planning ahead

“If it ain’t broke,” maybe you still should fix it

This meme popped up on one of my feeds recently, and whenever it does, it makes me smile (and think). It's a picture of a horse tied to a lightweight plastic chair. The horse is standing patiently and obediently, presumably unaware that he could easily shake off the chair, break it, or drag it along and run away if he chose to. The caption is always some variation of, "The thing holding you back might be all in your head." Time to break free? It's an idea always worth exploring in my opinion. Whenever working on an intractable problem, I always seem to find that testing some assumption or another can lead to a solution. It's natural for business owners and managers to rely on assumptions. No one has time to rethink every workflow or financial policy or technology strategy every day (obviously). That's one reason why unhelpful or outdated assumptions can be hard to spot. It's a challenge that affects everyone, but perhaps especially very busy people who shoulder a lot of responsibility. What's more, "if it ain't broke, don't fix it" or "that battle's not worth fighting" or "we tried that once and it didn't work"–some of the most common assumptions we make to help us keep things moving along—can be very useful maxims that help keep the to-do list manageable and avoid wasting energy. Even well-founded assumptions can outlive their usefulness as times change, though. And when they do, the same guideposts that once were so helpful can undermine progress. Part of my job as a consultant is to help practices identify and question their assumptions, to be sure they're still helpful. A mini case study I saw this play out recently with a practice that wanted to add clinicians but lacked office space, especially at the front desk. As a result of earlier expansion of the provider team, the front desk was already understaffed by at least fifty percent. ("We can't fix that. There's nowhere to put anyone else.") Despite this obvious constraint, the owners had an opportunity to hire two clinicians they really

By Morgan|2025-02-02T14:34:22-08:00February 2nd, 2025|

Maintaining medical practice cash flow in Q1

As we've posted here before, almost all practices face the risk of a cash flow crunch in January and, really, through all of Q1, thanks to the deductible reset. (January's revenue collections are sometimes also hit lower volume in December because of the holidays -- a double whammy.) In our experience, the decline in revenue can be anywhere from 10-20% for primary care practices (pediatrics and family medicine typically get a little 'help' maintaining Q1 volume from winter viruses) to more precipitous drops for surgical specialties (especially when there's little downside to patients for delaying surgery). The most important step practices can take to cope with the drop-off is to plan -- now that it's February, well, it's a little late for planning for Q12015, but if you're suffering from shrunken revenues that you didn't expect, mark your calendar now to start planning for Q1 of 2016 at the end of this summer. With enough notice you can plan to set aside cash reserves so that you don't need to tap lines of credit, cut expenses or delay needed purchases when the squeeze hits. You can also make sure you're ready to take advantage of the upside of the deductible reset: patients will be anxious to schedule procedures in Q4, after they've met (or come close to meeting) their deductible. Alert staff that vacation time will be limited in the fall quarter -- perhaps even offer staff extra time off in January. And, above all, start marketing procedures and mining your EHR for patients who may have wanted and needed a procedure, but put it off for financial reasons. Even though we're now in the thick of crunch time, there are still a few steps you can take to nudge the cash flow back up. If your practice's bread and butter is high-fee procedures, look into financing options and review your financial policies. If you're able to offer payment plans, that can take the sting out of patient responsibility payments. Technology solutions that can help you offer payment plans that comply with HIPAA and other security requirements are more readily

By Morgan|2022-01-01T22:52:01-08:00February 10th, 2015|

Authentic strategic planning for your medical practice

Medical practices are taking note of the importance of strategic planning, as they tread the unknown waters of healthcare reform and adapt to changes they may not have invited if given a choice. But do the key stakeholders of most private medical practices really understand what it takes to succeed with efforts to create and successfully execute a strategic plan? Do they know the importance of developing an authentic and that in order to be authentic it must be driven by the practice mission? If the strategic plan is not authentic in consistently delivering on the mission it is likely to fail. But if it is authentic, it will guide the practice in achieving its strategic goals. Start on your path to strategic success by keeping these essentials in mind while going through the strategic planning process. Begin the strategic planning process by making sure the plan encompasses what the practice is all about and what it represents to the community. This means the goals and the decisions outlined in the strategic plan must be aligned with the practice’s mission and vision. It is important to articulate the significance of this from the onset and revisit it as you go through the many processes of strategic brainstorming, goal-setting and formulating the written plan. This helps ensure that the decisions and actions identified in the strategic plan are authentic to your very purpose in being a medical practice. Next, identify what differentiates your practice from its competition. It is critical to examine market data to understand external factors that may impact the practice now and in the future. It is also critical to take an objective look at the practices strengths and weaknesses, exploring what opportunities this presents and what obstacles must be overcome. Sometimes, this is referred to as a "SWOT" analysis, for "strengths, weaknesses, opportunities and threats." These analytical steps help the practice address issues it must contend with and make appropriate strategic decisions based on the reality of your market position. Practice-wide engagement is needed to succeed with implementing a strategic plan. This means communicating your strategic goals

By Judy Capko|2022-01-01T22:52:08-08:00April 22nd, 2014|

Small practices: PCMH is not out of reach

The Patient-Centered Medical Home is so much more than just a payment innovation -- it's an idea that appeals for clinical reasons to so many physicians and practice managers, who were already aiming to provide the higher level of care-coordination and patient engagement that is the foundation of the PCMH. But many small practices we work with have been nervous about the hurdles for certification -- is it too much for a solo or two-physician practice to take on? A recent AAFP blog post offers a wonderful idea for smaller practices daunted by the prospect of tackling the PCHM checklist on their own: form an informal network with other, like-minded practices in your area, and divvy up the research and learning. What a great solution -- and a great way to expand your connections with other professionals in your community. Read about it here.

By Morgan|2022-01-01T22:52:08-08:00March 24th, 2014|

Trade shows – there’s so much to gain
Gallery
Trade shows – there’s so much to gain

Business, business sense, medical practice business, planning ahead, practice management, productivity, technology

Trade shows – there’s so much to gain

There are lots of reasons to spend time in the exhibit hall when attending practice management and other medical conferences. By visiting the exhibit hall you will learn a lot about what’s going on in the industry, how vendors are seeking to meet your future needs and what technology changes have emerged that can make a practice more efficient and profitable, while improving service and outcomes. Yes, there are lots of reasons to get down to the exhibit hall, but it's also important to plan how you can do this without being overwhelmed or wasting your valuable time. Forget about seeing everything – it’s just not possible and can lead to unnecessary frustration. However, with thoughtful planning you can see those things that can make a difference in your very own practice. Get off to a good start. Conference materials at the convention will include a list of all the vendors that are exhibiting. Match these with your interests. Then check-out their location on the exhibit floor. This will allow you the opportunity to plot your course. Visit your selected vendors, by covering one section of the floor at a time. It’s a strategic move that will get you off to a good start. Refer back to your vendor list as you move through the convention. You might want to take photos using your mobile phone or make notes. This will be valuable for follow-up and decision-making when you get back to the office. Pace yourself. Be realistic in evaluating how much time must be spent on the floor of the exhibit hall to achieve your goals and meet with the different vendors you have targeted. Allow an average of 5 minutes for each of the vendors on your list. When you meet with an exhibitor, it’s important to be a good communicator and get right to the point. Let the sales representative know what information you want and why. At the same time, if the sales rep is not a good listener you could be wasting valuable time. Don’t allow him or her to lead the conversation to information

By Judy Capko|2022-01-01T22:52:10-08:00January 21st, 2014|

The cost of poor decision-making

We were recently called into a group practice where the physician owners of Struggles Medical Group were disillusioned with the practice of medicine. Their concerns were typical, shrinking reimbursement, dismal profits and the threat of new competition, as a large urban academic faculty practice was beginning to penetrate this suburban community. Sound familiar? This is happening around the country as a response (or reaction) to healthcare reform, where larger healthcare organizations see new opportunities to get a bigger piece of the revenue pie. Struggles timing was perfect for bringing this consulting team in and here’s why. We performed a detailed practice assessment, examining the implications of past decisions and analyzing the current state of Struggles Medical Group in primary areas of performance including practice structure, finances, human resources, billing, clinic operations and work flow and marketing. One physician owned this practice and the other physicians and providers were employed. We soon discovered the physician owner had a history of making bad decisions. They did not analyze return on investment (ROI) before making investment decisions that would impact the practice operations, finances and possibly patient care. A perfect example of Struggles poor decision-making was buying very costly diagnostic equipment that they were unable to use because payers were contracted with a lab to provide these services. This meant the investment was rendered useless to the practice. Besides this, with new models on the market every six month,s there was no way to attract another buyer for the equipment. There were other equally disastrous investments Struggles made over the past two years. The most recent strategic error was changing the direction of the entire practice. In their quest for new revenue opportunities the practice decided to focus on expanding its service to workers compensation patients. Attracted solely by somewhat higher gross reimbursement rates, they went ahead with this in this in 2013 without thinking of the implications with would have on staff, workflow and profit. This was a costly error. Workers compensation is a practice model that is significantly different from other payers and requires specific expertise in report writing and tremendous

By Judy Capko|2022-01-01T22:52:10-08:00January 10th, 2014|

Will 2014 be a better year for your medical practice?

This is certainly a reasonable question to ask considering the rapid-fire change, threats and unknown factors medical practices face due to the Affordable Care Act. But here are a few things you can do to deal with all of this. First, keep your eye on the ball. Don’t throw up your hands in frustration, but follow the news and the legislation that is likely to impact the way you practice medicine, your future stability and the care and service offered to your patients. Read everything you can and keep your cool. In other words, don’t throw your hands up in despair. Put the emotions aside and be prepared to respond. If you know what’s coming down the pike you can be practice-ready and take strategic actions rather than wait, feel the panic and be reactive, which typically leads to poor, costly decisions. Well thought out decisions will explore not only the potential threats, but the opportunities that are available to you and your colleagues without compromising your integrity or patient care and service. Next, look at the numbers. How well did your practice perform compared to prior year and compared to other practices in your specialty? Benchmarking will help you examine the trends so you can examine areas where performance was disappointing and seek ways to bolster them for next year. The numbers tell the story of past performance and give you an opportunity to set future goals that keep the practice stable and on financially solid ground. Don’t make squeezing cost a primary focus. Sure, it’s normal to focus on costs when reimbursement is tight and may get tighter, but in reality you can only squeeze costs so much. If you focus most of your efforts on costs you are likely to reduce quality and service. The highest expense for a medical practice is staffing, but the old saying: “You pay peanuts, you get monkeys” is true. Hire well – highly skilled and experienced people; respect them, pay them well and set high expectation goals and staff well help your organization to me more profitable. Physicians and managers can

By Judy Capko|2022-01-01T22:52:11-08:00December 23rd, 2013|

Does Satisfaction Make Patients Sick?

A recent UC Davis study revealed a surprising finding - an inverse relationship between patient satisfaction scores and health outcomes. In other words, those most satisfied with their healthcare providers were, on average, sicker and more likely to die than their less satisfied counterparts! As might be expected from these findings, healthcare costs were also higher - by about 9% - among highly satisfied patients. The study compared health outcomes and patient satisfaction scores of over fifty thousand adult respondents of the Medical Expenditure Panel Survey, a product of the Agency for Healthcare Research and Quality under the U.S. Department of Health and Human Services. The survey is designed to be representative of the U.S. adult population and is the most comprehensive data set of its kind. Response rates for the survey have varied between approximately 60% to 70% over the last decade. Among the possible explanations is that physicians, motivated in part by physician compensation structures that consider patient satisfaction, stray from standard treatments and instead meet patient expectations. Under this scenario, patients are satisfied because tests and procedures are viewed in a more-is-better light, but clinical outcomes suffer, e.g., patients receive treatments that carry risk as a result of false positive lab results. The trend toward elevating patient ratings in measures of quality of care are likely to continue with the Center for Medicare Services (CMS) starting this past December with its initial phase of 1% rewards or penalties for hospitals under Value Based Purchasing. One-third of the evaluation process relies on patient data, i.e., survey data. These intriguing study findings certainly call for further research to solidify our understanding of the value of patient satisfaction ratings. This study and our firm's experience especially calls into question the value of very broad measures of patient satisfaction, e.g, how satisfied are you overall, because patients are notorious for confusing bedside manner with the quality of clinical care. The implications of this study may be far reaching, but enterprising providers can take simple steps to educate their patients, preferably long before they see them in the exam room. With email and social media making communication easier and less expensive,

By Joe Capko|2013-01-24T14:40:12-08:00January 24th, 2013|

Will 2013 be better than 2012? It’s up to you!

A new year has already begun! If you are hoping for significant year-over-year improvement you need to act – and sooner rather than later. Here’s how great practices help ensure that each year is better than the last. Examine past performance. Consider what data points are important to review. As a guide, great practices will compare their performance against at least these benchmarks every year: Total revenue per full time equivalent (FTE) physician Total operating expense as a percentage of total medical revenue Total visits/procedures per FTE physician Percentage of total A/R aged 120 days more Bad debt due to fee for service activity per FTE physician Determine what the numbers mean to you. Compare your performance between 2012 and 2011 to evaluate your year-over-year performance. Are you clearly performing better or worse? Then assess why there is a difference. If you did better was it because you were more assertive? Dit you have clearer established goals to guide you? Perhaps changes in performance can be traced to changes in staff or actions taken to improve contract reimbursement? Did you implement a marketing plan or are differences between years merely chance variation? If there was no change in 2012 or you did worse, you will want to take decisive action to make 2013 a better year. Plan for 2013. Of course, given the challenging business environment, leaders of improving practices make planning a priority. I recommend a strategic planning session be scheduled well in advance. Scheduling an off site meeting in early February can minimize interruptions. If you have a skilled communication facilitator on your staff, and your practice isn't facing especially serious challenges, your practice might conduct your meeting without an outside consultant. On the other hand, a consultant can increase the value of strategic planning sessions by facilitating communications on difficult topics, providing an objective overview of your practice’s performance, helping you understand your position in the marketplace, and assisting leadership in determining goals for the upcoming year. Practice leaders it is not too early to think about the steps you can take to protect and guide the practice’s

By Judy Capko|2022-01-01T22:52:36-08:00January 16th, 2013|

Beware of opportunity costs

Recently, we worked with an OB/GYN practice that had taken some big steps to reduce staff costs. In particular, the practice was concerned about their long-standing process of providing new maternity cases a lengthy consultation with an RN -- covering all the information a newly pregnant woman would need, and offering her a relaxed opportunity to ask questions. Because the RNs were paid at $22-$25/hour, the practice manager and managing physician partner felt that these consults were an extremely wasteful expense. They reasoned that the consults could be easily incorporated into the initial physician visit -- adding 15 or 20 minutes to the visit, instead of paying for 30-45 minutes of RN time for the consult. The maternity visit with an OB would be included in the patient's global payment -- no additional revenue would be generated by adding 15-20 minutes of physician time to the visit. But, the practice reasoned, they would no longer be incurring the RN costs of $15-20 per consult -- and, since the revenue was the same either way, the impact would be bottom-line positive, right? Wrong. What the practice failed to consider was the opportunity cost of tacking 15-20 uncompensated minutes onto the physician visit. While the practice no longer had to pay an RN $15 to discuss pre-natal vitamins and exercise with maternity patients, the practice was giving up 15-20 minutes of provider appointment time -- time which could potentially be billed out at much more than $15 if it were used for an additional patient visit. Provider time is a practice's most precious resource -- it's the only means the practice has to generate revenue. Using providers to do tasks that can be done by an RN or MA almost never makes economic sense for a practice. Plus, taking higher level tasks away from your RNs and MAs deprives them of the satisfaction they get from those activities. Keep everyone -- especially your providers -- utilized at their highest potential, and you'll keep everyone more satisfied with their roles and your practice more profitable.

By Morgan|2022-01-01T22:52:38-08:00November 13th, 2012|

Inspiration from small businesses

I recently completed a series of articles for Kareo's Getting Paid blog about how small business management issues relate to practice management. While medical practices have an important mission that reaches beyond business, they can't achieve that mission without succeeding on business terms. And, in many fundamental ways, medical practices are not so different from other kinds of small businesses. There's a lot to be learned from examining the success factors that apply to seemingly-unrelated businesses. Plus, it's kind of interesting and fun to think about other businesses in the 'real world' and how they deal with their challenges -- almost like looking at your own organization through a different lens. If you're interested in checking out the Small Business Lessons for Physician Practices series, here are the links: Small Business Lessons for Practices: Human Resources Getting Started with Marketing Financial Basics Operations Management for Physician Practices

By Morgan|2022-01-01T22:52:40-08:00January 9th, 2012|

Tackling a long list of resolutions for your practice? Here’s how to start.

It's that time of year again ... when every goal you've imagined for your practice seems possible, and every problem seems fixable. So you make that long list of resolutions, but, by week two, you're already overwhelmed and discouraged. After all, there was a reason you didn't fix all those problems or implement all those big ideas last year: it was too much to do all at once. Before you get discouraged, start again. And this time, pick just ONE thing. Focus on that, and you can tackle it. And once that one item is conquered, you can then move onto the next. For more on this approach, visit this article from Harvard Business Review. Need help setting your priorities for success in 2012? We can help. Contact us for more information about our practice assessment services and practice management consulting. Let's make 2012 your best year ever!

By Morgan|2012-01-02T10:38:30-08:00January 4th, 2012|

How to get what you want for the practice in 2012

Almost everyone wants to be more successful and achieve more each year than they did the year before. Here are a few straightforward things you can do to guarantee your success in 2012. First, ignite your passion for the practice. Recognize all the capabilities you have and how you can use those to grow the practice in the direction you want to take it. Your passion can energize everyone in the practice and give them the confidence and desire to help you achieve amazing things. Second, set goals that push your further, but are achievable. This is accomplished by reviewing benchmarks on key performance indicators and how they have trended over the past few years and raising the bar for 2012. Then set goals that stretch performance, but are achievable. This is accomplished by taking a historical look at practice performance trends and setting the bar a bit higher. Know what you want and then you can plan to achieve it. For example, do you want to do more of a particular procedure, do you want 10% more new patients, increase utilization of lucrative ancillary services or promogr a new procedure? You may even want to establish goals related to healthcare reforms push for monitoring quality and improving outcomes. Whatever you want to do, establish goals that are concrete and measurable. Next, develop a well-crafted written strategic plan. This is the beginning of a true commitment and using professional resources is worth the investment. An experience healthcare consultant can guide the process to ensure you develop a powerful plan that yields amazing results and positions the practice longterm success. So what are you waiting for? Contact Capko & Company, www.capko.com, and make 2012 your best year ever.

By Judy Capko|2022-01-01T22:52:41-08:00December 22nd, 2011|

Profit with a Clear View of Your Practice’s Competitive Landscape

Whether you're contemplating expanding your practice, starting a new practice, or simply wondering what your practice's profit potential might be, your profits depend on your understanding of local patient demographics. With a host of free online services available, it's easier and less expensive than ever to understand your area's demographics and how they might represent threats or opportunities. You need to know how well your area is being served by your practice-type! One very useful website is www.city-data.com that supplies wide-ranging demographic information on thousands of communities. Among the most telling information is the population and growth trends of your service area -- where your patients come from or nearby areas new patients could come from. Often service areas are defined by geographical barriers, valleys, rivers, etc.. When we work with medical practices, we find that compiling data from the various communities in their service area (and other areas of interest) in a spreadsheet is invaluable. First, we take note of these population demographics: total population, population growth, income and, naturally, any demographic segment particular to your type of practice, such as women, children or the elderly. Next, combine the separate community data so that you can have a single figure for "service area" for each demographic segment. Now that you've compiled data to define the demographics of your service area, you can compare how your service area compares to nearby or similar-sized areas anywhere in the country. Is there a relatively high, low or average number of your practice-type in your service area when compared to similar other regions? You'll need to employ your first-hand knowledge to help you define the "service areas" that compare to yours. Be mindful of population density, income and geography and you should be able to identify at least two competing service areas. You can plug these data from their respective communities into your spreadsheet to calculate the same measures you have for your service area. Now that you've become somewhat of an expert on the population, it's time to gather information on the physicians. You'll goal is to find the number of physicians (FTEs)

By Joe Capko|2022-01-01T22:52:56-08:00March 8th, 2011|

Dr. Newbie may be sinking

I've seen too many practices go through one, two and even three associates over a short period of time. They get sour and think young doctors just aren't what they use to be. Maybe, but maybe you aren't the same either. Physicians and administrators are so busy these days and have so much going on that they sometimes fail to give Dr. Newbie the tools to succeed. It's your job to provide Dr. Newbie with a good orientation, clear expectations, an understanding of the schedule, documentation requirements, billing processes and what support staff he or she can depend on. In other words you need to plan ahead, communicate well and be there when Dr. Newbie needs help. Then everyone wins and the team gets stronger! That's doing your job right. So look in the mirror when you have an associate physician that jumps ship after year one or two and think about what you might have done to make things turn out differently.Judy Capko is one of America's leading practice management and marketing consultants, and author of the runaway top-selling book Secrets of the Best Run Practice. Check it out by clicking on the book icon at www.capko.com

By Judy Capko|2011-03-13T12:22:56-08:00June 12th, 2010|