Michael Lovett

Physicians' practices are facing many compelling pressures today, from the transition to ICD-10 and complying with meaningful use initiatives to setting themselves up to operate under new reimbursement models. At the end of the day, though, most independent physician practices are just trying to see patients and stay afloat - focusing more on what's happening next

. Amidst all the day-to-day activities and competing priorities, it may seem easier to respond to issues as they come up rather than take an intentional approach to practice management.

However, it's often said that failing to plan means planning to fail. Running a practice on-the-fly is a sure-fire way to miss opportunities, frustrate staff and patients, and limit financial viability. To avoid this, practice leaders must make a concerted effort to proactively manage - looking for ways to increase efficiency, enhance performance, and plan for change.

The following survival guide offers some key activities that can move a practice beyond reactive management and toward a tactical approach to optimizing business performance.

Step 1: Leverage your most valuable assets.

A practice's primary assets are its people, so leaders must make sure they are optimizing the skills and talents of their staff. To that end, you should closely review how tasks are assigned and delegated among clinicians and front-line staff, checking that every individual is performing necessary tasks that match her skill set. For example, there is nothing more frustrating for physicians than getting bogged down with a to-do list that prevents them from practicing at the top of their licenses. In fact, all members of the team should practice to the top of their license.

In order to avoid this, ask questions such as:

• Is there a way to use technology to automate certain activities and free up time for more direct patient care?

• Can we limit steps in a process so that the function runs more smoothly with less waste?

• Are there things physicians are currently doing that a nurse practitioner, medical assistant, or an administrator could just as easily do?

By taking a closer look at staff utilization and job function, organizations can create efficiencies, ensure reliability, and reduce organizational friction and stress.

Step 2: Review and standardize processes.

There are many recurring tasks in a medical practice. By standardizing these processes, an organization can not only increase efficiency and reliability, but also facilitate better personnel allocation and patient satisfaction.

Standardization drives reliability and accuracy by making certain an activity is completed the same way every time. For example, if an organization standardizes registration, eligibility verification, or claims coding, it can ensure staff collects all necessary information from patients, regularly submits clean claims, and efficiently receives all the money to which it is entitled.

By using consistent processes, practices also can ensure everyone understands his responsibilities and can cover for other people during vacations or sick days without decreased productivity. Patient satisfaction goes up because people know what to expect when they come to the practice and are not asked for the same information over and over.

To get started with standardization, meet with staff involved in a particular process and outline the current approach. Then, the group can pinpoint ways to streamline the effort, incorporate best practices, and enable consistency.

A strong technology foundation can underpin both talent optimization and process standardization. For example, by using an EHR, clinical documentation tool or other clinical systems, organizations can free physician time and help them function at the top of their licenses. Similarly, using a revenue cycle management system can support greater standardization, and in turn generate clean claims faster, leading to speedier payment and increased revenue.

How a practice uses technology may depend on its size and experience, however. Larger practices have often internalized technology into their work flow and can focus on engagement initiatives, working to take advantage of patient portal capabilities, or use sophisticated analytics for population health management. Smaller groups may not be as far along and may need to prioritize ways to improve EHR proficiency. In either case, the key is optimizing the IT infrastructure currently in place by prioritizing efficient implementation, training staff how to use technology and weaving it into their work flow to support their day-to-day needs and goals.

Step 4: Prepare for new payment arrangements.

In addition to getting a handle on day-to-today operations, organizations should also be looking ahead at the healthcare changes that will almost certainly impact them. The shift from fee-for-service to quality- or risk-based payment, for instance, is one inevitable change for which every provider group should be preparing, regardless of size.

Before considering a risk-based payment arrangement, however, double check that everyone is on the same page about the organization's vision and goals. To this end, leadership should bring all partner physicians together to gauge their perspectives and to level-set expectations. If there are competing visions for the future, it can spell danger for the survival of the business. For example, if one group wants to forge ahead and assume new levels of risk, while a more conservative faction believes in positioning the practice for sale to a health system, it may be time to reorganize the partnership.

Once everyone is aligned, organizations should then build knowledge around quality measure performance - and which areas make sense for value-based arrangements. Aim to better understand the cost model, too; think about how to quantify costs and streamline where necessary. Before taking a definitive step toward alternative payment models, leaders may want to bring in specialists or consultants to help with new contract arrangements and to transfer knowledge of new reimbursement methodologies in-house.

Change is the one thing that's certain in healthcare. Even while making concerted efforts to more effectively manage the practice, providers should also plan for the unexpected. Many new initiatives coming down the pike are fraught with uncertainty, and it's good business strategy to mitigate risk wherever possible.

For example, this might be a good time to open a line of credit - even if it doesn't seem necessary right now. As groups transition to ICD-10, unexpected issues might arise and every business can benefit from a cash cushion to fall back on.

There is no perfect model for how to run a practice. How the abovementioned steps are prioritized will differ from organization to organization. The key is to be deliberate and avoid a seat-of-the-pants strategy. Moreover, practices must put their patients at the center of any management improvement efforts because, in the end, delivering optimal care that elevates outcomes and preserves satisfaction is the ultimate goal.

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This survival guide offers key activities to move a practice beyond reactive management and toward a proactive approach to optimize performance. 

Five Steps for Elevating Medical Practice Operations

To meet the challenges of today's rapidly changing healthcare environment, hospitals and health systems are acquiring physician practices at a record pace. While this strategy offers many benefits, it is not without its hurdles. For example, it can be difficult to get physicians fully integrated with current organizational processes and culture. Roadblocks, such as disparate work flows, diverse practice styles, and a tendency toward physician autonomy can stand in the way of smooth onboarding, impacting the speed of the effort as well as overall practice efficiency.

To fully realize the benefits of a new partnership, physicians and acquiring organizations must work together to overcome any challenges early in the relationship in order to sustain high levels of care quality and patient satisfaction while also improving business operations.

The following strategies offer healthcare organizations a roadmap for getting newly acquired providers up to speed and supporting greater collaboration as the organization grows and changes.

Before moving forward with a merger or acquisition, it is imperative that both the practice and hospital have the same vision for the new partnership. For example, if a hospital's pragmatic strategy to avoid risk does not fully align with a physician's idealistic goal of improving healthcare delivery throughout the community, then this mismatch could mean a less-than-effective relationship. Defining strategic goals, the model of care and the role of each party upfront strengthens the connection from the start.

Collaborate to Create Wins for Both Sides

As with any business acquisition, it is important to gauge each party's strengths and weaknesses and build on assets while mitigating limitations to create an effective organization. For instance, a mid-sized practice may be highly skilled at personalized care delivery but lack the resources to implement a robust information technology infrastructure, an area in which the hospital is highly skilled. When both sides remain open to resource sharing and other collaboration-enhancing opportunities, the total organization stands to benefit.

When joining a health system, a practice should expect to lose some degree of autonomy as technology and business systems become integrated. However, hospitals must refrain from simply requiring physician practices to use the hospital's clinical and financial systems. Instead, the acquiring organization should take a best of breed approach, ensuring specialty practices have the technology best suited to their clinical needs. This technology must also integrate well with hospital solutions to support information sharing across the continuum.

The change management necessary to merge a medical practice with a hospital or health system is much easier when physicians are involved in the decisions that impact the practice and the community. Physician engagement early and often is paramount to ensuring physicians feel welcomed into the organization. It also helps garner buy-in for organization-wide strategies, improves communications across the continuum, and creates synergy for the broader organization. For example, a monthly meeting between employed physicians and the hospital or healthcare system can increase dialogue between physicians and administrators and identify areas of improvement or future needs for both parties. Small physician focus groups can also be beneficial, especially when considering technology and infrastructure changes that will directly support physicians' practices and enable better work flow.

Organizations that take time to craft a technology plan, which takes into account both hospital and physician needs, can find it easier to get everyone on board with new systems. Both practice physicians and hospital physicians should be involved in creating and revising this plan. Technology decisions should be driven by a platform's ease of use across the entire organization and, more importantly, how it seamlessly enables both groups of physicians to get the information they need to effectively manage patient outcomes.

Onboarding should be a continuous process in which hospitals and practices regularly capture, report, and analyze information that reflects the evolving relationship. These measures should be defined upfront and take into consideration organizational goals, regulatory requirements, performance indicators, and so on. Before reporting on metrics, organizations should make sure that everyone clearly understands the data being gathered, how it will be reported, and the desired outcomes. The organization should also have a defined process for course correction if the data shows a less than optimal result.

Consider some of the following logical metrics to measure:

If this new relationship is based on financial drivers, define the most important ones, such as Medicare billings per month, overall practice cash flow per month, or payer mix measurement.


If the long-term goal is to improve patient care throughout the community, various measures such as the HEDIS Effectiveness of Preventative Care or the Effectiveness of Chronic Care can be assessed. These will also cross over into the financial view if the organization is moving toward outcomes-based reimbursement contracts. Another consideration includes ensuring that all parties really understand how these measures are derived and what they mean for the organization's success.


Sometimes considered a "third-rail" topic, measuring productivity is critical to gain - and maintain - alignment. Productivity is often measured by how many patients a provider sees in a given day or how many admissions the practice is sending to a hospital. The more important aspect, however, is to remain patient-focused. The new relationship between hospital / health system and the practice should help the provider to care for his patients in an efficient manner.

 is the executive vice president and general manager at NextGen Healthcare. Follow him on 

Here are six strategies to help practices and hospitals come together whether they are seeking to merge operations or simply enhance their working relationship.