You are paid to think

“You are paid to think.”

My friend Terry Coffey, a preeminent practice administrator of my time, gave me that advice. Those words have guided me for thirty years.

Terry was lightyears ahead of most of us because he set aside time to think. Some of that time was spent thinking about where the practice should be in a year or five years; time was devoted to discussing with his doctors, his team and patients about where they really were now; conversations that the numbers and metrics don’t always capture; and some of it was spent thinking about how to get there. His weekly thinking sessions were his most productive times of his week, and they kept his practice five years ahead of the curve.

I bring up Terry’s wisdom because few of us are deliberate in dedicating time to thinking. We are good at reacting, and we might set aside a few minutes at the end of an exhausting day occasionally or wax poetic during a business or committee meeting. We need to do better.

We must take time to think about the future if we want to change it. If we don’t, we stay in a rut. For doctors, that rut is often the production hamster wheel: see patients, document visits, review results, empty the portal inbox, and go home tired and often unfulfilled.

If we do schedule time to think, it is at the end of an exhausting day. Or it might be taking a rushed fifteen-minute block in the midst of the day. Neither is enough.

For me, I needed to change my physical environs to do best thinking.My best ideas never came when sitting at my desk. That meant scheduling – yes, scheduling – a coffee date with myself. I would head to the library or coffee shop, away from the unceasing demands and interruptions. It was in the library that I came up with ideas that moved the practice forward.

Or take a few members of your team out of the office for an hour and ask what continually creates inefficiencies in the work day. Ask them to think. Each member of your team has a different view; together, these perspectives weave a tapestry for improvement.

The authorizations guru in our office opined that doctors could save tons of time if they simply got it right the first time. First, she pointed out that referrals are often sent without clinic notes. Second, she pointed out that clinic notes often do not offer sufficient (i.e., what the payor needs to approve the referral) documentation. She was pointing out that missing on the first swing means time is wasted.

One of the least utilized means for improving one’s income is to adjust your payor mix:see more patients with better-paying insurance and fewer patients with worse-paying insurance. You aren’t going to get there by staying entrenched on the hamster wheel. Rather, you need to think about how it will be done.Adjusting your new patient payor mix will accomplish it over time. Asking your administrator to negotiate better payment with lower-paying insurances is another.

Here's a hint from me, a patient: align all my prescriptions to renew at the same time. I am on four prescriptions, each with a different renewal date. That means the pharmacy is calling my doctor’s office four times, rather than once, for renewals.

Take time out of the rut to think about how to get out of the rut.

Some of the fixes may involve collaboration. Getting back to Terry, he recognized that collaboration between practices creates both opportunities and efficiencies. He streamlined the referral process first; he marketed to other practices first; and his fingerprints are all over Virginia’s “Fair Business Practices Act," which was passed a quarter-century ago to level the playing field with payors. Thinking alone solves many problems; thinking together solves many more.

Here's my challenge to you. Schedule an hour away from the office with your phone on “Do Not Disturb”. Think about your hamster wheel and what you like and don’t like about it. Take a piece of paper, make two columns, and fill the left-hand column with bottlenecks and irritations. Fill the right-hand column with possible solutions.Lastly, commit to your right-hand column.

When you are back in the office, keep this piece of paper prominent where it serves as a constant reminder of where you are and where you want to be.

I have spent days, weeks, and even months in ruts, living in “react” mode or autopilot mode. It wasn’t until I set aside “thinking time” that I emerged from the ruts. As my friend Terry sagely told me, “You are paid to think”.

Lucien W. Roberts, III, MHA, FACMPE is a former practice administrator and occasional author.