Laurie Morgan

Laurie and Judy have written two articles about group visits recently, for Kareo and Physicians Practice.  (Click here for Laurie's, here for Judy's.) If you're looking for a creative way to spend more time with chronically ill patients,  a group visit program might be a good fit for your practice.  Under the group visit (or "shared medical appointment") model, each patient has a brief individual visit (often just vitals and a quick interview with the provider), and then shares the rest of their visit with a group of other patients who are managing the same disease.  Each patient sits in on their fellow patients' visits -- and, of course, vice versa. Group visits aren't for every patient, but many people respond very positively to the opportunity to share their physician time with others facing the same challenges.  The best part: everyone ends up spending an hour or more with the doctor. (Even though most of the time is not focused on any single patient, everyone typically ends up feeling that they've had more access, and more opportunity to share and get their questions answered.) Group visits have been more commonly started by primary care practices for conditions like diabetes that require lots of patient engagement and many visits -- but any specialty with a population (or multiple populations) fitting that description can potentially benefit from starting a group visit program. To learn more about what's involved, visit our article links above.  

In our work helping medical practices improve their profitability and efficiency, it's not uncommon to find that employee morale, performance, and turnover are problems.  Those problems, in turn, often stem from the relationships between staff and their leaders -- and staff perceptions about how physician owners and practice administrators regard them. Sometimes, there's a bit of a chicken-and-egg problem: are leaders coming down hard on employees because employees are under-performing?  Or are employees under-performing because they're stressed and discouraged by standards they can't meet, delivered emotionally by demanding bosses? In some ways, it doesn't really matter how leaders address unexpected shortfalls.  Good performers are typically hard on themselves already.  They know when they've messed up.  Often, what they really need is permission to regroup and fix the problem -- and to know that you trust them to do a good job.  Getting angry usually doesn't help -- it's usually counter-productive. This is the point of this excellent post on Harvard Business Review -- well worth a read (you can access up to five HBR articles for free, and a few more if you register). To the article's great points, I would add that it's also important to determine if a structural problem inside the organization made it hard for employees to do what was asked.  In a medical practice, for example, are employed providers not meeting productivity goals because they're unmotivated, because they haven't made an effort to grow their practices through referrals, or because there are patient flow bottlenecks that make it impossible for them to see more patients?  Is a biller's accounts receivable growing because she's not billing fast enough, or because there's no system to put patients on payment plans ahead of large procedures?  Are voice-mails piling up because the staff charged with answering the phone are juggling too many balls? Ask a few questions, take a deep breath before reacting to performance problems.  Be sure you understand what's really behind poor performance before you react emotionally and trigger consequences that will only make a tough situation worse.

Marcus Lemonis -- the investor/fixer who stars in CNBC's "The Profit" -- believes that the keys to success for any type of business boil down to three fundamentals: people, process, product.  Once you understand that all the shortcomings and the positives of any business will fall into one of these three areas, it's easier to see how to fix the problems that prevent a business from reaching its potential. These basics absolutely apply to medical practices, too. People:  Do you have the right staff? The right providers?  Is everyone doing the right things?  Are staff members empowered to solve problems? Process:  Is your patient flow process free of unnecessary friction, or are extra steps, poor communication and other inefficiencies slowing you down? Product:  Do your providers provide the services that are needed in your area?  Are patients getting access when they need it?  Are you committed to the technology options and other patient experience innovations that patients want and need?  Do you know what patients want? In this video (one of an excellent series from Inc.), Lemonis states plainly that if you want to understand whether your process works or not, "You really just have to stand on [the other] side of the counter and say, 'What is the consumer actually seeing?'" This is, in fact a big part of what we do as practice management consultants.  We shadow patients, we sit in reception areas and at the front desk, we go through the same processes your patients do.  It's how we learn what the patient experience is like, and how we spot problems in workflow (which usually reveal themselves almost immediately!).  Your staff can also help you understand the patient experience -- let them share with you what they see at your front desk, in your hallways and in your reception area, and let them take initiative to fix problems that are within their control.

Themes seem to emerge each season in our medical practice management consulting business; in 2014, one of the most striking has been the connection between physician productivity and physician compensation.  It's an issue we've seen play out in nearly all our engagements, in both start-ups and established practices, in both private practices and hospital-owned groups. As many practices face big organizational changes and others launch new strategies to adapt in the changing healthcare environment, it's natural that physician compensation needs to evolve, too.  But what's more surprising is that this particular issue seems so resistant to the clarity and structured decision-making that guide so much else in the medical world. Instead, too many practice owners view the idea of a productivity structure or clear goals as "insulting" or even unnecessary with "professionals." This idea seems to take root in private groups in particular – the physician owners are especially leery of offending their employed colleagues. Sometimes I wonder if a misperception of business compensation contributes to the resistance physician owners and practice administrators have to tying physician compensation to productivity (or even discussing it!).  Perhaps there is a sense that other professionals don't have the burden of having their performance measured.  But nothing could be further from the truth.  In business, even executives who don't generate revenue directly typically have objective goals.  Marketers may be measured on unique visitors to a website, inbound calls, awareness or other objective criteria besides revenue.  CIOs may be measured on uptime or the response time of systems, or cost containment, or some combination of results.  Customer service professionals may need to demonstrate that their teams beat benchmarks on hold times and call length. Sales executives are always measured on sales performance -- even when they're not.  Even when an organization sets a compensation plan for sales executives that doesn't directly tie weekly or monthly sales to regular compensation, the connection is in there somewhere.  Perhaps a big part of compensation is a bonus that depends on annual performance.  Or perhaps a sales executive collects all her compensation from day one, but she knows her

A not-too-surprising-but-still-interesting tidbit: a new poll by Sermo (the physician-only social network) shows that a majority of doctors disagree with the decision to hire a non-physician political professional as the "czar" leading the nation's Ebola defense. Read more about it on Sermo's blog: http://blog.sermo.com/2014/10/20/doctors-reject-ron-klain-as-ebola-czar/ Do you agree with the majority?