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Five Steps for Elevating Medical Practice Operations


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

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 week rather than next year. 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.

Step 3: Take advantage of technology.

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.

Step 5: Expect the unexpected.

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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