medical practice business

The Wall Street Journal had a thought-provoking opinion piece by Scott Gottlieb, MD, on Friday entitled "The Doctor Won't See You Now. He's Clocked Out."  Gottlieb asserts that the ACO model ObamaCare encourages is basically handing hospitals a monopoly in many markets, and encouraging them to buy up practices to take advantage of higher, 'facility' reimbursement rates from Medicare.  And he adds that, once employed, physicians are less motivated to take ownership of the full spectrum of patient care (e.g., because they hand their patients off to another hospital physician at the end of their shift).  The overall picture is higher costs and less productive physicians. As someone who's studied economics, I find it hard to argue with Gottlieb's analysis of the effect of market power: hospitals will inevitably use their monopoly (or quasi-monopolistic) positions in many markets to drive higher prices.  I wonder, though, if that won't -- at some point -- create opportunities for more entrepreneurial doctors.  To the extent that hospitals and other larger systems raise rates, that should make working with smaller, more nimble, and less expensive independent practices more attractive to payers.  And, that may ultimately enable more entrepreneurial physicians to find a path to keeping their practices open and profitable, and even developing new models (as occurred with, for example, ASCs in the past).

Today I stumbled upon an intriguing, although somewhat troubling, blog post from last fall entitled, "Disrespect ... is the Elephant in the Hospital."  The post referred to two academic papers by Lucian Leape of the Harvard School of Public Health that closely examine how a hospital environment that tolerates disrespect -- whether from doctors to nurses, staff to patients, administrators to clinicians or physicians to patients -- leads to all kinds of bad outcomes, including very demonstrably increasing medical errors. Tolerated disrespect isn't just a hospital problem -- it can happen in organizations of any sizes, including private practices.  And, the potential consequences aren't just clinical.  If a manager or physician creates the sense that staff aren't respected contributors to the team, it stifles staff contributions.  Team members who are in a position to observe operational problems will be discouraged from pointing them out -- and so the practice misses out on an opportunity to improve. And, of course, the daily grind of disrespect will eventually cause your practice to lose its best employees. Once a pattern of disrespect is well-established, it can be tough to break.  If a practice manager seems to treat staff dismissively or is demeaning to them, corrective action by the physician(s) he or she reports to is imperative.  If a physician seems unable to interact with staff without condescension or bullying, an intervention (perhaps with the help of an outside coach) is needed, and it may be necessary to carefully structure how he or she works with staff. Above all, the first step to repairing an office environment that has become hostile is to provide the means for staff to confidentially (anonymously) provide honest feedback, without fear of retaliation.  For a small practice, it may be helpful to work with a neutral outside party to gather employee opinions in a "safe" manner, and summarize them so that management can take corrective action.

My new column this month gave me a chance to share some anecdotes about really interesting, high-performing medical practices that have achieved their success by breaking a few rules!  One of my favorites, because it's so much fun to think about how these doctors and practice managers inspired us and taught us quite a few new tricks. Repertoire Magazine  

A few months back, we shared a link to HARO ("Help a Reporter Out"), a wonderful service that distributes daily inquiries from journalists from all sorts of publications -- we've seen everything from American Medical News, Medical Office Today, to national magazines like Parenting and Best Health, to national television outlets like CNN and Fox News.  The service also features queries from local news stations, websites and publications, too. Are you thinking, so what?  Well, the wonderful thing about HARO is that, unlike ordinary PR work -- i.e., the slog of pitching, pitching, pitching to reporters -- when you respond to a query on HARO, you are actually helping the reporter.  Meaning the reporter wants to hear from you and hear what you have to say. Getting your name and your practice's name and point-of-view out in the media has tremendous value.  The audience will perceive you as an expert selected by the journalist to comment on the subject.  This can elevate your image versus others medical practices in your specialty in your area. And don't let lack of time during the day hold you back from responding!  At least when the story is for print or web, the reporter will usually allow you to answer via email, instead of by phone or in person during business hours.  We do email 'interviews' all the time with reporters here at Capko & Company.  This also gives you more time to think about your answer -- if you're concerned about coming up with your best response on-the-spot. We often share items from HARO that we think will help our client practices and other friends -- if you don't want to receive the daily HARO emails (3x), join our email list (see sidebar) and you'll receive the tidbits we send out that are relevant to your practice.

If you haven't had a chance to read all of our 13 tips for 2013, here is the full list: Master the deductible re-set [commit to less bad debt in 2013!] Analyze your E/M code distribution [reduce audit risk, bill for what you've earned] Cash management quick tip [copays are not petty cash!] Patient service=patient care [the dreaded patient service conflation situation] Review maintenance contracts [don't let auto-pilot become auto-overpay] Get educated [lifelong learning: not just for clinicians] Reach out to local employers [you've got more than one customer] Manager's report card [everyone needs feedback, goals and recognition] Analyze payer performance [remember that you decide which payers you will accept] Engage staff with better meetings [such a simple idea, so much opportunity for upside!] Review payer contracts [it's okay to admit they've been stuffed in a drawer -- just pull them out and read them] Review your directory listings [don't miss out on free promotion -- or let errors online impact your revenue] Make haste slowly [take on important challenges with care -- and get help to jumpstart your planning!]

So, if we asked you where your payer contracts are, you could tell us, right?  And you'd know when you last reviewed them -- and when the next renewal period comes up? Or, are they ... at home, in a closet, where they've been (untouched) for several years?  Are they ... 'somewhere around here'? Well, we're not surprised.  Many of our clients have tucked their payer contracts in a drawer, only to forget about them.  So, don't feel TOO bad about this -- but, feel just bad ENOUGH to resolve to change your habits now! Reviewing your payer contracts annually -- before they end/automatically renew -- is more important than you think.  Many contracts have evergreen provisions that can make extension of your current rates mandatory -- even if you would have been eligible for an increase.  We've worked with practices that have foregone years of increases because they didn't realize their rates would remain unchanged if they failed to contact the payer at renewal time.  (Even when rate increases seem negligible, several years worth of them add up to significant foregone profit.) There also may be provisions in your contracts that you've forgotten about that can lead you to inadvertently fall out of compliance -- which can lead to unexpected reimbursement problems down the road. Bottom line: set a tickler to review each of your contracts a month or so before they renew.  (And, if you can, try to reset your contracts so that they all renew around the same time -- so that you can do your review in one fell swoop.)

New year, new budget, new goals?  Now is the time for practice managers to review their skills-building strategies for 2013 -- and to make the case for joining general practice management organizations like PAHCOM, MGMA and POMAA or specialty-specific groups like NERVES and Bones. The world of healthcare is changing.  The colleagueship and educational programs offered by established practice management organizations can be invaluable in  helping you and your practice stay on top of the changes -- and gather new ideas for managing change.  And, these groups can also often help you make crucial connections to vendors who can help your practice, often at discounted rates.  The certification programs can help you advance your own career -- and, if your practice's growth requires you to make some key hires, being part of one of these organizations can help you find qualified candidates.

We've been working on patient service training this month, so this great post on Physicians Practice got our attention.  Too many physicians and practice managers still misunderstand how patients perceive their quality of care: it's not just about the results.  Patients make judgments about their quality of care from the moment they arrive at your practice.  The article on Physicians Practice includes some great advice -- some of our favorites that we frequently share with our client practices include: Don't room patients far in advance.  Waiting in the exam room is more stressful and annoying than waiting in the reception area. Warn patients about long wait times.  If they're aware they'll need to wait 30 minutes, they'll be less upset about the delay. Use warm greetings, including the patient's name, to establish a connection and convey that you care. Check out the full story by clicking here.

We launched something new for 2013 -- just in time for our "13 for 2013" practice management quick tip series.  You can now receive our blog posts directly via email.  Just scroll down the right hand column to "receive email updates via FeedBurner," add your email to the green box, and click submit -- that's it. If you're a frequent visitor here, you already know that you won't receive tons of mail -- just an update or two per week, always aimed at helping your healthcare business shine.  And we'll never share your email with any outside party.