In this episode of SurgiSnacks, join Al Norweb along with special guest Megan O’Hara, President of AAOE and practice manager of Robert V Moriarity MD PC, as they discuss the challenges faced by small independent practices in an era of rapid consolidation. 

Al and Megan shed light on the innovative approaches employed by practices that embrace the David role and find strength in their size and agility.

Related content:

• Finding the Sweet Spot: Efficiency and Quality with Value-based Care | SurgiSnacks Episode 5

• How To Make Patients Love Your Surgical Practice

• How To Improve Patient Retention​​ 

• Improved Surgical Coordination Workflow Saves Practices and Healthcare Money

• How to Improve Your Patient-Reported Outcome Measures 

• How to Leverage Surgery Data to Make Better Business Decisions

Hi. Welcome back to another episode of SurgiSnacks.

My name is Justin Rockman and I’m

the VP of Business Development at Surgimate.

If you like to geek out about the business of

surgical practices, then you’ve come to the right place.

Here on SurgiSnacks, our goal is to provide

you with bite-sized sessions, about ten minutes each.

You can pop into your ear during a run or in

the shower or in the car to give you some new

and innovative ideas when it comes to running your surgical practice.

My fearless co-host, Al Norweb won’t be with me

today, but I’m very excited to be with you,

Jennifer Monroe, Director of Patient

Financial Services from OrthoTennessee.

Welcome, Jennifer.

Thanks so much.

I’m thrilled to be with you today, too.

Excellent. Thank you.

So, Jennifer, for those of our audience who might

not have had the pleasure of your acquaintance, could

you please share just a brief introduction about yourself?

Sure.

I’ve worked in the revenue cycle for

about 30 years, and the last five

years have been here at OrthoTennessee.

And I also am a little bit of a revenue cycle geek.

Love to focus on how do we create

great processes and move claims through the system

and get them paid in full.

That’s the goal.

And I became interested in Surgimate because our practice

was already using it when I came on board

here and through talking to the Surgimate reps at

various conferences and through different interactions, it became a

common interest between us that my revenue cycle team

was very fond of Surgimate.

We have a number of locations and practices,

and most use Surgimate and some are smaller

and have chosen a different option.

So what was appealing is why was that a difference?

How does that make a difference, even

in revenue cycle, as opposed to only

for surgery schedulers and physicians?

So, Jennifer, you may not know that one

of our traditions here on the show is

to select a snack that represents the topic.

Now, when we met at a conference just a few

weeks a few months ago, I asked you, what is

the number one issue that impacts surgical practices today?

And you said one word, staffing.

So today’s focus is on the staffing

shortages that are challenging practices everywhere.

So to align with that theme, we’ve

chosen potato chips as our symbolic snack,

reflecting the staffing “crunch” across the industry.

Today, I have two options here.

I have my scorching and my salt and vinegar,

which we can enjoy a little bit later on.

Okay, sounds great.

Okay, so, Jennifer, just to start off,

what are some of the challenges of

hiring today in the post-COVID period?

Oh goodness.

It’s really almost all aspects.

It starts with a lot of individuals

are using AI technology or different platforms

to apply for jobs on their behalf.

And when they hear from a recruiter or someone

in our office, they can’t always even recall exactly

what organization this is or will tell us

they didn’t even realize they applied for the job.

So there seems to be an effect where people

are just blasting their resume out and are not

necessarily applying very intentionally to certain positions.

So that becomes a time issue for us and

frustrating for the caller and for the individual.

Another factor is when we call folks, and I

don’t blame them, I’m the same way, they don’t

recognize the number so they don’t answer.

And that can result in a lot of

back and forth calling just to get them

on the phone for an initial phone screening.

So, that’s one issue. Secondary to that,

once they are interested in talking with us, we run into

a lot of questions about pay, about whether the position offers

a hybrid option or a work from home option.

And so we’ve shifted to those who are applying

for jobs having all of their list of requests

and demands, and it seems that the employees are

much more in demand than the jobs are now,

so that’s created a little bit

of an upside-down situation.

So those challenges really are quite significant.

Has that meant that you’ve changed

your approach during the hiring process?

Prior to COVID, you would take a particular way

in which you would go through hiring, but now

with things to attract candidates and sell yourselves more

as an employer, has that meant that you’ve changed

your approach in that process?

Yes, absolutely.

I’ve said a number of times that we really have to

think about what are we doing to make this job appealing.

We need the potential candidates to be interested in

what we do and to know that they’re going

to have good managerial support to understand in advance

what the job looks like day-to-day.

So, we’ve done several things as an organization.

We have increased our orientation day to be a full day.

And it’s great because we can reassure them from

the start that this is a great and strong

organization, that they’re going to have good leadership throughout.

Our CEO talks to every orientation group,

which we provide twice a month.

And that was a big change.

Previously we would offer orientation on an irregular schedule,

and now it’s published a year in advance.

You know what dates you

have available to start individuals.

And so that kind of structure, I think

even from the start, recognizing that every conversation

with the candidate is part of the interview

process and the selling process and them getting

an impression of the organization.

They know that we’re structured and we have a plan.

So, that’s been one benefit is the day-long orientation.

They’re hearing from the full C-suite, they’re getting

added into all of the software apps they need.

Our it team is involved and they really leave

that day with a lot of confidence that they’re

going to be cared for as an employee.

Wow, I love that.

That day-long orientation sounds really excellent.

You touched on this a little bit earlier with regards

to no-show rates and companies experiencing for all manner

of reasons, whether or not it’s because AI has impacted

the number of candidates that you come or people not

picking up off the phone, but what solutions have you

come up with to minimize that risk of you spending

a lot of time and effort to schedule candidates in

and then they just don’t show? Yes.

So one thing that we did specific to our

department is we created a front and back flyer,

essentially about each of our positions that gives them

a lot of FAQ, frequently asked questions about the

role, about what the revenue cycle team does, how

do we fit into this larger healthcare organization.

And one of my favorite features is that

it talks about a day in the life.

So a day in the life of a payment poster is

very different than a day in the life of someone who

works in patient collections or in the billing team.

And those titles can be vague and they can

mean a lot of different things across various organizations.

So we want them to know, here’s what

you actually would be doing throughout your day.

And it helps them commit more to know if

it’s an accurate role that they’re interested in.

After we send them that, and we have

the initial phone screening, we’re bringing in each

candidate and interviewing them for two roles.

We will tell them we have openings in these

various departments, and it sounds like you originally applied

for one role, but we think you could be

a great fit for this other one.

So we’re going to invite two supervisors and sit

down with you and really have a conversation.

And on that flyer that we send to them with

all of the details, it explains exactly where they need

to show up, which door to enter, where to park

and what to expect, what we expect them to wear.

They don’t need to be overdressed.

And what are some sample

or potential interview questions?

We’re not giving them the full list, but we’re

saying, here are some of the things that you

might want to be prepared to answer.

And I know that that might

be counter to previous interview culture.

People would try to sort of

catch people not knowing a thing.

And what we want to do is have them come in

as confident as possible to reduce that no show rate.

And that has helped.

Wow, that so interesting.

So you found a great candidate for one or maybe

both positions and now you want to hire them.

How do you onboard a new member to your team?

Has that changed?

What does your current orientation plan

look like at the practice?

So they will start with the day

long orientation to the organization, which means

they’re always starting on a Tuesday.

And when they actually show up in the office, we make

sure that we have a really clean desk space for them.

We have new fresh office supplies.

They’re going to be in office and we make

sure that we have a schedule and we share

that with them, again, providing them reassurance.

They’re in a new place, they’re meeting new people.

They don’t want to be uncomfortable on day one.

They want to feel really cared for.

So, we’ve shifted our focus to be more human

and people-focused and tried to show empathy to

what it’s like to be a new hire.

And unfortunately, people are changing jobs

more than they used to.

So, for perhaps people of an older generation,

they might have had a first day of

work five times in their life.

We are now working with individuals who have

had a first day of work many, many

times, and we want to stand out.

So, the transparency is greatly important and improvements

that you’ve made to the hiring process,

but there still is a question about how

to actually attract fantastic candidates in this market

today. You mentioned that the balance has

shifted and it’s become an employees’ market.

What have you done at OrthoTennessee to ensure that

you can stay competitive, not just only within healthcare, but

competing with other brands within the area so that you

can target the best talent out there.

We have our recruiter that works for us using

a lot of different platforms and reaching out.

Our HR team attends a lot of job fairs.

We’re fortunate to be in an area where we have

a number of counties that surround us so they can

go to different counties’ job fairs, and that’s something that’s

really stepped up the last two years.

They’re very attuned to the local universities and

community colleges, different schools, and just really putting

ourselves out there in front of people who

may be able to refer employees or the

actual employees themselves that are searching.

I don’t know that we’re doing anything tremendously different than

others are doing, except being a very positive presence and

letting them know that we have lots of different opportunities

across not only our clinics, but our surgery centers, and

that we can find a fit for anyone that’s really

interested in a new opportunity.

So it’s not just about who you are,

it’s also about what is it that you

can offer within the framework of the organization.

And attracting great talent is so critical.

Often people say, well, just pay more.

And that way you can bring more

people in, which can be difficult in

certain industries, healthcare being one of them.

How have you approached that problem at the practice?

So, we’re doing the best we

can, like lots of other groups.

And I think sometimes there is a lack of awareness about

what does it cost to add a dollar an hour or

$2 an hour across the course of the year?

It’s quite a bit, and we have to make

our budgets in advance and adhere to those.

So, what we’re also looking for are ways that

we can use technology to make the job easier.

And I spend a lot of time talking

with my team about what’s in your way,

what’s frustrating you, what are your repetitive tasks?

So, we’ve done some things to add

some automation that has been very beneficial.

And at first, people were concerned, “Oh my goodness,

is this going to take our jobs away?”

And now they recognize, no, this is going to

help to do the parts of our job that

we don’t love so much that are a little

bit just monotonous, that don’t require deep thought.

And we’re focused on using the brain power of our

great staff to really work on the harder problems.

Wow, that’s amazing.

And using technology to leverage employees and also make

a change to the corporate culture and creating that

new and compelling culture is really so critical.

Is any advice which you can give to

other practices on how you can create a

compelling and innovative culture within the organization?

Yes, I actually could speak about

this for quite a while.

We have a new CEO that’s been in place for a

year, but has been with our organization a long time.

And he had heard several years ago about a

program called Culture By Design that we’ve implemented at

OrthoTennessee and it’s really been fantastic.

We have 26 behavioral standards that we

have agreed to adhere to, and these

are introduced during that day-long orientation.

Everyone is very clear on what’s expected, and

we call them the play of the week.

Other organizations might call them something else.

So each week we have a particular play of the week

we’re focused on, and it is a direct statement of a

particular behavior. It’s very clear in black and white whether our

staff are living up to this or not.

But we open each meeting with the play of

the week and give examples of what we’ve seen.

One of my favorites is assume positive intent.

And so we’ll talk with everyone that we’re in a

meeting with about what does that mean to you?

Or where have you seen this happen?

Or where have you exercised this in your own work?

And so we’re really integrating

that into the daily workflow.

And we kick off our week each Monday morning

with a video from someone in the organization.

Right now it’s our CFO who’s doing the cycle of 26,

and they tell a story that relates to it, and it’s

a really great way to keep us focused on all the

behaviors and actions that make a great team.

Wow. So, I’m going to take you up on that, but

we’re not going to do it at the beginning.

We’ll do at the end.

Not a play of the week.

We’re going to do a play of the SurgiSnack.

And please, is there any other last-minute advice

or recommendations you could give to other companies in

a similar position to you looking to attract great

candidates or improve their hiring process?

You know, I think the main thing to do is to take steps.

You can’t do everything at once to make

everything better, especially when you’re short-staffed.

It is an incredible challenge right now.

And the need for healthcare did not diminish

with COVID. If anything, we’re aware that it increased.

So, we had a period of time that people perhaps

were not getting surgeries, and then that really resumed.

And we’ve been catching up on that for

a while because COVID comes and goes and

people have to cancel surgeries sometimes.

I would say take some steps.

Make sure that you’re engaged

with your professional organizations.

You’re attending conferences, you’re listening to podcasts, you’re

using technology and figure out what are the

things that are effective in your particular area.

Jennifer, thank you so very much for your time today.

It’s been such a pleasure speaking to you, and

I look forward to seeing you at the next

conference and coming on-site and working with you

and seeing this fantastic, new, innovative culture you have

with all of your fantastic, amazing staff.

All right, thanks, Justin. It’s been a pleasure.