be

accomplished

• If physician cannot see the patient when the

patient wants to be seen, it is best to speak to

the patient personally (physician)

• Suggest alternative sources of care

• Important: Emergency departments may not

be equipped to carefully evaluate ophthalmic

complaints; direct patient to source of care

that is likely to be beneficial

New Patients

• Does practice accept new patients

– Step 1: Ask caller if current patient

– Step 2: If no, inform caller that practice does

not accept new patients

– Step 3: Offer caller names of ophthalmologists

in the area or the state/local ophthalmology

society

– Caution: staff should not discuss caller’s

condition or complaint if ophthalmologist is

not available to treat caller

10

When Staff Have Questions

• Staff should be encouraged to consult with

the physician at anytime

• EXAMPLES

– Complaints that are not listed on the

screening guide

– Those that fall into more than one

appointment category

– Routine patients that want to be seen that

day

Staff Qualifications

• Authorize only staff members with the

necessary language and communication

skills to screen ophthalmic problems over

the phone

• SKILLS

– Patience

– Cheerfulness

– Compassion

– Clarity of enunciation

– Professionalism

– Ability to abide by guidelines

Office Telephone Assessment Form

11

Prescription Refill Protocols

• OPHTHALMOLOGIST (documentation)

– Name

– Dosage

– Route

– Frequency of medication

– Number of refills

– Date for follow-up appointment


• PATIENT OR PHARMACY REQUESTS

– Instruct staff to verify if patient is

authorized to have the prescription refill by

reviewing Medication Summary Sheet or

Progress Notes form


• VERIFICATION

– Staff verifies date of last office visit. If

greater than one year, instruct staff to tell

patient needs to be seen by physician

– Document this activity by dating and

initialing form

– Staff member notes time and date of call

12


• ACCEPT – DENIAL OF REFILL

– Staff gives request and patient’s record to

ophthalmologist for approval

– Staff contacts pharmacy with request

– Staff notes include date, time of call and

the physician’s initials indicating

authorization

Postoperative Contact Protocols

• Postoperative patients play a significant role

in malpractice claims

• Important: Always treat a postoperative

patient as a high risk contact


• Proactive written instructions

– Medications

– Activity

– Wound care instructions

– Date of follow-up appointment

– State symptoms that should be reported and

consequence of not reporting them

13


• STAFF ISSUES

– Ask patient if they are postop, and if so,

date and type of procedure

– Ask patient if they still have the written postop

instructions

– Staff should categorize the patient’s status

• Urgent or Emergent

– Postoperative patients must be documented by

staff and reviewed by the physician on a daily

basis

CASE STUDY

Risk Management Issues

• Patient abandonment following surgery

• Handling of complaints of postoperative

patient

• Patient handoffs to on-call partner

• Management of postoperative

complications of increased IOP and vision

changes

14

Case Summary

• 53 year old male referred to retina specialist for

vitreo-retinal evaluation. Diagnosed with lattice

degeneration superotemporally OD. Very

prominent posterior vitreous separation.

• Patient warned of possible retinal detachment,

told to call if those symptoms developed.

• 2 ½ months later, Pt complained of spots OD

and was diagnosed with retinal detachment and

giant tear.

Case Summary

• Had microscopic pars plana vitrectomy, retinal re-

attachment surgery, internal fluid gas exchange &

endophotocoagulation. Postoperative IOP 27,

doing well.

• Two days after surgery, called insured, who was

in his car. “Eye felt different.” Denied upset

stomach, nausea, vomiting.

• Patient instructed to increase medication to every

8 instead of 12 hours.

• Patient informed that physician was going out of

town and that partner was covering.

Case Summary

• Patient called covering MD next day complaining of feeling pressure, seeing black

• Partner not concerned since patient had gas bubble three days prior, was on steroids and IOP lowering agents.

• Told patient to come in next day (Monday).

• During office visit, Pt complained of nausea and vomiting during the night.

• NLP, mild swelling of lids, IOP 60. Lens and iris shoved against cornea. Decompressed eye.

15

Case Summary

• Treated eye with gas withdrawal, decompression, injection of fluid and air over next 3 days. IOP remained high; NLP.

• Patient had pars plana lensectomy and vitrectomy, with removal of retinal blood.

• Next day, IOP 7. Laser surgery attempted, unsuccessful.

• Eventual outcome: LP, phthisical eye, needed prosthesis. OS developed retinal tear.

Legal Issues

ABANDONMENT

• Occurs when a physician fails to provide for necessary medical care to a current patient without adequate justification

• Includes providing “coverage” for patients when the physician is ill, on vacation, when treating other patients, etc.

• If care provided by covering MD is inadequate, and the original physician did not exercise due care in selecting the covering physician, could be liable for harm to patient.

Claims Analysis

• Significant damages: lost right eye,

required prosthesis, left eye vision

continued to deteriorate

• Damages evaluation • Health care needs of plaintiff

• Income loss

• Age of patient

• Presence/absence of damage caps in state law

16

Claims Analysis

• Factors affecting decision

• Reviews by OMIC Claims Committee, and

experts retained by defense attorney

• Level of support for standard of care

• Level of supporting documentation

• Credibility and witness quality of plaintiff

• Credibility and witness quality of defendant

Claims Analysis

• Credibility issue since no documentation of

phone calls or of decision-making process that

led to phone treatment versus examination

• No support for standard of care for either

physician, but especially telephone treatment by

covering ophthalmologist when pt complained of

“seeing black” and delayed treatment of

increased IOP.

Polling Question

• What do you think is a reasonable amount to

pay the plaintiff to settle the lawsuit

• $75,000

• $500,000

• $1 million

• > $1 million

17


Patient “Hand-Offs”

• When covering for another physician...

– Identify high-risk patients

• Recent surgeries or procedures

• Unstable patients

• Patients who have already called to report

problems

– Clarify when you will go off-call



• Document -

• Documentation promotes continuity and

defensibility of care.

• Keep after-hours and on-call contact forms

with you (see sample).

• Document each patient contact.

• Document your decision-making process.

• Document the patient hand-off.



• When going off-call...

• Contact physician for whom you were covering

• Identify patients who called

• Fax contact form

• Keep original copy of contact form in “On-call

Patient Contact” file

18

After Hours Documentation

• WHEN GOING OFF CALL

– Once you return to the office, place or tape the

contact form in your patient’s medical record

– When providing on call coverage for a physician in

another practice, tell the physician when you go

off call and fax a copy of the contact form and

other records, retain the original in a file

designated “On-call coverage contacts”

Patient Care Phone Call Record Pad

Email: [email protected]

for booklet

mailto:[email protected]

19

Handout Material

• “Telephone Screening of Ophthalmic

Problems” at www.omic.com for:

– Sample screening guidelines

– Patient Telephone Screening Form

– Complaint categories: emergent, urgent and

routine

– After-hours/On-call Telephone Contact

Thank You!

Steven R. Robinson, FASOA, COE

Steven Robinson is currently an independent senior consultant with Advantage Administration of Dallas Texas, consulting with medical offices around the country on human resource issues, operations and financial management and optical operations. He was formerly vice president and chief operations officer of Professional Eye Associates, Inc. in Dalton, Georgia, where he served in this capacity for 18 years. He received his education from the University of Tennessee at Chattanooga in Business management and the United States Army Professional Development Institute in the field of logistics. He is a graduate of the prestigious Wharton Professional Management program for ophthalmic administrators, and he has also completed the New York University, Wagner School of Business series of courses in ophthalmic medical practice planning and financial management. He is one of only 220 persons currently holding the Certified Ophthalmic Executive credentials and he also holds an Ophthalmic Coding Specialist designation. He has lectured extensively to medical administrator and physician groups around the country. He is a regular course presenter at the American Society of Ophthalmic Administrator National Congress, The Southeastern Congress of Optometry and the American Society of Ophthalmic Executives. He has written numerous articles for medical management periodicals, and he is a contributing writer to a book on the management of Ambulatory Surgery Centers. He is a past president and vice president of the American Society of Ophthalmic Administrators and served on the board of directors of this 2,000 member international organization for 8 years. Steve is a retired reserve army officer who was decorated 26 times during his career and served his last tour of duty as a logistics advisor on the senior staff of the commanding general of army forces during Operations Desert Shield and Desert Storm. He has held officer positions in the North Georgia Medical Managers Association, the Retired Officer Association, he presently serves on an advisory team for Lake Forest Ranch, a camp ministry for children in central Mississippi, also served on the board of directors of a non-profit speech and hearing Center, and the National Board of Certified Ophthalmic Executives. Steve and his wife Ruby reside near Chattanooga Tennessee. He is an avid computer enthusiast and also has a passion for the outdoors with interests in hunting, fishing and backpacking.

1

Organizational Management

Steve Robinson, FASOA, COE

Senior Consultant

Steve Robinson is a paid consultant

and provides management consulting

services to physician practices and

has some financial interest in the

material presented

BORING……

Organizational

Management

101

2

Why

organizational

management ?

Types of Management

H. R. Management

Financial Management

Facilities Management

Security Management

Information Management

Types of Management

Tyranny of the Urgent

Baby Sitting Management

Anger Management

Crisis Management

Drama Management

3

Isn’t this where it

all breaks down ?

What is your

Vision ?

1950’s

Made in Japan…..

Cheap, Shoddy,

Imitation,

Worthless

4

We will create products that become pervasive

around the world.…. We will be the first

Japanese company to go into the U.S. market

and distribute directly.… We will succeed

with innovations that U.S. companies have

failed at - such as the transistor radio.…

Fifty years from now, our brand name will be as

well known as any in the world…and will signify

innovation and quality that rival the most

innovative companies anywhere.… “Made in Japan” will mean something fine, not

something shoddy

Sony - 1950’s

Intentionally left blank

5

What does this

tell you ?

The story of Microsoft’s lost decade could serve as a

business-school case study on the pitfalls of success.

For what began as a lean competition machine led by

young visionaries of unparalleled talent has mutated

into something bloated and bureaucracy-laden, with an

internal culture that unintentionally rewards managers

who strangle innovative ideas that might threaten the

established order of things.

Excerpt from article in Vanity Fair Magazine

Microsoft’s Lost Decade By Kurt Eichenwald

By the dawn of the millennium, the hallways at Microsoft

were no longer home to barefoot programmers in

Hawaiian shirts working through nights and weekends

toward a common goal of excellence; instead, life behind

the thick corporate walls had become staid and brutish.

Fiefdoms had taken root, and a mastery of internal

politics emerged as key to career success.

In those years Microsoft had stepped up its efforts to

cripple competitors, but—because of a series of

astonishingly foolish management decisions—the

competitors being crippled were often co-workers at

Microsoft, instead of other companies.

http://m.vanityfair.com/contributors/kurt-eichenwald

http://m.vanityfair.com/contributors/kurt-eichenwald

6

Staffers were rewarded not just for doing well but for

making sure that their colleagues failed. As a result, the

company was consumed by an endless series of internal

knife fights. Potential market-busting businesses—such

as e-book and smartphone technology—were killed,

derailed, or delayed amid bickering and power plays.

That is the portrait of Microsoft depicted in interviews

with dozens of current and former executives, as well as

in thousands of pages of internal documents and legal

records.

NOTE:

In the quarter ending March 31,

2012, just the iPhone had sales of

$22.7 billion for Apple;

the entire Microsoft Corporation,

$17.4 billion

“They used to point their finger at IBM and laugh,”

said Bill Hill, a former Microsoft manager. “Now

they’ve become the thing they despised.”

#1 problem

listed in

administrator

survey

7

I never seem to

have enough time

to accomplish all

that is expected

Why organizational

management ?

Number 1 problem in

administrator survey ?

Why organizational

management ?

Number 1 problem in

administrator survey ?

WHY ? WHY ? Will I remember any of

this ?

Organizational

Management

8

4 Distinct

Elements

P O C C

C C

P LAN O

C C

RGANIZE

OORDINATE ONTROL

9

Planning

Identifying Goals & Objectives

Stating Premises & Assumptions

Developing Specific Details

Identifying Goals & Objectives

Stating Premises & Assumptions

Planning

Types of Planning

Short Term Planning

Long Term Planning

Strategic Planning

Disaster Planning

????? Planning

Short Term Planning

Long Term Planning

Strategic Planning

Disaster Planning

????? Planning

Organization

Breaking work down

into components Group related work

activities and units

Breaking work down

into components Group related work

activities and units

10

Organization

Developing

organization chart Developing position

descriptions

Developing

organization chart

Organization

Developing

organization chart

Developing

organization chart

11

Why do we need an

Organizational

Chart?

Coordinate

Communicating

objectives

Leading members

to objectives

Communicating

objectives

12

Coordinate

Training & Supervising

Integrating Individuals

into organization

Training & Supervising

Why do we lose

Great People ?

Control

Measuring

accomplishments

against stated goals

Correcting deviations

from goals

Measuring

accomplishments

against stated goals

Correcting deviations

from goals

13

Control

Developing feedback

mechanisms

Developing feedback

mechanisms

Adjusting for

variation

Adjusting for

variation

Control

Assessment,

Acquisition, Assembly

And Commitment of

Resources to

Accomplish the Plans

PLAN

ORGANIZE

COORDINATE

CONTROL

14

PLAN

ORGANIZE

COORDINATE

CONTROL

PLAN

ORGANIZE

COORDINATE

CONTROL

Achieving the Objective

PLAN

ORGANIZE

COORDINATE

CONTROL

15

P LAN O

C C

RGANIZE

OORDINATE ONTROL


P LAN

O RGANIZE

16

COORDINATE

COORDINATE

!

Doctor Administrator

17

P LAN O

C C

RGANIZE

OORDINATE ONTROL


If I don’t have enough

time to get everything

done, when am I going to plan ?

If I don’t have enough

time to get everything

done,

Unless something

changes…..you won’t !

18

Sometimes, it is extremely difficult to

keep your objective in perspective!

Organizational

Management

Try re-evaluating your

priorities and see if

following some of these

steps won’t produce

different results

19

P LAN O

C C

RGANIZE

OORDINATE ONTROL


Organizational

Management

Intentionally left blank

20

Management Organizational

Steve Robinson, FASOA, COE

Senior Consultant

This program has been sponsored by the:

Florida Society of Ophthalmology

6816 Southpoint Parkway, Suite 1000 Jacksonville, FL 32216

Phone: 904-998-0819 Fax: 904-998-0855 www.mdeye.org

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