In the past four years, Seattle-based Virginia Mason Medical Center has improved patient and staff satisfaction, increased revenue, and improved overall quality of care, and it has a Japanese auto manufacturer to thank for it. In 2002, Virginia Mason revamped its practice using the Virginia Mason Production System, an in-house adaptation of the Toyota lean production system, a rigorous management system focused on eliminating waste and mistakes to deliver a quality product. Although Toyota uses the process in automobile factories, some of the same principles apply to healthcare and can improve the quality of care in an office-based setting, says Shirl Diaz, MAOM, director at Virginia Mason Kirkland, a division of Virginia Mason Medical Center.

Without question, one of the trickiest responsibilities an office manager has is navigating the multitude of human resource (HR) issues. Each month, TDO receives HR questions from readers seeking advice. We asked Tom Ealey, CPA, a consultant and administrator with 20 years of healthcare and risk-management experience, to address some of your HR concerns.

When it comes to E/M coding, the rules are clear-that is, unless what you're coding happens to fall into a gray area. E/M codes are especially detailed (and complex) and, as with all codes, rely entirely on documentation. But just because the rules are out there doesn't mean that physicians follow or understand them, says Wanda Ziemba, MFA, BA, RHIT, CPC, E/M auditor and full-time faculty member of the health information technology department at Chabot College in Hayward, CA.

In 2000, nearly one in five people in the United States spoke a language other than English at home, an increase of 15 million people since 1990, according to the U.S. Census Bureau. Of those who primarily speak a language other than English, only 55% reported speaking English very well. That translates into a need for bilingual physicians who can communicate with limited English proficiency (LEP) patients. Title VI of the Civil Rights Act of 1964 and Executive Order 13166 both entitle LEP patients to an interpreter and make it illegal to deny services to a patient because of his or her national origin.