Yearly Archives: 2023

Few things are more unnerving than realizing your business is less profitable than it once was—or than you counted on. The instinct to take immediate action is understandable. If you’re a physician, responding quickly to urgent situations is second nature. And after all, if your profit is suddenly on a lower trajectory, you may have reason to be concerned that you’re heading toward a personal financial emergency. Though it’s natural to act fast, resist the instinct to attempt a quick fix. Here’s what to do instead. Invest enough time to be sure you’ve accurately identified the problem. First instincts about the causes of profitability problems are often incorrect. That’s why getting a handle on the root causes of your situation is crucial—before taking corrective action. Start with a meticulous review of your financial statements and accounting data for the past few years. Compare each revenue source and expense line in detail, making sure you have all the information you need to compare apples-to-apples. For example, if your accountants have changed up your chart of accounts, ask them to help you dig into the expense and revenue ledgers to find any specific items that have increased or decreased significantly over time. Carefully consider the impact of extraordinary items, lags, and run rates. Be sure to review both year-over-year and month-by-month financial data. Any one-time expenses or revenues (e.g., an unforeseen legal expense, preventable inventory spoilage, or unexpected income like Meaningful Use payments) should be separated out to determine underlying, standardized financial performance. This will help you avoid confusion about whether specific items constitute harmful trends or are simply timing differences or extraordinary items unlikely to recur. Let’s say, for example, that you’ve hired a new physician during the year. At the end of the year, you may find that her revenue falls short of expectations. But it might be incorrect to conclude that her production is not on target. Several types of lags could affect her total for that first year. Her productivity for the final two or three months of the year will tell you more about the pace she’s

Physician burnout is widely considered a pernicious epidemic that puts physician and patient health at risk. Frustratingly, it’s also often assumed that inescapable facts of physician life are to blame: increasing documentation demands; mandatory EMR technology that’s far less than ideal; and a physician culture that prizes self-reliance and endurance over self-care. Individual practices may not be able to move the needle at all on these huge factors, but we don’t have to throw up our hands and give up on avoiding or ameliorating burnout. There are many small but significant changes that managers and owners can make that can have a positive impact on physicians’ work lives, reducing stress and boosting morale – and the great news is these changes often bring other benefits to the practice business. Fairness and transparency: technology can help I often write about technology that can help practices run better. It’s one of my favorite topics, partly because I feel that challenging EMR implementations have left many physicians and administrators feeling very skeptical about technology and hesitant to adopt recent innovations – even ones that were developed in a more physician- and practice-focused way. Many newer tech tools can both increase practice efficiency and improve communication and transparency, changing physicians’ work lives for the better. For example, for specialties with on-call responsibilities, scheduling is often a massive chore. When the process is regarded as a “black box,” it can be a source of stress and distrust. On-call scheduling usually involves a patchwork of requirements and assumptions. When the rules aren’t automated, crafting a compliant schedule is a tedious process usually handled by one or two experts (who had better not get hit by a bus, lest all that knowledge disappear!). Even something as simple as two physicians swapping call can throw a monkey wrench into the works. Tech solutions for on-call scheduling address all these operational issues. They’re marketed mainly as a means to streamline scheduling and reduce errors and liability – worthy and profitable advantages to be sure. But there are happy byproducts of automating the schedule – such as making sure it

Whether you’re hiring a physician or a non-physician provider, odds are you’ll spend a great deal of time (and probably money, too) attracting the right clinician candidate to you practice. If that new hire ultimately doesn’t work out, you practice will face the costs of going back to square one—as well as lost revenue while that job remains unfilled. Effective on-boarding can help ensure your new hire knows what is expected and become productive more quickly. Yet despite the high stakes involved, getting new hires off to a good start often gets much less attention than recruiting does. Protect that big recruitment investment by getting your new clinicians off to a strong start. Here are some quick tips for how to do it. Be realistic about ramp-up time. It’s natural to be excited about the productivity a new clinician can bring to your organization. It will take a while, though, for your new hire to ramp up to their full capacity. Plan more accurately for the ramp-up by considering the individual’s training and their prior experiences. A nurse practitioner or physician assistant may need a lot of training and oversight for many months, especially if they’ve just graduated or are coming from a different specialty. (Remember that less-experienced clinicians will likely be counting on your training—and not providing it could severely affect their morale.) Even experienced physicians will need time to get acclimated to your systems, protocols, and workflows. And if expect a newly hired physician to attract new patients of their own, keep in mind that creating a reputation and building a network also take time. Be clear from the start about expectations. When employed clinicians fall behind on unspoken expectations, resentments may fester—and relationships can fray if both sides come to feel deceived. Before you even recoup your investment in recruiting, your new hire could end up leaving your practice. Unfortunately, it’s a sad pattern we’ve seen too often in our consulting work. The first step to avoid such costly misunderstandings is to be as clear as possible about what you expect. Invest time to document a full