practice management

Managing includes developing practice staff

Sometimes, the business of medical practice management is a fuzzy science.  Managers have to keep the patients, and their bills, moving through the practice.  Most often, physicians are satisfied if their managers accomplish that much. But managing optimally includes softer skills, like bringing out the best in staff.  Recently, we've worked with several practices with managers who do a great job of managing upward -- reinforcing the confidence their physicians feel for them -- but who don't have much insight into really managing their own teams effectively. Keeping an eye on the team, and making sure everyone's doing what they're supposed to do, is a huge chunk of a manager's role.  But it's not the entire role of a truly effective manager.  A truly effective manager helps each member of the team develop his/her skills, understanding each person's strengths and weaknesses, and figuring out how each direct report can contribute more and be challenged and grow.  This is not just key to helping the practice improve its short-term results, it is critical to retaining the best staff and successfully completing growth initiatives. Turnover alone can be so costly to practices.  Hiring and replacing employees is a time-and-money sink.  And while critical jobs stay unfilled, mistakes can happen -- and patient service can suffer. This recent Harvard Business Review article delves into this issue -- and makes the important point that a poor relationship with their direct manager is a primary reason (if not THE primary reason) employees quit.  We see it every day! Medical practices often pay a great deal of attention to provider education -- partly by necessity. And managers can often attend conferences and find other paths to learning and development.  But staff are often left out of the equation.  And if managers aren't finding out what staff career goals are -- and how they can help them learn, grow and achieve them -- then the practice will suffer as a result.  Make sure you're evaluating your managers on this important skill!

By |2022-01-01T22:52:10-08:00January 28th, 2014|
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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 |2022-01-01T22:52:10-08:00January 21st, 2014|
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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 |2022-01-01T22:52:10-08:00January 10th, 2014|
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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 |2022-01-01T22:52:11-08:00December 23rd, 2013|
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A taste of MBA training for doctors — without the hassle and cost

If you follow this space, you may already know that I'm dubious about the value to physicians of stopping out for an MBA.  As an MBA-holder myself, I think the coursework can be overkill for independent physicians who just want to run their practices better (this is less the case for those that intend on corporate careers, of course). So much of modern MBA training focuses on things that aren't generally relevant to the small/medium business owner (and, therefore, the typical private practice physician partner).  Even worse, some of the business basics that doctors need most usually aren't well covered by MBA programs -- managing people; the minutia of local, state and federal regulations; the marketing of a small, local business; real estate finance; negotiations, etc. The other issue facing physicians (and sometimes practice managers, too) is the opportunity cost -- and actual cost.  The opportunity cost is the income lost by taking time off from practicing/working to attend an MBA program, and the actual cost is the (often very high) tuition at business schools.  For many, perhaps most, private practice owners and managers, it just may not 'pencil out' to take the time and invest the money*. One solution that can work well as a substitute is taking local classes (e.g., nights and weekends) that focus just on what you really need and want to learn.  This can be a reasonable approach -- and even a trial to see if further investment in MBA education is of interest.  But, there is also the issue of having to attend class at set times -- not always convenient ones. Now, though, there is a better alternative: MOOCs, massively open online courses.  Incredibly, some of the most prestigious business programs in the country, including Stanford, Wharton and Columbia, are making some of their most valuable content available through the free platforms like Coursera and EdX.  And it's not only self-directed -- i.e., you take the classes at your convenience -- it's FREE!  (Yes, unbelievable.) Lest you think this is just throw-away content, Business Insider has kindly assembled a list of some of

By |2022-01-01T22:52:14-08:00October 16th, 2013|
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Teaching your medical practice employees vs. coaching them

Today's Harvard Business Review  features a wonderful tip for medical office managers: Know when to coach versus when to teach. Teaching -- i.e., demonstrating or instructing an employee on exactly what to do -- is key for bringing new employees up to speed (aka, training).  It can also be useful when corrective action is needed -- e.g., "Emily, please be mindful of HIPAA when speaking with patients about private information -- ask them to step out of the reception area, like so." Teaching can backfire, though, with competent and motivated employees who just need a little help with problem-solving. Coaching -- supporting and gently helping staff find the right solution -- is the right approach in that case. For example, let's say one of your receptionists is having trouble collecting co-pays -- but, she's a quick learner who's eager to try new things. Giving her ideas and asking questions about what she's already tried could help her develop an effective style she's comfortable with -- and that she'll be able to use routinely. By coaching employees with ideas and, most important, asking questions, you help your employees feel competent and trusted. What's more, even though it might take a little longer to solve today's problem, your coaching might lead to your employee finding a better solution that will pay off over the long run.  For example, if your instinct would have been to pick up the phone to get urgent payer feedback, but your encouragement leads a biller to find an important source of information via the payer's portal, that could save a lot of time for you and your biller down the road.

By |2022-01-01T22:52:15-08:00October 8th, 2013|
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Wharton School online MBA-level courses: free!

I've previously recommended Dr. Christian Terwiesch's introductory MBA-level operations management course on Coursera -- and, great news, it's being offered again this fall. UPenn/Wharton have expanded their selection on Coursera to include four "MBA foundation" courses in operations, marketing, finance and accounting -- an incredible opportunity for physicians and practice managers alike to explore these first-year courses (and maybe learn if further MBA training is right for them). I can vouch for Dr. Terwiesch's operations management course -- I took it to get a refresher on my own MBA training in operations, and was delighted to find that many of his excellent examples were actually drawn from healthcare. The course will provide you with some new insights for evaluating your own practice workflow.  Best of all, it's presented in digestible online sessions of 15-20 minutes -- perfect for busy professionals. To learn more about the ops course and the entire MBA Foundation Series, visit this link -- or to see more about Penn's other offerings on Coursera, or the program in general, visit coursera.org.

By |2013-09-25T11:48:31-08:00September 25th, 2013|
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Lessons and reminders from the Yahoo! work-at-home flap

Practice managers and physician owners might look at the media attention focused on Yahoo! CEO Marissa Mayer's decision to end work-from-home at her company and think, well, that doesn't apply to me.  And it's true, with only a few exceptions (say, billing), medical practice staff members are unlikely to be able to do their work from home -- not just because they need to be where the patients are, but also because of the privacy risks of bringing documents out of the office. That doesn't mean, though, that the controversy and discussion that Mayer's decision engendered (and now Best Buy CEO Hubert Joly's as well)  are completely irrelevant to physician practices.  Because even though working at home is an option that won't often make sense for medical office staff, the media frenzy about one company's HR decision does illustrate how challenging it can be to make management changes without unintended consequences, even when the need for the change seems obvious. Change sparks fear One of the theories that immediately emerged about the Yahoo! telecommuting ban was that Mayer was simply implementing "backdoor layoffs" -- i.e., that she'd determined that forcing everyone into the office would be an easy way to encourage telecommuters to quit to achieve needed cost reductions.  Naturally, this theory provokes fear in all staff -- what if there aren't enough quitters to bring costs down, and my job ends up on the chopping block? There are mixed reports of how the end of telecommuting is actually playing with Yahoo! employees -- despite the ongoing outrage of bloggers, there are also reports that many current Yahoos understand the need for and actually support the change.  But, certainly the situation is a good reminder about how important it is to communicate effectively with employees, to help prevent unnecessary fears from taking hold -- otherwise, you risk losing  your most valued employees, who will begin job hunting in earnest when they sense trouble.  (I have seen changes as small as eliminating free coffee to save a few bucks lead to swirling rumors that bankruptcy is imminent!  When communication is missing,

By |2022-01-01T22:52:33-08:00March 9th, 2013|
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13 for 2013 Tip #10: Engage staff

Most practices have an underutilized resource - namely, their employees' ability to identify and solve problems. As practices deal with the day-to-day business, it's all too easy to fall into a routine-inspired complacency. To establish some positive momentum, make a point to ask each of your staff to identify problems and possible improvements - and give everyone an opportunity to contribute their ideas during your regularly scheduled staff meetings. We think you'll be surprised at the sources and quality of ideas that emerge. Be generous with your appreciation and praise and you'll see a staff that is happier and more motivated than ever.

By |2022-01-01T22:52:35-08:00February 4th, 2013|
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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 |2022-01-01T22:52:36-08:00January 16th, 2013|
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13 for 2013 Tip #2: Analyze your E&M code utilization

For most practices, E&M codes represent a significant portion of billings -- and, for some practice types like pediatrics and other primary care, E&M codes can approach 100% of billings.  Physicians and non-physician providers are often so sensitive to the risk of down-coding, denial or audit that they develop a bad habit of 'defensive' E&M coding -- i.e., sticking to the lower range of the codes for virtually every patient.  Far from being an effective defense, though, this type of habitual coding may actually create more audit risk, since it leads to a distribution of codes that is skewed rather than the expected bell-shaped curve.  And, it does so while also leaving thousands of the practice's dollars on the table! The end of one year and the beginning of another is the perfect time to analyze your practices E&M coding patterns -- and set new habits for the new year.  Run a report for each physician by code for the full year, and you can create a table like this that totals how many times each provider used each code: code 99201 code 99202 code 99203 code 99204 code 99205 Total Anderson 12 252 900 12 24 1200 Buford 0 132 996 348 0 1476 Cochrane 12 996 96 0 0 1104 Delaney 0 36 732 432 120 1320 Elliott 12 48 1092 156 24 1332 From this data, you can easily calculate percentage utilizations to get a clearer idea of distribution -- and from there create a chart to spotlight any skewed coding: E&M Distribution Chart E&M Distribution Chart Notice the skewed utilizations of Cochrane, Anderson and Elliott?  It's unlikely these codes are accurate -- especially Cochrane, who appears to be habitually and defensively under-coding.  (Note, also, the addition of the CMS averages to the chart -- available from the CMS website.  This is a great double-check to see the typical coding mix based on all practices billing Medicare -- and to get a sense if your coding patterns will look odd (or audit-worthy) to the CMS.) Next step: identify the number of instances of

By |2022-01-01T22:52:37-08:00January 8th, 2013|
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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 |2022-01-01T22:52:38-08:00November 13th, 2012|
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Faux busyness

It might be the toughest message a practice management consultant has to deliver to a physician client: you're just not working hard enough.  When doctors bring us in to analyze their practices' profitability problems, they usually expect us to find they're over-staffed, or that their building expenses are too high, or that their billing service is inadequate.  And, to be sure, we do often find those problems. But, it's just as often the case that we find that the physicians are seeing many fewer patients than they thought.  And, when we show the doctors data comparing their visit volume against other practices in their specialty, we'll hear, "but we're so busy!"  How is it possible that we can walk into a practice and see underutilized exam space and know immediately that visit volume is an issue, while the physicians simultaneously feel -- truly believe -- that they're operating at capacity? This is the phenomenon I like to call 'faux busyness.'  The physicians feel busy -- fully occupied -- but the real number of patients they're seeing tells a different story.  The sad thing about faux busyness is that it's just as tiring as the real thing, but a lot less profitable. What are some of the causes of faux busyness?  Here are a few: Provider calendars with gaping holes -- so that the physician is in the office all day, but not seeing patients much of the time Providers scheduled in multiple places for partial days -- adding transit time and scheduling hassles to every day Layout issues, inconsistently prepped exam rooms, and other issues that require physicians to be moving around the office too much -- cutting into possible visit time Is faux busyness cutting into your practice's profitability?  There's only one way to find out: start digging into data.  Analyze your scheduling processes to determine if they include unnecessary complexity.  Make sure your staff understand the importance of booking next-available appointments.  And look to benchmarks to reality test your patient volume against comparable practices.

By |2022-01-01T22:52:38-08:00October 30th, 2012|
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An operations management classic

I recently heard about a classic book from the eighties that apparently was all the rage among business students and aficionados back in the day, but that somehow slipped by me. Since it was about operations management, and presented in an unusual format -- a novel -- I felt compelled to check it out. Now that I have, I think medical practice managers should, too.  It's called The Goal, by Eli Goldratt, and it tells the story of a plant manager named Alex Rogo who must turn around abysmal performance in his manufacturing plant.  Despite achieving 'efficiencies' in many steps of production, the plant's productivity overall has deteriorated to the point where orders are backed up for weeks, and the company's salespeople can't reliably forecast when orders can be delivered (and so can't really sell any new orders, either).  If Alex can't fix the plant, it will be shut down. Alex is mentored in the book by a professor named Jonah, who guides him in the process of understanding the plant's constraints -- bottlenecks -- and how to increase their throughput.  By analyzing what really drives (or holds back) production in his plant, Alex learns that many of his most relied-upon assumptions aren't correct -- and develops a better way to improve his plant's productivity. I happened to be reading this book while working with a medical practice that was having workflow problems, and the parallels were striking.  This practice was proud of its wonderful system for triaging patients -- but, the system was so efficient, patients were waiting for ages in exam rooms for their providers.  The practice had over-optimized in triage, creating huge bottlenecks down the line at the exam rooms -- and, no benefit whatsoever to patients and no improvement at all in the number of patients seen!  They needed to look at their "plant" with fresh eyes, just like Alex did, to see that overall process efficiency is dependent on the performance of the slowest link in the chain.

By |2012-06-27T14:26:42-08:00July 3rd, 2012|
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Doing things the MBA way

My partner Joe Capko and I just had a new article published in Practice Link, a magazine for job-hunting physicians.  Our assignment was to explore the idea of a "15 minute MBA for doctors." In other words, are there guideposts that we can draw from business school training that might help physicians know what they need to learn, and how to develop the business skills they'll need to thrive in the future -- whether they run their own practices or work for a larger system? We're delighted with the input we had from the physicians we interviewed -- wonderful advice for newly minted doctors.  We spoke with a wide range of physicians -- including anesthesia, OB/GYN, pediatrics, family practice and academia -- as well as a number of practice management experts to get a diversity of viewpoints. Check it out here - we'd welcome any feedback.

By |2012-01-22T18:50:57-08:00January 22nd, 2012|
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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 |2022-01-01T22:52:40-08:00January 9th, 2012|
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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 |2012-01-02T10:38:30-08:00January 4th, 2012|
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How to be a better-performing practice

We hear a lot these days about best-practices, benchmarks and key performance indicators, but what does it really take to be a better-performing practice?It starts with developing your own report card. Determine what key performance indicators you want to follow. Here are some standard industry measures: Total accounts receivable (A/R) and days in A/R (DAR)Percentage of A/R over 120 daysPercentage of insurance contract adjustmentsCollection ratio as a percentage of charges minus contract adjustmentsIncome and expense as a percentage of revenueStaffing costs as a percentage of revenueNumber of full-time equivalent employees (FTEs) based on 40 hour work weekNumber of new patient visits and established patient visitsNext, Review your data and past performance history. Prepare your calculations based on per FTE provider number. Compare this year's practice performance to the same time last year. Also compare your figures to national data from MGMA's Cost Survey, http://www.mgma.com/ and NSCHBC's statistical report, http://www.nschbc.com/ for your specialty. Some of the national data represents the average among all the sampling practices - that is the 50% mark, so this should only be a base. Shoot be in the top 10% to be a best-practice. Now set improvement goals where you are not in top 10%, increasing your goal each year until you reach the mark.If your performance with these key indicators is already at the best-practice level, expand the tracking to include other indicators that compare your performance in these suggested areas:Indicator: GoalLow turnover: Rolling three year average under 15%Staff over-time pay: Less than 3 hours per provider each weekPatient wait time: Less than 15 minutesClaims error rate: Less than 3%Collection at time of service: 90%Missed appointments: Less than 5%Now you'll have some real tools to work with - so start tracking! If you need help, call on a consultant in your area.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 Practices. https://capko.com/

By |2022-01-01T22:52:57-08:00August 7th, 2010|
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