Laurie Morgan, MBA is a partner and senior consultant for 

. Her consulting focuses on practice management effectiveness and practice profitability. She is the author of the book 

People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business

Laurie Morgan

An email from the MGMA delivered an exciting tidbit into my mailbox this morning.

, which analyzes financial and operational excellence. It asked readers to guess which organizational effort was correlated with an extra $85,000 in annual revenue per physician. The choices were trimming waste, reducing headcount, or launching an employee appreciation program.

It didn’t surprise me that the answer was the employee appreciation program. But it also won’t surprise me if you guessed one of the other two options. In my experience, many physician-owners and practice executives assume staff is a cost they should always look to minimize. This notion is something my partners and I are always trying to combat.

While there is, of course, an expense associated with staff, your employees are also essential to generating revenue. That’s why I argue it’s better to think of your team as an investment—and consider the revenue and profit they contribute to your business, not just the cost.

Here are just a few examples of how focusing primarily on minimizing the out-of-pocket cost of front office staff to bolster profit can have an unintended opposite effect:

Many practices we’ve worked with are more troubled by front desk staff having occasional downtime than by what might not get done timely when staff are overloaded. For example, a common hidden cost is lost business when phones aren’t answered. If your practice is not the only option a new patient is considering, they may call another office and book with them if they get voicemail when they call yours.



It doesn’t take many lost new-patient opportunities to exceed the cost of an additional staff member. Even just based on the initial missed visit, a single new patient per day offsets much of the cost of a staff member—but the actual revenue potential of a new patient is likely much higher in terms of lifetime value and referrals.

Many practices are reluctant to have enough phone/scheduling support to enable insurance eligibility verification at the time of booking, instead waiting to verify a day or two before the appointment (or worse, not at all). But this may mean that appointments need to be cancelled too late to offer the slot to a different patient—a deadweight loss for your practice and any other patient who wanted to be seen.

Similarly, if mistakes in demographic information make their way through the billing process, they create extra re-work and delays in getting paid. (And this extra work and delay is actually the best-case scenario—in which the patient is actively insured under a plan you’re contracted with. If it turns out the patient isn’t covered, you lose both the billing time and, likely, the revenue.)



Balancing medical industry work with a healthy private life

Practices that focus on minimizing staff may leave themselves vulnerable to spikes in demand, the exit of an employee, or a bug that sweeps through the office. Being slightly short-handed versus your norm shouldn’t put your practice into a high-pressure situation, but if you’ve cut your headcount to the bone, this can easily occur. You may have been patting yourself on the back for keeping costs as low as possible, but if your employees feel overly stressed by their workload, especially if they’re dealing with impatient or angry patients to boot, you’ll likely have higher turnover than you should—and the costs of it can quickly exceed the profitability gains you thought you were getting.

So how does all this connect with the MGMA finding? The presence of an employee appreciation program suggests that a different mindset about staff, one that seems “softer,” yet can pay off with the bottom-line impact practice owners and managers are looking for. Staff who feel recognized may work harder, be more creative, take more initiative, and be less likely to leave—all ways in which they boost your revenue and profitability. So, while it may seem counter-intuitive, investing more in staff, not less, may actually be a more reliable path to a more profitable practice.

MBA is a partner and senior consultant for 

. Her consulting focuses on practice management effectiveness and practice profitability. She is the author of the book 

People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice 

business as well as the Management Rx series of e-books, and blogs at 

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More staff may actually be a more reliable path to a more profitable practice.

Protecting your investment in staff resources

Practices have begun to resume services and 

, especially patients who’ve put it off because of anxiety about COVID-19. While ensuring (and communicating about) patient safety naturally takes center stage, the revenue side of practice management needs extra attention, too. Patients may hesitate to visit your office not just because of fear of infection, but because of financial concerns.

Some patients face uncertainty about their job security. Some may have already suffered a job loss (and even a corresponding loss of insurance). For patients who are struggling financially, or are simply anxious about money, anything but urgent health concerns may be pushed to the back burner—even though this might increase the risk of more dangerous problems down the road.

Of course, practice managers and physician owners also have their own financial concerns to contend with. Generating and capturing revenue is crucial to ensure employees can be retained and the bottom line remains healthy, especially as government supports expire.

The high cost-sharing many patients face may seem like a formidable obstacle when patients are already nervous. But there are ways you can shore up your practice’s financial picture and collect more effectively from patients—without jeopardizing your patient relationships. In fact, with the right efforts, your practice may be able to improve both your financial picture and the patient experience.

5 questions every older physician should ask themselves

One way practices can help reassure patients is by helping them get a handle on their costs. Often, the out-of-pocket owed is less than patients fear. Even when it will be more than they hoped, patients will be better served by a 

straightforward and honest conversation about costs

Providing accurate information depends on staff training and technology. Be sure your schedulers are aware of how to access an up-to-date estimate of costs from your patients’ health plans. Proper training, including role-playing, can help staff become more comfortable with broaching financial terms.

Sharing this information with patients at the time of scheduling also provides an opportunity to 

 to process payments after services are provided. Storing a credit card (in a PCI-compliant fashion, with a maximum charge amount authorized by the patient) eliminates the need for the patient to hand over their card at the front desk—one less physical point of contact for patients to worry about. At the same time, knowing you can charge the account automatically, even if the payments must be spread out over a few months, helps ensure you’ll be paid in full.

Sometimes, patients may avoid care out of fear of costs when copays and deductibles don’t even apply. Make sure staff knows which services are typically covered as preventive, with no cost-sharing, or as follow-up visits included with a globally billed service.

Be sure you’re current on payer policies

AHIP (America’s Health Insurance Plans, the trade group for health plans) recently shared 

 its members have made to help patients and providers cope with the pandemic. While some responses are common across most plans, such as waiving copays for coronavirus testing, individual plans in your area may offer unexpected extra concessions. For example, some plans are waiving copays for regular office visits or telemedicine. Knowing about cost-savings like these can be handy when trying to coax wary patients to book an overdue visit.

Waiving copays or discounting cash services that apply towards deductibles may be a violation of your contract, but it can’t hurt to check in with payers to be sure you can’t offer some flexibility to cash-strapped patients. In some cases, payers may be willing to allow such discounts (just be sure to get that confirmed in writing before proceeding).

You may also find that some of your patients will have swapped their employer plan for an ACA marketplace one if they’ve been laid off. Make sure your staff asks each patient what their current health plan is, and that it’s clear which networks your practice is part of. (Marketplace plans offered by large payers may or may not be part of your contract with them. Knowledgeable staff can help avoid unpleasant denied-claim surprises for both your practice and your patients.)

 RVUs: The basics of physician compensation

A surefire way to put your patient receivables at higher risk of non-payment is to bill your patients months after they visited your office. If the bill arrives long after services are rendered, your patient may have forgotten it was coming and believe it to be in error. That sets the stage for disagreement, unpleasant interactions, and extra handling and collection costs (at best), or even non-payment.

Ensuring your patient statements are delivered promptly starts with 

billing patient insurance quickly and accurately

. With some payers short-staffed due to the pandemic, it’s even more important to get claims right the first time. It may be much harder to get assistance by phone or email.

Many practice management systems have rolled out more advanced claim scrubbing tools in recent years. Much more of the billing process can be automated than ever before. Make sure your billing team is up-to-date on all the billing features of your system and prepared to take advantage of them to get bills submitted and paid as quickly as possible. And make sure all clinicians understand that it’s more important than ever to complete documentation and sign notes so that claims can be generated within a day or two of services being provided.

For patients who are struggling financially, or are simply anxious about money, anything but urgent health concerns may be pushed to the back burner.

Protecting revenue and patient relationships during the pandemic

Have you heard of the marketing rule of seven? I’m guessing you haven’t-and even if you have, you’re probably wondering what it has to do with rebuilding patient volume as the novel coronavirus pandemic evolves. 

The rule of seven is a longstanding idea in marketing that a message must be seen at least seven times before a prospect is primed to buy. It takes that many interactions, the theory goes, for a person to remember you and your communication.

It’s a guideline that’s been around for decades. But since it touches on both human psychology and the barrage of media communication, it’s more relevant than ever, given the tsunami information delivered by platforms we visit every day.

So what does this have to do with COVID-19? If you’re like many practices that had to slow down (or even temporarily shut down) in response to the pandemic, the marketing lesson of the rule of seven could be crucial to starting back up effectively.

Most practices we work with at Capko & Morgan are concerned about contacting patients too frequently, except, of course, for the most urgent reasons. Whether it’s the result of people in healthcare being kinder and less sales-oriented, or because physicians themselves get too much annoying email, practices may hold back on communicating about the same things more than once. Yet even in normal times, being too cautious could cause some patients to overlook important non-urgent information.

Consider the structural forces working against your communication efforts. Social media, for example, is great for getting the word out inexpensively. But because of recent algorithm changes, a message posted on your Facebook page is only seen by a fraction of your followers. You will need to rotate that same message through multiple times just to approach one view per person.

Email messages are easily missed, too. Spam filters can be too aggressive. Many patients use Gmail, which automatically sorts mail into categories and may wrongly sort yours as a “promotion.” And regardless of the email system, most of us receive so many emails, it’s easy to miss ones that are not urgent, even when they’re important.

Add these technology problems to the normal challenge of getting a message into a busy patient’s consciousness, and it’s easy to see you’re probably not communicating enough-and that’s before even considering the extra challenge the pandemic presents.

Remember that your task of encouraging patients to resume regular visits to your office may be hampered by public health advice that is in flux. Some patients may be afraid to come to the office simply because they aren’t sure they understand their risk of COVID-19 infection, or how to weigh it.

The trust you’ve established with your patients can help you help them break through the clutter of confusing messages and rules. The need to clarify or explain expert information that changes on the fly also provides a reason and opportunity to reach out to patients more frequently.

RVUs: The basics of physician compensation

Use multiple platforms, multiple times-and the personal touch

One easy way to boost the signal of your messages is to share them on multiple platforms. Technology can help. For example, if your website is set up in Wordpress, plugins can automatically share your blog posts on social media. (And even if not, your web developer may be able to automate cross-posting using a protocol called RSS.)

Facebook enables the scheduling of future posts. Set up important information to post multiple times and reach more followers. 

Your newsletter platform also likely enables “view this message in a browser.” Sharing that link on your Facebook page and website is another way to get multiple views (and more use) out of your newsletter.

Of course, nothing beats the personal touch for encouraging patients to take better care of themselves. All of the general messages sent to all patients via newsletters, your website, and social media can be accompanied by direct phone and/or your portal outreach to individual patients. Nothing more effectively communicates that you and your practice are concerned for a patient’s well-being.

When reaching out to patients, keep the focus on the things that will help them feel comfortable getting back on track.

For example, explain all the steps your practice has taken to keep patients safe. If you’ve added technology for telemedicine or the ability to schedule appointments or pay online, share how these innovations add convenience and help reduce the risk of germs spreading in your office.  

Remember that patients may need to be told about your safety measures multiple times, simply because they’re worried. Fearful patients may have trouble hearing what you’re saying the first time.

In their focus on the coronavirus, patients may also forget other threats to their health. For example, they may delay follow-up care, vaccinations, or preventive screenings. Help them put these needs in context and prioritize.

And if some of your patients have been laid off or furloughed, they may have had to switch health plans or be stressed about finances. Patients may skip preventive care or follow-up visits because they don’t realize those services don’t require out-of-pocket costs. Be sure staff is prepared to explain these differences to patients during outreach, to avoid an unnecessary fear causing some patients to delay care.

People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice

 business as well as the Management Rx series of e-books, and blogs at 

You’ll have to routinely reach out to patients to get your safety messages to stick.

The rule of seven and restarting your business 

If your practice is looking to add new staff, either as you re-open for business or contemplate expansion, you may be facing a tough labor market. Give yourself the best chance of attracting the right people by using all of the assets at your disposal-including presenting your location in its best possible light.

Location may not seem like a particularly valuable asset for recruiting staff. Won’t job-seekers simply search for open positions near them? How can location be an advantage when, for most people, the city where they’ll work is a simple yea or nay decision?

It’s unlikely staff workers will be lured from far away based solely on the city you’re in, but details about your specific location can make your job more attractive to the candidates looking for work in your community. Here are a few to consider spotlighting:

Telehealth compliance programs avoid and mitigate risk

Many candidates will focus primarily on how far away your office is from their home, not realizing that the surroundings of the workplace can provide a lot of convenience and enjoyment.

For example, if your office is close to amenities like a shopping district, promote that. (It can make it easy for staff to pick up essentials or just have a fun break during lunch.) A location near the city center can make burdensome errands like going to the post office, library, or DMV easier to accomplish. An affordable gym nearby can make it possible to squeeze in workouts before or after work. (Maybe you can even negotiate a membership discount for your staff.) And if your office is located near walking paths (or just in pleasant environs for strolling), staff can take advantage of that, too-and get fresh air and exercise during lunchtime for free.

Is your office in or near a major medical center? Are you surrounded by many medical offices? This can be an advantage for job-seeking healthcare workers. Especially when starting out in a first job, it’s reassuring to know colleagues are nearby and friendships can be maintained as people move from one office to another. Working near large medical campuses may also offer easier access to continuing education and networking for future advancement.

While being located near other job opportunities may not seem like something you’d want to promote, remember that your retention of employees will depend on the kind of experience you can provide. Use your location in a fertile career area help attract employees, and your competitive salaries and positive work culture to keep them. 

Employees may also value being in a healthcare hub because it makes pursuing their own medical care easier. 

Is commuting in your area a hassle? If commuting is a challenge in your area, your practice may still have advantages that ease the pain. Even something as mundane as being located near a freeway exit can make a difference in daily travel to and from work. If the commute is easier than candidates might assume, be sure to let them know.

If there’s no getting around congested traffic, is working an off-peak or staggered schedule possible for any of your roles? Could a biller work from home part of the time? Be sure to spotlight that if so. 

Public transit may appeal to some commuters in urban areas-especially if you can provide financial assistance for it. Make it clear if you do.

Easy parking-whether in a lot at your office, or affordably nearby-may be the best commute amenity of all. Be sure to promote it if you have it!

Repurpose materials from physician recruiting

If you’ve created a location packet for physician recruiting, consider reusing appropriate materials from it on your website. Although a medical assistant or biller might not be planning to pick up and move to a new city, they may need to if their spouse is searching nationwide for a new job. Any materials you can provide that sell your local area could help you attract candidates who are on the hunt with a partner.

Details about your location can make your job more attractive to candidates looking for work in your community.

Author | Laurie Morgan

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