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11/11/2013 PAHCOM member profile: Renee Mancine, CMM | Medical Practice Insider
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PAHCOM member profile: ReneeMancine, CMMApril 02, 2012 | PhysBizTech staff
Renee is not the typical PAHCOM member. She isrepresentative of the new vanguard of small group andsolo physician practice managers. What makes her sospecial? Well, let’s start with her credentials, ReneeMancine, MSHSA, CHM, CMM. Notice that she has aMaster’s of Science in Health Services Administration.Notice also, that Renee is a Certified Medical Manager.The typical PAHCOM member in the last 24 years of theassociation’s existence had only a high school diplomaand maybe some college. Those members sought theCMM certification to validate their knowledge ofmanaging a physician practice. The current trend is formanagers with Bachelors and Masters degrees to joinPAHCOM and obtain the CMM for the same reason…tovalidate their knowledge of managing a physicianpractice.
What makes Renee so special is that she is one of a new breed of physician practicemanager that has evolved as the management of medical practices of every size andspecialty has grown to be spectacularly complex. Renee recognized that physicians werebeing challenged to specialize, sub-specialize, and then sub-specialize more in their clinicalexpertise. At the same time, clerical/administrative rules and regulations expandedaccordingly.
As the administrator of West Coast Infectious Diseases PA, Renee is responsible forensuring that five physicians and a nurse practitioner keep a full schedule providing clinicalcare to a needy community of patients. Those clinicians expect Renee to “not bother them”with paperwork that is not directly related to patient care. A sample of the scope of Renee’sresponsibilities, under the umbrella of “oversee office operations” include: accounting,payroll, human resources, facilities management, development and support of computersystems, software selection and updates, and a host of other duties that would be beyondconception if they were to be fully listed.
Renee’s medical practice is not that different from many other practices facing theaccelerating technological growth in both medicine and management. The organization wasstarted as a solo practice in 2004 by Dr. Brent Laartz. It only took one year before Dr. ToddGroom was added as an employee. One more year (2006, for those of you who arecounting) found Dr. Michael Phillips joining the practice. Renee was hired two weeks priorto adding the third doctor.
Naturally, the facility’s size was totally inadequate with only three exam rooms and onephysician office. This situation should sound very familiar to many PAHCOM members. It is
11/11/2013 PAHCOM member profile: Renee Mancine, CMM | Medical Practice Insider
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the classic “Manager, we doctors have a problem and we want you to come in here andsolve it for us right now.” Renee recalls, "It was still 2006 when we opened two satelliteoffices. Without catching a breath, we moved the main office to a 2,500-square-foot facilityin 2007 and closed one of the satellites."
In 2009, the practice added a fourth physician, Dr. Niveditha Reddy. The next year thepractice expanded the main office to 4,000 square feet. Would it ever stop and give Renee abreather? Not likely! Renee coordinated the addition of a nurse practitioner, Patricia Gilliam,in 2011 followed by the addition of the fifth physician, Dr. Aurelia Schmalstieg.
Professional resourceRenee has relied heavily on her professional association (PAHCOM) as a resource forinformation and guidance. In an interview with PhysBizTech, Renee stated, “I can’t speakhighly enough about the PAHCOM ListServ. All the managers come together and supportone another. And in this day and age, quite frankly, we need all the support we can get.”The PAHCOM ListServ is a member communication system that allows each PAHCOMmember to post a question on any topic related to medical management. The questionreceives responses within minutes from experienced professional medical managers thathave personal knowledge of the topic. Best news of all: It is free with PAHCOMmembership.
Renee observed, “I’ve been in healthcare for 25 years, and I’ve seen a lot of transition. Andit’s not getting any easier. I think whether you are a doctor or an office manager orsomeone else within the healthcare field, it’s getting more difficult to practice medicine.”With PAHCOM membership, Renee is networked with more than 3,000 members throughoutthe country. From her office in Safety Harbor, Fla., Renee has “…picked up the phone andcalled other managers all the way out in California for advice. Everyone’s experience isvaluable. You may get an e-mail and find out about something that you never reallyconsidered.”
Renee added: “I’ll give you an example with the 5010 conversion that took effect in January.Historically December is a low month for getting payments. It seems like everybody fromthe insurance companies is on vacation. So reimbursement slows down. This year it wasworse than usual. It seems that the 5010 conversion gave the insurance companies anotherreason to withhold payments.
With our payments, we were able to get them in by the middle January, but I know ofproviders who were having trouble getting paid. I even heard locally of an office managerbeing fired because of the whole situation.
Using the PAHCOM ListServ, I was able to go to our doctors, reference other practices, andsay, ‘Look, we’re not the only ones in this boat. Others are experiencing the same thing.’ Sothe ListServ is not only a support tool as far as knowledge, but it also backs me up indiscussions with the physicians”.
Renee also attends the Annual National PAHCOM Conference. She has attended for the lasttwo years and says “The speakers are leaders in our field, so I get a lot of goodinformation. It’s also valuable to talk to the vendors who exhibit at the conference, becauseyou just never know when you’re going to want to look for another vendor.”
When asked by PhysBizTech how she feels about her position, Renee responded, “I wearmany different hats every day. I’m sure any office manager will tell you the same thing. Ihandle everything except the clinical side of the practice. I handle payroll and all themanaged care negotiations -- and that’s getting more difficult, too. So it’s a lot of work, butI have the autonomy to look for ways to improve operations."
Meeting the EMR challengeThe following story about implementation of the EMR system in her practice should soundvery familiar to a lot of readers. In her own words, "We had a billing company, but we hadbeen trying for years to bring billing into the office to do it directly. We probably reviewedabout five systems, and it came down to three of them. Then we went through furtherreview and eliminated two more. We had negotiated the contract and basically hadimplemented it on our servers and were getting ready to go live. We signed the contract inJune 2008, but then in October 2008 we found out that our vendor had been purchased by
11/11/2013 PAHCOM member profile: Renee Mancine, CMM | Medical Practice Insider
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a larger company – and our system was no longer going to be supported.
"We went back to the vendor and said…We’re a growing practice. No support means noupgrades, no improvements. We need something that will grow with us. The acquiringcompany came back and offered one of their products.
"We put the go-live on hold in October, negotiated the contract for the new system, andsigned it on December 23. But there was one little caveat: We had given notice to ourbilling company back in September that, as of January 1, we would no longer use theirservices. So here it was December 23, we had signed the contract with no system up andrunning, and January 1 was right around the corner. Talk about pressure!
"We were very aggressive. Our staff worked long hours and weekends, but we got thepayments in. We knew we had to do it because the doctors’ livelihood was at stake. ByJanuary 9, we had the software on the server, and by Jan. 25 we had the systems built andwere using it. We had charges and payments turned around by the end of January 2009."
PhysBizTech asked what the key was in being able to make that quick transition. True toform, Renee gave credit to others that helped... "The billing manager was knowledgeable inclaims billing. We also had a support person from another company called DoctorsAdministration Solutions who was knowledgeable in the specific system. She was alwaysavailable. I could call or text her and she would answer me, even if it was 10:00 at night."
When asked if the practice was a meaningful user of an EHR? Renee responded, “Yes weare. We have received our incentive payments and are just waiting for our new doctor whostarted last year. She didn’t certify until January, so we’re waiting for her incentive payment,but we have received the payments for the other doctors. In addition, we do PQRI on topof that."
Additional servicesIf that is not enough, the practice has expanded beyond the typical clinical treatment ofinfectious diseases.
The practice runs a travel medicine business called West Coast Travel Consultants. It’s aseparate business from West Coast Infectious Diseases. They treat “clients” (rather thanpatients) that travel all over the world. The business provides information on the countrythey are traveling to…ranging from travel warnings to advisories on disease outbreaks, suchas the cholera outbreak in Haiti. The doctor talks to the client about those types ofconcerns and prescribes what the client needs medically. If the client needs vaccinations,he or she can get them done in the office. For example, certain countries won’t allow entrywithout a yellow fever vaccination.
A third business, Galileo Real Estate, is the holding company for the satellite office. InSeptember 2011 they opened a separate practice in St. Croix, Caribe ID. It is just getting upand running.
Renee also told PhysBizTech that she is involved in all of the above operations as well asthe West Coast AIDS Foundation. It is a non-profit foundation that provides casemanagement services to clients. Renee stated, "They’re not always our patients. We providePAC waiver [Project AIDS Care] services for the state of Florida. It may be as simple asproviding a gas card because the client may be running out of money and can’t pay for gasthat month. We help clients navigate the healthcare system. Our workers are liaisons forthe clients, but we call them case managers.”
Like many medical managers, Renee has a full plate but being networked with otherprofessionals is key to staying organized and informed. That's how leaders like Renee worksmarter and are able to do so much more for their practices, their communities and theirpatients.
We appreciate Renee taking time to share her knowledge and welcome you to participate inthe conversation as well. PAHCOM members interested in telling their story should contactPhysBizTech Editor Frank Irving at [email protected].
11/11/2013 PAHCOM member profile: Renee Mancine, CMM | Medical Practice Insider
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