Managing a motivated and efficient dermatology staff

Across America, healthcare industry professionals play pivotal and often pressure-filled roles in keeping individuals and communities safe. However, this commitment to service comes with a toll in the form of heavy turnover rates. One two-year study found that family practices experienced an average turnover rate of 53 percent. Now is the time to ensure you’re running a motivated and efficient dermatology clinic staff.

While tending to patients is every dermatologist’s most critical concern, maintaining a productive and satisfied staff isn’t too far behind. By increasing your team’s high-level patient contact, sharpening your staff-retention efforts, and making sure you hire qualified individuals, your practice can continue to administer the level of care your patients have come to expect.

High-Level Patient Contact

Expanding individual responsibilities can improve staff morale while helping to reduce your workload. Since medical assistants represent the biggest group of individuals providing clinical support to dermatologists, increasing their contact with patients can result in more time for you to address other priorities. 

A well-trained MA may be capable of sharing diagnoses with patients on a case-by-case basis. To ensure seamless quality care, do the following:

  1. Provide staff members with a dermatology atlas to familiarize themselves with more common cases.
  2. Make sure every patient experience is consistent and professional by developing formal staff training programs.
  3. Promote knowledge and curiosity by teaching your team about frequent medications and treatments.

It would also help to train your staff to be conduits between your clinic and the dermatopathology lab. While full-service digital dermatopathology labs like PathologyWatch return diagnoses directly to your patients’ EMR, having a staff member that follows up on orders and results is a positive way to keep the lines of communication open. 

Staff Retention

Spending more time now to retain reliable dermatology staff members means spending less time in the future filling positions and training new employees. Since preventable employee factors are responsible for 80 percent of healthcare industry turnover, here are some suggestions to ensure your team members feel job satisfaction:

Create a comfortable office culture.

Is anyone happy working in a frantic environment that treats every task like an emergency? While there will be times when urgency is in order, do your best to set the example of composure and positivity by setting reasonable expectations for tasks and time management. This includes keeping a level head and being respectful in your actions and speech.

See team members as individuals.

You’re all in this together, so avoid focusing on individual mistakes. Likewise, nobody wants to be singled out or embarrassed in front of others. Be encouraging, promote camaraderie, listen to employee feedback, and find teachable moments to increase efficiency and skills.

Share accolades and rewards. 

Small gestures can go a long way. In addition to praising accomplishments with kind words, keep your staff motivated with performance pay or other incentivized bonuses

Provide employee discounts.

Offer discounts on procedures and products to turn your staff into brand ambassadors. As a result, you can build loyalty from your employees while increasing public awareness. 

Creating an environment where people look forward to coming to work benefits your staff retention while leaving a good impression on your patients.

Hire Qualified People

Tending to patients while meeting the demands of running a thriving dermatology practice would be a daunting challenge without reliable staff support. Start on the right foot by hiring individuals with the characteristics and skill sets you require to deliver quality care to your patients.

According to the Bureau of Labor Statistics, the healthcare industry will add nearly 2.5 million jobs by 2029. With a labor pool that size to choose from, make sure you aren’t settling for employees that aren’t going to make long-term contributions to your clinic. Trust your instincts if you don’t feel someone is a good fit for the job’s values, pace, or expectations. If you’re on the fence, suggest a trial period to ensure both parties are satisfied with the duties and performance. 

Here are some personality traits to keep in mind as you identify features that translate to a valuable dermatology staff member:

  • Ambitious: Your workload can get lighter with the support of enthusiastic individuals who don’t mind shouldering additional responsibilities.
  • Personable: Single out people who are comfortable communicating and showing compassion with patients of all ages.
  • Teachable: Surround yourself with staff members who are eager to learn and share new knowledge and skills.
  • Team Player: Dermatology clinics require staff members to wear many hats to keep the front office and exam rooms working efficiently. 

Managing a motivated and efficient dermatology clinic staff requires consistent attention and leadership. By expanding your team’s patient contact level, focusing on staff-retaining actions, and hiring qualified team members, you can surround yourself with the right people to serve your patients. 

Communication Strategies for Talking about Diagnoses with Your Patients

The healthcare industry is becoming increasingly convenient for patients with the rise of telehealth and greater access to medical records. Patient portals are now offered by nearly 90 percent of providers. While convenience is important, it is critical for your dermatology clinic to develop a personal touch and sound communication strategies for talking about diagnoses with your patients.

By taking the time to ensure your patients understand their diagnoses, training your staff to help share results, and knowing how to discuss diagnoses, you can help your practice keep patient experience and treatment a priority.

Taking Time to Educate Patients

Walk into a busy dermatology clinic and you will find staff members moving briskly to attend to patients, communicate with labs, manage the billing, work with insurance companies, and schedule out calendars. On top of this, the dermatologist balances limited time bouncing between exam rooms to take biopsies and guide treatments.

However, when it comes to sharing biopsy results, it’s vital to shift gears and take the time to help patients receive and understand the information with clarity. Because only 12 percent of patients can interpret their pathology report results correctly, dermatologists must be vigilant to ensure each patient leaves with an accurate comprehension of his or her condition. Here are a few suggestions to help engage the patient in their care.

Name their condition

By writing down the diagnosis and explaining it carefully, even if complicated (think CNH or GA), patients’ understanding and recall of their conditions improve. This correlates with increased patient satisfaction and adherence to treatment. Studies also show that patients forget 40-80 percent of what you tell them, so written communication is often best.
Give them a copy of their pathology report.

Consider printing out a copy of their pathology report. Having them read along as you explain the results can help to build confidence and absorb information. They will likely feel more comfortable asking questions.
Explain additional tests. A patient who understands his or her test results is likely to comprehend your reasoning for ordering further biopsies or studies.

Empower the patient

The more that patients understand, the more they are able to take personal responsibility for their own health and well-being. Time spent upfront counseling patients can result in improved outcomes, improving both patient and physician satisfaction.

Training Your Staff

The most powerful tool a dermatologist has is a supporting and capable staff. In addition to training team members on front and back-office tasks, you can save valuable time by giving medical assistants more ownership of the diagnosis-sharing process.

Patients want to receive their results as soon as possible. In one study, 67 percent of patients requested phone calls to receive their skin biopsy results because they wanted the information fast. By training and trusting your staff to communicate test results directly to patients, you can use this time to add an acute patient or catch up on documentation.

Your staff is listening as you interact with patients. Ask them to pay close attention to how you counsel patients so they can repeat the process on their own. Train your MAs to use handouts, images, or other devices to convey information in a comprehensible manner. Building relationships of trust by counseling with patients can make it easier and more personable when MAs follow up on treatments.

Putting Your Practice Management Tools To Work for Your Dermatology Clinic

Your practice management tools can be a costly part of your dermatology practice overhead. New practice management solutions are popping up frequently. With busywork costing physicians an average of $50,000 a year in lost revenue, it can be overwhelming to evaluate the latest timesaving or job-simplifying solutions in a busy practice. 

However, by examining your existing practice management tools, such as billing, your EMR, and your dermpath lab partner, you may discover increased efficiency may require some simple finetuning that makes a big difference to your bottom line.

Billing 

Collecting payment for the work you perform seems an obvious yet sometimes daunting task. A common question for dermatologists is whether to keep billing in-house or use a professional billing company. Each option has its benefits.

The advantage of a professional billing partner is the experience they bring to the table. About 10 percent of claims will be denied, and a high percentage of those (63 percent) are recoverable, so it’s important to resubmit denied claims. In addition to submitting and challenging claims, billing professionals can perform coding audits, credentialing services and potentially negotiating superior rates with insurance companies.

These companies typically charge a percentage of collections, ranging from 5 to 10 percent, and are therefore incentivized to maximize your collections. Look for a company that specializes in dermatology billing and talk to reference clients. Make sure they can work with your particular EMR or PM software.

A common issue for physicians using in-house billers is how to be confident that billing is being performed correctly. There are services that will perform a complimentary revenue cycle audit to ensure that you are maximizing your reimbursement.

EMR

Embracing the advantages of a modern, cloud-based EMR system can simplify record-keeping and maintain effective patient care in your dermatology clinic. It’s exciting to see more dermatology-specific EMRs created by dermatologists who understand the unique workflow of dermatology. While almost 86 percent of office-based physicians employ EMR/EHR systems, many have yet to tap into the full breadth of productivity-increasing features. 

Look for an EMR company that performs consistent upgrades and frequently informs and educates users about new timesaving benefits. After comprehensive onboarding, keep in touch with your EMR customer service representative to get answers to any questions or challenges your staff may encounter. Resolving performance issues is part of their job description, and it will save your team valuable time. Often, chat or emailing support is the most time-efficient way for staff to reach out for questions or troubleshooting, rather than calling the helpline.

Dermpath Lab

The working relationship between your dermatology clinic and the dermatopathology lab is critical to maintaining accurate and timely results for your patients. This alliance is particularly vital when you consider that a third of dermatologists work as solo practitioners.

One effective way to build this relationship is to establish open lines of communication. This includes providing accurate clinical information on your requisitions, conversations about difficult clinical cases, and correlation on challenging slides, such as alopecia or melanoma cases. In addition to quality assurance, these frequent conversations can also head off complicated billing issues before becoming a problem.

Your dermpath laboratory partner should keep you in supplies so your staff isn’t left scrambling to find requisition or shipping materials. The lab is also responsible for tracking samples from when they leave your practice until you receive the final results. 

Finding a lab that establishes an interface with your EMR can make a significant impact on your workflow. Instead of spending time managing paper charts and faxes, a full-service dermpath lab like PathologyWatch can return reports electronically into each patient’s EMR chart. Digital slides are also provided to the clinician along with the pathology report. This instantaneous, 24/7 access eliminates your MAs’ need to track and file paper trails and glass slides, leaving more time for meaningful patient correspondence. Also, labs like PathologyWatch offer broad insurance coverage and locum tenens contingencies, so there is always a backup ready to keep up with your tissue samples.  

Many dermatologists carry the daily pressure of meeting patient expectations while running a proficient and profitable clinic. By breaking down ways to make billing, EMR, and your dermpath lab partner work smarter and more efficiently, you may find ways to simplify and improve operations through your existing practice management tools.

What the @!#% Is an HL7 Interface, and Why Should I Want One?

You May Save FTE Time by Switching to an EMR Interface

By April Larson

In an increasingly digital world, where digital devices make us more efficient (except for time spent playing Candy Crush), we often find that digital healthcare solutions cost us time and efficiency. While we anticipate technology will improve efficiencies, we often find we are trading one inefficiency for another. Why does my iPhone seem to solve my every problem (“Hey Siri, where is the closest gas station?”), yet I’m still spending my evenings feeding my kids Top Ramen while I catch up on my clinic notes? Ironically, in the increasingly sophisticated digital age, healthcare technology feels outdated and less robust than we experience in competitive arenas like entertainment or business.

In this article, we will discuss ways to save FTE time and simplify clinic workloads by examining some of the obstacles created by new technology, defining what an HL7 interface offers, looking at the challenges of paper, and digging into the advantages of digital pathology. 

What are the technological challenges?

  1. There is no universally accepted electronic medical record.
    One challenge with information sharing in healthcare is that there are many universally accepted electronic medical record systems. In fact, over 130 vendors produce EMR systems. Therefore, while healthcare is becoming increasingly digital, many of us are still disconnected and cannot share medical information—such as clinic notes, lab results, and pathology reports—as seamlessly as we would like. Dermatologists and staff spend lots of time tracking down reports and medical records, sending consult letters, or performing other necessary communication to provide the continuity of care patients need.
  2. Regulations can complicate the sharing of medical information.
    This is a crucial reason why the medical world is one of the few industries where old-school faxing is still widely embraced. Digital communications are complex and sometimes may not be compliant with HIPAA or HITECH requirements.
  3. Electronic documentation is often less specific.
    It can be beneficial to use templated descriptions for common diagnoses. However, when I biopsy a lesion, a more specific description is preferred. Manual entry of a lesion description can be cumbersome, especially when training a new medical assistant; either I accept a less detailed description or differential, which can limit the amount of information getting to my pathologist, or I spend my evening catching up on my notes rather than binge-watching Schitt’s Creek.

As digital technology makes its way into healthcare, perhaps Siri will one day be able to scribe and bill all my notes while my medical assistant and I happily engage with and educate our patients. In the meantime, the most exciting way to start sharing electronic information is through an HL7 interface. 

What is an HL7 interface?

HL7 stands for Health Level Seven, which refers to set standards for transferring healthcare data between healthcare providers. With a membership that includes 90 percent of healthcare system vendors, the organization establishes specifications to safely and accurately exchange sensitive healthcare data.

How do I get the LIS and EMR talking?

Laboratories, including dermatopathology laboratories, use an electronic system called the LIS (laboratory information system). The dermatopathology world’s EMA and EZDerms include an LIS such as PowerPath, Beaker, or WebPathLab.

While these systems are not designed to talk to your EMR, the HL7 interface enables EMRs and LIS programs to communicate the same language. This allows for the transfer of data between otherwise incompatible electronic medical records.

Why do I want an HL7 interface?

While 60 percent of clinics already have implemented EMRs in their practice, most have not experienced the game-changing capabilities that an interface provides. The exchange of information through this interface can simplify your daily workflow considerably. By way of an HL7 interface, the lab can send reports electronically directly to your patient chart and, in certain instances, populate the diagnosis and treatment, streamlining your review and signoff.

The adoption of technology can save the staff from menial, time-consuming tasks and allow them to participate more in patient care, which increases both staff and patient satisfaction.

What are the challenges of paper?

When a dermatology practice sees 40–50 patients per day, relying on paper to manage the workflow can create inefficiencies and impact the time to deliver results to patients. Consider the following weaknesses:

  1. Handwritten requisitions and labels take a lot of time, are redundant, and can be difficult to read.
    Pertinent information must be recorded both on the requisition and the label. Handwritten forms not only take time in the clinic, but labs must also use manual entry. When the dermatopathology lab receives the requisition, the lab tech must manually enter the requisition information into the LIS and match it to the biopsy. This process is prone to human error.
  2. Reports must be faxed and scanned.
    The dermatopathologist signs an electronic report, which is often faxed and then scanned into the dermatologist’s EMR. Papers also occasionally get lost or misplaced in a busy clinic.

What are the benefits of a digital pathology workflow?

To move beyond the challenges of paper, dermatopathology lab services like PathlogyWatch can build an HL7 interface directly to the dermatology clinic’s EMR to optimize margins of error and turnaround times, preserving precious staff and provider time.

  1. There are fewer redundancies and room for mistakes with electronic requisitions and labels.
    When you document a lesion in the electronic chart, you can use this description and diagnosis to generate electronic requisitions and labels rather than write down the same information in multiple places, like the location or date of birth. Patient information is also easier to read, more accurate, and simple to double-check with the patient.
  2. Reports automatically upload to the patient’s chart.
    When dermatopathology reports are signed out, the reports are uploaded directly into the patient’s EMR.
  3. Automatic data entry is also possible.
    In some instances, the diagnosis and treatment options autopopulate for the dermatologist’s quick review and signoff.
  4. A digital pathology log can be easily shared amongst providers and staff.
    Providers can quickly sign off on a report, and a reminder is automatically sent to the electronic pathology log, where multiple staff members can work simultaneously.

The pressure is on dermatopathology laboratories to simplify the way information is shared with their partner dermatology clinics while maintaining compliance. By assuming the many time-consuming, routine tasks involved in a traditional dermatopathology workflow, a secure and compliant HL7 interface allows both dermatologists and their support staff to spend more time in patient care areas that are more rewarding, such as patient interactions and education. We win by spending our time doing what we’re best at and most enjoy: seeing patients. 

And who knows? Maybe we’ll have time to get in an episode or two of that show we’re behind on.

Diagnostic Testing in Atypical Spitz Tumors

Dermatologists diagnose and treat various skin disorders, including eczema, psoriasis, infections, and skin cancers. The average dermatologist sees 40 to 50 cases per day and is exposed to uncommon conditions, such as atypical Spitz tumors.

Considered borderline lesions, atypical Spitz tumors can make it challenging to predict metastatic risk or biologic behavior. Because they can resemble malignant melanoma, it is essential to recognize atypical Spitzoid tumors, become familiar with associated diagnostic testing, and partner with dermatopathology experts that can provide your patients with accurate and efficient results. 

Understanding Atypical Spitzoid Tumors

Lesions designated as atypical Spitzoid tumors (AST) confusingly appear as both Spitzoid melanomas and wholly benign Spitz nevi. Most commonly found in females with an average age of 22 years, the enigmatic lesion lacks standardized histological benchmarks, making consensus difficult for pathologists. 

Because of the difficulty in defining the biologic potential using morphology alone, dermatopathologists will sometimes order additional ancillary testing to help characterize the lesion. 

Additional testing platforms

Two techniques sometimes utilized to help characterize atypical Spitz tumors include Flourescence in-situ hybridization (FISH) and Array-based comparative genomic hybridization (aCGH). Flourescence in-situ hybridization (FISH) tests for characteristic chromosomal changes seen in tumors. Using a fluorescence microscope, short DNA fragments known as “FISH probes” are examined as they hybridize to tumor cells. By counting the resulting fluorescent dots, dermatopathologists can detect a loss or duplication of chromosome fragments. The method, used in combinations of four and five-probe FISH assays, is sometimes preferred as the primary molecular test because it is quick and straightforward and allows histopathologic correlation. In atypical Spitz tumors, probes are performed for covering the chromosomal loci 6p25, 8q24, 11q13, centromere 9, and 9p21.

Array-based comparative genomic hybridization (aCGH) is used to establish areas of genomic imbalance. While few academic centers perform CGH due to the high cost and limited insurance reimbursement, the method produces higher resolution results, which enable the identification of genes related to Spitzoid melanocytic neoplasms. When a Spitzoid neoplasm has a genetic pattern similar to malignant melanoma, this can potentially result in a poorer prognosis and possibly a reclassification to Spitzoid melanoma.

There are additional ancillary testing modalities marketed in the dermatology community to aid in the diagnosis of melanoma. None of these tests, however, have been shown to be consistently reliable; therefore, many dermatopathologists do not utilize them except in very rare circumstances.

Finding Experts in Molecular Testing 

When a dermatology clinic encounters an unfamiliar lesion, they turn to their dermatopathology laboratory for a correct and timely diagnosis. Aligning with a lab that embraces digital pathology can decrease turnaround time by 20 percent to up to 75 percent

Partnering with expert dermatopathologists, like the team at PathologyWatch, means access to academic-level interpretations and judicious use of ancillary tests when indicated. In addition, utilizing a digital pathology workflow enables simultaneous corroborations on difficult lesions by multiple experts. Having a team of qualified pathologists on your side can be the difference between diagnosing a tissue sample as Spitz nevus or Spitzoid melanoma. 

Though uncommon, your dermatology clinic may come across borderline lesions from time to time. By learning more about atypical Spitz tumors, understanding diagnostic testing, and knowing what to look for in a dermatopathology lab partner, you can empower your practice and continue to provide your patients with optimal care.

Greg Osmond, MD, CMO at PathologyWatch, Joins Raise the Line Podcast to Talk Pathology of the Future

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

In these turbulent times, healthcare practices must adapt to the evolving needs of their patients. How is that impacting the direction of a pathologist’s role? And how will those role changes impact patient care? 

Recently, Greg Osmond, MD, chief medical officer at PathologyWatch, joined Rishi Desai, MD, host of the podcast Raise the Line, to discuss the future role of pathologists on the care team and how pathology is changing, especially in light of the emergence of AI technology. 

Here are some highlights from Greg and Rishi’s interview:

What are the benefits of pathologists being more visible to patients?

Greg: As a clinician, when you need answers—and there are a host of variants that can be the cause—you need qualified and highly trained people that you trust to sort out those variables. That’s one of the main drivers of involving pathologists more directly in patient care. 

What future role will pathologists fulfill for healthcare and health organizations? 

Greg: I believe we’ll see a transition from working exclusively behind the scenes to a public-facing role. Hospitals and organizations are increasingly looking for ways to integrate points of patient care into a comprehensive, holistic care plan to give the best patient outcomes. Pathologists are best suited for that role. 

How is the industry responding to the transition from glass slides to digital?

Greg: Many pathologists are waiting to see how this move toward digital innovation plays out. The industry investment into digital pathology is massive and will change healthcare within the next five years. 

Don’t miss this fascinating interview! Click here for the full podcast, and learn more about the important points doctors need to understand about digital pathology and other emerging modalities that are sure to change the practice of pathology in the coming decade.