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Using Staff to Improve Your Bottom Line


Looking for ways to increase practice profits? You may find the answer on your payroll.

It's no secret that your office staff is the heart of your practice, but the ideal staff doesn't look like it used to. Back in the day, a medical practice had a receptionist, nurses, doctors, maybe a few lab techs. Today's medical practice has all these people, too, but it also has coders, IT experts, and maybe a few other clinical staff, such as physician assistants and nurse practitioners. A smart practice knows how to hire the right people and train them to match their skills to the needs of the practice, thus turning what might have been a human resources nightmare into a trim, smoothly functioning team that actually improves your bottom line.


These days every practice needs someone who can deal with the electronics - not just using the programs, but installing, updating, and fixing them when they don't work properly, and the same goes for hardware. Whether you need to hire someone to handle your IT or outsource it depends on the size of your practice. A small practice can get away without outsourcing, but a large practice definitely needs an in-house IT department or at the very least an IT manager. How large? The rule of thumb, says Jeffery Daigrepont, healthcare IT expert and senior vice president of the Coker Group, a healthcare consulting firm in Atlanta, is that once you have over 100 electronic devices (workstations, phones, copiers, fax machines, etc.), you're ready for your own in-house IT support expert or some IT co-sourcing support.

"If your practice's EHR or the voice-over-IP phones go down, your practice immediately comes to a halt," says Jennifer Perry, practice administrator for Norwood Clinic, a large multispecialty practice in Birmingham, Ala. "Having someone who knows your systems and can respond quickly greatly decreases the chance for lost productivity when something goes wrong with the technology."

Even if you have a full-time IT expert on staff, you'll probably still do better to outsource some of the IT work. "Just like doctors, IT people specialize," says Daigrepont, "and your full-time IT person may be strong at desk-top support, but will need other experts for special projects such as networking or programing."

If your practice isn't big enough for a full-time IT expert, there are a lot of advantages to outsourcing, the main one being that you get access to an entire team of experts for typically the cost of less than one employee. Keep in mind, though, that choosing your IT support company is as important a decision as hiring an employee - maybe more - so do your homework. Know exactly what you are getting for your money and ask other practices about their experiences.

If you plan to hire an in-house IT person, don't be too swayed by degrees and certificates. "Usually college certifications are standards for this position," says Perry, "but that is not required. A lot of great IT managers got their training on the job and kept up their skills."

You might find that the perfect IT manager is already on your staff. "Sometimes nurses or other clinical staff will have the necessary tech skills," says Daigrepont. "Or you can train a nurse, giving you an opportunity to have someone knowledgeable in both IT and clinical. You'll never regret training your staff in IT." Whether it's a tech-school grad with lots of certificates, a lab-tech who knows his way around computers, or an outside company with 24/7 service, be sure you get the right person or team for this job. Your entire practice can come to a halt if they can't help when you need them.


Another way to fill all these new positions without destroying your payroll budget is to cross-train. "All positions should be cross-trained with someone else whose job is closely related," says Perry. "In a smaller office, the receptionist may cross-train with the biller. In a larger office, the check-in receptionist may cross-train with the checkout receptionist." People get sick or stuck in traffic, making it wonderful if you have someone who can step in and temporarily cover the gap. Another reason for cross-training is that some jobs just don't require a full-time employee, but the workload may be too irregular to justify the cost of a regular part-time staff member. Being able to pull someone from billing to help out at the front desk on a busy day during flu season, or send a front-desk staff member to billing when things get crazy there, could help you keep things running smoothly without having to hire additional part-time help (and keep you from having to find something to keep that extra help busy on days when everything is going smoothly).

On the other hand, "Don't try to save [money] by understaffing," advises Elizabeth Woodcock, founder and principal of Woodcock & Associates, an Atlanta-based physician practice consulting firm. "That puts too much pressure on the physician. The most expensive person in the practice shouldn't be doing what others can do." Often these others are physician assistants and nurse practitioners, and having them on staff can be a huge help with finances. "If used in the office seeing patients in addition to the physician, using these physician extenders can positively impact revenue if billed under the NP," says Perry. "If used as initial screening either in office or hospital, using them can allow the physician to add more patients to the schedule as the physician spends less time with each patient, and you can bill the visit under the physician as long as documentation standards are met."


Clever and efficient use of staff can also benefit from a little creative thinking when it comes to scheduling. "Telecommuting for schedulers and people who do phone triage or follow-up calls can really help," says Woodcock. Patients are increasingly demanding after-hour services and workers are asking for flexible scheduling. A combination of part-time workers and workers on flexible hours, such as four 10-hour days or alternating weekends, can help you fill holes in your staff without having to hire more people than you need. "It can also be a great help with retention," says Woodcock.

These days it is harder than ever to give good patient care while meeting all the regulations and still stay in the black. Using your staff in the most efficient way might mean the difference between staying afloat and going under.

Avery Hurt is a freelance writer based in Birmingham, Ala. Her work has appeared in publications including Newsweek, The New Physician, Muse, Parents, USA Today, and the Washington Post. E-mail her at

This article was originally published in the April 2016 issue of Physicians Practice.

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