Both are essential and the two are inseparable.

Trying to compete solely on the basis of product or price is insufficient. It is necessary for a practice to create a perceptible difference that separates them from competitive practices. The key is service…attention to the customer. Service is the competitive edge.

Market research has shown that it is five times more expensive to obtain a new customer than it is to keep an old one. Another way to look at this concept is to consider that the cost of losing a repeat customer is approximately five times the value of that annual account. What drives most people away is rude, discourteous, inept, or incompetent service. It could be due to a matter of apathy or inattention. In either case, a practice will not survive if their patients view them in this negative light.

What management policies and values produce the highest standards of service quality, timeliness and delivery? According to Robert L. Desatinick "Managing to Keep the Customer", the following characteristics can help a practice become a "superstar" in customer service:

Service superiority begins with dissatisfaction with the status quo. It is a matter of designing the practice value system to build these values into every aspect of the employment contract. It also begins with hiring the right people who share management's views. If the owner/manager of the practice is dedicated to establishing and reinforcing new standards of service superiority then the practice can achieve and maintain a true competitive edge.

Top 10 Reasons to Attend PMI's National Conference For Certified Professionals on May 18-19 in San Antonio, Texas

Visit the web site: www.pmiMD.com and click on the conference link for more information.

How Your State Insurance Commissioner Can Help
By Linda Lindsay

Q. We are struggling with one insurance carrier who never pays claims on time. What can we do to get them to speed up payments?

A. If an insurance company is continually a slow payer, a method to speed up payments is to include a note to the carrier stating they have 30 days to pay or deny the claim, or a formal written complaint will be filed with the state insurance commissioner. You state's insurance commissioner handles the following types of disputes:

1. Improper denial of a claim or a settlement less than indicated by the policy.
2. Delay in settlement of a claim
3. Illegal cancellation or termination of an insurance policy.
4. Misrepresentation of premiums paid to an agent or broker.
5. Misappropriation of premiums paid to an agent or broker.
6. Two companies cannot determine which is primary.

Requests to the insurance commissioner must be in writing. In some states, the insurance commissioner requires that the complaint come from the patient even if an assignment of benefits has been signed. You may want to prepare a form letter for the patient to sign and then submit. Depending on the situation, you may want to send copies to the state medical association and/or an attorney. Mail may be sent certified, return receipt requested. The request should contain the following information:

1. The inquiring person name, address and phone number
2. The policyholders name, address and phone number if they are not the inquiring person.
3. The name and address of the insurance company, broker or agent.
4. The policy effective date.
5. The policy or claim number.
6. The date of loss.
7. A statement of the complaint, if possible a copy of the policy, medical bills, unpaid insurance claim, cancelled checks and any correspondence from the insurance company pertaining to the claim.
8. The commissioner's responsibility is to the patient, not the physician, therefore the letter must include the patient's signature, address and phone number.

If an insurance company pays the patient directly, even though the physician has accepted assignment and signs such a statement, file a complaint with the insurance commissioner. The commissioner will write to the insurance company and request a review of the claim. If the insurance company admits they violated the assignment, the insurance company must pay the physician within 2-3 weeks. This will be done even if they have not recovered payment from the patient.

Good Luck!

Health Care Quality Standards
By Tom Stevens, CMC, CMIS, CMOM

Medical errors are one of the Nation's leading causes of death and injury. A recent report by the Institute of Medicine estimates that as many as 44,000 to 98,000 people die in U.S. hospitals each year as the result of medical errors. This means that more people die from medical errors than from motor vehicle accidents, breast cancer, or AIDS.

Setting and maintaining proper standards for our patient (customer) services are important for many reasons. Since our patients come to us for health care, the quality standards we should follow are critical in not only providing friendly efficient health care, but also in eliminating errors. Knowing and keeping up with the Federal standards that are provided to patients will help us provide appropriate patient services as well as minimize our legal risks.

Government agencies, purchasers of group health care, and health care providers are working together to make the U.S. health care system safer for patients and the public. Resources are available online to help. The Agency for Healthcare Research and Quality (AHRQ) provides a fact sheet to help providers prevent medical errors. The following information appears on the AHRQ web site. A link to the site is provided at the end of this article.

What are Medical Errors?

Medical errors happen when something that was planned as a part of medical care doesn't work out, or when the wrong plan was used in the first place. Medical errors can occur anywhere in the health care system:

• Hospitals
• Clinics
• Outpatient Surgery Centers
• Doctors' Offices
• Nursing Homes
• Pharmacies
• Patients' Homes

Errors can involve:

• Medicines
• Surgery
• Diagnosis
• Equipment
• Lab reports

They can happen during even the most routine tasks, such as when a hospital patient on a salt-free diet is given a high-salt meal.

Most errors result from problems created by today's complex health care system. But errors also happen when doctors and their patients have problems communicating. For example, a recent study supported by the Agency for Healthcare Research and Quality (AHRQ) found that doctors often do not do enough to help their patients make informed decisions. Uninvolved and uninformed patients are less likely to accept the doctor's choice of treatment and less likely to do what they need to do to make the treatment work.

Patients are advised to be involved in their healthcare by taking part in healthcare decisions. Practice members should understand the following guidance given to patients by the AHRQ, as well as for their own healthcare needs.

1. The single most important way you can help to prevent errors is to be an active member of your health care team. That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Some specific tips, based on the latest scientific evidence about what works best, follow.

   Medicines

2. Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs. At least once a year, bring all of your medicines and supplements with you to your doctor. "Brown bagging" your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.
3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines. This can help you avoid getting a medicine that can harm you.
4. When your doctor writes you a prescription, make sure you can read it. If you can't read your doctor's handwriting, your pharmacist might not be able to either.
5. Ask for information about your medicines in terms you can understand - both when your medicines are prescribed and when you receive them.
   • What is the medicine for?
   • How am I supposed to take it, and for how long?
   • What side effects are likely? What do I do if they occur?
   • Is this medicine safe to take with other medicines or dietary supplements I am taking?
   • What food, drink, or activities should I avoid while taking this medicine?
6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed? A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.
7. If you have any questions about the directions on your medicine labels, ask. Medicine labels can be hard to understand. For example, ask if "four doses daily" means taking a dose every 6 hours around the clock or just during regular waking hours.
8. Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you're not sure how to use it. Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.
9. Ask for written information about the side effects your medicine could cause. If you know what might happen, you will be better prepared if it does - or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.

   Hospital Stays

10. If you have a choice, choose a hospital at which many patients have the procedure or surgery you need. Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.
11. If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands. Handwashing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A recent study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.
12. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home. This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.

    Surgery

13. If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done. Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.

    Other Steps You Can Take

14. Speak up if you have questions or concerns. You have a right to question anyone who is involved with your care.
15. Make sure that someone, such as your personal doctor, is in charge of your care. This is especially important if you have many health problems or are in a hospital.
16. Make sure that all health professionals involved in your care have important health information about you. Do not assume that everyone knows everything they need to.
17. Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can't). Even if you think you don't need help now, you might need it later.
18. Know that "more" is not always better. It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
19. If you have a test, don't assume that no news is good news. Ask about the results.
20. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources. For example, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse™ at http://www.guideline.gov. Ask your doctor if your treatment is based on the latest evidence.

Web Resources

• The United States Department of Health & Human Services provides a web site for patients called the Agency for Healthcare Research and Quality (AHRQ). Visit: www.ahcpr.gov/consumer/guidetoq/ to review the AHRQ "Guide to Health Care Quality – How to Know When You see It."

The tips presented here are provided to help patients be active in making decisions about their health care. One of the links at that site (www.ahcpr.gov/consumer/20tips.htm) is titled "20 Tips to Help Prevent Medical Errors"

Internet Citation:

• 20 Tips to Help Prevent Medical Errors. Patient Fact Sheet. AHRQ Publication No. 00-PO38, February 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/20tips.htm