As June 30th approaches, here's a little reminder that my "attbi" email address will be obsolete soon.  You can still reach me, though, as the FootZine email and web site addresses should remain the same: gaylejohnson@footzine.com       www.FootZine.com

This week's issue features one of Dr. John Guiliana's Practice Management Pearls, and has more information from Lynn Homisak about last week's announcement of the new status for assistants in the AAPPM.   An experienced assistant is available to help your practice, and .... how far back do you remember?

~ Gayle

From:  Sue Dissinger
re:      How Long to Keep Charts

Hi Gayle!  How are you?  I have a question for the FootZine.  I would like to ask other offices how long they keep deceased patient charts?  Someone told me three years but I would like to hear from other people.
Thanks!

Sue Dissinger
Ephrata, PA

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Dear FootZine Subscribers,

In the last issue of FootZine, Gayle posted an announcement from the Executive Director's office of the American Academy of Podiatric Practice Management (AAPPM) regarding the new membership division for podiatric medical assistants.  As a member of the Board of Trustees of the AAPPM and one directly involved with this new division, I would like to take this opportunity to expound upon that announcement so that it is clear to my friends and colleagues the importance and impact that this new development can have on your office.  I encourage you to share this letter with your doctors and challenge you to be a part of something new and exciting.

The AAPPM has been a doctor-only organization for over 40 years and I had my first dealings with it back in the '70s when my first and former employer, Dr. La Barbera, was President.  I recall the information that he would bring home from his meetings....books, tapes, notes that he was anxious to share with me in the hopes of building our practice to its fullest extent.  I wanted so much to share in his enthusiasm, but because I received the information second-hand, I did not have the same energy that he had to see it through.  Sometimes, the ideas would develop....but unfortunately, many times they would die.

After I joined the Academy Board, it became apparent that assistants, too, have a voice in podiatry...and at our February Board Meeting, it was acknowledged that if given the opportunity, we, too, can contribute significantly to the growth of the practice.  In fact, I'd like to share with you something I read in an article on office efficiency....it simply stated, "PLEASE PAY ATTENTION TO YOUR STAFF."  The article discussed the value that staff brings to an office because of all they deal with on a daily basis.  The American Academy of Podiatric Practice Management has recognized this value and has done just that.  In every attempt to pay attention to staff, they have opened up their membership and their meetings to now include the staff of their members in the hopes that they can take part in the learning process and share side-by-side with their doctors some of the "secrets" of success.  Our recent meeting in Philadelphia this past May was proof positive that this formula works!  In our attempt to bridge the doctor/assistant communication gap, this new venue not only encouraged open discussion of problems that have gone unaddressed, but offered solutions to help eliminate them.  The focus of these meetings is NOT what Doctors can do to be successful...and it's NOT what assistants can do....it is on the Doctor/Assistant TEAM and what they can do TOGETHER that will make a difference.  Doctors that sign their assistants up and assistants that want to join believe in the concept of teamwork and both come with a ready attitude to grow and learn.  It is a win-win situation.

The Academy has chosen some very enthusiastic assistants to head up this assistant division and I am very proud to introduce them to you now.  In the Northeast, there are Marlene Kern and Lynne Rosequist of New Jersey and Sue Dissinger of Pennsylvania.  Down South is Catherine Marsh of North Carolina and in the Northwest, Ann Orminski, Gayle Johnson and myself, all from the State of Washington.  These ladies are some of the most respected assistants in the nation and we are very proud to have them help pave a new direction for assistants.

Academy President Hal Ornstein and I want to personally invite and encourage all assistants to become members.  Yes, our focus is practice management and while some may think that is limited to front office duties, let me assure you that the information we discuss relates to the entire office, front and back.  Our very next meeting, in fact, is on Durable Medical Equipment (DME), to be held August 22-24, 2003 in Philadelphia. It will be an all-inclusive program and will include everything that we, as assistants, need to know including the description, application and effectiveness of each product, casting techniques, billing information, our role in terms of patient care and how to deal with the changes of instituting such a worthwhile program into the office.

Membership allows you a ticket into our world of professional partnership with doctors and we will strive to make the dues well worth every penny that your doctor pays to have you join.  This is a personal invitation to step in and "partner" with us. For more information, please contact the AAPPM office by calling 978-686-6185 or email: info@aappm.com
Tell them Lynn sent you!  Hope to see you soon.

Lynn Homisak, PRT
LynnPRT@msn.com
Member, Board of Trustees, AAPPM
Renton, WA

Podiatric medical assistant with >12 years experience in chairside, billing, insurance, seeking full-time position in Snohomish County (between Edmonds and Everett), WA.
Please call (425) 894-2356

Notices of positions wanted or positions available, as well as other "classified" information, are welcome. They are posted at the FootZine web site's Networking page. Have a look at http://www.footzine.com/FZ_6.htm

In this rapidly changing medical financing system, one skill, which runs closely behind the doctor’s actual medical skills in the ranking of importance, is the skill of conflict resolution. 

Conflicts arise in many situations and take on many disguises. As an example, in the private practice setting, conflicts may arise if a patient shows up unexpectedly without an appointment or referral, if they show up early or late, if the doctor is running behind, or if they disagree or are confused over their bill.  The conflict may be manifested by the emotions of anger, frustration, rudeness, or in some instances, simply silence.

Unresolved conflicts usually end in disputes, with the most devastating outcome being that of litigation.  Long before a dispute may arise, however, a conflict will result in loss of goodwill, loss of the customer (and their potential referrals) and lost revenues.

The “art” of conflict resolution DOES NOT mean relinquishing your position and “giving in”. Actually, it’s just the opposite. Conflict resolution involves a positive outcome. It will usually result in people crossing over to “your side”.

Let’s start by reviewing a typical response to a conflict. As humans, we have a strong desire to express our point of view. This usually involves lots of talking (sometimes very loud talking). We have a “position” and we want it heard. The other party, however, also has a perspective and wants to be heard. They want their position acknowledged. This usually results in what is known as a “positional based” dialog. Positional based dialog strives for “one winner” and “one loser”. It’s a win-lose technique.

If we realize that all humans have a desire to maintain and express their interests, we must start by examining what these interests are and UTILIZE THEM TO RESOLVE THE CONFLICT.  Let’s break down the possible interests for each party in a typical conflict. You may THINK that a patient’s primary concern and interest in a conflict over a bill is to SIMPLY NOT PAY THE BILL. While this may indeed be the case in some rare instances, I assure you that this is not the majority of the cases. This is what the interests may look like:

Patient’s interest:

1.       Being heard…Made to feel that their interests are also important
2.       Venting their frustrations. Their frustrations may be as a result of this particular crisis, or may have nothing to do with it. The frustration may be a secondary emotion to confusion or perhaps the feeling of losing control.
3.       Lastly, NOT paying the bill.

Our interests:

1.       To GET PAID with as little hassle as possible

Again, in rare instances, the patient may have no other interests other than avoiding the payment. I’m certain that most Psychologists would agree, however, that in this type of conflict people generally have other “primary interests”.

The key to conflict resolution is to negotiate utilizing an “interest-based” system rather than a “positional-based”. Interest-based negotiation involves a “win-win” phenomenon. The interests of BOTH parties are addressed.

RESOLVING CONFLICT UTILIZING INTEREST-BASED NEGOTIATION  

If we are truly committed to resolving a conflict, we must start by identifying the interests of the OTHER party. How do you accomplish this?

Through what is known as empathic listening you can begin to identify the patient’s needs. This involves intense listening (not talking) and trying to “feel” what the other person feels like. With this type of listening (also known as active listening), emotions such as frustration, anger, fear of loss of control, etc. can be identified. These emotions must then be acknowledged.

A person’s feelings are acknowledged when you are able to accurately paraphrase them back to them. As an example, a paraphrase to a person whom you have identified as frustrated might be  “I know how frustrated this makes you feel; it drives me crazy as well when an insurance company doesn’t pay my doctors.” This paraphrasing opens the gates of communication since the patient now feels that they have been acknowledged and you UNDERSTAND.

Allow them to vent all frustrations. The “listening to talking ratio” should be about 10:1.

Only after opening of these gates of communication should you proceed to “tell your side of the story”. Choose your words carefully. Continue to speak in an empathetic tone and periodically interject those same emotions (frustration). DO NOT patronize.

If the patient hasn’t yet crossed over to your side, you may want to ask what we can do to resolve this conflict. Again, listen…don’t talk. If the results are not realistic, again state your case and explain why this is not realistic.

In those rare instances in which a person’s main interest is to simply not pay the bill, it is time to terminate the conversation. Ask the person if you can get back to them at a mutually convenient time to discuss this further. Disclose that you need to review this case further (with your supervisor, for example). The reason for this termination at this point is two-fold. It will allow some time for things to “sink in” for both parties. It will also give you some time to evaluate the potential decision from an “analytical” standpoint. You must explore the financial impact of trying to collect an $8.00 co-pay from a loyal, high referring patient and the risk of losing the patient as a result of this collection.  The classic “risk/benefit ratio” must be analyzed.  Perhaps not a popular view, but that ratio changes with each person. As a person, EVERYONE is valuable. But as a CUSTOMER, some are more valuable than others. There are times in which relationships need to be terminated for the benefit of both parties.    

The next time that you find yourself in a conflict, remind yourself of these skills. Are you listening and trying to establish an understanding of the other party? Can you make them feel as though you have addressed their interests? When it’s time for you to discuss your side of the story, are you continuing your empathetic tone?  Lastly, know the economic outcomes of all of your potential decisions.

Dr. Guiliana is a Fellow of the American Academy of Podiatric Practice Management and a member of their Board of Trustees. He is a nationally known lecturer and author on topics pertaining to medical practice management.

Dr. Guiliana's articles and Pearls can be found on the FootZine web site on the "Feeture Article" page: http://www.footzine.com/FZ_P.htm

How far does your memory stretch?  One still-vivid memory for me is getting to go to the shoe store with that neat machine that let my sisters and me see our toes wiggling inside our new shoes.  Even the grown-ups thought that was a pretty good thing.  Little did we realize that what we didn't know about radiation safety could indeed hurt us.   By the mid-1960s, the shoe stores began to remove or disable those early fluoroscopes because of concern about excessive radiation exposure.  What brought this to mind?   An article in the July Smithsonian Magazine about those devices, which can be found at this link:
http://www.smithsonianmag.si.edu/smithsonian/issues03/jul03/object.html

The print version does include a copy of a "Certificate" that was given to customers to provide them with "scientific data" to evaluate how their shoes fit according to the images seen via the fluoroscope, as well as other measurements such as "ankle roll" and "weight distribution".

Hope you enjoy this little memory-lane detour ..... Don't forget to write!

~  Gayle

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