Todd Shryock

Burnout has become as much a part of medicine as the stethoscope, with too many doctors feeling overworked, over-regulated, and underappreciated. The result is physicians retiring early, changing careers, or losing their love of medicine at a time when there is already a shortage of primary care physicians.

In the Medical Economics 2019 Physician Burnout Survey, 92 percent of respondents indicated they have felt burned out from practicing medicine at some point in their career, 68 percent said they are burned out right now, and 73 percent said they have thought about quitting medicine. Despite the prevalence and scope of the problem, only 13 percent plan to seek or have sought professional counseling.

Solutions are elusive, because the causes can vary by specialty, location, or practice, and doctors rarely have any control over contributing factors like regulations or EHR design. But that doesn’t mean all doctors have given up or are willing to tolerate the status quo. In fact, as burnout has become increasingly common among physicians, so, too, has the fight against it.

Here are the stories of seven health professionals and what they are doing to battle burnout in the profession.

Gabe Charbonneau, MDFamily Medicine, Stevensville, Montana

Gabe Charbonneau, MD, experienced burnout in 2009 when the demands of practice limited the time he and his wife, also a practicing physician, were able to spend with their new son. When the family grew to three kids, something had to change. His solution was to share a practice with his wife, so that one of them would always be at the practice while the other was with the kids.

“It was super scary, but the best decision we ever made,” says Charbonneau. “We gave up a massive amount of income and had to throw some material things overboard, but our quality of life went way up.”

From there, he began to think about how he could help other doctors fight burnout. “I met so many people who were intelligent, smart, and good doctors, but they were stuck with issues that were insurmountable,” says Charbonneau. “I had an idea that I needed to come up with something symbolic that would give hope to these smart people that they could get to a better place than where we were stuck.”

The result was an image of the Rod of Asclepius being lifted out of the ashes by a phoenix that he printed on a shirt and displayed on his website, fightburnout.org. The American Medical Association wrote an article about his efforts, interest in the shirts and the cause grew, and now he describes himself as “an accidental person who became an expert on burnout.”

He hopes that his efforts lead to greater awareness of the problem, and that employers will take a hard look at physician workloads and start indexing their burnout so they can measure progress-or lack thereof.

“Leaders often talk about well-being and burnout, but it doesn’t make it onto their financial spreadsheets,” he says. “They offer wellness classes and nice things that are supposed to be helpful, but there is no accountability for physician well-being. They can make a decision in the boardroom that can destroy their doctors, because they are chasing after every dollar.”

One proven solution for reducing burnout is to have physicians meet in a social setting outside of work to share experiences, where they can see they are not alone in their feelings and can share coping advice, he says. There is also a doctor-to-doctor peer support group on Facebook if no local group is available.

“I throw down the challenge that all of us need to start to help unravel this problem before we lose more good physicians and drive them out of medicine,” he says. “I know we can do better. As a society, we have to own this problem.”


Tyree Winters, DO, wanted to be a physician since he was five, with a great desire to help others. “But then you get out there and realize it can be a thankless job,” says Winters. “Even though you want to help people, sometimes as much as you do, it’s never enough.”

His loss of interest created an internal conflict: What do you do when you’ve wanted to be a physician your entire life only to achieve your goal and realize that maybe it wasn’t the best choice?

The breaking point came about five years ago. His mother had just passed away, and the next day, while trying to be both an administrator and filling in as a pediatrician, he diagnosed a child with a cold and offered the mother advice on basic care measures that would help. The mother was furious, telling him, “You don’t care about my child. You physicians don’t care about anything.”

“It was the perfect storm,” he says. “I was thinking to myself that I don’t want to do this anymore.” Winters accepted the fact that he was burned out and needed help, not only by seeking counsel, but also in identifying what his passion was. He found a different way to reach his dream of helping people.

“Even if I’m not seeing patients, I’m doing things like teaching and attending community events, using my medical degree to educate people to make an impact in their lives,” says Winters, who is medical director of the Healthstart Pediatric Clinic and associate program director of pediatric residency for Atlantic Health System. “That’s what motivated me to get over the feeling of burnout. I’m not immune to burnout, but I want to get up in the morning.”

Winters says medical students need to be educated on the challenges of being a physician and the risks of burnout. “They need to be able to seek help-not even professional counseling, but just surrounding themselves with individuals who are going through the same thing. There’s an unwritten rule where doctors are taught to believe if you are not able to handle things, then that’s a weakness. So people keep it to themselves and we need to get over that stigma.”

Winters says doctors don’t always recognize signs of burnout in themselves, such as apathy, or coping through alcohol or food. “They write it off as just having a bad day or just needing some sleep,” he says.

Physicians need to focus on what brings joy in their lives and find a way to escape from the rigors of their day. He recommends finding a couple of hours to do something that isn’t work-related, whether it’s exercising, binge-watching Netflix, or in his case, dancing.

“Doctors have to be able to step away and just live their life,” he says. “And don’t be afraid to be open and direct with your supervisor or department chair to tell them you are starting to feel burned out and that you are looking for advice. You might be surprised how a lot of institutions respond.”

ACP vice president for clinical education, Philadelphia

Smith leads the ACP’s efforts to demystify and build awareness about burnout, including how physicians can identify warning signs in themselves. “We need to fix the water clinicians are swimming in,” says Smith. “We know medical students are more resilient when they start medical school, but their risks increase as they complete their training.”

She says it’s important for doctors to recognize burnout in colleagues, because it can be contagious, spreading through an entire staff. “It is part of your responsibility to not only identify and address it when you see colleagues suffering, but to also help intervene and fix the overall culture.

“The overall causes of burnout are a workload where people keep adding more and more things to front-line clinicians, but nothing gets taken away,” says Smith.

Physicians should look for sudden changes in behavior in their colleagues as a warning sign that all is not well. “If someone who was outgoing and is now withdrawn, that can be an indicator,” says Smith. Missing meetings or conferences, or even not answering pages can also be a sign of potential burnout. Physical pain, difficulty sleeping, changing appetite or a crisis of confidence are other warning signs.

“They may have a lack of confidence in their work that comes from a sense of powerlessness because they can’t change things or make things better,” she says. “They may become more cynical, be quick to anger or have relationship problems or trouble getting along with family or friends.”

The ACP has resources on its website for physicians who feel burned out and has trained a cadre of 160 members around the country to fight burnout. “Our message is, don’t worry, you are not alone in this,” says Smith. “This is a common issue and a problem that everyone needs help with sometimes. We encourage them to reach out to a friend, a colleague or call their employee assistance line-whatever they feel comfortable with.”

In addition, the ACP is looking to patients as allies in fighting burnout. “The same things that bother doctors are bothering patients,” says Smith. “They want more time together. We think if we join forces with patients and patient advocacy groups to reform healthcare delivery, we might be successful.”

Internist and AMA practice transformation officer, Oak Park, Ill.

Brown says that many organizations are well intentioned when they set up mindfulness training or yoga classes for physicians, but that while such programs may be helpful in some regards, they can also contribute to burnout.

“Offering classes without fixing the working environment just sends the doctor home an hour later and exacerbates their time away from their family, and takes away time that could be used for exercise or sleep,” says Brown. “We also know burned out physicians write more prescriptions, send out more referrals, make more errors, order more tests, and have higher readmission rates. In every other profession, the higher the education level, the more control the person has over their day and the work they do, with the exception of physicians.”

Brown focuses much of her efforts on helping doctors find small solutions to free up more time. “They often say, ‘What can I do, I can’t fix the whole system?’” says Brown. “What I suggest is to begin by looking at their practice and the things they control.”

For example, Brown changed how she prescribes medication for chronically ill patients. It’s common to write a prescription for three months with one refill, so physicians are refilling the same prescription every six months. She suggests changing that to three months plus four refills, so that doctors are writing the prescription once per year. “If you do that, six months from now, the number of refills decreases by half,” says Brown. “With that extra hour, you can stop drowning long enough to see what else you can do.”

Another area to examine is the EHR. Brown says doctors need to look at all the notifications they are receiving. She turned off discharge summaries and notifications about tests that did not include results.

“I decreased my inbox by about 50 percent,” she says. “It doesn’t take any resources and doesn’t cost a lot of time. When you are at your wits end, this is something you can do tomorrow.” She also encourages physicians to seek peer-to-peer training on using their EHR more efficiently.
Whenever possible, make sure patients who require lab work have their labs completed before the visit. “That way when you see them, you’ll have everything you need to have a discussion,” says Brown.

“The greatest driver in preventing burnout is being able to deliver quality care, but there are so many obstacles that stop us from delivering it,” says Brown.

Urogynecologist, director of physician engagement, Rowan University School of Osteopathic Medicine, Stratford, NJ.

“If you do not have engaged physicians who have a vested interest in being there five years from now, you are not going to be able to provide a good patient experience,” says Adam S. Holzberg, DO, adding that healthcare organizations that want to improve their patient experience must tackle physician burnout. “Every study has shown that if you have engaged providers, the patient has a better experience and that results in better outcomes.”

Healthcare administrators must start by measuring burnout in their organization. They should do this by enlisting an outside company to survey the doctors, says Holzberg. “You have to be willing to then act on it and create an action plan,” he says.

Progress is possible when leaders take the time to listen. In a prior position, Holzberg helped move the physician engagement scores from the 24th percentile compared to the national average to the 73rd percentile in less than five years. “It wasn’t because we gave them so much more, we just listened to them,” says Holzberg. “We had good methods of communication.”

The organization created a blog to keep physicians up to date on changes. It included a way for doctors to make suggestions on how to improve working conditions. Doctors always got a response to their suggestions, even if they weren’t feasible. “You can say no with a good explanation-you would be surprised at how much they appreciate that compared to no response at all,” Holzberg says.

Listening is a great way to reduce burnout. “There’s not a lot that providers want,” says Holzberg. “They want to take care of patients, have a say in the plan for the organization, and have some recognition for what they do. They want to have the supplies and tools they need to do their jobs and do it without a lot of obstacles. If you pay attention to a lot of that, you will be surprised at how much difference it can make.”

Pulmonary/critical care fellow at Boston Medical Center



Swamy was a third-year medical resident working nights with two small children at home when burnout hit him. “I became very cynical and laughed about a lot of things-beyond the gallows humor physicians typically use to get by,” he says. “I was falling apart, getting less sleep, and I felt like I was failing with my patients and at home.” He says his work was becoming shoddy and he was being selfish and passing patients off to the next shift.

“It was unprofessional and a really bad spot for me,” he adds. “The big takeaway is, at the time, I could not have told you it was because I was burned out. I couldn’t recognize it in myself, and if I had done so, there were innumerable supports that could have helped.” When he rotated off that shift, his situation improved. Now, he advocates for doctors to look for signs of burnout in each other and to take action when they do.

He advises doctors who suspect a colleague might be heading for burnout to meet with them outside of work to discuss it. “Say, ‘Hey, is everything OK?’ or use other open-ended questions,” says Swamy. “You don’t have to say burnout, because people are often sensitive to that. They might be defensive in the moment, but it lays the groundwork to actually talk to them.”

Speak with them alone, he adds, and not from a position that implies they are unable to do their job. If there is no personal relationship, talk with someone who knows them better and tell them about your concerns. For residents, Swamy advises speaking to the chief resident, but choose your words carefully.

“There’s a big stigma speaking about mental health in medical culture, and burnout relates to that” says Swamy. “If you are in a world where you cannot show weakness and someone is very clearly suffering, the answer is not to go to their seniors and effectively say you think they are weak.

You never want to throw people under the bus.”

While he appreciates employers providing yoga or massages for physicians, those do not address the root causes of the problem. “I personally find a lot of wellness in running and doing yoga, but that doesn’t address the root cause of sitting in front of a computer going mad trying to click all the boxes.

“Burnout is a symptom of an incredibly broken healthcare system,” says Swamy. “It needs addressing, but the root causes are deep and pervasive."

Articles

How physicians fight burnout

What’s the difference between a highly successful practice and one that just gets by? Oftentimes, it comes down to focusing on a handful of key financial details. Physicians who institute best practices bring in more revenue and profit than those who do not, and this can be the difference between being successful and being out of business.

® 2021 Physician Report, only 11% of practice owners said they did better in 2020 than in 2019, while 46% said they were doing worse. The top reason listed was lost revenue and increased expenses due to COVID-19.

With patient volumes still below normal because of the pandemic, growing competition from urgent care centers and retail clinics and rising operating costs, experts say every dollar counts. Here are the five best financial strategies to boost a practice’s bottom line.

Practice leaders who want to succeed must track key performance indicators so they can identify opportunities for improvement, says Andrew Hajde, assistant director, association content, Medical Group Management Association. These indicators include physician productivity, accounts receivable, insurance claims, reimbursement, and denials. Other measurables might include compensation to staffing ratios, expense management, performance to budget, and patient satisfaction.

With that data, Hajde says practices can not only track their own performance over time, but also benchmark themselves against data from similar providers. (National data is available from MGMA and other sources.) “It gives them a bar to see if they’re doing well or if they have some opportunities for improvement in any of those areas,” Hajde says.

Practices need to take action to find the formula for success. “What are the other practices actually doing to get that patient engagement and quality rating and everything else?” asks Hajde. “I think that’s where it is critical to work with your peers across the country that are achieving those best practices via conferences, member communities with associations, and in researching, reading articles, podcasts or any way you can get in front of how people are achieving those things to bring to your practice.”

Naresh Rao, D.O., FAOASM, a private practice physician who is also the founder and CEO of MAX Sports Health Inc., says he and his private practice partners get a lot of useful information from talking to peers at conferences. He seeks out those who are also in private practice so they can compare strategies for tackling different challenges.

The most successful practices analyze their claims denials and take action to reduce them. “It’s really important to go and look at what denials are actually coming through from which payers, whether it is commercial payers or Medicare or Medicaid, and then look to see why they are happening,” says Hajde.

Likewise, look at your accounts receivable and analyze those that fall into different aging groups, such as 30 days and 60 days old and determine the cause. “Is it because you are not getting paid in a timely manner, or that a lot of claims are being denied?” asks Hajde. “Determine the causation and, going back through those based on high volume or high dollar amounts, go back to your physicians or front-office employees. Make sure they are entering the information correctly so that if you get it straight on the front end, you’re going to reduce those denials.”

In addition, practices need to make sure all claims are filed in a timely manner, and that all denials that are deemed inappropriate are appealed within the established deadlines from those payers. “Sometimes you only have 30 or 60 days, so make sure you are on top of that,” says Hajde. “Prevention of denials is key to being a high-performing practice.”

Rao says the billing department is the most important aspect of the business. “If you did a service, and you don’t get paid for it, your payment for your time is zero,” says Rao. “You need the ability to be savvy when it comes to charging what’s appropriate, but also to know that insurance companies may put up roadblocks, so you need to have a really, really good billing system to deal with that.”

Understand payer contracts & patient demands

Every contract has its own unique details about requirements for prior authorizations, medical necessity, timely filing and other details in addition to the reimbursement agreement. Hajde says it’s important practices understand the details to avoid denials and delays.

“The other thing that a lot of practices that are underperforming fail to do is they haven’t reviewed or renegotiated their payment rates, and in some cases, for many, many years,” says Hajde. “I’ve talked to some practices that haven’t renegotiated with an insurance payer for five or 10 years, and they are underperforming in terms of their payment rates.”

Also, verify payment compliance and do not assume the payer is always accurate. “Confirm the payment is actually for what your contracted rate is, because sometimes you are inadvertently underpaid,” says Hajde.

Another aspect to understand is what the reimbursement rates are for physician extenders and how they might be able to help—or hinder—the overall profit of a practice, says Ross Nelson, MD, health care strategy leader for consulting firm KPMG. Having all providers work at the top of their license is the best formula, but reimbursement has to be taken into account to determine who should provide each service.

Practices also need to understand the services patients want. “You should make sure that you have the whole complement of services to the best extent that you are able to offer so you can best serve them and not lose them if they have to go somewhere else for those services,” says Nelson. “Practices should have a good sense either anecdotally or qualitatively of what services are required by their patients and whether those are being outsourced or not. They need to figure out if there is sufficient demand, the level of competition and whether they have a right in their patient’s mind to deliver that service.”

Patient communication ties directly to a practice’s finances. Patients need to know what they’re going to be responsible for when they first come into the office, says Hajde. They should be informed what part of the payment they will be responsible for and if they can’t pay, how payments will be handled.

“Patients want to know what they owe, as soon as possible,” says Rick Gundling, FHFMA, senior vice president professional practice, Healthcare Financial Management Association. “Also, make sure that you’re able to talk through any payment plans or all other alternatives so that if a patient can’t pay, then they know what’s available.”

All payment policies and procedures need to be clearly communicated to staff as well. “Establishing with your staff how to work with patients is a great recipe for having good outcomes for collecting from patients and for people knowing exactly what they are going to be into upfront,” says Hajde. He recommends training staffers so they align with the best practices in the hospitality industry where service is paramount. The more communication a practice has, the more cooperation it will get from patients because they understand in advance what is going to happen and feel like they are getting exceptional service.

Gundling says to survey patients on how they wish to be contacted: text, phone, portal or app. Different patient populations have different expectations, but knowing their preferred communication type can help with billing- and care-related messages. Gundling says an online payment portal is vital because patients expect the convenience and it can speed up payment.

Remember that communication goes both ways. Post-pandemic, patients may have new expectations for practices. “The whole flow of patients’ needs to be looked at because people do not want to be sitting around in waiting rooms anymore,” says Gundling. “You could reconfigure your space, and you may not need a large waiting room, or you may need less leased space, which could save money. The other thing to look at is how are you going to use telehealth going forward as part of your practice and how do you coordinate that into your care process?”

If new services are being added, or a practice needs to boost visits, communicate with the existing patient panel first, says Rao. “We already have their information, they’ve already signed everything, so we just push out the ‘Hey, you are due for your physical’ notices. If you take care of a lot of diabetics, you may be able to point them to a webinar on diabetes, for example. Marketing to your existing patients is more powerful because they already know you.”

Management consultant Peter Drucker once said that culture eats strategy for breakfast. A practice can have the best strategy, but if the culture doesn’t align, retaining key employees will be difficult.

“You really need to demonstrate and have a high-quality mission, vision and values statement for your organization and commit to customer service training to really create a high morale and great patient experience,” says Hajde. “Patients really pick up on it and anyone who’s been in a medical practice or other health care facility, they can just tell when employees are dissatisfied, and it doesn’t lead to a great experience. It won’t make patients want to tell their friends and family to go to this practice or organization.”

When a practice starts tracking productivity and patient satisfaction levels, it might reveal some harsh truths about the existing staff. Some employees — including those who may have been with the practice for many years — may not be contributing as much as they should.

“Maybe the physicians were just looking the other way when the person was reading a book in the afternoon or whatever was happening, where they maybe weren’t doing what they should have been or could have been doing,” says Hajde. “I think it’s really important to kind of set expectations that apply to absolutely everyone, and that ties back into having that culture.”

Everyone should know the goals of the organization and the practice should work with them to make sure they are equipped to meet those expectations. Sometimes, people fail because they don’t understand how to do their job as well as they should, so it can truly be a training issue.

“In some cases, a process has been made so complex that they can’t possibly do it right,” says Hajde. “For example, if you look at the number of steps to check in a patient, there might be 75 steps. People are going to make a lot of mistakes. If you can apply some lean principles and get 75 down to 10, all of a sudden, the person making errors every single day can do those 10 things correctly. Sometimes the process is broken, not necessarily the individual.”

Employees become disengaged when they don’t really understand what their goals are, and they don’t understand how they are contributing to the success or the organization. Disengagement can also occur when there is a poor relationship with the supervisor.

Hajde says by making sure both employees and supervisors are properly trained, and everyone understands how they contribute to the organization, a positive culture can take root, boosting patient satisfaction and profits. “If you do those two things in parallel, it can really create a great culture for a practice,” he says.

Rao notes that employee retention is the biggest benefit of putting effort into creating a great culture. “The most costly thing you can do is to take a high performer and not have them feel valued,” he says.

Even the best practices aren’t necessarily doing all of these things exceptionally well, so there’s always room for improvement. Focus on the areas with the biggest financial return first, such as productivity, accounts receivable or expenses, and benchmark those areas and track the budget for them. Once the habits of tracking and analyzing data on regular basis happen, it becomes part of the daily routine. Hajde says a practice of any size can accomplish this and it doesn’t necessarily require consultants or outside help.

For struggling practices, start by focusing on one or two items. “Benchmark those key performance indicators—that’s where you really want to begin,” he says.

Rao says successful practice leaders dedicate time to paying attention to the numbers. “You have to make sure you have a good pulse on what the finances are, because sooner or later, a crisis will come up, and that’s when you’ll realize you are in big trouble.”

Physicians who institute best practices bring in more revenue and profit than those who do not, and this can be the difference between being successful and being out of business.

5 Winning financial strategies for medical practices

Competition is increasing, and reimbursements are decreasing. Every dollar counts for most medical practices, yet many physicians have fallen into bad business habits that are costing them money.

Patients and payers have changed their payment expectations, but practices often lag behind, relying on outdated systems and processes to collect money. Budgets lack essential details needed for planning, leading to cash crunches at inopportune times, and safety nets like a line of credit either don’t exist or are inadequate.

“All businesses are leaking cash,” says David Zetter, founder and president of Zetter HealthCare Management Consultants. “There is money being lost in almost every single business, and medical practices are even more at risk because of a whole host of issues. When you can’t explain a variance as to why you deposited $43,000 — yet your billing report says you had $60,000 — either every penny needs to be explained or that is telling you that you have problems and need to figure out where the discrepancies are.”

Practices can minimize their leakage and maximize cash flow by setting up detailed financial systems, understanding their payer contracts and managing costs.

The first step to improving a practice’s cash flow is making sure a system exists to track and manage it.

“I think the No. 1 mistake that I’ve seen is people just not actually having a cash flow management system at all,” says Akash Madiah, chief financial officer of the Medical Group Management Association. “And when I say system, it’s the process around it and understanding what the future cash flow needs are going to be for the practice. It all starts with the budgeting process.”

Practices need a thorough understanding of what’s going to happen in the practice in the next year, including when people get paid, whether it’s salary or bonuses and if investments in medical equipment are needed, as well as all the regular costs that need to be accounted for.

“It’s different from a P&L forecast because it’s the actual cash you need out the door that you’re going to need to make,” says Madiah. The forecast needs to also consider expected patient volumes. “Are you going to have a lot more patient visits during flu season? It’s just understanding all those nuances of your practice that is really key for any kind of forecasting ability.”

The system needs to also include a commitment to communicating with patients what their financial responsibilities are before the appointment and then collecting the money due while they are in the office.

“What you have to do is let the patient know upfront — and we advocate for two days out — that they pay not only the copay” but also “whatever their coinsurance may be” by doing an estimate when you verify the insurance, says Derick D. Perkins, a managing partner at Metis Advisors LLC. “And more important than that, you also set up the outstanding balances from previous visits.”

Most offices send letters about balances due to patients but don’t always realize that same patient might be coming in for a visit that week. “That’s your opportunity to set them up on a realistic payment plan,” Perkins adds. “One of the things that most organizations do not do well is they don’t have a firm policy and standards on how to set the plan up for the front office staff.”

To make sure patients can pay the practice, offer financing options. More patients are relying on high-deductible plans, putting more of the burden for payment on them rather than a payer. There are third-party organizations that work with doctors to help patients pay their bills. Patients with financial challenges may rack up thousands of dollars in care, making it unrealistic to pay the practice $25 a month for decades. Instead, they can finance it, and the office collects 85%-90% of the money upfront.

A good cash flow system should also focus on collecting money that’s past due. Perkins says to be careful not to focus exclusively on the largest bills when trying to collect. “Sometimes you never get down to the lower dollar balances,” he says. “Sometimes they can be $100, sometimes it can be $50, but those are the ones that are the most collectible in terms of monthly or one-time payments.”

In some cases, Perkins says it might be more expedient to offer a patient a settlement with a 15%-20% discount just to get cash into the practice rather than spending months trying to collect the full amount. It’s not usually hard to figure out who to offer the deal to.

“You can see the difference in the ones who really care about their credit or the ones that typically want to pay their bills because they are going to offer you something,” says Perkins. “They will take advantage of it and pay something versus the one who is never going to pay. You can see balances in the system from previous visits, and that’s why it’s so important to try to collect as much as you can upfront when they first come in because when that person hasn’t paid their previous balance, the chances of them paying even with the discount are pretty slim.”

Practices need to spend time understanding their payer contracts because the reimbursements are where the revenue cycle starts. Having copies of the contracts with reimbursement rates allows practices to project revenue based on past patient volume and current procedural terminology codes and to double-check that actual reimbursements match with the contracted rates.

Perkins says practices should track key metrics for each payer. For example, if certain procedures are being denied but then paid on appeal 90% of the time, that’s something that can be discussed at the next negotiation. Eliminating denials will boost cash flow by speeding reimbursement from the payer and freeing staff time for other activities.

Knowing the data can also boost a practice’s future reimbursement rate. “Not everyone can really negotiate in certain markets — what you get offered from certain payers is what you are going to get — but you have to have the analytics,” says Perkins. “When you sit down to let them know you want to get paid this amount, at least have the numbers available. Analytics is the key going forward because it reveals a lot more about what’s going on in your accounts receivable and what you are trying to get to.”

With detailed reporting, instead of looking at data on a 30- or 60-day lag, trends can be identified that might show a dramatic drop-off midmonth from a particular payer, buying time to reallocate resources to focus on another payer or making other financial moves, says Perkins.

In addition to payers, track vendors for their efficiency and how they affect your cash flow. For example, many practices use a vendor for collections but don’t always pay much attention to its performance. Perkins suggests using a second placement for debts the first agency didn’t collect on — to not just collect as much money as possible but also to measure the effectiveness of the first agency.

“If the second agency can pick up a good percentage, that means your first agency is probably not doing a good job collecting,” says Perkins.

The quickest way to boost cash flow is to cut costs, but for medical practices, most costs are usually labor.

Madiah says practices need to understand the costs of physicians, nurses and office staff and be willing to make adjustments based on forecasts. “It really starts with understanding your volume that’s coming in the door,” he says. “When you know your volume, you know the right staffing levels to have.”

A common mistake is having the same staffing all year when volume is cyclical. In the down months, hours should be reduced.

Whether to lease or buy equipment is another consideration. Leasing might appear to cost a practice more over the life of the machine, but certain variables need taken into account. “Is this equipment something that’s going to need a lot of maintenance over the years? If so, leasing is always a good option because someone else will take care of that,’ says Madiah. “If you buy it, it’s yours, and you have to commit the time and money to fixing it.”

Likewise, buying an office space for the practice instead of leasing may make sense in some cases, but is managing building maintenance cost-effective for the staff?

“When you have a lease, you might have a landlord that will build out the space and offer you incentives to rent,” says Madiah. “If you own the space, are you going to have the patient volumes to service the building? And is that really what you want to be spending your time doing?”

Improving cash flow doesn’t have to be complicated, but setting up the right system can be the difference between success and failure.

“It’s all about setting up proactive revenue cycle policies and being able to predict what your cash flow is and being proactive with the entire process,” says Zetter. “Most revenue cycle management has been and still is reactive — we chase money. And businesses that chase money don’t make money, and they don’t stay in business.”

Improve your practice’s cash flow with the right financial strategies.

Stop leaking money

 had a deadline of May 16 to notify the public that the Public Health Emergency would end in 60 days. Because the deadline has come and gone with no word, it is expected that the PHE will be extended past the current July 16 end date, but how far is unknown.

The American Medical Association in conjunction with the American Nurses Association and the American Hospital Association wrote Department of Health and Human Services Secretary Xavier Becerra 

Becerra told health care leaders after the first extension that he would give them a 60-day warning if it will not be renewed.

, allowing Medicare reimbursement and elimination of various site and security requirements, giving doctors and patients the ability to use whatever technology they had access to. While the Biden administration has pushed to make some of these changes permanent, congressional action is required.

While much of the country has moved on as if the pandemic was over, the CDC shows a rising number of cases in recent weeks, with a rise in hospitalizations, as well. These rising numbers concern the professional medical groups, who point out that new variants may emerge that strain hospital and health systems.

HHS did not notify the public by the May 16 deadline that it will be ending.

Public Health Emergency expected to be extended

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