medical practice business

Careful ways to address a profit decline

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

By |2023-05-28T10:46:40-08:00September 5th, 2023|

Embrace professionalism for a stronger practice business

I had an inspiring conversation with a young physician recently. He is looking forward to one day owning a practice. He envisions himself establishing a practice ethos that encourages colleagueship and respects physician excellence. “Expert culture,” he says, is the key to physician engagement and avoiding burnout. His passion was infectious. I can’t help be animated by the idea of brilliant doctors motivating each other to be even better! Moreover, like many of us in healthcare, I’m concerned about the rise in physician burnout, and I agree with this ambitious doctor that more respect for expertise could help alleviate it. But a question occurred to me as we were talking: What about applying the same thinking to the business side of medicine? The idea of setting a similar standard of professionalism for administration may not be intuitively obvious. It only makes sense that clinical expertise is king in our practices. Sometimes, though, even unintentionally, acknowledging this can translate into a more casual attitude about the administrative work being done to support the practice of medicine. This can mean that important business pillars of the practice are not as strong as they could be. This is not unique to medicine. It’s become a cliché that law firms, for example, often struggle with business management, despite being populated by brainy overachievers. Many fast-growing startups are created by smart people with an avid interest in a particular invention, technology, or service—and less interest in the daily nuts-and-bolts of management, which gets the short shrift. In all these examples, when management takes too much of a back seat, the financial success of the organization—and even the ability to achieve the core mission—may suffer. Adopting the same professional standards on the business side that you aim for on the clinical side can help avoid unnecessary costs. What’s more, it can encourage profitability and growth, building the value of your asset. It can also make your practice a much more pleasant place to work! So what are the hallmarks of a professional practice organization? Here are a few: Formalized, forward-thinking human resources policies Small businesses of

By |2023-05-28T10:31:34-08:00August 10th, 2023|

Hidden sources of burnout that you can fix

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

By |2023-05-28T10:18:04-08:00July 1st, 2023|

Leveraging your location to attract staff

If your practice is looking to add new staff, either as replacements due to contagious "Great Resignation" exits or as you contemplate expansion, you're likely facing a tough labor market. Give yourself the best chance of attracting the right people by using all of the assets at your disposal—including presenting your location in its best possible light. Location may not seem like a particularly valuable asset for recruiting staff. Won’t job-seekers simply search for open positions near them? How can location be an advantage when, for most people, the city where they’ll work is a simple yea or nay decision? It’s unlikely staff workers will be lured from far away based solely on the city you’re in, but details about your specific location can make your job more attractive to the candidates looking for work in your community. Here are a few to consider spotlighting: Nearby amenities Many candidates will focus primarily on how far away your office is from their home, not realizing that the surroundings of the workplace can provide a lot of convenience and enjoyment. For example, if your office is close to amenities like a shopping district, promote that. In many locations, cities are working hard to lure businesses to re-energize their downtown neighborhoods--and so are the local businesses that populate these zones. A convenient downtown location can make it easy for staff to pick up essentials or just have a fun break during lunch. Burdensome errands like going to the post office, library, or DMV may be easier and more pleasant to accomplish. An affordable gym nearby can make it possible to squeeze in workouts before or after work. (Maybe you can even negotiate a membership discount for your staff.) And if your office is located near walking paths (or just in pleasant environs for strolling), staff can take advantage of that, too—and get fresh air and exercise during lunchtime for free. Office setting matters, too Is your office in or near a major medical center? Are you surrounded by many medical offices? This can be an advantage for job-seeking healthcare workers. Especially when starting

By |2023-05-28T09:59:50-08:00June 8th, 2023|

Position your newly hired clinician for success

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

By |2023-05-25T14:03:09-08:00May 25th, 2023|

New PracticeLink article on burnout

My two newest PracticeLink articles are on a subject that's top of my mind: burnout (what it is, how to spot it, how to respond, and how to think about it in the context of a job search). I had the chance to talk to several well-informed, passionate, thoughtful physicians in pulling the piece together. If you're interested in the subject, I'd love to hear any comments on the article that you care to share. The second, shorter piece is aimed at physician recruiters. (Is there anything I didn't say that you'd like to tell them about burnout?)   By the way, I've got at least four more PracticeLink features booked this year. I'm always looking for sources. If you're interested in commenting (and helping out residents and fellows who are starting their job searches), I'd be delighted to speak with you. (I promise it will be painless... dare I say it, even a little fun! Plus you'll be helping physicians who are just starting out by sharing what you've learned so far in your own career.) Some of the topics I'll be working on: different ways to practice (cruise ship? overseas? I'll be looking to learn about any practice settings that are outside the norm of expected physician recruiting) what to look for in a potential employer (beyond compensation) how to shine in your job interviews -- from first contact through the interview process what lawyers look for in physician employment contracts

By |2023-02-26T18:06:09-08:00February 26th, 2023|

PracticeLink: “Timeline of a Physician Job Search”

I recently learned that this article I wrote for PracticeLink ("Timeline of a Physician Job Search") took silver in a national awards competition! Quite a pleasant surprise (partly because I didn't even know the editor had submitted it). If you or someone you know is a job-seeking physician, check out this link (and if you have comments, I'd love to hear them).   -  

By |2023-05-25T14:17:56-08:00May 1st, 2022|

Five tips to elevate communication

Nearly all practices can benefit from improved communication.  In this column, I’ll be sharing some tips on forms of group communication.  Reaching out to groups within your practice can improve morale, invigorate and encourage problem solving and generally make your work life more pleasant and profitable. Reinforce what is important and solidify culture. Any opportunity to communicate with a group is an opportunity to build a common understanding of the goals and challenges facing the practice. Without this holistic understanding, how can you expect staff to show any initiative beyond their narrow job description? Accordingly, be sure to point out how staff’s activities advance your strategic objectives and how the practice is moving towards these goals together. Insist on engagement. Leadership can actively and consistently seek feedback from the entire staff in the most welcoming way possible. Staff is generally delighted to be consulted. Recognize any ideas they contribute as broadly as possible to help build cohesion. Along with asking for feedback, it’s critical to demonstrate a positive and receptive attitude to feedback - especially when it’s feedback that reflects critically on the management. This is precisely the information you need to hear most, because it’s likely in your personal blind spot. In the majority of practices we’ve visited, at least a few valuable ideas from staff go unrecognized and untapped. Occasionally, management even has a know-it-all or even a belittling attitude summed up well in a line from the Honeymooners – “I’m the boss and you’re nothing!” The response of “Congratulations, boss over nothing!” reflects how the healthy functioning of the practice relies on the competence and goodwill of all its contributors. Encourage accountability and reward commitment. Staff meetings and group memos present an opportunity to acknowledge accomplishments in full view of others. We strongly urge management to take every opportunity to thank staff in group contexts. A heartfelt thank you and even a modest gift, such as a $10 Starbucks gift card, can be surprisingly meaningful to staff that can feel invisible unless they make a mistake. Build and reinforce positivity. Since it’s unlikely a demoralized staff is

By |2023-05-28T13:56:32-08:00October 28th, 2021|

Protecting Revenue and Patient Relationships During Our Pandemic

Practices have begun to resume services and urge patients to resume care, especially patients who’ve put it off because of anxiety about COVID-19. While ensuring (and communicating about) patient safety naturally takes center stage, the revenue side of practice management needs extra attention, too. Patients may hesitate to visit your office not just because of fear of infection, but because of financial concerns. Some patients face uncertainty about their job security. Some may have already suffered a job loss (and even a corresponding loss of insurance). For patients who are struggling financially, or simply anxious about money, anything but urgent health concerns may be pushed to the back burner—even though this might increase the risk of more dangerous problems down the road. Of course, practice managers and physician owners also have their own financial concerns to contend with. Generating and capturing revenue is crucial to ensure employees can be retained and the bottom line remains healthy, especially as government supports expire. The high cost-sharing many patients face may seem like a formidable obstacle when patients are already nervous. But there are ways you can shore up your practice’s financial picture and collect more effectively from patients—without jeopardizing your patient relationships. In fact, with the right efforts, your practice may be able to improve both your financial picture and the patient experience. Provide accurate information One way practices can help reassure patients is by helping them get a handle on their costs. Often, the out-of-pocket owed is less than patients fear. Even when it will be more than they hoped, patients will be better served by a straightforward and honest conversation about costs. Providing accurate information depends on staff training and technology. Be sure your schedulers are aware of how to access an up-to-date estimate of costs from your patients’ health plans. Proper training, including role-playing, can help staff become more comfortable with broaching financial terms. Sharing this information with patients at the time of scheduling also provides an opportunity to set up a credit card on-file to process payments after services are provided. Storing a credit card (in a PCI-compliant

By |2023-05-28T09:50:04-08:00August 1st, 2020|

Should you buy the practice down the street? [on-demand webinar]

In recent years, clients and friends of C&M have been involved in practice acquisitions or mergers. In many of these cases, a practice in a nearby area has come up for sale, perhaps due to retirement or death of a physician owner. These can be exciting opportunities, but stressful, too. There is usually pressure to respond quickly. And, of course, the decision usually involves a significant investment. (And one of the stressful aspects of it is that the total investment--not just the purchase price, but all costs involved, before, during, and after the transaction--can be hard to project and easy to underestimate.) The need to move fast often makes it hard to even think through all the questions you want to ask -- much less get answers to all of them. When the pressure's on, fear of missing out may take over. But if you move too fast, you may "win" the opportunity without realizing what it really costs. "Buying the practice down the street" may be a fantastic way to quickly expand your practice, but it's not without significant pitfalls. Information and a solid plan are your best tools for protecting your interests. In this short webinar (about 30 minutes), Laurie Morgan outlines some of the key questions to consider when deciding whether to buy a nearby practice. To view the recording, click this link. You'll be asked to register. Once you confirm, you'll receive a link to the video page. Once you've watched, we'd love to hear from you if you have questions. And, of course, we're at-the-ready to help you with consulting services before you make a purchase decision (or before you put your practice on the market). Use the contact form to email us or give us a call.

By |2022-01-01T22:51:43-08:00March 2nd, 2020|

Net collections: Are you waving the white flag?

The subject of net collections seems to be in the ether these days. (For the purposes of this discussion, I'm referring to net collections as the amount your practice is ultimately reimbursed for services it provides, i.e., your net reimbursement after adjustments or credits.) Though it's long been a staple metric, its usefulness in our high-deductible environment may be in doubt. Since net collections measures how much of what you're entitled to has actually been paid, an accurate calculation of it can be invaluable. But therein lies the rub. An accurate calculation of this "simple" metric is increasingly hard to come by. Practice management systems have gotten much better at tracking multiple fee schedules and comparing them against what we've actually been paid--this isn't the problem. The problem is that more of our reimbursement must now come from patients, so it may take months for any service to be fully reimbursed. If you run a report on net collections for a recent time period, this lag in reimbursement will suppress the average net collected for all your payers. If you're running the report primarily to keep an eye on your payers, this lag is enough to make the aggregate data all but useless for that purpose. The report will almost always "show" that your payers haven't reimbursed as promised, even when the reason is simply that it takes more time to bill patients and for them to pay. An executive at one of the larger groups we've worked at confessed to me that "we don't even bother with net collections reports anymore. Entering the fee schedules is a waste of time." While I can understand the frustration, I think there's a risk of throwing the baby out with the bathwater. There's a lot of value in calculating net collections. We want to know--no, we need to know--if payers are reimbursing as agreed. And when slow patient collections drag down the net collections figures, that information is also important to understand. What if patient bad debt is starting to climb? Net collections analysis can help you spot this and take action.

By |2022-01-01T22:51:43-08:00February 12th, 2020|

Have you seen Laurie’s popular article about the deductible reset?

Laurie's 2018 article for Phreesia's blog is one of their most popular posts. If you haven't seen it yet, here's a link to check it out. It includes time-tested ideas for dealing with the roller-coaster ride that is the transition from the busy-busy fall season to the slowdown in January, including: Identifying the patients who can benefit most from booking services they've postponed before the year ends Making sure staff are trained and confident they can explain the pros and cons of booking care before year end Deploying and taking full advantage of all the tech at your disposal that can make it easier for patients to pay Planning to make conscious use of downtime in the spring--whether by increasing patient visits through promotion, using the time for other important tasks you've put off, or both There's still time to make a plan to have your practice business's best fall/winter season yet. If you'd like to discuss more ways to do so--and how we can help--please get in touch!

By |2022-01-01T22:51:43-08:00November 10th, 2019|

Top tips to make the most of the fall season and prep for the deductible reset

It may seem hard to believe—I know it does to me—but we’re approaching the last quarter of 2019. The summer season goes by fast, probably for obvious reasons, and when autumn arrives, it feels like it sneaked up on us.Of course, for many practices, there’s another reason it feels like a stealth attack by the calendar: the workload can go from one of the slowest times of the year to one of the busiest, seemingly overnight. This time of year can be crucial for your profitability. With many patients wanting to book services before the end of the calendar year, especially those who’ve met high deductibles, it’s an opportunity to meet patient needs and make more money. Now’s the time to plan how you’ll make the most of this busy time of year, without unnecessary stress. Here are some of our favorite tips for maximizing the upside of this season—while also staying well and enjoying what this high-productivity time of year. 1) Set a plan and get everyone on the same page Many of our practice clients seem to have an allergy to staff meetings! We understand the fear of wasted time. But at this crucial time of year, a group huddle can help make sure everyone knows what to expect and, above all, understands why the season is so important to practice health and stability. (This is likely obvious to physicians and practice managers, but it may not be to your staff.) Patients who know they’ve met their deductibles will be anxious to book care that they’ve put off. That means staff may need to be a little more patient when patients are less so. Patients will also likely be confused about their insurance, so making sure everyone knows the right way to answer their questions is critical (even if the right answer simply means knowing who to transfer their call to). If anyone on your staff is rusty on your technology capabilities or the billing/scheduling rules they’ll need to explain make sure you encourage them to speak up without feeling ashamed. Review your scripts and manuals, and assess

By |2022-01-01T22:51:43-08:00September 17th, 2019|

Are you an in-house medical biller or billing manager?

Are you an in-house medical biller or billing manager? We are looking to speak with a few billing professionals (either currently working as in-house billers, or who have been employed by practices in the past) for a project. If you are willing to speak with us for about 5-10 minutes for our research project, which focuses on attracting, motivating, and retaining medical billing staff, please reply contact us. We're looking for five to ten qualified respondents. Besides our gratitude, you'll receive a $5 gift card :) Better still, your responses will also help physicians and practice administrators better lead and manage billing teams. Thank you!

By |2019-09-12T14:49:06-08:00September 12th, 2019|

Teaching patients about their health insurance shouldn’t be your job–but it is

If you are frustrated by how confused patients can be about their insurance, and by the conflicts this confusion often leads to (especially about patient balances), you have good reason. Insurance is provided by employers, who theoretically should be able to explain it (it's an important part of employee compensation, after all). And it's offered and managed by insurance companies, who set and enforce the terms. There seem to be several good ways, logical ways to get information about insurance rules. So why do many patients misunderstand how it works? A few things are obvious. One is that health insurance can be very complicated. (It is complicated for those of us who work with it every day, even.) And the training and information patients have access to from their employers and insurers is simply not clear or accessible enough for many patients and many situations. This gap shouldn't be your problem. But it ultimately becomes your problem, since you'll have to deal with patients' confusion and corresponding reluctance to pay. All of which is a long way of saying that helping patients understand how their insurance works may not be something you should have to do, but it is something you're better off doing. And the earlier in the relationship you start the education process, the better. The clearer patients are on their financial responsibility before they receive care, the less likely they will be surprised by a large balance they didn't expect to owe. There is an old saw in marketing about how you have to repeat a message seven to ten times before anyone really absorbs it. The seven to ten is not regarded as a scientific analysis by anyone. But the idea that you have to repeat things, usually more often than you expect, and ideally via different media, is well accepted. (There's a reason you see and hear advertising by the same companies in different places and via different channels.) To this end, we often suggest to medical practices that they have some explanatory material at the front desk that covers common insurance issues--things like what

By |2022-01-01T22:51:44-08:00September 3rd, 2019|

The way we speak about colleagues matters [practice management tip: leadership]

Do you tend to refer to staff or their roles in your practice with generic terms like “billing person” or “someone on phones”? These descriptors seem like innocuous shorthand. But when physicians and managers speak about people in this generic way, it can send an unintended message that you view your employees as interchangeable cogs. Employees may assume that their career progress will never be recognized, or that employees’ specific contributions are not appreciated. Morale may suffer, and, over time, that can mean higher costs due to turnover. Productivity may be suppressed, too. Whether you’re a physician or a practice administrator, you worked hard to earn the respect that comes with your title. Feeling recognized for your achievements and contributions enriches your work life. The “billing person” who is working to bring money in your door may have invested in education to learn their profession, too. Though the training is nowhere near as competitive or lengthy as medical school or climbing the management ladder, becoming a skilled medical billing professional takes energy and commitment. Perhaps you now have an expert biller on your team, where you once had an eager novice who needed to apply herself to becoming proficient—a point of pride for her, and a financial benefit for you. Even roles like receptionist that have few education or experience requirements can be done with inspiration and excellence when your staff is engaged—benefitting your patients and your practice. On the flip side, if your staff is disengaged and going through the motions, you’re missing a big opportunity for your practice to stand out. Regardless of the roles they play, most of your employees spend more time working in your business than doing anything else. An atmosphere where there are a few valued players at the top and everyone else is considered interchangeable is not one where motivated people will want to work for long. Investing some time in creating (and using) meaningful titles for your employees costs nothing—but may earn a lot in improved morale and stability. A happier workplace with a more positive atmosphere means lower costs -- and

By |2022-01-01T22:51:44-08:00August 4th, 2019|

Don’t let the bastards get you down

We recently found out that another client of ours has been embezzled. Yes, I said "another." Employees stealing from practices unfortunately happens way too often. Though not rare, even just hearing about it is jarring. I find it sticks with me for days, like a black cloud reminding me that people can be awful. Of course, the effect it has on us is trivial compared to the impact it has on the actual victims of this terrible abuse of trust. The point of this post is not to advise you on how to reduce your risk of embezzlement. (We can do that, so contact us if you want to learn more, or start with our short quiz on the subject. But this post is about the emotional impact of having been robbed and deceived by someone you trusted.) If you've discovered that someone you relied on stole from you, here are some things I would like you to know. It's not you, it's them.Becoming a victim of embezzlement has nothing to do with your intelligence. Read that again: being a victim of embezzlement has nothing to do with your intelligence. Too often, victims of embezzlement feel ashamed that it happened to them. But though embezzlers are often clever, the difference between you and them is more about worldview than intellect. In some cases, people who were once honest find ways to rationalize their first theft while working for you. In other cases, embezzlers are repeat offenders who treat their crime as a trade, moving from employer to employer to ply it. Either way, it's clear embezzlers have a completely different sense of what is right and wrong than you do. In all likelihood, you didn't suspect them because you'd never consider doing something like this yourself. It's wrong to blame the victim of any crime, even when the victim is yourself. The only person to blame is the perpetrator. But you can put your intelligence to work for you by learning how to avoid a recurrence. You'll need to look at the world in a different way, so that you

By |2022-01-01T22:51:44-08:00July 15th, 2019|

Hiring your best new medical practice administrator

Since administrators play such a critical role in practices, recruiting a new one for your practice may provoke a fair bit of anxiety. If you’ve been left with little time, you may feel rushed. If your previous practice manager was a flop, you might even be feeling dread. Addressing the challenge head-on and systematically can help get you the result you desire. One familiar mistake we see is failing to define your needs thoroughly. This is not just a matter of “minimum of five years experience” – it’s a matter of understanding your practice’s mission, goals, and culture. It’s a matter of identifying what success looks like with the right administrator in place. Without mapping your practice’s needs and culture to a candidate’s qualifications and characteristics, you’re left merely hoping for a good outcome. Considering the lost time, productivity and general disruption that comes along with a poor hire, you need the odds in your favor. If you have infighting among your staff, which isn’t uncommon unfortunately, you may need a no-nonsense administrator with more of a hands-on approach as opposed to a spreadsheet genius who prefers to stay locked in her office all day. On the other hand, perhaps you have a mature and well-functioning staff and feel that you need a candidate with particularly strong financial management skills—for example, if growing your practice by adding a new office or even acquiring a competitor is on your agenda. Whatever you decide, you may want to create a spreadsheet table so that you can rate each candidates on the dimensions you think are most important - a simple 1-5 rating is a great start. You may want to use weighting as a tool to further refine your analysis. The old management saying of “be slow to hire and quick to fire” is useful to keep in mind along with some caveats. While it’s certainly important to find the best possible candidate, the cost of stop-gap management can be high. We see many practices where some staff is “temporarily” filling in as the practice administrator – often poorly attending to many

By |2022-01-01T22:51:44-08:00July 2nd, 2019|

Let’s talk staffing levels

Many administrators and physicians struggle to find the optimal staffing level.  When patient volume is especially high or an employee has called in sick, it can seem like you’re horribly short-handed.  On the other hand, seeing staff idle can make physicians feel as though they are paying for nothing at all – hardly a comfortable thought when profits are being challenged in multiple fronts.   Evaluating your ongoing staffing needs in a methodical, evidence-based manner can be a challenge, but it’s well worth the time and trouble. While it’s natural to look to other medical practices to see how you compare, don’t give undue weight to such comparisons.  While staffing levels typically fall between 3-6 FTE staff per clinician, it’s underappreciated that the strongest, most profitable practices often have more staff per provider.  To the extent staff assists the physicians in working efficiently, they increase the revenue potential of the practice.  Every task that a physician does that a staff member could do is a lost opportunity.  When we visit our medical practice clients, we almost always notice productivity gains that could be made with existing practice staff.  If your practice is like most, you can benefit from looking carefully to see if more tasks can be done by staff generally.  And here’s a great little secret: if you have staff who sometimes feel a little bored or underappreciated, simply asking them how efficiency can be improved can yield immediate results. Even after decades of experience, we’re still surprised by how many excellent ideas can come from even the most junior staff.  But more than that, staff feels more valued, engaged, and committed to the practice when you recognize their knowledge by asking their opinions. Also keep in mind that there may be tasks staff would be motivated to do during brief down periods that are beneficial to your practice. For example, many practices fail to update their websites and social media on a regular basis. This type of work can be a perfect fit for slow times at the front desk if you have a person who has the enthusiasm

By |2022-01-01T22:51:44-08:00June 14th, 2019|

‘Accept that almost anybody is a volunteer’: what does it mean to your medical practice?

We've started a new website feature you might like. We're listing some of our favorite famous inspirational management quotes (along with a few of our own). Classic quotes are fun and useful because the gurus who said them figured out how to succinctly express management ideas that can sometimes be obscure in practice. One of our favorites deals with a brutal truth of managing employees: Peter Drucker's advice to "accept that we have to treat almost anybody as a volunteer." You've got the title and you sign the paychecks. In theory, that gives you a lot of leverage. You can insist on having everything your way, at least for a little while. Eventually, though, a dissatisfied employee can put on his or her walking shoes and go work somewhere else. This freedom to hit the road goes double for people in high demand. (Like, say, physicians in practically any specialty, or talented administrators or billers.) If you're finding your practice is experiencing a lot of turnover in key roles, it can be very costly for your business. And even before they leave, unhappy employees can harm your practice with low productivity, negativity, and, in extreme cases, even sabotage. So how can thinking of employees as "volunteers" help you improve morale and retain key people longer? Here are a few things to consider: The idea that employees are "volunteers" means more than just "they can leave." Modern employees want to be inspired by their work. They want workplaces that align with their values -- just as they would if donating their time. This doesn't mean you should retool your practice culture to match the preferences of every new hire. What's more important is to know your culture and be clear about it when hiring. That will help you avoid a costly revolving door of employees whose expectations weren't met. And what if you suspect parts of your culture or your work standards could use an upgrade? The upside of better morale and lower turnover is a good reason to consider making needed changes. Money is important. Make sure you're not notably

By |2022-01-01T22:51:44-08:00March 19th, 2019|

Should you buy the practice down the street? [on-demand webinar]

In recent years, many of our clients and friends have been involved in practice acquisitions or mergers. In many of these cases, a practice in a nearby area has come up for sale, perhaps due to retirement or death of a physician owner. These can be exciting opportunities, but stressful, too. There is usually pressure to respond quickly. And, of course, the decision usually involves a significant investment. The need to move fast often makes it hard to even think through all the questions you want to ask -- much less get answers to all of them. When the pressure's on, fear of missing the opportunity may take over. But if you move too fast, you may "win" the opportunity without realizing what it really costs. "Buying the practice down the street" may be a fantastic way to quickly expand your practice, but it's not without significant pitfalls. Information and a solid plan are your best tools for protecting your interests. In this short webinar (about 30 minutes), Laurie Morgan outlines some of the key questions to consider when deciding whether to buy a nearby practice. To view the recording, click the link. You'll be asked to register on the video page. Once you've watched, we'd love to hear from you if you have questions. And, of course, we're at-the-ready to help you with consulting services before you make a purchase decision (or before you put your practice on the market). Use the contact form to email us or give us a call.   "Should You Buy the Practice Down the Street?" [on-demand recording - registration required]  

By |2022-01-01T22:51:44-08:00March 14th, 2019|

Ask us anything!

Ever wonder how a practice management consultant might respond to the questions that come up every day in your business? With our new Ask Us Anything website feature, you send us your questions, and we'll share our thoughts on them here -- where you and other physicians and practice managers can see how we think about management ideas and challenges.It's free, and it's anonymous. Check it out at our Ask Us Anything page.

By |2018-12-28T18:44:49-08:00December 28th, 2018|

Don’t believe the hype: patient portals aren’t “largely unused”

A provocative headline got my attention recently. It proclaimed that patient portals are "largely unused." It caught my eye partly because it didn't sound all that plausible -- and because taking such a headline at face value could be unhealthy for your businesses, dear clients and friends of Capko & Morgan.  I decided to dig into the matter. The article text actually mentioned that 37% of patients have recently used portals. Could the author actually believe that 37% utilization is trivial? That seemed to be what they were saying, yet it's hard to imagine they believe that. (Would a 37% decrease in salary leave one's pay "largely" unchanged?) Perhaps, you may be thinking, this was just a forgivable, inadvertent misuse of "largely." But I tend to think not. This type of exaggeration is just too common in modern media, even in our world of the business of healthcare. I tend to think the headline intended to sensationalize. Yet even if that wasn't the intention, it's still not a benign error, which is why I'm calling it out. Mischaracterizing portal adoption has a hidden cost Clients often tell us they've held back on technologies that could make their practices more efficient because they're concerned patients won't use them. But that thinking usually means practices miss out on significant benefits, since the tools they delay adopting (or forgo altogether) could make interaction easier for patients or make their practices more profitable (or both). This tendency to hesitate has been especially true for patient portals, and it's often very costly. Somewhere along the way, the idea took hold that portals aren't worthwhile unless nearly every patient uses them. But this is not true. It's not even close to true. If even a small percentage of patients regularly uses a portal, those patients will benefit -- and their physicians will save time, too. (And that's strictly on the clinical side. Portals have the potential for even more dramatic benefits on the payment and administration side, even when utilization is very low.) What's more, relative to other recent technologies, portal adoption is arguably not that

By |2022-01-01T22:51:45-08:00December 20th, 2018|

Credentialing: is it time to upgrade your process with software?

Credentialing can be a frustrating, mysterious, time-consuming process. It can seem like a black box: you throw your (copious) data in (with no idea what will happen to it), then hope you'll get what you want out of the other side (eventually -- you have no control over when). Worse, unlike most other administrative tasks your staff handles, credentialing has seemed immune to process improvement. It's no wonder so many practices outsource this tedious, unpredictable paper-pushing. But that can lead to another set of problems. For example, when delays occur, how do you know whether there's a problem with the application, the payer is just slow, or your credentialing service dropped the ball at some point? Constantly checking in with a credentialing service for updates wastes valuable time on both sides -- especially since your credentialing service has no more control over how long it takes payers to respond than you do. Thankfully, dear reader, you and I are not the only people who've observed the built-in productivity drains in credentialing the old-fashioned way. In recent years, technology whizzes have stepped in to improve the process. There are still frustrating pieces of the puzzle that technology can't yet fix -- like the need for physicians to gather all that information in the first place, and like the uncertainty about where submitted applications stand with payers. But technology can help with: maintaining a single source of credentials -- to avoid submitting out-of-date information or incomplete information tracking key dates enabling physicians to enter their own information via a portal -- to avoid double entry of data, and the associated costs and errors automating the completion of many forms in some cases, automatically updating or communicating electronically with important third parties like CAQH If you are not yet using a credentialing software product, now is the time to check your options out. And if you're outsourcing, it may be more efficient to bring the task back in house, supported by up-to-date software. Or if you continue to use a credentialing service, be sure that your partner uses a cloud-based system that you

By |2022-01-01T22:51:45-08:00December 4th, 2018|

Our Thanksgiving letter

We're grateful for the opportunities we've had to work with you, for your support of our books and presentations, and for the work you do keeping patients healthy. Our Thanksgiving tradition is to make a charitable donation on behalf of our clients and friends. Usually, we keep the focus on medical organizations. But this year, many of our neighbors in both Northern and Southern California have suffered terribly due to the devastating wildfires at both ends of our state. So we've decided to add organizations that provide relief to wildfire victims to our 2018 list, which includes: American Red Cross - Disaster Relief California Fire Foundation GlobalGiving - California Wildfire Relief Fund Conquer Cancer Foundation If charitable giving is part of your year-end traditions, we encourage you to give these options consideration. Resolved: A Prosperous 2019 Every January brings another opportunity for your practice business to have its best year ever. We're at the ready to help with fresh ideas; new books, webinars, and other content; and customized consulting. Trends suggest that independent medical practices are poised to resurge and thrive. The challenges that make it more difficult for complex conglomerates to efficiently and profitably provide quality care are becoming very clear. And burnout is a greater risk for physicians in high-pressure, low-control employment situations. Now is the time to turn your own practice into your ideal employer and your source of pride. It's easier and more cost-effective to work with us than ever. If you're ready to make 2019 the year your practice takes off on a more profitable, more rewarding, less stressful trajectory, let's talk! Year-end round-up: Did you miss these popular blog articles? These are the top five most-read posts on capko.com's blog this year. Click on the headlines to check them out: "It's everyone's responsibility,but no one's doing the job" "Improving front desk performance" "Reducing the cost of no-shows at your practice" "The power of your front desk to influence the patient experience -- and your reputation" "Fix the problem, not the blame"   Stay in touch and never miss a post! Here are

By |2022-01-01T22:51:45-08:00November 21st, 2018|

How will you make the most of year end — and prepare for the deductible reset?

I just published an article for Phreesia's blog about how to make the most of year end (when many patients with fulfilled deductibles may rush to get care) and prepare for Q1 (when the deductible reset causes some patients to delay care). Please click here to read the article to get the full scoop. In a nutshell, here are the suggestions I made in the post: Alert patients to the deductible reset and the benefits of receiving services before December 31 Try to identify patients who opted to delay care earlier in the year and contact them personally Offer financing options for patients who need them Make sure your reminding approach is up to snuff Prepare to promote preventive services in January-March Consider how you might use the lighter load of Q1 to your advantage One additional idea to think about. Remember that you may feel your workload slow down in January and February, but the impact on your revenue will lag a bit. (In January, you'll still be collecting some payments from the end of the year.) So if cash flow is a concern, remember that you may still feel the pinch as late as April, depending on how quickly your volume rebounds. I also strongly recommend you use this time of year to review your technology set-up. Keeping patients informed about insurance, making it easy for patients to pay, and improving your practice productivity can all be made easier with the latest technology options. If you're not sure how to evaluate your technology infrastructure, Capko & Morgan can help with a cost-effective review. Contact us for more information about that.

By |2022-01-01T22:51:45-08:00November 16th, 2018|

Cost-cutting: pick your battles wisely

We recently worked with a smart, energetic practice administrator who was very motivated to improve his practice’s bottom line. He’d already found significant savings by switching billing and phone services (even getting better billing results, to boot). Spurred on by those successes, he’d turned his attention to clinic staffing. While the physicians in his practice mostly used conventional medical assistants (MA) for support, a few of the doctors and non-physician providers (NPPs) had opted to use “scribe assistants.” These hybrid staff help clinicians by both scribing during the visit and handling typical MA tasks like test orders and scheduling follow-up care. Because of the extra duties, and because they were hired through an agency, their hourly cost was a bit higher than for the MAs – a 15-20% differential that caught the administrator’s attention. The administrator estimated the hourly cost of hiring a new MA would be about $20, including taxes and benefits. The scribe assistants, meanwhile, cost the practice about $24 per hour. The scribes did some tasks the MAs weren’t trained or expected to do – notably, scribing. But the administrator believed that at least one of the NPPs who was currently using a scribe assistant could do just fine with an MA (she was a recent grad and tech enthusiast). So the administrator decided to suggest gradually switching some of the contracted scribes with employed MAs – and was surprised that his idea met with resistance. (After all, 18% would be a significant cost savings – yet even some of the partners resisted the idea!) As the administrator repeated his idea at a few monthly meetings in a row, the resistance grew into a testier conflict. Was the conflict a sign the administrator was wrong to bring up the idea of saving money on clinical staff? We wouldn’t say “wrong” per se – but we might have not have prioritized this particular cost-saving avenue. It’s natural for clinicians to be wary of any changes to clinic staffing. Clinical support staff is essential to physicians’ productivity. Anything that disrupts clinic flow can make it harder for physicians to

By |2022-01-01T22:51:45-08:00October 15th, 2018|

Creative ways to support more services — and more patients

A few years ago, my partners and I worked with an open-access pediatric Medicaid clinic that had a very creative approach to helping as many patients as possible. Their ingenious ideas helped them bust many of the assumptions about Medicaid (especially the big one: that patients can’t be served without losing lots of money). One of their biggest gambles was investing in a small bus to transport people who couldn’t get to the clinic because they lacked transportation or child care. Ultimately, the bus wasn’t much of a financial risk at all, since it brought patients in when the clinic was typically less busy. Plus, if a parent had one sick child and one well child, everyone could come to the clinic on the bus. The well child could be seen for an overdue check-up at the same visit as the sick sibling. This allowed the clinic to deliver more timely preventive services to more of its at-risk patients, while also generating more revenue. It helped address a clinical challenge while also improving the clinic’s financial picture. With the list of preventive screenings always seeming to grow, finding creative ways to accomplish more in less time—without putting more pressure on clinicians or the budget—is essential for any busy clinic. Of course, providing open access or transportation for patients is not an appropriate solution for every pediatric or family medicine clinic. But every practice can discover novel ways to do more with the same team by thinking creatively and questioning long-held assumptions. Here a few ideas that are a bit more conventional than adding a shuttle bus, but still might spark your practice team’s creativity about how to provide more services without adding stress: Group visits. Transportation and child care are common obstacles for Medicaid patients. Establishing evening group visits might make it easier for families who are in the same neighborhood to travel together for wellness checks. Because everyone in the group attends everyone else’s visit, messages about the importance of screenings and vaccines can be amplified. For example, if the nurse or physician asks one parent about lead testing

By |2022-01-01T22:51:45-08:00September 20th, 2018|

When communication becomes overwhelming, the web and social media can lighten the load

It can happen to any practice at any time. Your practice is humming along like fine-tuned machine. Your schedule is booked up. Clinicians are running on time. Patients are getting the appointments they need. Everything’s working like clockwork. Then, out of the blue, boom! A story about a possible new link between a drug many of your patients rely on and a dangerous side effect blasts hits the national media. Suddenly, the hum of efficiency is replaced by the sound of phones ringing off the hook. Nervous patients are clamoring to speak with their doctors, and your staff struggles to reassure them. Patients who need appointments have trouble booking them, because your lines are overloaded. Many are frustrated because they only reach your voicemail. Even the best-run practices can be temporarily disrupted by factors outside their control: drug and device recalls; unexpected research findings; power outages; and severe weather are just a few examples. These disruptions can be severe enough that your practice can suddenly feel very understaffed. Of course, most of these types of unpredictable disruptions existed before the internet age. The internet has allowed news to spread more quickly, though. Sometimes, inaccurate information and questionable advice gains just as much traction as useful advice – and that can mean more nervous patients calling your practice with questions. But the good news is that when it comes to rapid communication, that same internet that spreads anxiety and uncertainty like wildfire can also help your practice spread smart answers with a lot less effort. And it can make dealing with unforeseeable problems a bit easier, by scaling your communications and allowing your patients quick access to trustworthy answers. One of our pediatric practice clients recently faced a double whammy of communication problems. First, their phones went out. Then, in truly unlucky fashion, their website also chose that same moment to go down. They were unable to respond to phone calls and couldn’t even access their email database. They still had a couple of resources available to them, though – and those tools turned out to be lifesavers. First, the practice

By |2022-01-01T22:51:46-08:00August 21st, 2018|
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