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Dr. C-E-O: Practice Management
Dr. A: “It’s just a minor fracture. I’ve looked at everything; now you can see the nurse who will walk you through what we’re going to do.”
Dr. B: “OK, so we have some good news here. You have a simple fracture, meaning that the skin is still intact. What I would like to do is called a reduction, whereby we realign the bone…”
It’s no mystery which surgeon will receive accolades from the patient—not to mention calls from his or her friends and family. With regard to practice management, doing patient care right is a powerful way to ensure that your group succeeds—and survives in this competitive environment. But, say our experts, there are other important tools that you can, well, put into practice.
Dr. Michael Freehill, the CEO and President of Sports and Orthopaedic Specialists, a practice with four locations in Minnesota, has participated actively in the creation of a well-organized practice. He says, “There are several building blocks of a well-run practice, the first of which is often misguided. Many practices overemphasize marketing when it’s unclear if it actually pays off. What does result in more patients is word of mouth."
The bottom line is that if you are taking good care of patients then the marketing will largely take care of itself.
Not that you shouldn’t be assertive in letting others know what your practice has to offer, says Dr. Freehill. “Your competitors are advertising, so you should do so as well. But many health systems are cutting back on the marketing dollars. In such an environment it helps to be creative; the Internet is one of the most cost effective ways to do this. It is inexpensive to develop a website that can provide a significant amount of information on the practice, as well as interactive videos. Additionally, it is often effective to deliver presentations to groups such as the Chamber of Commerce or groups of physicians.”
And don’t forget the staff care, advises Dr. Freehill. “Who you have on staff and how connected to the practice they feel is critical. Start with hiring an exceptional practice manager who knows people well and who understands that he or she must delegate in accordance with the specific needs of the practice. With regard to hiring, newspaper ads typically do not work as you get a flood of applications from unqualified individuals. In this instance as well, word of mouth is best. Another significant issue is how to maintain enthusiasm within the group in terms of engaging support staff and ensuring that they feel like part of the practice. To the extent possible, try to let them have a say in how the practice is run on a daily basis. We have an idea box that allows people to anonymously put forth ideas as to how we can improve patient care or enhance efficiency. The key is to follow up on these suggestions.”
Whatever the staff is involved with, you want them to be enthusiastic…even if it is in the somewhat dry areas of coding and billing. Dr. Freehill: “Keeping coding on track is critical to the sustainability of the practice. Coding is getting increasingly complex and is costly because of having to upgrade coding software or purchase new software to remain in compliance with regulations. More and more hoops to jump through means that you must have more people to handle the extensive activities involved in coding.”
On the billing side, the primary issue is one of timeliness. The longer you hold onto a bill the longer you are giving the payor a free loan. You should have all of your i’s dotted and t’s crossed so that when you submit the bill the first time it is ‘clean.’ Also, you must be proactive in anticipating obstacles that might occur. For example, if a procedure is out of the ordinary we send the insurer a letter comparing what we did to the more common procedure. That has significantly helped us obtain payments.
But what if those letters were stored on a problematic server? “Information technology is also vital, and you must have a system that works. We had a server breakdown last year and the backup didn’t have enough capacity. That meant no electronic scheduling or billing. During this expensive outage we reverted to pen and paper activities…and learned a few important lessons.”
Leaving his own role until last, Dr. Freehill says, “Governance is of course vital to the practice’s future. When I took over as CEO five years ago I met with each person about his or her concerns and needs. While most people were dedicated to their jobs, some individuals were not engaged with the practice and I had to let them go because they were affecting the rest of the staff’s morale. I have found that seeing the world from the staff’s perspective results in great rewards because they know you are trying to understand what they have to grapple with.”
Hopefully, the new technology available to practices will make things easier for all involved. Dr. Thomas Grogan, an orthopedist in Santa Monica, California, has studied a number of system management programs that can increase the efficiency of practice management. He states, “One of the tools available is the electronic medical record (EMR); there are also electronic health records (EHR), a digitalization of the paper chart that can be put on the Internet. EMR goes beyond EHR in that it gives outcome quality data that can be sent to doctors electronically. This allows physicians to compare their practice to other practices, something that is of great interest to the government.”
But with the costs involved, not all are signing on. Dr. Grogan: “The average EMR system costs $40-$50,000; as a result of this, and the fact that it doesn’t add to the bottom line, only 15% of doctors actually have these in place. There is data suggesting that out of every dollar saved by the use of EMR, 91 cents of that is saved by the holder of the risk (the government or insurance company). For the practice, the big savings with EMR is in a reduction of errors. To incentivize doctors to adopt EMR, the government has put forth a policy whereby they would pay doctors a supplement via Medicare so that the average doctor gets an extra $40,000 if they use EMR…and if the data they submit demonstrates ‘meaningful use’, i.e., quality outcome data.”
Rather than adopt this system, however, Dr. Grogan has adopted a “wait and see” attitude. “I am waiting for the dust to settle, meaning that I will purchase an EMR when the powers that be say this is the EMR to have. I don’t want to purchase a system and then be in a position where the regulations change. The key is to become digitalized in a cost efficient way.”
One way to shave costs, says Dr. Grogan, is by using a PACS (picture archiving communication system). “With a PACS you take Xray images using a cassette and a computed radiography (CR) machine that reads the image. That data is stored in a computer and interpreted via a software program into an image that can be put on a computer screen. As it is now the Xray machine generates the Xray, the image is placed on a film and that film has to be developed (meaning that you pay developers). In a process that takes only 40 seconds, the CR reader reads the image on the cassette, puts it in a digital format and takes the image and sends it to a computer. The software then converts it to an image that can be put on a computer screen.”
To take an Xray in my office costs $7 and includes the cost of buying and developing the film ($1.51 per image), maintaining the processor, storage, etc. A digital system, on the other hand, has no ongoing costs. We were doing 19,000 images annually; when I did the math it turned out that we saved $9,000 per year by converting to the CR system.
Furthering the acronym soup, we have the CEDS—cross enterprise document sharing systems. “Remember in the old days when Apples and PCs couldn’t ‘talk’ to one another? That is what CEDS is all about. At present, if I want to share an image with another doctor, I have to give the patient a disc with his or her data—and the software to view it. That is highly inefficient. CEDS creates common points so that medical professionals can share images. Let’s use digital photos as an example…you can put them on any computer because the system to read them is universal. We don’t have that in medicine when it comes to medical records or Xrays. When Apple and Microsoft started to connect the user had to buy a bridge program—that is where we are now in medicine with CEDS.”
And then there is the old fashioned telephone, which could be on the wane in some offices.
“As it is now, if a pediatrician or other doctor needs me to see his patient, someone from his office must call my office to check my availability. I am now testing a system powered by zocdoc.com whereby any doctor—or patient—can go onto my site, hit the scheduling icon, and see what availability I have that day. This system should really help doctors maximize productivity.”
And spend more time on patient care!
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