Innovative Practice Interview with Carolyn Chamberlain of Asheville Neurology

July 10, 2019

Innovative Practice Interview with Carolyn Chamberlain (Practice Administrator of 15 years) of Asheville Neurology regarding the development of new, innovative positions to improve efficiency at the office. 

Q: Please list the new positions you’ve developed recently at Asheville Neurology. 

A: Recently, we’ve introduced a Practice Operations Supervisor position which focuses on onboarding and training (OSHA, HIPPA, new Phone system, etc), a Front Office Supervisor, Clinical Supervisor, and Financial Supervisor. These were the 5 areas consuming a lot of time, so we placed lead people in each area, promoting within. Our goal was to focus on workflows and improve efficiencies and quality. Another position we’ve introduced recently is the Lead Physician. This role allows for a Physician to take on a leadership role and be involved in the leadership team. 

We also created a new department called the Patient Experience Department, supervised by the Practice Operations Supervisor. This department also developed new roles such as the Patient Navigator, Referral Coordinator, Clinical Assistant, and Patient Records Coordinator. 

Roles are changing as more things are becoming simplified and automated. I’m finding that as we automate things, it creates opportunities to branch out into other areas, focusing on quality, meeting criteria for MIPS reporting, generating Patient Surveys, starting new programs (example: Chronic Care Management Program for patients that have dual chronic conditions such as parkinsons and depression or epilepsy and chronic migraines), looking at the Social Determinants of health, and other things that help patients become healthier with the variety of issues they might be dealing with outside of direct Patient care.


Q: What were the reasons you decided to implement each of these positions?

A: I noticed my workload was becoming overwhelming as a multitude of new and changing requirements unfolded (MIPS, prior authorization, new medications requiring start up forms, etc). Delegating some of these tasks has allowed us to stay ahead and coordinate to be ready for upcoming changes. 

Having an active research program/department that participates in clinical trials before drugs come to market and builds relationships with pharmaceutical reps has been a great resource for staying ahead as well. It allows for us to know what new drugs are coming out and have experience with them before they become available on the market. 

Q: Have you learned any key lessons implementing these changes?

A: Historically, in any practice or hospital settings there has always been a focus on FTEs which presents a challenge in justifying the addition of a position because that of course adds expense. That being said, I have found that my Physicians trust my judgement and see my vision. Tracking, benchmarking, and keeping up with each change has helped foster that trust. Having a method to track tangible progress is key. 

For example, initiating a no show policy, having buy in from all departments, communicating that to patients, and being able to track those outcomes has allowed for me to demonstrate measurable savings. We are always exploring other programs and apps that are available to help us target where are our problem areas are and benchmark our progress and we are always seeking to improve. Now that we’ve improved our no shows, we can look further and seek more specificity about the problem (time of day, payer mix, diagnosis, etc). 

Education is also key. We are committed to communicating with our patients as we make changes to keep our patients growing with us. It wasn’t popular when we initially sent the no show policy. One patient with Parkinson’s was very offended at the idea that he would be charged if he had to go to the hospital and couldn’t notify the facility that he wasn’t able to make it. I was able to explain that policy and what that meant for other patients, the financial burden of no shows, etc. and he was so thankful to have a better understanding. Making sure patients understand the portal and how it relates to their care has been huge for us. Having a Patient Navigator position in place allows us to talk to our patients more often and be more proactive. 

Q: What aspects of these new positions are working well so far?

A: These new roles have allowed me more time to plan, organize, and communicate so that I’m not running around putting bandaids on programs or training or lack thereof, etc. These positions have opened the door to new access to resources and support. 

Q: Have you experienced any challenges making these additions?

A: The key challenges involved in introducing these new positions have been the financial burden along with the interpersonal challenges that come from promoting within in a small office setting. Making quick, progressive changes sometimes comes with growing pains, as not everyone is on board with that approach. 

Over my 15 years at the practice, several employees have now retired so there is a new generation of staff that are young. Unemployment rates are low right now so there are a lot of opportunities out there right now and we have to be competitive. This has made staffing another key challenge. I’ve had tenured staff move on or retire or move out of the area and for the first time two years ago, I realized that recruiting and finding the right person isn’t always easy. For example, when I needed an appointment scheduler, I hired someone knowing they would eventually be the Patient Navigator so you have to be very selective and you’re no longer recruiting for a $12/hour receptionist. I’ve had to be creative getting to the end result, taking different routes to get people in the positions I need. Someone we hired recently previously worked at a spa and had great customer relations skills and she’s doing great. We’re not always looking for someone with direct medical experience. She has since already advanced from front office to the medical records position. The goal is always to share our objectives, where we want to be, and the opportunities in between. 

Q: How would you describe the impacts and outcomes of these additional positions? 

A: We are utilizing a big project management tool so we can keep track of all the different projects we have in place so we know where we’re at in the process and understand who’s doing what and where it’s at. I can log on anytime to see the progress with each project and we can communicate to prioritize different projects, etc. Teams also can share within. Investing in education, professional development, meetings, etc. has added a lot of value as well.  

Q: Did you have influencers or mentors who helped make the decision to develop these positions?

A: I didn’t have a mentor or see any specific model per-se. I’ve always been the type of person looking for the next project and keeping the big picture in mind. Being involved in consulting, start ups, networking with other PMs, and working closing with our CPA, Mary Williams with Johnson, Price, and Sprinkle who helped start the practice, have all been helpful experiences. I always learn from Mary and she’s always available to talk things through. I’ve gotten a lot of insight from her, as she works with other practices. I’m excited about technology and I always need a project to work on so I don't wait for things to happen. 

Networking and working with other practice managers has also proved helpful. I’m a speaker with some pharmaceutical companies which allows me to create relationships with other PMs of Neurology practices throughout the East coast and we can lean on each other with questions or for support. For example, I had someone from Savannah Neuro call recently with a clinical question and we ended up sharing experiences and learning from each other. They came to talk to us about our infusion suite because they have one outsourced by a 3rd party housed in their building and they wanted to look at it from a financial and clinical standpoint and I wanted to talk to them about their research department and understand the benefits of outsourcing that. I was curious about the company they use, etc. 

Things could change at any minute but for now our plate is full, our projects are moving forward, and I’m excited about where we’re headed and the next generation of AVL Neurology. 


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