Medical Practice Management - Medical Group Management

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BODY OF KNOWLEDGE FOR

Medical Practice Management 2nd edition

About MGMA Medical Group Management Association (MGMA) is the premier membership association for professional administrators and leaders of medical group practices. Since 1926, MGMA has delivered networking, professional education and resources, and political advocacy for medical practice management. Today, MGMA’s 22,500 members lead 13,600 organizations nationwide in which some 280,000 physicians provide more than 40 percent of the healthcare services delivered in the United States. MGMA’s mission is to continually improve the performance of medical group practice professionals and the organizations they represent. MGMA promotes the group practice model as the optimal framework for healthcare delivery, assisting group practices in providing efficient, safe, patient-focused and affordable care. The American College of Medical Practice Executives (ACMPE) is the standard-setting and certification body of the Medical Group Management Association (MGMA), and promotes the professional growth of leaders. By developing the Body of Knowledge for Medical Practice Management, ACMPE provides a central framework for MGMA resources. MGMA is headquartered in Englewood, Colo., and maintains a government affairs office in Washington, D.C. Please visit mgma.com

BODY OF KNOWLEDGE FOR

Medical Practice Management 2nd edition

What’s inside… 1. About the Body of Knowledge . ................................................................................................. 2 2. Professional Development: Four Competencies . ................................................................ 4 3. Business Operations .................................................................................................................... 6 4. Financial Management .............................................................................................................. 8 5. Human Resource Management ............................................................................................. 10 6. Information Management ...................................................................................................... 12 7. Organizational Governance . .................................................................................................. 14 8. Patient Care Systems ................................................................................................................. 16 9. Quality Management . .............................................................................................................. 18 10. Risk Management ...................................................................................................................... 20 11. Appendix: ACMPE Board Certification and Fellowship . ............................................... 22 12. Credits .............................................................................................................................................24

We encourage you to share it: > Educate others about the profession by sharing the Body of Knowledge with colleagues, staff,

physicians, faculty, students and business associates. For additional free copies of this brochure (Item 5961), visit mgma.com/bok or call toll-free at 877.275.6462, ext. 1888. > T he Body of Knowledge for Medical Practice Management was created by ACMPE and contains

copyrighted material. Anyone is welcome to use it, reprint it, reference it and share it. Permission to reproduce excerpts is granted as long as attribution of ACMPE’s authorship is displayed as follows: The Body of Knowledge for Medical Practice Management was developed by the American College of Medical Practice Executives® (ACMPE®), the standard-setting and certification body of the Medical Group Management Association® (MGMA®).

© 2011, American College of Medical Practice Executives (ACMPE). All rights reserved. Unauthorized use prohibited. Permission to reproduce excerpts is granted so long as specific attribution of ACMPE’s authorship is displayed.

What does it take to be a successful medical practice management executive? You are in one of the fastest growing and most rewarding careers in healthcare management. The role of a medical practice executive is demanding — and always evolving. It requires mastering a broad knowledge base and a deep skill set unique to the group practice environment. How do you objectively define the roles and responsibilities of a medical practice management executive? What qualities and competencies must the successful executive possess? How do you assess an individual’s performance? How will you assess your own capabilities?

group practices across the country, big and small, that use it to develop job descriptions and professional development plans. Ask the university and college health administration programs that use it to develop their curricula. Ask the countless professionals who have already used it to advance their careers.

Just ask the medical practice executives who used the Body of Knowledge for Medical Practice Management to become Certified Members and Fellows of the American College of Medical Practice Executives (ACMPE). Ask the medical

The Body of Knowledge is the most comprehensive, authoritative resource for those who seek to assess and develop their skills and knowledge in this profession.

What is the Body of Knowledge?

What is the origin of the Body of Knowledge?

The Body of Knowledge for Medical Practice Management encompasses a broad spectrum of information about the profession. It defines the unique knowledge and skill set for the medical practice management executive. The role of a medical practice management professional is decidedly dynamic. Changes in the healthcare industry, healthcare legislation, technological leaps in information management and many other factors contribute to the constant evolution of the profession. Every book that’s written, every article published, every change in legislation — they all add to the Body of Knowledge. Quite simply, the Body of Knowledge is the authoritative guide to managing a successful medical group practice.

The Body of Knowledge for Medical Practice Management was developed by the American College of Medical Practice Executives (ACMPE), the standard-setting and certification body of the Medical Group Management Association (MGMA) utilizing a role delineation study and an expert panel of medical practice executives to define and legitimize the unique knowledge and skill set for the medical practice management profession. The Body of Knowledge determines the content and structure for a valid and reliable certification program as well as developing educational resources. The Certified Medical Practice Executive (CMPE) and Fellow in ACMPE (FACMPE) designations are the accepted marks of excellence in the profession.

THE BODY OF KNOWLEDGE: > Engage in continuing education: Many

universities and colleges use the Body of Knowledge to develop curricula. The ACMPE uses the Body of Knowledge for its certification program. MGMA uses it to develop education and information resources. Stay up-to-date with the most current continuing education in the profession.

> Developed by the American College of Medical

Practice Executives (ACMPE) in conjunction with an expert panel of medical practice executives > Defines and documents the professional competencies and areas of responsibility, or domains, required for successful medical group management > Outlines the knowledge and skills necessary to attain board certification in medical practice management through ACMPE

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How will you use the Body of Knowledge? Think of the Body of Knowledge for Medical Practice Management as a blueprint outlining the knowledge and skills to guide your professional development and make your medical practice successful. ASSESS

EXCEL

> Evaluate your skills and knowledge: Use the

> Advance your career: Use the Body of

Body of Knowledge to identify your capabilities in practice management. LEARN > Engage in continuous education: Take

advantage of MGMA’s education programs for every level of experience, from novice to executive. Conferences, seminars, books and online courses focus on expanding your knowledge and skills. Visit mgma.com/acmpe for a comprehensive list of resources. CERTIFY > Become certified: Obtain certification through

Knowledge as the foundation for your job description, compensation structure and employment contract. > Improve your practice: Benchmark key areas

of your practice operations using the Body of Knowledge as the foundation of an operational assessment. > Manage your staff and educate your physician

leaders: Benchmark staff performance reviews, establish professional development plans and inform your physician leaders about the key success factors in practice management.

ACMPE, which is considered a mark of excellence and proof of professionalism in the medical practice management field. ACMPE board certified professionals and Fellows demand higher salaries than noncertified professionals.

The Structure of the Body of Knowledge The Body of Knowledge has been outlined to identify the various knowledge and skills required of today’s medical practice executive. Competencies are woven among eight distinct knowledge areas or domains. Within each domain are tasks or statements detailing the responsibilities that comprise that knowledge area. Tasks are further delineated as specific skill statements. Visit mgma.com/bok to view the most up-to-date tools, resources and educational opportunities. Competencies

Tasks

Competencies are essential themes threaded throughout the Body of Knowledge and form the strong foundation for successful job performance. Pages 4-5 describe the four competencies, or skill sets crucial to performing each domain successfully.

Tasks are individual job responsibilities, activities and functions. Each domain in the Body of Knowledge is defined by a series of tasks. Each task is further broken down into an outline of essential knowledge and skills required to accomplish the specific task.

Domains A body of knowledge is organized into major areas of responsibility, called domains. Pages 6-21 present the eight domains in the Body of Knowledge for Medical Practice Management.

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Body of Knowledge for Medical Practice Management | 3

COMMUNICATION SKILLS PROFESSIONALISM

CRITICAL THINKING SKILLS LEADERSHIP

The distinguishing marks of professional development: Four competencies What qualities and competencies must the successful executive possess? There are four competencies that are critical across every role and responsibility a medical practice management professional performs: professionalism, leadership, communication skills and critical thinking skills. They form the strong foundation for every aspect of successful job performance. For more information and up-to-date resources visit mgma.com/bok.

Professionalism A commitment to achieving professional standards that enhance personal and organizational integrity and contribute to the profession.

> Participate in and encourage service

> Commit to competence, integrity, altruism and

> Demonstrate and promote cultural sensitivity

promotion of the public good > Commit to self-assessment and continuous

learning

and volunteer activities to support the development of colleagues, staff and the community

> Demonstrate knowledge of the healthcare

system and the environment in which it operates

> Support collegial relationships with peers

through networking, information-sharing and mentoring

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Leadership Collaborating with and supporting the practice’s physician leadership to provide strategic direction to the organization. > Uphold and advocate ethical standards and

decision-making > Foster teamwork between clinical and

administrative staff > Understand effective techniques for working

with boards and governance structures

> Focus on implementation of organizational

strategy > Inspire others toward a shared vision > Support innovation and creativity > Demonstrate effective change management

skills to ensure effective patient care and safety as well as improve practice performance > Understand and effectively manage

expectations

Communication skills The skills necessary to elicit multiple points of view from internal and external sources, facilitate constructive interaction and present information clearly and concisely. > Write clearly and effectively > Speak clearly and effectively before

individuals and groups in formal and informal settings > Develop effective interpersonal skills > Seek out and incorporate the views of

stakeholders for decisions that affect the quality of care, work environment and business stability of the organization

> Listen and respond effectively to the ideas and

thoughts of others > Recognize and use nonverbal forms of

communication > Demonstrate effective negotiation and

facilitation skills > Support and promote effective conflict

resolution > Provide effective communication linkages

within the organization and to its external environment

Critical thinking skills A systematic, logical approach to problem-solving, decision-making and the development and administration of systems to address day-to-day issues and the long-term improvement needs of the practice. > Collect and analyze data from internal and

external sources relevant to each situation > Demonstrate the ability to discriminate

between important and superfluous aspects of situations to support sound decision-making

> Understand cause-and-effect relationships > Learn from mistakes > Manage the overload of information and stress

generated from diverse situations that occur in the practice and in your personal life > Implement planning methods and tools,

including project management, process improvement and systems thinking

> Ask the right questions when making

decisions

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How do you develop and implement an effective business plan? How do you ensure the effective management of day-to-day operations? Business operations in a medical practice include planning, purchase of materials and equipment, facilities management and maintenance, business partnerships, and marketing and communication plans.

Business Operations 1 Develop, implement and monitor business operation plans. > A  lign business plan with mission and strategic plan of the organization > I dentify types of business plans and plan components > Identify organizational goals and needs > P  lan for the future, set goals and assign responsibility and accountability > R  eview and monitor effectiveness of business plan and operations > Understand project management techniques > F  ind opportunities to increase revenue streams (e.g., new ancillary services, products), including needs assessment, feasibility and return on investment

3 Manage facilities planning and maintenance activities to meet the organization’s current and future needs. > E  nsure effective facility planning, design and layout to ensure efficient work flow, storage, patient flow and patient safety > O  versee facility management and preventative maintenance, including leasing, landscaping, housekeeping, fire drills and evacuation > A  pply utility requirements and maintenance inspection schedules for mechanical, electrical and plumbing > E  nsure regulatory compliance, including Occupational Safety and Health Administration (OSHA) and Americans with Disabilities Act (ADA)

2 Develop, implement and oversee systems for the purchase of materials and equipment. > I dentify types of supplies and equipment, including fixed assets, nonbillable supplies and billable supplies > E  stablish procedures for ordering, use and monitoring of supplies and equipment > E  stablish purchasing procurement procedures, including authorization, approval and reconciliation > I mplement an inventory control plan for supplies and equipment > E  nsure proper disposal of biohazardous waste products

“Today’s changing market demands education, business savvy and human relation skills that only a manager who has achieved credentialing in ACMPE can offer.” ­ – Katherine Mack, business/case manager, Coastal Physical Medicine and Rehabilitation Services, New Bern, N.C.

> U  nderstand equipment purchase vs. lease options > Ensure effective vendor relationships 6 | Body of Knowledge for Medical Practice Management

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4 Manage discernment process for identification and utilization of outsourced expertise and business partners. > D  etermine the need for outsourced expertise for the organization > E  stablish selection requirements and process for business partners > P  ursue and establish partnerships and strategic alliances to strengthen competitive position > U  nderstand the typical knowledge and skills that financial advisors, accountants, attorneys, architects and others can provide to the practice > E  ffectively manage and monitor partnerships and alliances

5 Develop and implement a marketing and communications plan. > F  ocus on customers, including patients, other physicians and groups, payers, vendors and the community > A  pply the components of marketing and communications plans, including situational analysis, market analysis and consumer analysis > A  nalyze local market trends, demographics and current economic influences > E  mploy marketing research, market strategy and advertising > Use public and media relations > E  stablish corporate image and branding strategy > P  romote community outreach and collaboration

Refer to the Patient Care Systems domain for tasks that relate to the operational processes surrounding the patient encounter.

RECOMMENDED RESOURCES: For current Business Operations articles, tools, resources and education programs visit mgma.com/BOKBusinessOperations.

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How do you develop and maintain financial systems to ensure a profitable practice? Financial management in a medical group requires skills in accounting, budgeting, revenue cycle management and financial analysis.

DOMAIN:

Financial Management 1 Develop and implement the organization’s budget to achieve organizational objectives. > U  nderstand types of accounting, including financial, tax and managerial

2 Establish internal controls for cash management. > A  ssess risk and identify where potential loss can occur > Implement bank reconciliation procedures

> A  pply financial accounting principles, including generally accepted accounting principles (GAAP)

> E  stablish a process to monitor and evaluate internal financial control processes

> U  nderstand cash and accrual accounting and modified accrual accounting

> M  onitor actual revenue and expenses to budget and prior period amounts on a regular basis

> U  nderstand budgeting, types of budgets and budget methodologies > O  versee accounts payable and accounts receivable > Implement a chart of accounts > Understand methods of depreciation > Track the flow of financial information > Understand accounting systems and software > Understand capital financing

> D  evelop standard procedures and separation of responsibilities for accounting functions > R  econcile the billing system with the accounting system > D  evelop and implement policies for approvals, authorizations, verifications, check signing and invoices

3 Implement and maintain a process for external financial audits. > D  etermine need for an external audit, review or financial compilation for the practice’s financial statements > Understand types of audits and audit reports > C  omply with generally accepted auditing standards (GAAS) > E  stablish effective relationships with accountants and auditors

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4 Develop and implement revenue cycle management and accounts receivable management. > M  anage front-end operations, including scheduling, insurance verification, authorizations, co-pay collection, medical record process, etc. > O  versee medical record documentation, encounter form and coding > Manage charge audit, charge entry and fees > Ensure proper claims submission and edits > I mplement accounts receivable follow-up, including paid claims, unpaid claims, denied claims, insurance collections and patient collections > M  onitor net charges and cash collections trends, days in accounts receivable, percent of accounts receivable more than 90 days

5 Analyze and monitor financial performance and report financial results to stakeholders. > U  nderstand elements of financial statements, including balance sheet, assets, liabilities, equity, investments, distributions, revenues, expenses, gains, losses and income > C  onduct financial analysis, including measures of profitability, profitability ratios, current/prior period comparison, comparisons by department/location/division and productivity analysis > C  onduct financial benchmarking, including revenue, expenses, adjusted collection rate, collection rate by payer, payer mix, reimbursement, productivity, accounts receivable and profitability > C  ommunicate financial information to stakeholders such as graphs, narratives, presentations, dashboards, scorecards and executive summaries

6 Direct the payroll process. > E  stablish policies and procedures to ensure the organization is paying employees the correct amount for the exact hours worked > I mplement reporting system to gather employee work hours > E  nsure accurate record-keeping for payroll records > E  nsure regulatory compliance for payroll filing, including Federal Insurance Contributions Act (FICA), social security, deferred compensation and workers’ compensation > E  stablish guidelines and process for monitoring payroll recorded benefits > C  omplete all payroll audits as required by tax agencies, insurers or government entities

7 Establish and maintain the organization’s banking, investment and other financial relationships. > D  evelop effective working relationships with bankers, accountants, auditors, consultants, real estate professionals, life insurance professionals, attorneys and other outside financial professionals > E  stablish periodic regular review with physicians regarding financial relationships

8 Develop relationships with individual insurance carriers to optimize contract negotiations and maintenance of existing contracts. > E  stablish formal review of insurance carrier contracts as well as auditing contract payments > A  nalyze payer performance, including timely payment, correctness of payment and denials > Manage contracts > Develop negotiation skills > E  stablish personal contacts within each major carrier

RECOMMENDED RESOURCES: For current Financial Management articles, tools, resources and education programs visit mgma.com/BOKFinancialManagement.

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How do you utilize human resources to achieve and enhance organizational performance? Human Resource Management involves staff recruitment and retention, an effective staffing strategy, training, a performance evaluation process, a personal commitment to enhancing your knowledge base and compliance with employment laws.

Human Resource Management 1 Coordinate the recruitment and orientation process of clinical and nonclinical staff. > I dentify recruitment sources and techniques, including internal posting, advertising, search firms and temporary agencies > R  ecruit clinical and nonclinical staff to meet the skill mix and staff needs of the organization and its culture > R  ecruit with an emphasis on customer- and patient-focused skills > Define job scope and develop job descriptions > D  evelop interviewing skills, ensuring regulatory compliance > E  stablish effective selection process, including pre-employment screening, background, criminal and reference checks

2 Manage the retention of clinical and nonclinical staff. > M  anage employee motivation and teamwork to obtain high performance > E  nsure a healthy workplace environment, including conflict resolution process and grievance procedure

3 Develop and monitor an effective staffing strategy. > I dentify and analyze staffing needs and expectations > I dentify the various roles staff and physicians play in a group practice > E  stablish job classification systems, including position analysis, job descriptions and working conditions > E  nsure the appropriate number of clinical and nonclinical staff with the correct mix of skills > A  nalyze the impact of work space on staffing levels > Use and benchmark data for effective staffing

4 Develop, implement and evaluate performance management programs for clinical and nonclinical staff. > I mplement performance management review system, including performance standards, professional development plans, goal-setting, schedule for periodic reviews and evaluation tools > E  stablish policies and procedures for job promotions

> A  nalyze employee turnover and develop a strategy for improvement

> E  nsure an effective process to manage performance and behavior

> I mplement an employee satisfaction survey to measure employee engagement and to create opportunities to enhance the workplace

> M  aintain documentation and personnel records

> P  rovide access to an employee assistance program

> I mplement policies and procedures for terminating employees

> E  nsure accurate record-keeping for personnel records > Understand labor relations 10 | Body of Knowledge for Medical Practice Management

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5 Develop and implement staff compensation and benefit plans

7 Establish systems and processes for

> U  se market data to develop and monitor a wage and salary strategy

awareness, education and compliance with employment laws and regulatory standards.

> E  nsure effective compensation and benefit administration

> M  aintain an updated employee handbook of human resource policies and procedures

> E  valuate types of benefit plans, including defined benefits, defined contribution, 401(k), 403(b), self-directed, employer-directed and profit sharing plans

> Ensure staff education and training



• Department of Labor

> E  valuate insurance, retirement and severance benefits



• Fair Labor Standards Act (FLSA)



• A mericans with Disabilities Act (ADA)

> Ensure confidentiality of compensation data



• Family and Medical Leave Act (FMLA)

> O  versee compensation for clinical staff — refer to the Organizational Governance domain, Task 5



• E  qual Employment Opportunity Commission (EEOC)



• Equal Pay Act

6 Provide systems, processes and structure



• Civil Rights Act/Title VII



• Age Discrimination in Employment Act



• Affirmative Action



> F  oster a culture of learning and professional development

• E  mployee Retirement Income Security Act (ERISA)



• Workers’ compensation



> O  versee training, including orientation, management, technical skills, career development, certification and cross-training

• H  ealth Insurance Portability and Accountability Act (HIPAA)



• C  onsolidated Omnibus Budget Reconciliation Act (COBRA)



• O  ccupational Safety and Health Administration (OSHA)



• National Labor Relations Act (NLRA)

for administrative and clinical training for medical providers, employees and students.

> I mplement effective training programs that include on-the-job training processes, continuing education and professional development activities > U  nderstand adult learning styles and delivery methods, including computer-based training, distance learning and classroom teaching > E  stablish policies and procedures for training, including time off for training, paid attendance, and continuing education requirements of professional and licensed staff

> E  nsure compliance with employment laws, including but not limited to:

8 Provide personal commitment to enhance knowledge, skills and abilities in healthcare administration. > D  evelop management and leadership skills to enhance performance and effectiveness > E  ngage in continuous learning to acquire advanced professional knowledge > D  emonstrate and foster ethical standards, behavior and decision-making > D  evelop interpersonal skills and selfawareness

RECOMMENDED RESOURCES: For current Human Resource Management articles, tools, resources and education programs visit mgma.com/BOKHumanResourceManagement.

> D  evelop effective communication skills including written communication and presentation skills > D  evelop effective stress management and time management skills > Display self-confidence and personal integrity

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We live in an electronic world and you oversee countless pieces of information. How will you manage evolving technologies, practice management systems, electronic health records and compliance? In a medical practice, robust information systems and strong information management capabilities are essential strategic resources.

Information Management 1 Develop and maintain appropriate internal communication pathways for clinical and nonclinical staff. > E  stablish communication system for patients to reach physicians and support staff > E  stablish communication system for clinical and nonclinical staff to communicate among themselves and with other healthcare providers and organizations, and to respond to patient requests > E  nsure good communication pathways through careful planning, selection of appropriate communication channel and a consistent professional message > O  versee meeting management, including facilitation skills, agendas, decision-making processes and record-keeping > F  oster ongoing development of effective interpersonal communication skills > U  nderstand the interplay and options for internal and external communication systems and channels, including telecommunications, answering service, voice mail, fax, Internet, Web sites, e-mail, cellphones, pagers and mail services

2 Develop a technology plan that establishes the criteria for selection and implementation of information technology, including computer systems, Internet strategies and telecommunications. > D  evelop an effective technology plan and budget to support business needs and organizational goals, including an information system needs assessment > U  nderstand types of information technology systems and applications used in a medical practice, including practice management systems, accounting and billing systems, electronic communication, EHRs, prescription management and disease management > E  nsure appropriate information technology selection, procurement and installation, including request for proposals, a selection committee, physician buy-in, vendor relationships, contract negotiation and technical support > E  nsure effective technology implementation, including installation, training, work flow redesign, process integration, reporting and ongoing support > E  nsure maintenance of technology systems, equipment and services, including personal computers, networking, telecommunications, Web portals, application systems, software and technical support > E  nsure training and support for clinical and nonclinical staff

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3 Plan and design a technology security

5 Develop and implement processes

process to protect patient and practice data systems.

to comply with mandated reports of specified patient issues to regulatory agencies.

> E  nsure effective security processes and standards for technology systems and applications as well as current technological threats

> U  nderstand reporting requirements for medical conditions as established by state and federal department of health

> E  nsure information integrity, security and confidentiality according to the Health Insurance Portability and Accountability Act (HIPAA)

> G  ain knowledge of disease, vaccine and other registries that require physician reporting > E  nsure compliance with federal and state requirements for biohazard or epidemic response requirements

> O  versee database management and maintenance





> D  evelop a technology disaster management plan > E  stablish and implement security audit procedures for all technology systems > D  evelop policies to address employees’ personal use of the practice’s technology

“The ACMPE certification program is a good example

> D  evelop policies to prevent the theft or loss of technology equipment, including items which contain employee or patient data

of how to ensure that our professionals possess basic

4 Manage medical information systems

competencies in a variety

including medical records, medication administration and healthcare related document storage. > D  evelop and maintain policies for release, update and maintenance of confidential information, in accordance with Health Insurance Portability and Accountability Act (HIPAA)

of areas.” ­

– E  laine Bertles, director of clinical services, Watson Clinic LLP, Lakeland, Fla.

> E  stablish policies for document and electronic record storage, retrieval and destruction > E  stablish requirements and processes to ensure all technological systems have fault-tolerance in accordance with accepted standards for continuous availability > E  stablish policies and procedures that adhere to regulatory requirements for the prescribing, transmission and monitoring of patient medications > E  nsure security of protected health information (PHI)

RECOMMENDED RESOURCES: For current Information Management articles, tools, resources and education programs visit mgma.com/BOKInformationManagement.

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Effective governance is essential to a successful medical practice. How do you ensure effective governance and leadership through policies, long-term strategies and the strategic direction of the organization?

Organizational Governance 1 Facilitate the establishment and monitoring of the appropriate corporate legal structure for the organization. > U  nderstand types of legal structures, including sole proprietorship, professional corporation, limited liability partnership, limited liability company and business corporation > R  ecognize liability and taxation issues related to the legal structure > M  aintain legal compliance with corporate structure, including tax law, physician selfreferral (Stark law), anti-kickback law, False Claims Act and antitrust laws > U  nderstand the impact of the legal structure on the governance system and culture of the organization

> U  nderstand board composition and procedural rules > M  aintain adherence to corporate bylaws and review annually > P  rovide orientation and ongoing training for board and committee members > Ensure record-keeping and record retention > Maintain organizational history > P  articipate in board/committee meeting management and board evaluation > Ensure effective succession planning

3 Lead the integration of the corporate mission statement into all aspects of the organization’s culture.

> Use outsourced expertise of an attorney

> E  ffectively communicate the organization’s mission, vision and values to influence the strategic direction

> D  evelop shareholder agreements and physician employment contracts

> P  rovide leadership, innovative thinking and change management

> U  nderstand the impact of independent practice associations (IPAs), hospitals and ancillary providers

> U  nderstand organizational culture, including patterns of behavior, shared values, traditions, politics, power and group interaction

2 Facilitate organizational governance structure and maintain proper corporate record-keeping of strategic decisions. > S  upport the governing body in the development of a committee structure to meet the needs of the organization

> U  phold and advocate ethical standards, behavior and decision-making > Foster a culture of trust and respect > M  anage the intricate interrelationships of the organization, staff and stakeholders

> U  nderstand types of committees within a governance structure, including finance, personnel, quality review, research, recruiting, performance and ad hoc > D  ocument the roles and responsibilities of the board of directors and committees 14 | Body of Knowledge for Medical Practice Management

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4 Lead development of the organization’s strategic plan and its implementation. > U  nderstand components of a strategic plan, including mission, vision, values, goals and objectives > C  onduct SWOT (strengths, weaknesses, opportunities and threats) analysis > F  acilitate group self-assessment and stakeholder needs assessment > Understand market trends > Facilitate board monitoring and review > F  acilitate board retreat and meeting management

5 Establish, communicate, implement and monitor production and compensation standards for physician and midlevel professional staff. > E  nsure linkage between the compensation plan and the organization’s mission, goals and culture > I mplement an effective allocation system of revenues and expenses, serving as a performance, incentive and feedback system for physicians > U  nderstand components of an effective compensation system, including practice and physician goals, rewarding productivity and clarifying physician responsibility and accountability > R  ecognize compensation plan considerations, including practice size, practice setting, capitation and on-call obligations

6 Implement and/or support organization leadership management of clinical staff conduct and performance expectations or programs. > D  ocument professional standards of conduct and expectations > E  stablish professional standards violation policy for physicians > E  ffectively communicate and clarify performance expectations > S  upport organization leadership, the governing body or a professional standards committee, regarding conflicts of interest, performance issues and disruptive behavior

7 Foster the growth and development of physician leaders as knowledgeable, participative stakeholders. > W  ork effectively with the leadership to foster a team culture > E  nsure effective communication between physicians and administrative staff > F  oster the development and growth of a physician/administrator leadership team > C  ommunicate, educate and facilitate physician understanding of good business standards and financial practices > Facilitate conflict resolution > Demonstrate professional integrity

8 Encourage and lead participation in advocacy endeavors at local, state and national levels.

> U  nderstand types of compensation plans, including individualistic models, teamoriented models and base salary plus incentive

> U  nderstand how social, political and legal issues affect access, cost and quality of healthcare

> U  nderstand revenue allocation methods, including actual collections, gross or net charges, work RVUs and hybrid measures

> P  articipate in local, state and national advocacy efforts affecting healthcare management

> U  nderstand expense allocation methods, including cost accounting and modified cost accounting

> Educate staff on advocacy issues

> U  nderstand practice buy-in, buy-out and transition arrangements > E  nsure regulatory compliance, including Stark and anti-kickback laws

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> E  ncourage and participate in community and civic activities

RECOMMENDED RESOURCES: For current Organizational Governance articles, tools, resources and education programs visit mgma.com/BOKOrganizationalGovernance.

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A critical component of medical practice management is the effective and efficient processes surrounding the patient encounter. How do you ensure that patients receive the best possible care, focus on patient safety and strive for efficient operations?

Patient Care Systems 1 Establish and monitor business processes to ensure effective and efficient clinical operations. > E  nsure effective operations to ensure clinical quality-of-care standards > Understand and monitor patient outcomes > G  ain knowledge of emerging models for healthcare delivery > Ensure effective nurse triage systems > U  nderstand principles of clinical trials research

2 Provide relevant and accurate resources to enhance patients’ knowledge, understanding and participation in their medical care. > E  stablish patient communication procedures, including appointment confirmations, followup, notifications and financial counseling

3 Develop and implement a referral management process. > U  nderstand the referral process and plan requirements > Enhance referrals in and out of the practice > E  stablish administrative protocols for followup and reporting > D  evelop and foster good relationships with referral physicians

4 Design efficient patient flow patterns to maximize physician schedules. > E  stablish an effective patient flow process, including registration, appointment scheduling, patient arrival and check-in, encounter management, and patient checkout > M  anage practice’s daily flow, including emergencies, cancellations and no-shows

> F  acilitate patient educational support and materials

> U  nderstand scheduling methodologies and systems for physician maximization

> E  stablish procedures for informed consent and disclosure of unanticipated outcomes

> E  nsure effective scheduling of clinical and nonclinical staff

> E  nsure documentation and communication of the patient’s treatment plan

> Establish emergency call procedures

> Oversee prescription and refill management > E  stablish policies and procedures for termination of care and the patient relationship

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5 Manage front office operations to maximize patient satisfaction, collection of payments and customer service efforts. > Establish call center processes and procedures

“For manager or executive

> Establish pre-visit registration process

openings, we always pay

> Ensure effective patient check-in

particular attention to

> Oversee billing and collections > Promote patient-focused customer service > E  nsure confidentiality and compliance with the Health Insurance Portability and Accountability Act (HIPAA)

6 Implement a plan to control

candidates who are board certified or Fellows in ACMPE. Certification indicates broad and thorough knowledge of practice

pharmaceutical supplies.

management — and that can make

> U  nderstand types of pharmaceuticals, including vaccines, injectable medications, narcotics and samples of prescription medications

a real difference to our business.”

> E  stablish procedures for security, storage and access of pharmaceutical supplies

– Frank Ford III, FACMPE, vice president, physician services, Mission Hospital, Asheville, N.C.

> E  stablish an inventory system, including rotation of stock, tracking of utilization and disposal > E  nsure regulatory compliance of pharmaceutical supplies > E  ffectively manage relationships with pharmaceutical sales representatives

RECOMMENDED RESOURCES: For current Patient Care Systems articles, tools, resources and education programs visit mgma.com/BOKPatientCareSystems.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 17

For your practice to thrive, quality management programs must be developed for both patients and staff. How will you best implement those programs? How will you ensure the effective development and implementation of continuous process improvement?

Quality Management 1 Design and implement a quality

3 Develop and oversee patient satisfaction

management system that leads to the improvement of healthcare delivery and ensures patient safety.

and customer service programs.

> E  ngage clinical and nonclinical staff to apply quality management approaches to address and ensure safety for patients and staff as well as improve business and clinical operations

> D  esign and implement patient satisfaction survey, analyze results and implement improvements to operations and customer service

> U  nderstand quality management approaches and philosophies, including Total Quality Management, Six Sigma and Lean Thinking

> Implement customer service training for staff

> A  pply quality management tools such as process maps, run charts, Pareto diagrams, flowcharts, affinity diagrams and decision matrices > U  nderstand the cost of quality, including internal failure costs, external failure costs, appraisal costs and prevention costs > E  stablish continuous process improvement review and practice assessment, including coding documentation, risk assessments, chart audits and auditing regulatory compliance

2 Monitor the peer review process for clinical staff.

> U  nderstand and select an appropriate survey instrument to measure patient satisfaction

> Foster a customer service focus and culture

4 Identify, develop and maintain benchmarks for establishing practice performance standards. > I mplement a data collection strategy and plan, identifying meaningful measurements to benchmark > D  evelop effective benchmarking reports, such as dashboards and scorecards > I dentify key metrics for financial growth, customer service, quality and innovation > I dentify appropriate internal and external benchmark data to guide strategy performance

> U  nderstand malpractice insurance carriers’ requirements for reporting, researching and defending claims > E  stablish and oversee protocols and processes for managing adverse events > S  upport physician leadership in the design and implementation of an effective peer review process

18 | Body of Knowledge for Medical Practice Management

mgma.com/acmpe

5 Create internal processes and systems

6 Develop and monitor a program for staff,

to participate in pay-for-performance programs to enhance healthcare quality.

business and equipment credentialing and licensure.

> D  evelop a process for capturing clinical data needed for reporting

> I mplement a process for physician enrollment in health plans for hospital privileges and to maintain medical licenses

> M  easure effectiveness and value of participating in pay-for-performance programs > E  ngage physicians in establishing clinical pathways and clinical protocols > E  ngage physicians in participating in pay-forperformance programs > U  nderstand third-party quality measurement requirements such as the Health Plan Employer Data and Information Set (HEDIS), the National Committee for Quality Assurance (NCQA) and the Physician Quality Reporting Initiative (PQRI)

> E  nsure regulatory compliance with licensing and credentialing requirements > E  nsure the organization meets accreditation requirements for organizations and facilities, including the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Accreditation Association for Ambulatory Health Care (AAAHC) > E  nsure compliance with requirements for clinical laboratory services, i.e., Clinical Laboratory Improvement Act (CLIA)

“Obtaining the CMPE designation is essential for practice managers to elevate their credibility and our profession.” – Valerie L. Johnson, CMPE, business officer/administrator, Health Center Montgomery, University of AlabamaBirmingham, Montgomery, Ala.

RECOMMENDED RESOURCES: For current Quality Management articles, tools, resources and education programs visit mgma.com/BOKQualityManagement.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 19

Risk management is essential to protect the assets of the organization. How do you ensure compliance with all regulatory bodies and protect the practice from medical malpractice and adverse legal events?

Risk Management 1 Develop and implement a risk management plan to ensure a safe environment for patients, staff and visitors. > U  nderstand risk management process components, including risk identification, risk analysis, loss control alternatives to manage potential risks, and monitoring risk control techniques > D  evelop a risk management plan including policies on blood-borne pathogens, emergency response, respiratory safety, fire safety, personal protective equipment, material safety data sheets and right-to-know for hazard communication materials > P  eriodically monitor new issues relating to risk management as they arise and incorporate into the risk management plan > C  onduct regular and ongoing risk exposure monitoring > E  nsure compliance with legal requirements of record-keeping, including retention, storage, retrieval and destruction > E  nsure staff are properly trained in all aspects of risk and safety, including infection control, environmental hazards and medication errors

2 Develop and implement policies and procedures to manage the impact of adverse legal events. > A  ssess and procure insurance coverage, including professional liability, medical malpractice liability, general liability, property and casualty, and directors and officers liability > U  nderstand and identify possible adverse legal events > U  nderstand personal impact of legal events on physicians and the organization > I nvestigate all grievances, claims and complaints against the organization, assessing legal ramifications > U  se and develop effective relationships with insurance brokers and legal counsel

3 Establish a plan for disaster response and recovery. > C  oordinate disaster preparedness, including planning, implementation and recovery > E  stablish emergency and evacuation procedures > U  nderstand and identify the organization’s vulnerabilities to various type of disasters and catastrophic events > D  evelop an effective disaster recovery plan to ensure business continuation

20 | Body of Knowledge for Medical Practice Management

mgma.com/acmpe

4 Develop and implement a compliance program for federal and state laws and regulations. > U  nderstand the components of a compliance program, including standards of conduct, designation of a compliance officer, effective training, effective lines of communication, auditing and monitoring, disciplinary guidelines and corrective action initiatives > Conduct periodic compliance audits > E  nsure regulatory compliance, including but not limited to:

• D  epartment of Health and Human Services (HHS), Office of Inspector General (OIG)



• P  hysician Self Referral – Stark law, antikickback law and antitrust



• C  enters for Medicare & Medicaid Services (CMS)



• H  ealth Insurance Portability and Accountability Act (HIPAA)



• O  ccupational Safety and Health Administration (OSHA)



• Clinical Laboratory Improvement Act (CLIA)



• C  enters for Disease Control and Prevention (CDC)



• E  mployment laws and regulations — refer to the Human Resource Management domain, Task 7

“Early in my career, I was ‘learning on the fly’ until I heard about MGMA and ACMPE from a colleague. The board certification process gave me a much clearer picture of how all areas of practice management are connected and the tools I need to really move my practice forward.” ­– R  uth Lander, FACMPE, practice administrator, Columbus Oncology Associates Inc., Columbus, Ohio

RECOMMENDED RESOURCES: For current Risk Management articles, tools, resources and education programs visit mgma.com/BOKRiskManagement.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 21

APPENDIX

Your pathway to ACMPE board certification and Fellowship One of the best career decisions you can make as a medical practice management professional is to earn board certification and Fellowship through the American College of Medical Practice Executives (ACMPE). The Certified Medical Practice Executive (CMPE) and Fellow in the ACMPE (FACMPE) designations command the highest levels of respect and recognition in your field.

Becoming a Certified Medical Practice Executive (CMPE)

Becoming a Fellow in the ACMPE (FACMPE)

ACMPE uses the Body of Knowledge for Medical Practice Management as the foundation for assessments, examinations and other resources for the board certification program. The board certification process requires you to:

The FACMPE designation is the highest distinction in medical practice management. It demonstrates that you have made significant contributions to your career and your profession. To advance to Fellow status, individuals will need to:

> Enter the certification program > Meet eligibility requirements > Pass a 175-item, multiple-choice objective

exam that measures your understanding of medical practice management principles and practices > Pass a written essay exam that gauges your

in-depth knowledge of medical practice management, problem-solving and decisionmaking skills as well as your ability to communicate effectively in writing

> Complete the requirements to earn the

Certified Medical Practice Executive (CMPE) designation > Enter the Fellowship program > Write a professional paper or case studies > Earn and maintain continuing education hours

Visit mgma.com/fellowship for more information.

> Earn and maintain a minimum of 50

continuing education hours Visit mgma.com/certification for more information.

> Take the Personal Inventory self-evaluation:

Assess your current skills and knowledge in the profession at mgma.com/inventory. Get more information and resources online: Visit mgma.com/bok to view the most up-todate resources, tools, recommended books, seminars and educational opportunities to support your professional development and practice improvement.

22 | Body of Knowledge for Medical Practice Management

mgma.com/acmpe

11%

9%

6% 19% 12% Preparing for the certification exams The Body of Knowledge is the outline for the ACMPE objective and essay examinations. It is designed 16% the specific content 16% that may be tested. The objective to help you prepare for the exams by identifying exam is designed with the percentage emphasis presented on this page for each of the eight knowledge 11% are essential to performing each knowledge domains. Additionally, the four professional competencies domain successfully: professionalism, leadership, communication skills and critical thinking skills. Identifying and defining those competencies are part of the exams.

Risk Management Quality Management

6%

9%

11%

11%

9%

6% 19%

Patient Care Systems

12%

Business Operations

19%

Financial Management

12%

11 

Organizational Governance

16%

16%

16% 16% 11%

11%

6%

H  uman Resource Management

Information Management

12%

TIPS: > Are you ready to realize your professional development goals and become certified? Take the

16%

first step and assess your knowledge and skills with the Personal Inventory — a free, online tool at mgma.com/inventory. > Identify strengths and weaknesses with the in-depth, member-recommended Knowledge

Assessment. Find out more at mgma.com/assessment. > Prepare for the certification exam by purchasing the Certification Exam Workbook at

mgma.com/workbook. > Find the most current information about certification and Fellowship at mgma.com/acmpe.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 23

Thank you to the ACMPE-member volunteers for their expertise and dedication to the Body of Knowledge update project. These individuals served as subject matter experts to address the evolving roles and skills required for a medical practice executive.

CREDITS: 2007-2008 ACMPE Body of Knowledge Task Force: > Becky L. Ayers, MHA, MBA, FACMPE

> R. Andrew Nelson, CMPE, MBA

> David A. Caldwell, MPH, MBA, CMPE, FACHE

> Jayne L. Testa, CMPE

> Rebecca S. Dean, MA, FACMPE

> Ed Whitver, MBA, CMPE, CAE

> Frank Ford III, MBA, MHS, FACMPE

> Debra J. Wiggs, FACMPE

> William S. Henderson, FACMPE > Samantha Kempster, MBA, CMPE

Psychometric consultant: > Stephen B. Johnson, PhD, CASTLE Worldwide

> Janet E. McIntyre, MBA, FACMPE > James B. Mitchell, CMPE > Charles D. Moses, MBA, MSHA, FACMPE,

Staff liaison: > Laura Woodruff, MA, ACMPE director

CMQM/OE

Production Credits Content Editors: > Lindsay Hayes, MA > Heather McHugh, MBA

24 | Body of Knowledge for Medical Practice Management

mgma.com/acmpe

The Body of Knowledge for Medical Practice Management is the most valid and reliable resource available in the field. Developed by ACMPE, it is based on an extensive study of group practice management professionals that identified the current knowledge and skills necessary for competent performance.

The American College of Medical Practice Executives (ACMPE) is the standard-setting and certification body of the Medical Group Management Association (MGMA).

BODY OF KNOWLEDGE FOR

Medical Practice Management

104 INVERNESS TERRACE EAST ENGLEWOOD, CO 80112-5306

Toll-free 877.275.6462, ext. 1869 acmpe.com | mgma.com

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