Navigating a Shifting Landscape: Solutions to Top Practice Management Challenges
Larry Sophian, CPA, MBA
Every medical practice faces ongoing challenges in maintaining a successful bottom line. New challenges crop up whenever Medicare and Medicaid policies, or the economy, changes. Still, a handful of problems rise to the top in most medical practices. Here are some ideas for solving them before they become overwhelming.
What are some problems?
In looking at the top challenges that medical practices face, first on the list might be administrative burdens. Most doctors go into medicine because they want to help people and because they are interested in science and medicine. They probably do not expect to spend a significant amount of time filling out forms and figuring out how to practice medicine profitably.
Although administrative burdens are not likely to go away, there are some potential solutions. These include staying current with business trends and creating standard operational procedures and routines, both clinically (to the extent possible) and administratively. It is also important to train and empower select staff members to handle most business-related activities, so you can concentrate on practicing medicine.
The decision of whether to opt for maintaining an independent practice or joining a health care system is another significant challenge many physicians face. Currently, there is a trend toward consolidation into larger group practices, thus enabling physicians to leverage size without having to work for hospitals. This option also allows physicians to share resources, which can go a long way toward relieving the administrative burdens. For some physicians; however, hospital work may be the way to go. It all depends on your personality, energy and focus.
Often one of the biggest headaches for physicians is the need to do battle with payers. It is hard to imagine that this problem is going to go away anytime soon. However, having a lean practice with motivated and trained staffers who can stay on top of billing and payer issues can go a long way toward easing the pain. Size matters in negotiations with payers, so group practices or regional networks can help to make this issue more manageable and profitable.
What about patients?
The advent of the Internet and easy access to health care information—regardless of how inaccurate or uninformed it is—can complicate the doctor-patient relationship. It can be hard to balance practicing good medicine with handling patients who attempt to dictate their own health care. Talking to patients about their ideas for their care in a respectful manner can be challenging if you feel that their ideas will not produce optimal results or could even be harmful.
It is important for physicians to be firm in clarifying doctor-patient roles. Sometimes, no is the appropriate response. Also, like parenting, medicine can be a business of tough love.
What about staff?
Keeping quality staff is also a common challenge. Recruiting and retaining skilled staff—from the receptionist to the physician partners—can be tricky. Studies indicate that high pay and benefits are not the only reasons people stay at a job.
A key to staff retention is often related to empowerment—letting staff be in charge of their duties and showing them that what they do is important and appreciated. Rewards for good results can be both creative and meaningful and do not necessarily have to be raises. Ideas to consider include extra paid time off, gift cards and flexible schedules. Showing appreciation to staff for their efforts also can go a long way.
What about legal issues?
Finally, a top headache is liability. Some states and specialties are hit particularly hard by liability insurance. This issue can drive physicians out of private practice into health care systems because those systems can more easily absorb the tab for liability insurance.
If there is a solution here, it is for doctors to practice defensive medicine, erring on the side of caution. Although this can defy trends in paying, physicians who order more diagnostic procedures may find this can lead to less litigation. Of course, this needs to be balanced with quality care, with the reasons for additional tests being well documented. You also need to keep in mind what will and will not be reimbursed to payers and the cost (both financial and other) of additional procedures to patients.
Good management leads to a healthy practice
There is no doubt that practicing medicine in modern times has challenges, particularly in the areas of billing and reimbursement. But, savvy doctors who recognize that they are business owners and physicians can ensure that the practice runs smoothly and profitably, while continuing to offer high-quality patient care.
Five Common Sense Strategies for Preventing Physician Discord
Amanda Gutierrez, MBA
Issues and problems can arise in even the best-managed medical practice. When physicians in the same practice disagree about how to handle job responsibilities, administrative issues or other matters, the actions and reactions of the doctors can make the problems even worse. It is important to foresee this possibility and have strategies in place for resolving issues before the practice becomes completely dysfunctional.
- Emphasize Leadership
Many partnerships consist of one partner who leads the practice. The other physicians may have appointed this leader because the articles of incorporation require them to pick someone. Alternatively, they did so because that physician seems like the only one who has the interest or skills to run a business.Subsequently, the leader becomes the administrator responsible for daily practice issues. The problem—they are also left holding the bag while other partners focus on issues that affect only them, not the practice as a whole. The solution—elect a strong leader and pay a monthly compensation for handling administrative matters.Unfortunately, physicians often downplay the importance of leadership instead of emphasizing it. It is important to define partners’ job responsibilities and ensure that partners are compensated for their hard work, extra hours and positive contributions.
- Renew Your Vision
If a practice stagnates, it will die. One key to staying alive is renewing your practice vision—its purpose, expectations, concerns and goals. Whether starting a new venture, adding new partners or implementing strategic changes, your partners must mutually maintain this vision.Of course, there will be challenges. The practice will likely encounter issues if it opens up a new office or hires additional physicians. Such operational changes can alter your practice’s vision and create significant problems.Because weathering these changes is not easy, do not expect partners to always agree. Instead, allow each the opportunity to express his or her viewpoint. After all, rational, professional debate is healthy as long as it does not deteriorate into intense arguments.
- Treat Everyone Equally
Physician partners’ age differences can also cause problems. Doctors from different generations (and cultures) often disagree about how to practice, what constitutes work hours and whether senior physicians deserve preferential treatment.For example, older partners may feel they have the right to make special requests of younger partners, such as to take on an older doctor’s night and emergency calls. Their reasoning is often because they themselves had to comply with such demands early in their careers.However, younger partners may disagree with these requests and feel they unjustly create more work for them. In addition, they are usually right. In a true partnership, partners’ accountability lies in direct proportion to their ownership percentage. Therefore, partnerships typically should not provide unequal rewards based on seniority.
- Review How You Pay
When reimbursements do not keep pace with operating costs, partners’ stress levels may rise. A need to decrease partner bonuses can add even more fuel to the fire. Moreover, if you are trying to unify your partners, or add new ones, the financial turmoil only intensifies.For instance, ill will can occur when one partner is not as involved in financial decisions as the others are. Similarly, many practices struggle with partners who fail to produce results commensurate with their salaries.To mitigate these issues, implement a clear, amenable compensation model for physician partners. At minimum, each partner must generate enough revenue, less expenses, to cover his or her salary. Also, annually set partners’ goals and review their performances and compensation.
- Create a Committee
The best time to prevent conflicts is before they occur, and transparency is key. Consider forming a committee to negotiate any issues that come up between physicians within the practice. It can include both internal parties, such as the physicians themselves and perhaps the office manager, and outside advisors such as your CPA and attorney. That way, you will have somewhere to turn when inevitable disagreements arise.
Keeping a practice running smoothly is important to maintaining profitability. It also will increase everyone’s job satisfaction over the long term.