Five Hiring Tips for Medical Practice Managers

Your new billing clerk looked great on paper. She had all the right credentials, interviewed well, and appeared eager to hit the ground running. Three weeks after you brought her aboard, however, it was painfully clear she was in over her head.

Office managers and administrators often fill vacant positions with new recruits who don't measure up. As a result, they expose their practice to legal risks when they let those workers go. "Most people inflate their resumes," says Keith Borglum, a medical practice consultant with Professional Management & Marketing in Santa Rosa, Calif. "Everybody has skills and weaknesses. That's part of the risk of being a business owner and the burden of being an employer."

By using proper hiring and firing techniques, however, you can find the right candidates the first time around, lower costly turnover, and insulate your practice from the majority of frivolous claims.

HIRING

• Test run. Before offering any applicant the job, says Borglum, test for the skills you seek. That may include software literacy, diagnostic or procedural codes, math or spelling, or people skills. "If that person is going to be independently performing reviews of a staff member, have them role play a review, or ask them how they'd handle certain situations," says Borglum. You can create your own informal tests, or pay for online assessment tools such as totaltesting.com.

• Trust but verify. It takes 10 minutes, but can yield so much. A quick call to your top candidates' references provides valuable insight on their strengths and weaknesses. You might find out they exaggerated their employment history, lied about their degree, or were fired for harassing coworkers.

• Team effort. When it comes to hiring right, input is the key. Managers should never try to go it alone, says Bo Snyder, a practice management consultant in Kalamazoo, Mich. "Peer interviewing is very effective," he says. "Get your best team players and your most customer service-focused employees to interview all of your candidates. They will help you guard the gates." The act of soliciting their input, says Snyder, has the added benefit of boosting morale. "It's an honor and a perk to be asked to sit on that team," he says.

• Ease in. Before you commit to a full-time hire, and the benefits that go along with that, try using a probationary period to observe and evaluate his performance, work habits, and conduct. Ninety days is standard. During that time, your practice and the prospective employee may terminate employment immediately, with or without cause. If you're still not sold when the three months end, don't be afraid to extend the probationary period, says Snyder. This is your last, best chance to get it right. "Just say, 'Let's make sure and give this a little longer,'" says Snyder.

• Reprioritize. Recruiters in the medical field get too hung up on work experience, says Rob Saunders, a senior consultant with San Francisco-based McKesson Business Performance Services. As the industry becomes increasingly complex, he notes, practices will need to select for adaptability, intelligence, and communication skills to remain competitive. "Too many times this industry tends to recycle people whether or not they're competent," says Saunders. "Just because they've been doing the job for 30 years doesn't mean they were good at it."

FIRING

Despite all efforts to recruit effectively, however, a few bad apples will slip through the cracks. They may be chronically tardy, rub patients the wrong way, repeat costly mistakes, or merely fail to meet expectations. Don't let mediocrity slide, says Borglum. It sends a message to your best and brightest that your standards are subpar, which results in a "why bother" mentality. Instead, address infractions promptly and put disciplinary processes in place that set your team members up to succeed, but culminate in their termination if performance doesn't improve.

• Three strikes. Many practices embrace a progressive disciplinary process, using verbal instruction and feedback first to correct performance shortfalls, followed by written reprimands on the second occurrence, and finally termination. At every step, managers should set measurable goals, invite input from the employee and provide resources to help them develop professionally. They should also document each disciplinary action in the employee's file.

• Be consistent. Managers and physician owners must also be consistent. You can't bend the rules for your favorite medical assistant and fire the receptionist for the same infraction. If the employee in question is in a protected employment category, based on race, religion, gender, or age, make doubly sure that no pattern of termination even appears to exist. All employees should be treated the same, lest you open the door to discrimination claims, says Ricki Roer, an attorney with Wilson Elser Moskowitz Edelman & Dicker in White Plains, N.Y.,

• Keep your cool. Employees are often angry or defensive when dismissed, which can fan the flames of litigation. Give them an opportunity to vent and offer feedback. At no point during a termination should managers escalate the emotional response by making personal attacks or expressing frustration, says Snyder. Keep it professional, cite the reasons for their dismissal, and thank them for their service.

• Have a witness. Always include a third party when telling a staff member her time is up. "That way they can't make a claim that something inappropriate happened," says Snyder. Others recommend recording the exit interview. Borglum concurs. "There are bad employees out there and you have to use safe hiring and firing practices," he says, recalling one employee of a former client who feigned a back injury after being fired (for failing to disclose she was on work release from prison) and later filed a worker's compensation claim.

• Give them dignity. Unless the employee poses a serious threat of violence or vandalism, allow him to leave with his dignity. "I strongly recommend against escorting them off the premises," says Roer, noting employees who sue their former boss frequently state that being ushered out the door was one of the most damaging scars of the process. "It makes them feel like a criminal," she says. "It's hugely embarrassing and what you gain will be so minimal compared to what you will lose." That said, you must still take steps to protect the safety of your staff and privacy of your patients' protected health information by taking his keys, work phone, and laptop, and changing any alarm codes and passwords to which he had access.

If you have just cause and you've followed disciplinary procedure, don't be afraid to cut an underperforming employee loose, says Snyder, noting many mangers hang on too long for fear of litigation. "You need to have your ducks in a row but that's not hard," he says. "You can fire people for lots of great reasons. Often, it just takes discipline and carving out time to go through the progressive process."

COMMUNICATE EXPECTATIONS

It bears noting that you'll need to hire less often if you offer competitive pay, communicate expectations, and establish measurable goals, all of which have been linked to lower turnover. When it does become necessary to fill a hole on your team, you can help smooth the transition by creating an operations manual that details how your office runs, says Borglum. What's the process for opening the office, greeting patients, answering phones, rooming patients, collecting at the point of service and setting up trays for your physicians? "All employees leave at some point and you've put all this training into them," says Borglum, noting it should not be necessary to reinvent the wheel. "Write it all down in an organized manual so it's that much easier to train new people." Clear direction also yields a higher probability of success, he says. "That even helps with recruiting because when you tell them you have an organized training process, it alleviates much of their concern," says Borglum.

LOOK FOR MEDICARE EXCLUSIONS

In addition to checking backgrounds and recommendations, medical practice managers should be sure their top job candidates do not turn up on the Medicare exclusions list. Health and Human Services maintains a list of nearly 52,000 healthcare workers and executives who, due to their conviction of healthcare crimes, are excluded from providing even indirect care to Medicare patients. On an ongoing basis, the department recommends providers check their personnel rosters against the list once a month. Companies that violate the exclusion rules can have their Medicare payments taken back, plus incur fines of $10,000 per claim.

Shelly K. Schwartz,a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article was originally published in the November/December 2015 issue of Physicians Practice.