Make the most of practice staff

The traditional raise isn’t so traditional anymore. Due in part to declining reimbursements and other struggles, some practices are finding themselves short when it comes to handing out yearly pay increases. The 2018 Physicians Practice Staff Salary Survey revealed that 13 percent of respondents have frozen or even cut workers’ salaries.

That doesn’t mean there’s less for employees to do. One challenge identified by 36 percent of survey respondents was dealing with increased workloads and employees who performed dual roles within the practice.

Knowing where financial and workforce difficulties intersect, practices are increasingly trying to get more out of staffers despite being unable to pay them more money. It’s tricky, but it is possible to juggle the issues of workload and pay.

The right staff, the right roles

Evaluating the need for staff against existing workloads is often a good place to start.

“There’s information that shows that overstaffing and understaffing are equally bad,” says Juliana Stanley, MBA, CMPE, practice management consultant at the Texas Medical Association. “If you’re overstaffed, you have too many people that you’re paying to do the same tasks. If you’re understaffed, you don’t have enough people to bring in the revenue that you need.”

Instead of increasing or decreasing headcount, she suggests it may be more effective to focus employees’ time on the tasks that matter most.

“It’s common in small practices to try to do more with less,” Stanley explains. “We have data that shows if you staff properly, instead of three staffers for billing and coding maybe you have three and a half or four, for example, you’ll make more money because you can bring in the revenue that’s generated.”

The strategy is also linked to what Stanley refers to as “hitting that cultural reset button,” where physicians ensure that everyone in the practice is on the same page. Establishing a culture centered on patient care can be useful in centering the staff’s efforts as well as creating job value and satisfaction without increasing salaries.

“We can take better care of our patients if we’re doing things really well, and when everyone is on the same page, employees feel more valued and empowered in their jobs,” Stanley says.

Shuffling responsibilities-either to better consolidate similar tasks or to take advantage of particular skill sets within the practice-may make existing employees more efficient.

At April Gardner DO and Associates Inc. in Lebanon, Ohio, practice administrator Alicia Overman, CMM, says over time, individuals hired to work at the front desk have evolved into other roles. They’ve gained knowledge about the practice’s operations and found ways to expand their skills.

“We’ve had some move to the back to become MAs, and then we’ve had one who started at the front desk and has now moved into a care manager role,” she says. The change has allowed the practice to shift some of the responsibilities away from the clinical staff and add it to the care management basket.

The care manager position now focuses on prior authorizations and the chronic care management program via telephone with patients, Overman says, reminding them of things such as getting labs done and checkup reminders. Clinical staff no longer need to take time out to handle these types of tasks, but patients still receive the level of care they require and the practice maintains a focus on the revenue cycle.

Making the most of clinical staff may require some additional considerations. Kate Othus, MHA, partner and healthcare consultant at Aldrich Advisors in Lake Oswego, Ore., says one area to think about is “making sure they [physicians] have the right types of licenses in their practice.”

Because some states have made changes to LPN, RN, and other licenses, it might be worthwhile to reevaluate how those workers are best utilized within the practice. “It’s about what each of those different levels of employees cost, plus what’s the best and most needed for your specialty from a clinical standpoint,” Othus explains. If practices can add additional responsibilities or roles that are currently distinct are combined, it may factor into how many employees are needed and how they are compensated.

Make it about more than money

Employees are frequently willing to put in some extra effort without extra pay when they see that they’re appreciated. For Administrative Professionals’ Day, for example, Overman says that Rose S. Ebel, DO, the practice’s main physician, treated everyone to lunch.

“We recognize a job well done,” she says. When someone from an outside facility called to commend one of the practice’s employees for being particularly helpful and going above the call of duty, Overman says, “We got a little gift card for that staff member.”

Non-traditional work arrangements may be another option in some practices. Though not typically costly to implement, the ability to work remotely can be a powerful perk for employees. Physicians should be mindful, though, to be sure it’s a viable situation for their practice’s particular needs.

Overman says her team tried it at one point with their billing role, but it didn’t work as well as expected. “It leads to isolation from coworkers and they don’t feel they’re part of the group,” she says. “We also saw lower production and even lower accuracy with them being outside the office.”

The use of flex hours can sometimes be added to give employees with a perk outside the paycheck. “It’s tough with a smaller staff, but there are ways to do it,” Overman says. Even providing the ability to shift working hours earlier or later one day a week could offer staff the opening they need to run errands or spend more time with their families, both of which can help make job satisfaction about more than the amount of a paycheck.

Alternate benefit strategies, such as the availability of voluntary benefits, wellness programs, and similar extras, are also employed by some practices to encourage workers to do more without increasing salaries. But Stanley cautions that any program must be carefully implemented. “The problem is that, when we give people non-monetary compensation, we need to put a value on that so it doesn’t get taken for granted.”

The solution doesn’t need to be time consuming to track or communicate. It can be something as simple as a line on a paystub that indicates the portion of medical insurance paid by the employer. “When I see how much they take out of my check for medical insurance, I can see how much they pay, too,” Stanley says.

The practice environment also lends itself to recognition programs, which Stanley says are “super helpful and can be very inexpensive.” Patients often don’t feel well (thus the reason for their visit), but they’re increasingly expected to pay more for services that used to cost them less out of pocket.

For office staff and care providers, it can sometimes be a thankless job. “When an employer says, ‘You did a good job, here’s a ticket to a movie,’ that’s really cool,” Stanley says. A quick email to everyone in the practice touting the great thing a team member did can be equally appreciated, not to mention a morale boost for the whole group, especially if things seem uncommonly dreary. “You want to thank those people who busted their tail,” Stanley says. An extra gesture here or there can often fill the gap when paychecks are static but expectations of employee performance isn’t.

Even if alternate work arrangements aren’t suitable, practices might consider providing flexibility through a paid time off (PTO) or similar program. This gives employees the ability to take time off when needed without committing to a long-term alternate schedule.

“That can be tough in a small practice because you may not have coverage,” Othus says. Though that barrier exists, it’s still a strategy that could be hugely beneficial if there’s a way to make it work. “It’s been successfully implemented and it has translated to employees as a feel good,” she says.

Holidays could also be used to provide employees with a perk that doesn’t require a traditional raise. “Think about your patient base and when your popular appointment times are,” Othus says. “Could you afford to add a holiday, or maybe just close the office and allow employees to choose if they want to take it as PTO or as unpaid?” Whether planned around school breaks or holidays, staff appreciate the opportunity to spend extra time with their families and loved ones. They’ll also be reinvigorated during working hours to crank up their productivity.

Giving employees the ability to attend training-either on-the-job or in a more formal educational setting-is another benefit that can sometimes take over where the paycheck ends.

“Additional training is beneficial for both the employee and the employer,” Othus says. “Encourage them to go annually to some type of course that’s applicable to their role.” And though advancement opportunities in smaller practices may be more difficult to provide, offering workers a chance to expand their skills is still valuable to everyone involved.

When tasks come along that fit their increased knowledgebase, an employee is more likely to agree to take on that additional responsibility.

Tackle “the talk”

The topic of pay can be uncomfortable, especially when there’s little room in the budget for higher salaries. If a physician or practice manager thinks talking about financial arrangements with patients is bad, they’re really going to dread telling employees their paychecks won’t be going up any time soon. With a few tips in mind, it is possible to make compensation discussions less awkward.

Physicians should begin by setting employees’ expectations around salary increases, both the timing (tied to yearly performance evaluations or a separate compensation cycle, for example) as well as the likely amounts.

“It’s important from the get-go-from the hire date-that you let employees know,” Stanley says. “Tell them if you do performance evaluations and if you do or do not give annual bonuses or whatever else you might offer during the year. Also, tell them there may not be a raise at every single performance evaluation.”

If the rest of the local economy seems to be bustling but the firm simply can’t afford to bump pay rates, it’s important to be as honest and transparent about the situation as possible. Employees often don’t understand the business’s financial strains if they aren’t on the front lines of balancing the books. “Say that you’re putting a hold on raises right now,” Stanley suggests.

No matter which philosophy the practice adopts about annual raises, Overman encourages physicians to think about compensation in all its forms throughout the year. Recognizing a job well done, ordering lunch for the office, and handing out small incentives such as gift cards when someone goes the extra mile go a long way.

“Then when the time comes for the evaluation talk, it helps employees realize there are other perks of being at the practice besides the money,” she says. Reminding them of those benefits during the conversation is useful, as they may not be top of mind at the time. “It’s looking at the whole picture,” Overman says. “Help them look outside that paycheck as a way of feeling a part of the team, of being well compensated and recognized.”