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Where change is the NORM: Guiding rheumatology practice managers through a field in flux
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Rheumatology practice managers and administrators operate in an environment of nearly constant change. Whether it is new regulations or insurance rules, electronic records updates, changes to local building codes or emerging CMS proposed rules, it falls to practice administrators, who typically operate in small private practices, to deal with it all.
In such an environment, it helps to have some support, according to Andrea Zlatkus, CPM, CRHC, president of the National Organization of Rheumatology Managers (NORM).
“With all of the different payers, all of the different pharmaceutical companies, and the different Medicare initiatives, it is really hard to stay on top of everything that you need to know,” Zlatkus, a practice manager for Chester County Rheumatology PC, in West Chester, Pennsylvania, told Healio Rheumatology. “It’s nice to have an organization that can help foster knowledge and learning, and help you along, so you are not reading millions of emails and maybe missing something. It’s good that there is someone out there who is willing to look at the overall big picture and help us to dig in.”
Established in 2005 as part of the Coalition of State Rheumatology Organizations (CSRO), NORM is that someone, according to Zlatkus. The group, which has since gained its independence from the CSRO as its own 501(c)6 nonprofit, formed with the goal of creating a strong organization and forum to promote and support education specifically catered to rheumatology among practice managers, administrators and office staff.
One manager, many hats
According to Zlatkus, who joined NORM in 2006 and began her 2-year term as president in September 2017, the most pressing issue she and her fellow rheumatology practice managers face is the near-constant changing nature of the industry.
“I had a meeting with one of our committees, and we were talking about change management,” she said. “In rheumatology, there is constant change, whether it is from Medicare, or new products that are coming out, new treatments, new procedures or new billing information from payers. There is constant change within our industry.”
Additionally, administrators and managers are forced to become champion multitaskers in order to meet the daily demands of the smaller practice environment.
According to Ethel D. Owen, PCP, former president and current board member of NORM, managers often take on any and all nonclinical responsibilities required by their often-small practices.
“The small practices do not have much management oversight, like the larger organizations do,” Owen, a practice manager for Arthritis & Rheumatology Associates of Palm Beach, in West Palm Beach, Florida, told Healio Rheumatology. “We are responsible for OSHA, we are responsible for building and coding compliance, regulatory compliance, electronic health record updates, MACRA and MIPS updates, reporting measures, advancing care and security-risk analysis. We are responsible for all of this.”
In addition, any errors in any of the above responsibilities could jeopardize the practice’s ability to stay open and operating, Zlatkus added.
Owen noted that NORM’s membership of more than 450 administrators look to the organization as a resource to stay up to date, whether through webinars, a community forum, its annual conference, or simply calling up a colleague to reach out for assistance.
Education and network support
NORM’s main asset for its members is education, according to Zlatkus and Owen. The organization hosts an annual conference, as well as monthly webinars where members can listen to updates on policy and CMS initiatives, a mentoring program, a copay industry spreadsheet and an online document library of administration workflows and procedures.
In addition, NORM offers a course on rheumatology-specific coding from the American Academy of Professional Coders, in addition to other continuing education opportunities.
“Much of what we do, and much of what we offer, is through education,” Zlatkus said. “We have an education portal on our website, which describes rheumatology diseases in basic terms — or at least not in highly clinical terms — so the average medical assistant or office staff member can understand what we are doing. Also, we have documents on practice workflows, which describe common responsibilities of managers and administrators, knowing that each practice is slightly different.”
Later this year, NORM will host a “rheumatology boot camp” for new members who are practice managers with 0 to 3 years of experience. According to Zlatkus, the camp will educate newcomers to the rheumatology specialty in what they need to know as a new practice manager.
The group also organizes advocacy efforts at both the state and national levels through town halls, as well as their online health care policy and industry pages. In addition, NORM’s website is home to an extensive community forum, where members can network, ask questions, receive quick answers, and enjoy support from their peers.
“It’s great that if I have a question, within 5 minutes I can get an answer on the community forum,” Zlatkus said. “In this organization, it’s about peers supporting each other.”
Emerging issues
Looking to the future, Owen said many practices are struggling with a shortage of rheumatologists, with some trying to fill the gaps with physician assistants and nurse practitioners. However, this has also led to expanding responsibilities for practice managers, as well as the specter of burnout — among both the clinical and administrative staff.
“As you are trying to grow your practice and trying to accommodate the overall patient volume, you have to deal with the fact that there are not many rheumatologists out there — only about 5,000 in the country, half of whom are in academia,” Owen said. “As the patient population continues to grow, I think we are seeing some of our older rheumatologists retiring because they no longer want to deal with the oversight and documentation, because it is much harder now; not that they are not doing their documentation, but it is definitely more time consuming now. I think these rheumatologists do a great job for the most part, but I think that is one of the main causes of burnout and fatigue right now.”
According to Owen, one of NORM’s goals is to help rheumatologists and other clinical staff spend more time with patients.
“Now, I feel like not a lot of time is spent with the patient, but rather with the prior authorization process or the appeal process,” she said. “There has been some departure from the focus on the patient.”
NORM is also working with members and partners to address the ongoing opioid epidemic, which, although not specific to rheumatology, touches every facet of health care in the United States, Owen said.
“We don’t prescribe a lot of opioids in rheumatology, but I think that is the overall crisis in health care right now,” she said. “I think there isn’t one specialty that the crisis isn’t touching. That is unfortunate, but it falls into our legislative and regulatory reviews, to try to be a resource for our members, because states are implementing criteria specific to that, and many folks need support in what they need to do.” – by Jason Laday
Disclosure: Owen and Zlatkus report no relevant financial disclosures.