Can You Practice Medicine and Manage Your Practice?

May 9, 2012

Whether you practice alone, or in a group, if you're trying to see patients in this pay-for-volume environment and also run the business of your practice, you may be missing out on important opportunities.

If you're a solo provider, this might seem like a very silly question. But, is it? Whether you practice alone, or in a group, if you're trying to see patients in this pay-for-volume environment and also run the business of your practice, you may be missing out on important opportunities or even your family life! 

How many hours each week are you scheduled with patients - maybe 35 hours? Don't forget, that "seven-hour" day is actually closer to nine or ten hours when you account for communications (phone calls, test result reviews, additional orders, etc.) around those scheduled appointments - plus similar communications for patients who aren't on that day's schedule.

In the 2011 Medscape Physician Compensation Report, about half of the almost 16,000 physician respondents indicated that they spend about nine hours per week on non-patient activities in their practice. That quickly turns the 45- to 50-hour workweek into a nearly 60-hour workweek.

Ask yourself, "How much time does managing my practice take each week?" Simply seeing patients and billing for those visits (not so simple a task!) isn't a guarantee for success. You'll also need to manage continuous improvement in scheduling, operational efficiency, and the revenue cycle to assure profitability and sustain your practice.

Working in a well-managed practice is a lot like coming home to a newly cleaned home. When we walk in the house, we take for granted our appreciation for the lack of clutter and dust; when we see patients day-to-day, we take for granted the availability of staff in place, and working phones and computers.

So, in order to stay on top of management responsibilities that allow you to see patients every day in an efficient manner, make sure you have a good understanding of each of these critical practice areas:

• Start with staff. Assume you've got the right staff doing the right jobs (a big assumption) and that they are here to stay. You will still need to ensure that productivity and morale remains high - that means appropriate scheduling and payroll and benefits management. When employees present requests for both planned and unplanned time off, be ready and have a contingency plan in place so that the work gets done even in their absences. Payroll and benefits must be monitored and changed as needed; whether that is a simple employee enrollment change, or a switch to a new plan provider to control costs.

• Information technology has become a critical component in every practice. The PM-EHR (practice management-electronic health record) system is as core to the practice operations as is the telephone. That means you must manage hardware issues, ranging from a printer breakdown (even "paperless" offices need printers) to server upgrades and/or slow Internet connections. Software applications will always have upgrades and even if you are using a cloud-based solution (so you don't need to personally apply upgrades) you will need staff training on new releases, to fully utilize new functionality and realize all the benefits. Think of the 5010 format for insurance billing and the pending transition to ICD-10 diagnosis coding; those changes must be managed!

• Managing accounts receivable. The nature of healthcare is serve now, reimburse later. That means that we need to be very diligent in verifying that we have all the appropriate information necessary to submit an insurance claim correctly to get paid at expected rates about two weeks later. Managing the process of data collection from patients, verification of information, correctly transmitting data to payers, and monitoring the results can mean the difference between putting money in the bank or operating a free clinic. Inevitably there will be denied claims and partial payments. It will be your responsibility to make sure that denials are followed-up in a timely manner. And, don't forget, evaluating payer contracts means monitoring reimbursements and timeliness before extending your participation agreements.

• Customer service. And, certainly not the least important management responsibility is customer service! The patients' satisfaction with their ability to get an appointment, to be seen in a timely manner, to be treated by staff respectfully and with appreciation, to be billed fairly and in a timely manner, and of course to have their need for the appointments fulfilled, is really what management is all about. Can you facilitate that entire process from inside the exam room?

Looking for more guidance? Watch our video interview with Rosemarie Nelson as she offers simple tips and policies physicians can put in place to better manage staff, technology, reimbursements, and customer service.

Rosemarie Nelson is a principal with the MGMA healthcare consulting group. She conducts educational seminars and provides keynote speeches on a variety of healthcare-technology and operational topics. Drawing upon her diverse experience, Nelson provides practical solutions to help medical groups succeed in their practices. She may be reached at www.mgma.com/consulting/nelson.