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Janzen, Johnston and Rockwell » Questions You Should Ask

Questions You Should Ask

Does your hospital pay for your ER group’s malpractice insurance?

JJ&R provides malpractice insurance for all its physicians at its sole cost. JJ&R provides malpractice coverage for all its physicians at its sole cost. Current limits for professional liability are $2,000,000 / $4,000,000. The aggregate limit is per physician, not per group or per practice location. Our carrier is AIG, one of the nation’s largest and most respected malpractice carriers.

Does your hospital provide billing and collection services for your ER?

As part of our overall fiscal responsibility, we provide our own billing and collections, as well as our own accounts receivable financing. Since 1983, JJ&R has provided its own billing and collections for all of its contracted hospitals along with recievable financing at our own cost. We have become expert in billing and collection of “high volume, low dollar” patient accounts. Presently, we bill approximately 60,000 new patient accounts per month.
Any emergency medical group performing its own billing and collections must be able to do so with enough success to ensure an income stream for its physicians which is sufficient to encourage the best qualified practitioners to affiliate with the group. Such efficacy is not easily achieved in emergency medicine. We have been able to do so successfully for years, allowing us to attract and retain board certified physicians who practice high quality medicine and have a long-term commitment to our specialty.

Does your ER group assist in improving the hospital’s bottom line?

Let JJ&R show you how to maximize your revenue and enhance your bottom line. As a result of JJ%26R’s long involvement in emergency department billing, we have developed substantial expertise in the management of “high volume, low dollar balance” patient accounts. We now share this information with our hospital clients to improve their own collection performance on the hospital’s portion of the patient account.
We offer a range of services from chart review and coding to comprehensive billing and collections. Our progress and success to date has been rewarding, and our collection performance in excess of our original predictions. Most satisfying has been our ability to exceed the hospital’s collection performance for every financial class, including both Medicare and Medicaid.
As an example of the success of our program, one facility has elected to reduce its unit fees on several high frequency charges, while at the same time we conservatively estimate that our efforts may add $1,000,000 of collections to this hospital’s bottom line.

Has your ER group responded effectively to the challenges of managed care growth?

JJ&R has been recognized as a leader in working with managed care organizations. JJ&R has seen the emergence of managed care programs as an inevitable consequence of the preoccupation of both government and industry with the principle of reduction of healthcare expenditure. A number of years ago, we elected to view the growth of managed care as an opportunity for both JJ&R and its hospitals. Consequently, JJ&R has been recognized as a leader in the affiliation with managed care plans among the medical groups at all its hospitals. In some HMO relationships, we participate as capitated members and one of our medical directors serves as the Chairman and Medical Director of his hospital’s IPA.

Is your ER group a “revolving door” of unfamiliar faces, or is it a stable staff of well-trained, career-oriented Emergency Physicians?

JJ&R physicians are assigned to a single, base hospital and are dedicated to their facilities. JJ&R physicians are well qualified and career-oriented. We select only board certified/qualified physicians with an interest in the long-term practice of emergency medicine. Each of our physicians is assigned to one facility where he spends nearly all of his professional time. Our goal is to eliminate the “revolving door” of physicians that is still evidenced by some emergency medical groups today.

Does your ER group respond timely and satisfactorily to the needs of the hospital’s administration, nursing and medical staff?

JJ&R listens and responds to the needs of our client hospitals. In today’s highly competitive healthcare market, responding to and meeting the needs of client hospitals is essential. Many emergency medical groups, however, are not listening to the needs and desires of their hospitals. Many groups appear interested and concerned, but in practice, their performance and follow through do not reflect a “responsive” attitude. Some groups turn a “deaf ear,” others just “drag their heels.” Our goal is to listen to your needs, find solutions, and implement strategies in a timely manner. Whether it’s the development of a Fast Track system to improve patient flow, or to assist the hospital in gaining market share, we’ll listen.

What is your ER group’s ratio of patients treated to MD hours worked?

Overcrowding of emergency departments, poor throughput times, and burnout among ER physicians are all results of inadequate staffing patterns. We traditionally double staff our departments when the monthly patient census exceeds 2.0 patients per physician coverage hour (significantly lower than the national average of 2.7 patients). We find this ratio effective in our ability to process patients through in a timely manner, improve and enhance overall patient satisfaction, and to reduce the potential of “burnout” among our physicians.

Does your ER group provide programs designed to improve operational efficiency and increase market share?

JJ&26R has turnkey programs designed exclusively for improving department efficiency, patient satisfaction and gaining market share. We have developed the capability to provide our clients with value-added services not routinely found among other emergency medical groups. We offer marketing expertise through the development of new programs that are designed to capture new and attractive patient groups for referral to the hospital’s medical staff. These programs include Fast Track, Chest Pain Center, Occupational - Industrial Medicine, Pediatric Clinic, and an After-Hours Urgent Care for Managed Care patients.
We offer programs designed exclusively for improving patient turnaround times. We implement an evaluation and assessment tool to monitor the flow of patients through the department at all hours of the day. This information helps us assess where “bottlenecks” occur and allows us to develop systems to improve the flow. We work actively with clerical and clinical staff at all levels within the department from receptionist to triage nurse to emergency technician to staff nurse to lab and x-ray technicians.

Does your ER group follow through on the promises it makes?

JJ&R does not make promises. They keep them. Hospital administrators are constantly saddled with the worry about whether or not their group will follow through on the promises they’ve made. Will the group perform as expected? Or will they have to meet again and again to finally achieve resolution. At JJ%26R, promises are kept. It’s part of our commitment. Once a directive has been issued, it is our responsibility to see that it gets completed in a timely manner.

Does your ER group participate actively in the hospital’s medical staff affairs?

JJ&R physicians are active participatory members of their respective medical staffs. JJ&R requires that all its physician members become active members of the medical staff at their respective hospitals. It is expected that each JJ&R physician will participate in medical staff affairs and committees. Our group strives to overturn the generally held opinion that emergency department physicians don’t become involved with the medical staff.
At six of our hospitals, the JJ&R medical director rose to the position of Chief of Staff. At another, the director serves as Vice Chief and will assume the position of Chief of Staff shortly, and at yet another facility, our medical director has been elected Secretary of the Medical Staff, scheduled to become Chief of Staff in three years. Other JJ&R medical directors have held leadership roles such as Chief of the Department of Medicine; Chairman of the hospital’s IPA; and two directors have been elected the hospital’s governing board.

Does your ER group enhance the hospital’s overall image?

Understanding that the emergency department is the “front door” to many hospitals, JJ&R offers guest relations programs to improve the patient’s treatment and experience while in the department. JJ&R recognizes that the emergency department is not only the hospital’s “window on the community,” but also the door through which the community enters the hospital and the practices of its medical staff. To that end, JJ&R actively pursues an ongoing process of modification of its departments to meet the needs and expectations of the hospital’s surrounding community. By providing an attractive environment within which patients, family and friends can secure high quality and expeditiously rendered care, JJ&R assists its hospitals to maintain an image, attracting patients who might have chosen to seek care at a competitor.
Our physicians and staff at JJ&R’s client hospitals communicate with patients and their families regarding their care and we manage our departments in a manner, which minimizes waiting times and overall transaction times. Finally, we staff our departments with only board certified / qualified emergency medicine physicians who have a long-term interest in the practice. These physicians are dedicated to their hospitals, to their medical staffs, and to the community they serve.

Does your ER group offer programs to monitor and enhance patient satisfaction?

Understanding the needs of your patients in the emergency department is vital to its successful operation. Many patient satisfaction surveys being used today are not specifically designed just for the emergency department. Usually, these survey instruments are designed from an “inpatient” perspective. Since the trend in healthcare today is moving more and more to outpatient services, we believe that a specific instrument for monitoring the satisfaction of emergency department patients is vital. We offer our client facilities instruments to measure the level of satisfaction from patients; we routinely monitor the transaction times of emergency department encounters to improve efficiency; and we meet with the staff to develop strategies to deliver care to our patients in a more compassionate, understanding way. We recognize that for many hospitals, 40% to 50% of the hospital’s total inpatient admissions may come from the emergency department. Therefore, we make patient satisfaction, as well as medical staff relations, a high priority in our overall business strategy.

Is your ER group knowledgeable and sensitive to compliance issues?

Today’s number one “hot button” in medecine is compliance. Learn more about JJ&R’s approach. JJ&R is sensitive to the compliance issues raised by HCFA in the agency’s process to eliminate fraud and abuse by both healthcare providers and institutions. To that end, we have developed educational handbooks and documentation guidelines to assist our physicians and coding reviewers in ensuring that the services for which we bill are coded accurately and properly. Two JJ&R physicians provide education to our physicians and certified coders with respect to compliance requirements. Additionally, they monitor the coders to assure consistency within both industry norms and our own requirements for accuracy and reliability.