E136 Corrie White on Medical Office Assistants, Setting up an Office, EMRs and Billing!
Listen to this podcast on SoundCloud
Chad Ball 00:12
Welcome to the Cold Steel podcast hosted by Ameer Farooq and myself, Chad Ball. We consider it an absolute privilege to bring you guests from around the world who are truly experts in their craft. Our mission is to offer you a combination of not only masterclasses on clinical surgery topics, but also insights into achieving personal growth, productivity and fulfillment as both a surgeon and, perhaps more importantly, as a human.
Ameer Farooq 00:42
This week on the podcast we invited Corrie White, an absolutely fabulous and experienced medical office assistant, to talk about what it takes to set up a well-functioning office. Corrie breaks down how to find a good assistant, and what goes into setting up an efficient system. We'd love to hear from listeners. What do you wish you had known when you were first setting up your practice? Email us at [email protected], or Tweet at us @CanJSurg. Also, we'd like to make a plug for the upcoming Canadian Surgical Forum, or CSF. This year, the conference is happening in Toronto from September 15th to 17th. There's a fantastic program this year, so be sure to register and attend — and as always, the links are in the show notes — or, at the very least, follow the session highlights on Twitter with the hashtag CSF2022.
Chad Ball 01:35
Corrie, can you tell us a little bit about where you grew up and [your] career path up to this point?
Corrie White 01:39
I grew up in a small town of Hope, [British Columbia], which is about 2 hours outside of Vancouver. [It's a] little town tucked in the mountains. [I] went to a high school [with] less than 500 kids. So, I really enjoy the small-town, kind of, experience, and growing up that way was pretty special for me. I ended up moving to Chilliwack just after I graduated, just for the new life experiences — I didn't go very far — and then, I just, I hadn't thought about going to — you know, my lifelong dream wasn't to be an MOA. I hadn't thought about it, I just stumbled upon the MOA course. It's actually my grandma who brought it up to me. And I jumped in and went for it, and the rest is history.
Chad Ball 01:54
So for people who are outside of BC, a lot of people haven't heard this term, MOA, before. Can you just tell us what that stands for? And what, exactly — what is involved in the course? Where did you take it? How long did it take?
Corrie White 02:49
Yeah. So, MOA stands for medical office assistant. I think it's about a 10-month course. I finished it a bit early, because it was — some of it was self-paced, and then you do a practicum portion after the course in somebody's office, with another MOA training you; that's usually about 4 weeks. Yeah, the course itself, you're learning a lot of medical terminology, pharmacology, learning how to use your — I mean, when I took it, there wasn't a lot for EMR stuff out there, so now, you would be learning how to use EMR systems, that sort of process, billing, you learn a, kind of a brief rundown of billing. Yeah, just day to day, clerical stuff for patients and legalities and stuff like that, that you need to know to make sure that you're not getting you or your doctor in a bind when it comes to medicolegal stuff.
Chad Ball 03:58
Corrie, that sounds like a pretty long period of time, in terms of training, and it certainly, you know, in my experience, would reflect the complexities and the various domains that an MOA really has to deal with almost on a daily basis. I was curious, for our listeners, you know, besides bragging about growing up in Hope, where Rambo was filmed, and the significant impact that must have had on you, I was curious if you could walk us through, at a 30,000-foot level, what's encompassed in a typical surgeon's office from the point of view of the MO?
Corrie White 04:43
So, yeah, like, when I took my course — a 10-month course — it's really just a brief rundown of what getting [inaudible] in, what we might need to do in a family practice or a specialist's office. Um, it's kind of a generalized training; you know, you learn a lot of terminology and then you get — I got into a specialist's office. So then, you know, the learning really begins, because all of a sudden, now you have to learn — you're kind of more — I've been in general surgery for 12 years now, so I know a lot of general surgery terms, whereas if you hear me in a gynecologist's office, then you're going to, you know, pick up a whole bunch of different terms. So it starts, it's not just — you're not just a secretary. You're not just there answering the phones and booking appointments, you know? We're getting, you're getting calls from patients who are panicking because they've got something going on, they have no idea what to do or who to call, and they're reaching out to you, and then you're to make that call on, you know, what's the next step that this patient needs to take and to reach out to the doctor. And so it's a bit more, that's what you, kind of, learn, and you, kind of, learn on a day-to-day basis too. Every time a patient asks you a question, it's different; you're learning something new, and you've got to figure out where to go and how to take care of them and how to make sure that the situation is handled the best that it can. At the end of the day, I treat the patients like they're my patients too, not just the doctor's patients, because I want to make sure that they get the best outcome possible when they're visiting our office.
Chad Ball 06:32
Corrie, I wish I had known you when I started working. You know, I'm sure you hear this a lot, and I have no doubt that it is common, and that's that, you know, in my circumstance, for example, I went through a number of MLAs initially that were lovely people, but for a host of different reasons, were not a good fit at all. And then my current MOA, I've had for many years, and I love her to death, and I'm sure you would get along very well with her. And she's incredible for many different reasons. Ameer is starting out, and he's, you know, fallen into your lap, and he's a lucky guy. But for people who are surgeons who are starting to work, junior faculty, they're just coming on board. What should they look out for in a positive sense, and what should they look out for in a negative sense when they're starting to — maybe they're in a private office, and they're hiring an MOA, or maybe they're entering a hospital or university-based system where they're being, sort of, aligned without choice with an MOA; what are some of the good features and some of the red flags?
Corrie White 07:40
I think, ultimately, you want to find somebody that you're going to connect with. Maybe find somebody that has the same positive features that you do. You know, you want to find somebody who's a hard worker, who's efficient, who multitasks, all of those things, but at the end of the day, you want to try and find somebody that you can connect with, because, you know, if you have your own MOA, chances are you're going to be talking to this person every day of the week. You want to have a good relationship with that person. You know, they're not just your MOA; they're at the forefront of your practice. They're the first person that your patients are going to talk to or to see, so you want to have somebody that aligns with your values of how you want your practice to run. That can be hard to find in an interview. And as you get to know somebody, but it's hard. Interviewing is hard. Everybody's on their best behaviour in an interview, and they're going to tell you what you want to hear, right? If you ask them the average interview questions, "What's your," you know, "What's your skill set?" "Well, I'm a hard worker, and I'm a [...]" It's easy to say that you're a hard worker, but until you see that person working, like, you don't know that. So you really have to, kind of, try and read between the lines when you're doing an interview, and try and maybe, in the interview process, try and figure out how that person is as a person. Like, I don't know if that makes sense. Like, try and figure out a little bit more about them outside of work, because that'll tell you a lot about how they will be in your office.
Chad Ball 09:37
Corrie, you know, our listeners should know that you've actually been asked by other surgeons' offices to actually come in and help when things are not going so well; when they're having trouble with their assistant, when things are falling through the cracks. You know, you have heard some terrible stories about situations where you've been called in specifically to, sort of, right to ship. So what are — and so, you have a really good sense of what are, you know, what are good things to look for and what are not so good things to look for. So are there any key, kind of, interview questions or techniques that you think are important that people should be asking when interviewing an MOA?
Corrie White 10:17
Yeah. You want to — interview questions are hard. Like, I haven't done a ton of interviewing, per se. I've sat in with interviews. I just really tried to get a feel of the person, which, again, that's hard for some people to do. I can't really think of any specific interview questions off the top of my head. I would maybe ask if somebody has dealt with a difficult situation in the past in a previous job, or to explain that situation and see how they dealt with the situation, what the outcome of the situation was, because in the difficult times, when you're dealing with a difficult patient or a difficult situation, that's where you're going to struggle the most and potentially shine the most. So I would see if, you know — what's a difficult situation that you have had in the past, and how did you work through that, and what was the outcome, sort of thing.
Chad Ball 11:37
Corrie, maybe another way of asking this is: How do you find a good MOA? Like, give us the insider scoop? Where do you go to actually find — if you're, let's say, starting in private practice and are looking for an MOA or you're not joining someone else's practice, how do you find a good MOA? Where do you go? Are there any places people can look? Is it all word of mouth?
Corrie White 11:58
I mean, you can look — there's job posting services, like Indeed or Craigslist, there's many groups on Facebook, MOA groups and that sort of thing. One of your best bets is probably to reach out to your colleagues and talk to your colleague MOAs. You know, we all chat. We know, when we're talking to an office, you know, "So-and-so is a good MOA," because, you know you're chatting with these people, you're dealing with these people, you're getting referrals from other MOAs. So, I've had multiple doctors reach out to me and say, "Hey, do you know of anybody that's looking for work right now?" Right now, there seems to be few and far between. It seems to be very hard to find anybody. But a lot of it is word of mouth. The only issue with word of mouth is that you could be missing a really good, green MOA, that's — lots of people are scared to hire a green MOA, and they're told by their colleagues, "Don't do it," because they've had bad experiences. I wouldn't necessarily write off hiring a brand-new MOA just because they don't have experience, because you might get a real gem. I started my career at 19 years old, and I'm still working for the same doctor. You know, that worked out; I didn't come into the field with a bunch of bad habits or anything like that, and I was completely trainable to how they wanted me to be. So there's a catch for each of them, right? You could get somebody that's a little bit more experienced, but they're, kind of, stuck in their ways, or you could hire somebody green that is completely moldable, they just might need a little bit more training. And that's available as long as you're willing to provide that to them.
Chad Ball 14:09
Those are such good points, Corrie. You know, my next question surrounds — just touching on what you had brought up, which is that when, presumably an anxious patient, particularly, I think that's probably the case for those of us who do cancer or oncology work, when they call you as that first point of contact, you really are the face of not only the surgeon, of course, that you work with, but there's no question you're the face of the whole health care system at that point, and the most important person, you know, that that patient will talk to, probably for the month. How do you — what sort of tools do you use to talk to those patients? How do you frame — how do you put them a little bit more at ease than, perhaps when they dialed your number? How does that interaction go?
Corrie White 14:58
Well, I always try to answer the phone with a smile on my face. You can sense through somebody's voice when they're cranky, or they're short, or they're frustrated. So I always try to answer the phone with a smile on my face, and I try not to sound rushed. You can tell when you phone somewhere, too, and somebody's rushed, and then it puts you in a panic. So when I — first thing I do when I answer the phone, you know, I say, "Good morning. Doctor so-and-so's office," and I try to sound calm, because that's immediately going to bring that patient's level of anxiety down, even if it's just a little bit. And then, you know, we start our conversation, and you start to pick up if somebody's very nervous. They're stressed about a situation. So I try to do what I can to ease their nerves by explaining the process. Not everybody knows how the medical system works, and the referral process, and the time that it takes for everything. Everything takes time. So if they can understand the process, it becomes less frustrating for them navigating the medical system, when they're not navigating the medical system on a daily basis, like you and I are, they don't understand that, you know, these things have to be done prior to this. So if they can get a, you know, Coles Notes version of me walking them through it, then they say, "Oh, okay. Well, that makes sense. Thank you for explaining that to me." And that is going to just ease that much more frustration with them, that much more anxiety. And it makes the rest of their medical journey a little bit easier for them, because they have a bit more of an under[inaudible] to work on a day-to-day basis. I think it just — a little bit of explaining sometimes goes a long way.
Chad Ball 16:59
Yeah. That makes sense. Being calm and patience clearly goes a long way. In everything in life that we do, and we probably all need more of it, we can all learn from it, for sure. You know, the next thing we wanted to touch on was the concept of efficiency in an office, and I realized that's a 30,000-foot broad term. But, you know, one of the things, from the outside, that I think I've witnessed over the years is the importance of efficiency, particularly if you're a surgeon or — surgeons are high-volume in nature, whether that's operative or nonoperatively. I'm curious how you set up your office and your day, and maybe even your week, if it differs from day to day, in terms of trying to maintain that efficiency.
Corrie White 17:49
Yeah, I'm a big list maker, I will write a list and then prioritize the things that need to be done; things that are more urgent and things that, you know, can wait a little bit. Procrastination is a big killer of efficiency. If you're going to hold off on something and hold off on something, all of a sudden the, you know, the weeks go by really fast. So to just stay on top of things makes your office that much more efficient. Communication is a big efficiency thing, too. If you and your MOA have good communication, your practice is going to be that much better. So many offices don't have good communication. The MOAs hardly chat to their bosses about the day-to-day things. They're scared to bother them. They're — you know, so it's, if you can set up some sort of workflow where your MOA is okay to ask you questions, whether it be, "Yes, it's okay that you text me," you know, "I'm in surgery. I'm not going to answer your right away, but I will get back to you." The more you allow that in the beginning, the more efficient that is going to be down the road. If your MOA is allowed — okay to ask you, "Hey. This patient's phoning about this," they're going to get used to your style of practising, and, you know, they may not have to ask that question again down the road. So that will make things more efficient as you go. Everybody's different to it. Well, you know, some people are list-makers, some people are, you know, Post-it notes, some people use the task in the EMR. Everybody's got their own little workflows. You just have to figure out what is going to work well with you and your MOA and know when something's not working well, that it's okay to change it. You can't, you know, [if] something is not working well, you keep trying over and over and over again, and it's like, hey, we need to just change this. It's not working well. Let's do something different because it might be better for your team.
Ameer Farooq 20:15
So, Corrie, I want to get a little bit granular, here, because I really do think this is important because, you know, especially now that I've started life as an attending surgeon, you don't realize all the nuts and bolts and the mechanics that goes on the back. And if that's not going well, it's really hard to concentrate on your low anterior resection when there's, you know, a fire brewing in your office with your other patients. So, Corrie, like, there's obviously, there's, kind of, multiple components that you have to be in charge of. So one, one aspect of it is just simply scheduling. How do you — and you've been — I mean, I think one thing that's nice about the setup for myself and Bernie [inaudible], who I'm sharing the office with, is that there's a fairly predictable schedule of when the OR days are, when the clinic days are, etc., etc. But when you're looking at a given clinic day, how do you figure out, you know, how many new consults to put in there, follow-ups? Because, you know, you're not asking me every day, you know, how many patients should I put in? Or, who should I put in where? A lot of this is happening behind the scenes, as it should, because I don't think, you know, as a surgeon, we should have to necessarily think about that all the time. How do you go into figuring out specifically the scheduling aspects of a surgeon's schedule?
Corrie White 21:36
Yeah, you're absolutely right; a surgeon doesn't need to be thinking about their schedule, and whether or not their Monday is booked enough in the clinic, because that's why you hired an MOA, is to take care of your scheduling; to take that off your plate so that you can focus on doing other things. In a surgeon's office, you know, it's — in family practice, you just book the appointments; it doesn't necessarily matter. In a surgeon's office, you have your endoscopy days, you have your general day care, your ambulatory care, you know, smaller cases, and you have your surgery days. Those days need to be filled. We have resources that are given to us, and it is important that that time doesn't get wasted. So when you're looking at, that I have, you know, this much endoscopy time per week, I have this much OR time per week, I need to make sure that I'm filling the office with this many surgical patients and this many endoscopy patients, and you need to be looking 4 to 6 weeks out. If you don't have a little bit of a — there's a fine line between how big of a waitlist of patients you need. If you don't have a waitlist, you are constantly scrambling to pull patients into the office to get them to be booked for surgery. Otherwise, your surgery time is going to be given to another surgeon. I mean, if you have a gigantic waitlist and your surgery wait is 9 months down the road, then you don't have to worry about that scramble, but then it's, you know, the catch-22: your patients are going in your office constantly, you're getting 3 times as many phone calls, your MOA is dealing with it, because your waitlist is so long, and your patients are disgruntled because they're having to wait. So there's this, you know, nice little spot where, if you can be booked a certain amount out, you know, that I need to have this many endoscopy patients in a week and this many surgical patients, and then you're always going to get the consults that don't look anything. They're not, you know — you can't guarantee, "I need 14 scope patients to come in a week, and I'm going to book 14 consults." No, you probably actually need 25 consults for endoscopy to come in, and — because a lot of them aren't going to book at all, or they're not going to book in the timeframe that you want, because they have some other life going — things going on. It is a constant, constant juggle, to make sure that you have enough consults coming in for the appropriate things. And then you have to have your office time for your follow ups. So it's definitely a constant juggle, and it's something that you constantly have to be looking at. Going forward, you have to look about, you know, 4 to 6 weeks out, what do I have coming in here now, so that my surgery days 2 months down the road are going to be full?
Chad Ball 24:41
Yeah. And I recognize, obviously, that's going to vary a lot based on the surgeon, the type of practice you have and, you know, how quickly you see patients in the office, right? Those are all real, obviously, factors as well that go into that scheduling part of it. And the second part, you know, I think that I'd — I'd love for you to share your method. I know you said that, obviously, everybody has their own workflow, but I'm sure you've seen enough different workflows to kind of get a sense of what works and what doesn't. You know, there's constant things that people need — that surgeons need to follow up on. So it's, whether, for example, I get a follow-up with someone while I'm on call, but it's not really something I need to see emergently, so, okay, send them to the office, or if it's lab results or test results, or even patient questions, etc., etc., how do you try to integrate that into a surgeon's workflow, such that things don't get missed and, you know, no patient falls between the cracks? The tracks — or, between the cracks, rather. Are there any things that you've picked up? Is it — do you put everything in the EMR? What are your tips and tricks?
Corrie White 25:48
I try to book everybody for a follow up. Any procedure that we do, I just try to book them for a follow up. It's easier to pre-schedule them. It's easier to cancel somebody that doesn't need a follow-up than the opposite — accidentally not scheduling somebody for a follow-up because, for whatever reason, we didn't get their pathology report; that didn't come across our desk, and we didn't book them for a follow-up appointment, and they've fallen through the cracks, and their pathology came back not good. So I would — I pre-schedule everybody for a follow-up. They've had their procedure. You know, your report comes back and says: The patient to follow up with their family doctor. Okay, no problem. Now I know that your appointment. Worst case scenario, we phone them and just say, "Hey. Your results are normal." And, you know, "You don't need to come back and see us for 5 years." Oh, okay. The patient says, "Great. That's fantastic. Thanks so much." I would rather over-communicate with patients then under-communicate with patients, if that makes sense.
Chad Ball 27:11
Yeah, that makes total sense. You know, Corrie, one of the things, one of the many things, obviously, that's changed during this pandemic COVID era has been the explosion, I think, probably globally, of virtual consults, whether that's on the phone, or video-based, or are a mix of both, I think have really become popular and helpful for patients and physicians and their offices alike. I'm curious how you frame the virtual consultation and, in particular, if there's things that represent bigger challenges from your end of things, or are they easier? What are the do's and don'ts that surround that particular sort of new avenue?
Corrie White 27:58
Definitely some pros. For the virtual consult, it's easier for a lot of patients. Everybody's busy nowadays. Everybody is on the go, go, go. So for patients not to have to come and sit in the waiting room, to not have to drive to the office, to the doctor. Just to call them; lots of patients prefer it. Some patients still do like the one-on-one. They like to come into the office. I find that typically more so with the older generation. Sometimes it's an outing for them, right? They like to come into the office and chit chat because they don't have a lot of other stuff going on. But the virtual, for the most part, people have really — they enjoy it because they don't have to sit and wait in a waiting room, they don't have to take half the day off to come to an appointment; they can quickly take their lunch break and take a doctor's call. Some of the negatives that I see from that is: you lose a little bit of the personal relationship with your patient. There's a lot of patients that I don't even see in the office anymore because, you know, I booked their phone consultation, they chat with the doctor, they go to the hospital, they meet with the doctor and then, again, they do their follow-up over the phone. So there's a lot of patients that I don't even meet face-to-face anymore, which, it's a little bit sad, you know? You get to know your patients and you — it's, I find, a little bit easier to walk people through instructions when you're able to hand them a piece of paper and walk them through it, rather than over the phone and just emailing it to them. But, definitely, the ease of things; it's more flexible for the doctors too, you know? You guys get stuck in the OR, and you can't get to the office on time; well, I just can quickly move some phone appointments around to the end of your day or to the next day, and then we're not in a panic all day, running an hour behind all day. So I definitely see more positives than negatives with the virtual care, for sure.
Chad Ball 30:22
Corrie, you know, one of the things that you and I have chatted about or discussed or mulled over is the office setup itself. And, you know, obviously, this is going to vary from place to place, type of practice, number of servers, etc. But I'm curious what your thoughts are about the way the physical office is structured, as well as the way that patients come in through your door. So what I mean by that is, you know, in the old days, I remember my dad's office, everybody would have, you know, all the offices would have all these magazines everywhere. You know, Reader's Digest was a classic, I think I have read from going and sitting in my dad's office, when I was in school, and sometimes studying at his office — I think I'd read like, hundreds of Reader's Digest, which maybe I shouldn't be saying online in the podcast; my dad will kill me — but, you know, like, what are some of the things that you think are important to have physically in the office? Like, should everybody get a TV? Should we get an aquarium? Like, what are the things that you think really matter to patients or that you think would be helpful for patients? And the second thing is, you know, sometimes, I wonder if patients actually like coming into the office and seeing that it's a busy place, because they get some external validation that, look, this is a busy person, this surgeon — he or her — you know, they're really busy, they clearly have lots of people come to see them; they must be good. Or do people get irritated by the fact that, okay, we're having to wait, or that it's so busy. I'd be curious on your thoughts on both those fronts.
Corrie White 32:01
Yeah, I think some people definitely think, you know, they see that, well, it's a long wait to get in for my appointment; this doctor must be good. From my end, more often than not, people are annoyed about having to wait. Whether it be in the clinic, sitting and waiting for their appointment, or whether it be for their consultation, they have to wait 12 weeks to get in to see the doctor. I get a lot of complaints about that, you know, and you have to, "I'm sorry, I can," you know, "do my best. I'll put you on a cancellation list. We'll try to get you sooner." And I do my best to do that, but it's challenging. People are frustrated. "I've already been waiting this long." "I've already —" you know, all of this stuff. And you can't please everybody. Somebody's going to complain one way or the other. But I think more often than not, people are a little bit annoyed about waiting rather than looking at the positive side of it: "Oh, this doctor's," you know, "got a whole bunch of people waiting here. They must be a popular dude. They must be a good surgeon, because look at all the people waiting to see them." Yeah, some people might have that thought in their head, but they don't voice it to me; what they voice to me is, "Why do I have to wait this long?" "Why am I sitting here for 25 minutes?" "You must have not scheduled him properly if I'm sitting here waiting for half an hour." That's the feedback that I get versus, you know, "Oh, this guy must be — this guy must be good because I'm sitting here waiting because everybody wants to see him," sort of thing. As for, like, office — what people might want in the office: a good flow. I've seen offices where the amylase backs are actually turned to the door. The desk was opposite of the door, so when a patient came in, you know, the MOA was back towards you. And that's not very — like, it's not a nice greeting when you come into the office, because the MOA might be on the phone, and they might not be able to turn to you and say "Hello. How can I help you?" right away. People want to be greeted when they are in the office. They want to know they're in the right place. They're coming — maybe they're uncomfortable about why they're seeing the surgeon, so coming to an office that feels comfortable, where somebody says, "Hello. How are you doing? Are you just checking in?" Instantly, that's going to calm their nerves. Having a nice, you know, flow where you can walk right into the exam room is important too, like — everybody wants something a little bit different, I think. Some people like everything to be very, you know, flashy and new and updated, and other people don't mind if, you know — like, our office is kind of cozy, I would say, but I get lots of compliments on it. People like the way that it is. So yeah, I don't know how much the aesthetics side of it matters to patients, as long as it's not really run-down and just a weird layout. Definitely the desk facing opposite of patients walking in was a weird layout to me.
Chad Ball 35:50
What are some of the good EMRs that you've used? I know that you've used a bunch of different ones. What do you think? And, you know, we're, just to be clear to our listeners, we're not sponsored by any EMRs or any companies. We have no affiliations. This is really, purely — and you aren't either — just to really purely get a sense of what are some good EMRs? Specifically, let's go through a few, like Accuro, Plexia. What are some of the pluses and minuses of these different EMRs?
Corrie White 36:22
I use mostly Med Access and Accuro. I've seen some of the other programs but haven't really worked day-to-day with them, so I can't comment so much on those ones. Definitely, my favourite program to work with would be Accuro. It's just very user-friendly, it's very streamlined, it's very adaptable. You can customize pretty much everything that you would want on there to make it work with your practice. The other program I use, Med Access, there's a little bit — it's a little bit more finicky when it comes to certain aspects: building forms and making forms. We're constantly getting new forms from, you know, our health authority, and we have to tweak little things and update things. And Accuro has made that very easy to, for the user — the MOA — to just go in and adjust these things where, I find, Med Access, it's much more challenging to go fix this form, and often to actually phone tech support and have them do it for you. So that's a hassle. I don't like to phone and sit on hold when I've got a million other things to do to ask them to change something on one of the forms that, you know, our Health Authority has decided needs updating; I would rather just do it myself. So I don't like that aspect of it. It does have things that, you know, Accuro doesn't have, though. I had actually mentioned something to you the other day and I can't remember off the top of my head. It was a nice little benefit that it had, but I definitely, in a specialist's office, I think Accuro is a little more user-friendly than the Med Access.
Chad Ball 38:24
How about Plexia, Corrie? Have ever used Plexia?
Corrie White 38:27
I haven't used — I've seen a little bit. I haven't used a lot of Plexia. I have heard it's also a very good program. Right now, like, a lot of the surgeons in Abbotsford, in our group anyways, they're all using Accuro. So I just haven't had a lot of experience with Plexia to make a lot of judgment calls on it.
Chad Ball 38:52
Yeah, the world of EMRs is certainly interesting. As you probably know in Alberta, the entire province is going to Connect Care, which has some pluses and some negatives for sure. So it'll be interesting for the rest of the country to watch us transition into that interesting time. My understanding, Corrie, is that you've also done a lot of billing for a lot of surgeons for quite a while. I'm curious, again, how you frame billing. What are the absolute do's and don'ts — the tips and tricks, both on the surgeon side of things — so when Ameer started with you, what did you tell him were the absolute do's and don'ts in terms of what he had to hand you and what he had to track — and then at the back end, what makes your job that much easier and that much more difficult?
Corrie White 39:43
Definitely keeping some sort of record of what you have asked to be billed, whether or not you're doing the billing or you're having your MOA do the billing; having some sort of, whether it be a physical, written book of all of your billings, or whether it be, you know, an Excel sheet that you can share with your MOA. Because, obviously, this is in your EMR, and your records are all in your EMR, but if you're on-call, and you have a million different things going on, and you go to put your billings in your EMR and you miss a code or you miss, you know, you miss a few codes here and there, it adds up. So if you had some sort of easy, whether you put it down, take the patient's labels from the chart, and you put it in a little book that you keep in your briefcase, or whatever, and just quickly scratch it down, and then transfer it into some sort of record-keeping method. When, you know, Dr. Shop has a blackbook. He's used this his entire practice. This is what he does. I have endless amounts of times gone back into that book when our rejections come through, and looked at and thought, "Okay, this is what we billed. Obviously, we need to change it." But to have that to go back to look at, and not just try and remember off the top of your head. Or for your MOA; your MOA doesn't know what you did when you were in the hospital. She knows what you did when you were in the office. But when you're on-call, most of the time she has no idea that you've seen somebody at 2 in the morning and that needs a consult code and an after-hours code. So to have some sort of reference point that you can look back. You do need to look back at it 5 months down the road because MSP is rejecting it, then you have something to go on, not just, oh, here's a list of, you know, a couple things that I scribbled down and if this piece of paper was crumpled up in my pocket, can you figure it out for me? Well, sure, I can figure it out for you, but chances are, something's going to get missed, and you're not going to bill — that you put a bill, because it wasn't organized properly. That's not efficient. That's not my, like, motive. I want to make you make as much as you can, and billings are important. So some sort of record-keeping, I think, would be the biggest one; don't just rely on your EMR to do that for you.
Ameer Farooq 42:41
Dr. Ball, I'm curious — I don't think I've ever asked you this: What do you do? How do you keep track of your billing?
Chad Ball 42:45
Yeah. Very similarly. I don't think, you know, writing it down versus an EMR that you entered into. One way or the other, it matters a whole bunch, once you and your biller — if that's your MOA or, as you know, in many places, it's a separate person entirely or a separate company — as long as you guys all align, and everyone's agreeing. And I think the most important thing that Corrie mentioned there, of course, is just not to miss things. So if you do a phone call, or you see a consult, or you do a small procedure, to have some system to document it immediately, wherever you are, and then communicate that well.
Corrie White 43:26
Yeah.
Ameer Farooq 43:28
I mean, I won't gripe about this too much, but it does slightly irritate me that we have these electronic medical records, and, you know, it's easy to build things that you've seen in the office, but the call stuff is really irritating. And so I wish there was an easier way on an app or something like that. So any EMR companies listening to this, I'm giving you marching orders. There ought to be a better way to upload this stuff easily, such that I don't have to transfer it from a paper record then onto the EMR for billing. But anyways, that's just my early career griping.
Corrie White 44:01
I agree with that 100%. If you had — if we had apps on our phones — we all have our phones in our pockets, so if you had an app on your phone, you've seen a patient at 3 o'clock in the morning on a Saturday, and you could quickly scan something, scan the patient's label and it gets put into your — it gets registered into your EMR and you can quickly punch in your billing codes. I don't think that that is that hard or impossible to do. And it would make that so much easier with just that ease. You wouldn't have to miss anything, because you just know I just need to scan this label, it's inputted into my system, and I punch in my billing codes. Definitely something that needs to happen for, especially, on-call stuff.
Ameer Farooq 44:55
Well, Corrie, we can't thank you enough for spending the time with us on this show today; it's really been informative. I think this is going to be helpful for anyone starting out in practice. I know I've benefited from your expertise tremendously over the last few months, so thank you for that. I just wanted to also mention that you're like a very, very busy person. You've got a ton of side-hustles going on. Can you tell us a little bit about those? And, also, if people want to find you on social media, etc., where can people go to find you?
Corrie White 45:28
Yeah. So I am a, also, small-time farmer. My partner and I, his family has a 500-acre farm outside of Hope, so we do that, as well as we have a small campground. So that's called Washtock Family Farm. And then I also do some MOA consulting on the side. Just — yeah, I've helped go into offices and helped where the wheels are falling off, get things back on track, and make things a little bit more efficient and easy for them, as well as just practice startup for doctors that need to find an MOA and need, you know, to get their practice going efficiently and well.
Ameer Farooq 46:22
You've been listening to Cold Steel, the official podcast of the Canadian Journal of Surgery. If you like what you've heard, please leave us a review on iTunes. We'd love to hear your thoughts, comments and feedback, so send us an email: [email protected] or tweet at us @CanJSurg. Thanks again.