Tag: productivity

Conflicting Emotions

Conflicting Emotions

by Marguerite Mullaney, MS CCC-SLP and Lisa Yauch-Cadden, MS CCC-SLP

This entry of REFLECTIONS brings the founders of this website together once again following some disappointing news…

Lisa Yauch-Cadden and I met in 1999 when the SNF world was freezing to death in the new ice age of PPS. I was doing per diem with every company operating in MA because all the full time positions vanished between midnight December 31, 1998 and 12:01 am January 1, 1999. Lisa was the SLP Regional for a company that no longer exists and whose name is better left in the past.

My life was in a spiral. Lisa doesn’t know, at least she didn’t until she read this draft, how close to pulling the plug on my own life I was that winter day in 1999 when we spoke by telephone. The telephone was one of those super heavy Nokias which could be used as a weapon if some ruffian set upon me. I was in more danger from the internal bully egging me on to end my temporary misery with a permanent solution.

I was in the front seat of my car watching the gentle waves of Dorchester Bay near Castle Island in South Boston. Lisa was driving somewhere in southeastern MA. She was giving me a quick run down on what PPS was all about and how it would impact my service delivery.

To be honest, I was only half listening. My mind was stuffed with grief over my father’s death just 19 months before and all the things he left undone: a distraught and broken wife, a physically handicapped son, a mentally ill son, an incarcerated son, and very tiny grandchildren who needed every adult in their little lives who could feign normalcy, to do so. Then there were his bills. Hundreds of thousands of dollars with nobody to pay them except my sister and me. So, the collapse of healthcare and the resultant destruction of my steady, reliable paycheck could not have come at a worse time. Yet, there I sat in the frigid cold front seat of my car, having decided that today I would not just walk into the sweet Atlantic and end it all, listening to the confidence Lisa expressed about the future.

Surely, she was a mad woman.

Her advice resonated though. It made wonderful sense in a world of senseless new rules. The advice was, in fact, brilliant. It gave me a path forward from the professional and personal hole I was being consumed by.

“Just treat your patients. If we all just take care of our patients then everything else will flow from there.”

So, I decided that this SLP radical I was talking to, while she tooled around in the land of Lizzie Borden, might be on to something. And, if she wasn’t, I could always walk into the sea on another, warmer day.

That year, following Lisa’s ‘just treat’ advice, I made more money than in the previous two years or the following year as a full time employee for one company. The success of it went very far in restoring some stability in my still overly complicated life.

Lisa and I didn’t touch base for a few years following that call. The company she worked for folded and her supervisors opened a new group. They were planning to do it right. Patient care first. I initially inquired about work with them but the office manager was kind of … difficult and the pay rate was a little less than ok. But, then after a few months they advertised for a per diem at a place less than 15 minutes from home. I could take a few dollars less and a snippy receptionist for a clean SNF 10 miles from my front door.

Lisa met me on September 15, 2001. The country was in chaos. I was less suicidal than during our previous conversation but everything else in my life was just as complicated. It would have been the 48th birthday of my brother. He died 10 months before, leaving my sister and me heartbroken and lonely. I thought I was meeting Lisa for an interview. Lisa arrived with the employment forms and launched into my Orientation while I filled the materials out. When I asked her if this was an interview, she looked stunned.

“We already know each other. Why rebuild the wheel? Besides, there are patients waiting to be treated.”

So, that first day was Interview, Orientation, an eval and three treats all wrapped into one. It sounds crazy but Lisa’s confidence in “just treat our patients” made it seem silly not to do it the way we had. Besides, it was great to hear that certainty of the path forward again.

For the next two years Lisa and I developed a model which placed one SLP in each SNF. The ratio of therapists to buildings went from one therapist to nine buildings to one therapist per one and a half buildings. We were flourishing and growing. It was amazing. We started a CF program and launched the careers of some truly remarkable therapists. We established clinical relationships that flowed into lasting friendships. So much so, that my Facebook list of friends and family has almost fifty people I met through the company. I am super selective about work people being on my feed because I don’t like to blur lines, so it stunned me when I counted them up yesterday. It was such a period of exciting professional growth that I think of those days when I personally struggled with a family in crisis as some of the happiest days of my adult life.

But, all good things end.

The cash flow wasn’t enough for profit margins. The owners, who once prided themselves with answering the phone in the mornings, hired somebody to GROW the business. That is a euphemism for driving revenue to increase profits at all costs. The new management person quickly ended the homespun, family business approach. All communication went through her. The owners were not allowed to talk directly to staff. They stopped answering the phone. Which was easy for them to do because their sole office staff swelled to more than twenty full time people. Lisa left before me. I wandered away from the management end but lingered to treat. Eventually, the cultural shift drove me away completely.

It is easiest to describe the environment the company became like this: staff in the company office, which they dubbed corporate even though it was not a corporation, behaved as if their jobs would be better if there were no pesky customers and annoying therapist to call and cause them trouble. And, decisions about direct care which are best made by treating therapists and people who actually see the patients were being challenged by people in an office miles way reviewing records. The challenges were never to provide less billable units.

One conversation I had went something like this:

CORPORATE TYPE: The patient needs 50 min by all three therapies today.
me: Can’t do it.
CORPORATE TYPE: It’s your job, you will do it.
me: The patient is sick. I can’t do any minutes with her and neither can the others.
CORPORATE TYPE: Did you check to see if you can do education.
me: I did more than that. I held her hair back while she vomited and I got her a cold cloth for her forehead. None of that is billable. Maybe you should go up and see if she has stopped projectile vomiting yet.
CORPORATE TYPE: I’m not going to do that.
me: Somehow I knew you’d say that.

None of us saw our client that day for treatment. We all spent time with her trying to keep her comfortable which was nice for both her and the nurses. She passed away that night. So, the minutes not given to treatment didn’t matter even one little bit. I called the corporate type to let her know. She was unmoved by the news.

So, why am I babbling about a job I left in 2007? The FBI raided their offices on Thursday.

I met some of my best friends at that company. Lisa is not only a friend but she is a business partner and mentor and all around reasonable voice in an unreasonable world. The work she and I did there was life changing for staff and patients alike. The care model we developed is still being used by the national companies who won contracts at the homes our former company lost. So much to be proud of. So much to be grateful for.

Yet, today I am embarrassed to have the name of that company on my résumé.

It is unreasonable to feel this way. I left long before the rumors about ethical decline really picked up steam. My story pales in comparison to some of the war stories others have told.

Still, I don’t like how close my name sits to their name on the annotated history of my career.

It has yet to be determined if there is anything to the allegations. The FBI under the direction of OIG is investigating. There have been no findings to date. We are a country of laws. Innocent until proven guilty is the cornerstone of our due process. I firmly believe this to be true.

But, I feel betrayed by the news of the investigation.

I am left wondering how a company that started with the goal of doing it right, and was so single minded about patient care that it pulled me back from the brink of self annihilation, could end up with armed FBI agents storming in the front door to remove boxes and computers.

How did the owners let all those good people I met there, who they had the good sense to hire, down? How did they lose the key to greatness? How did they let themselves be lead astray from just taking care of our patients?


And the answer to that question of course is…MONEY. Money lead them astray and locked the door to greatness. Money let down the staff and the supervisors. Money tried to tell clinicians how to treat their patients. And Money forgot that patients and clinicians are people and need to be treated with respect.

When I began in the company, it was as Marguerite described: owners with simple, straightforward ideas about how to build a better mousetrap. Establish strong relationships with your contracts and staff. Do the right thing. Treat the patients according to their needs. Follow the rules. When you make a mistake own it and when your staff make a mistake, stand behind them.

When I spoke with Marguerite over the phone all those years ago, I believed what I said. If you treat the patients, the rest will follow. I still believe that. The best way to make money is to do a good job. If you want to make more money, do a better job and if you want to make the most money, do the best job of all of your competitors. What this means to me is that you understand your patients’ problems, you know how to treat them, you exhaust all possibilities in your quest to help them get better and you understand their funding source as it applies to your services.

I think where people may go astray is in their determination of how much money is enough. How much do you need to be successful? How many corners can you cut in the name of efficiency? When do your cuts compromise patient care and how long will it be before those cuts compromise your integrity?
And that is the slippery slope on which so many clinicians have found themselves.

The changes in healthcare have made it harder for clinicians to stand against the tide. I think this is particularly true for SLPs. Rarely is our supervisor in any setting an SLP. When we have a concern, who is there to stand up for us? Who understands our perspective?

A few years ago, I was looking for a new job. I did a phone interview for a large rehab company. I was told that none of their regional supervisors in New England was an SLP. My immediate, uncensored reaction was “That’s outrageous!” I suspect that the OT that was interviewing me at the time did not share my view because I never heard from that company again. But it is outrageous.

When Marguerite talks about the systems we set up, the programs we created and the staff we trained, one of the things we prided ourselves on was making sure our staff knew that we did not want them to do anything they were not comfortable doing, and if someone was asking them to do something that didn’t seem right, they needed to:
1). not do it, and
2). inform us so that we could look into it.

But that is harder now. Our economy requires job security. It is not so easy to walk out defiantly and directly into another position. And healthcare is changing. But that shouldn’t mean our core values have to change.

I sincerely hope that the investigation into our former employer turns up empty; that the founding principles of the company to which I devoted so much of my career remain intact. When I left, I was proud of the work I had done.
No one can take that away.

About the Authors
Marguerite Mullaney was born and raised in and around the Boston area. She continues to make her home in the Commonweath and rarely finds it necessary to travel beyond the 128 belt. Her undergraduate program was completed at Bridgewater State College and she attended Northeastern University for graduate school. Adult neurological disorders has been the primary focus of her clinical practice. Her vast knowledge of the field, thoughtful, pragmatic approach and incredible sense of humor have enlightened and inspired her patients, staff and colleagues for over 20 years. Contact Marguerite at mullaneycccslp@comcast.net.

Lisa Yauch-Cadden was born and raised in the Detroit, Michigan area. She has a Bachelor of Science degree in Biology and a Master’s in Speech Language Pathology from the University of Michigan. She has worked as an SLP in nearly all facets of the field: skilled nursing facilities, home care, acute care, transitional care, medical offices and schools. Throughout her career as a therapist, manager and business owner, Lisa has never strayed from providing direct line service, including state of the art evaluations using FEES/FEESST and MBS. While she needs no accolades to do her job, she is deserving of many. Her tireless efforts to advance the best clinical practices in Speech Language Pathology have changed lives for her patients, her clinical fellows, and those of us lucky enough to work with her on a regular basis. Contact Lisa at lycslp@gmail.com. ……

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Access Your Records Securely Anywhere, Anytime

Access Your Records Securely Anywhere, Anytime

by Bob Bond

As busy clinicians, our professional thoughts most often focus on our patients/clients. How can I best meet my patient’s needs? What can I do to help them excel? What will we do today to meet their goals?, and what will we do at our next visit? Always looming in the background however, are questions about efficiency and productivity. For clinicians in private practice, those questions likely loom as large as the clinical ones. This month, we introduce you to Bob Bond of WriteUpp.com, who has some suggestions for private practitioners on how to cut down on paperwork time and improve productivity.
Welcome, Bob!

How’s this for a scenario?
● One place for all your patient related information, including: notes, appointments and assessments, scanned paper records and bills
● No software to install
● No data to keep backed-up
● No specialist hardware required – run it on PC, Mac, iPad, Android Tab etc
● Collaborate with team members
● No paperwork to lose

It’s now more “do-able” than you might think…

Tipping Point
These days most of us are pretty accustomed to using technology in our personal lives but until recently, cost and complexity tended to put the majority of technology solutions out of reach of most SLP’s in their professional lives.

Of course, some SLP’s will always prefer pen and paper and that’s just fine.

But those of you that have dipped your toe in the water have probably had to bolt together a mish-mash of products (such as Email, MS-Office documents, Google Docs and storage platforms like Microsoft Live “SkyDrive,” Amazon’s “Cloud Drive,” Google Drive, iCloud, Dropbox or SugarSync) to manage your practice.

Thankfully though, time’s are a-changing!

A new breed of simple, affordable “cloud-based” Practice Management Systems (PMS) is coming to the market. These products combined with fast internet and increasingly ubiquitous WiFi are transforming the way SLP’s work and collaborate.

What does a Practice Management System (PMS) do?
Obviously different systems do different things but the core functionality you should look for in a PMS should include the following:

Patient Database
At the heart of every PMS is a secure patient database that is accessible to all authorised users. The PMS acts as a hub for all your patient-related information, including: Appointments, Notes, Assessments, Documents, Attachments and Invoices.

Diary Management
Manage your diary anytime, anywhere (as long as you have internet access). Schedule different appointment types (Initial, Follow-up, Travel, CPD etc.) with different durations (and where required different costs) and reconcile all of your appointments to the appropriate patients – a real time-saver when it comes to billing!

Clinical Notes
Write up and securely store your patient notes which are time/date stamped and locked-down after 24 hours in accordance with HPC best practice. Insert images, videos or annotated images directly into your notes.

Access a library of Speech-specific assessment templates which can be completed and attached to the patient’s record. Some providers will even convert existing paper-based assessments into electronic forms that can then be used within their applications.

Some systems allow you to create templates for documents that you create on a regular basis such as Patient Letters and GP Letters. These are then pre-populated with the appropriate information such as the patient’s address or the GP’s details so that all you have to do is enter your comments/professional opinion etc.

Sadly, none of us can go 100% paperless. Doubtless you still receive letters or reports in paper form. With a PMS these can easily be scanned and attached to the patient’s record so that everything is in one place and securely accessible from any location.

Different systems offer varying degrees of complexity when it comes to billing. Some provide the kind of detailed functionality that you might expect to see in accounting system, whilst others simply generate invoices based on appointments attended and supplies/goods provided to your client (where appropriate).

What is “the cloud”?
In the context of a Practice Management System it means the software is web-based, so there is no software to install and all of your data is stored in a secure data centre “in the cloud”.

You can securely access the PMS from any location using a web browser (such as Google Chrome, Internet Explorer, Apple Safari or Mozilla Firefox). All you need to do is enter your own unique URL into the address bar (such as http://yourpractice.writeupp.com) and login with the credentials, both of which are provided by your chosen software provider.

Regardless of your location (you could be at home, on holiday or in your clinic) you will be able to access your diary, notes, assessments, attachments, documents and invoices.

The Benefits
Its worthwhile pointing out that a PMS may not be for everyone and not all PMS’s are equal. Most of those that have come onto the market are aimed at mid-to-large practices and as a result they are very feature-rich, which may not suit smaller practices.

If you are a sole practitioner or a small practice and you are open to embracing some simple technology, the benefits you will enjoy from adopting a PMS are likely to be:
● Centralisation of all of your patient-related information in one place
● Accessibility anywhere (with an internet connection)
● No need to jump from one system to another
● Reduced administration time
● Improved collaboration with colleagues
● Faster billing and quicker payment

If you are considering a PMS there are a few things to bear in mind:
1 Test the product in your own environment before you commit. Most providers will allow you to try out their software for 30 days or so
2 Keep it simple. If you are a small practice you don’t need lots of bells and whistles
3 Verify the credentials of your chosen provider. Where are they, what’s their track record? Have they worked with any government approved bodies?
4 Gain specific assurances around data security. At the very least data should be backed-up and encrypted real-time but ideally your provider should replicate to an alternate off-site location
5 Don’t pay for features that you don’t need

Try Before You Buy
There are a number of web-based practice management systems on the market however most are aimed at mid/large clinics (i.e. 5 clinicians+).

WriteUpp is a very simple web-based practice management system aimed at sole practitioners and small practices. It provides all the functionality necessary to run an efficient, paperless clinic and includes a number of SLP assessment templates.

It costs as little as $24/month and a free 30-day trial is available if you go to WriteUpp.com and click on “Try WriteUpp Free”.

About the Author
Bob Bond is the CEO of WriteUpp.com, a web-based practice management system based in Europe. He has extensive technology experience having worked for Oracle Corporation and SAS Institute Inc. and is also the Founder of Pathway Software, a leading provider of systems to therapists in the NHS (National Health Service).
Contact Bob at:bob.bond@writeupp.com
Skype: WriteUpp
Phone: +44 1422 399525

Information contained herein does not necessarily reflect endorsement by the web host.

Do you have expertise or a product we should know about? Contact us at media@cccslp.net to inquire about guest blogging. We’d love to here from you.

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I hope you had a good day

I hope you had a good day

By Lisa Yauch-Cadden

“I hope you had a good day”

My family and I are ABC News fans. I always loved Peter Jennings. I, like many people was saddened at his passing, and I thought my news program would never be the same. I liked Peter’s sense of gravity and calm. He was always well so spoken and articulate, even in times of crisis, even when he was speaking extemporaneously – now that was a man you could trust. I now like Diane Sawyer very much, better in fact than I thought I would. But in between Peter and Diane, there was Charlie Gibson, and I loved Charlie. I thought he was great on Good Morning America, was happy when they brought him back and was really happy when he picked up the evening news. He had a fatherly, folksy way of delivering the news, was also well spoken and he had a great sign off – “I’m Charles Gibson and I hope you had a good day”. I loved that! What a great way to end a newscast. After all the bad news he’d delivered, he encouraged us take a moment to reflect on our day, and for me, that was refreshing, because I rarely had an opportunity to think about that when I was working 8, 10, 12 hours a day and always wondering what I had to do next.

I find that even now, when I am working just 30-35 hours a week, primarily in one location, with very little travel, that I can still get caught up in my day; rushing from patient to patient, worrying about productivity, always thinking: What do I have to do next? What else can I get done? What have I left undone? What’s on the schedule for tomorrow? Only recently, have I been able to slow my thought processes to reflect on my day. Was it a good day? Did I make a difference? Did I help someone? Did I contribute? Lately, I have been able to answer “Yes” to these questions, and to answer Charlie, I am having more “good days”.

So what’s changed? My caseload is about the same as it was a year ago. It goes up and down with the hospital census (and the flu season). The out-patient schedule is fairly constant. The productivity demands are the same. There has been no significant change in personnel as it relates to my position. So the difference must be me. I have changed how I look at my job. I am still cognizant of the productivity demands. I am still accountable to lots of people, but my top priority is to be of service to my patients – to do the best job I can and to provide them with as much information as possible to make decisions about their care, as it relates to my portion of the treatment plan (usually swallowing). I spend time educating patients and families, reviewing MBSs in detail, providing treatment beyond just the diagnostic kind, establishing home programs and making sure they understand what their options are. I am not successful 100% of the time, but more often than not, I feel like I am making a difference. When I reflect on my day, I can say, “Yes, it was a good day”.

I think if we can all find those small moments, those 1 or 2 patients, that if not for you, they might not be doing as well, that through your knowledge or kindness, you improved the quality of their life or their opportunity for a better outcome. If we can reflect on those things at the end of the day, we can all have a good day and look forward to a better tomorrow.

About the author

Lisa Yauch-Cadden was born and raised in the Detroit, Michigan area. She has a Bachelor of Science degree in Biology and a Master’s in Speech Language Pathology from the University of Michigan. She has worked as an SLP in nearly all facets of the field: skilled nursing facilities, home care, acute care, transitional care, medical offices and schools. Throughout her career as a therapist, manager and business owner, Lisa has never strayed from providing direct line service, including state of the art evaluations using FEES/FEESST and MBS. While she needs no accolades to do her job, she is deserving of many. Her tireless efforts to advance the best clinical practices in Speech Language Pathology have changed lives for her patients, her clinical fellows, and those of us lucky enough to work with her on a regular basis. Contact Lisa at lycslp@gmail.com.

If you have something to say, please submit your article for consideration to lycslp@gmail.com. .…

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