Rx News

Preparing Your Medical Practice for Tomorrow

William F. (Bill) Cockrell

November 5, 2015

If you are a physician in a small to mid-size practice, have you ever watched what your manager does? If not, it could be eye-opening when you actually see what they do, and what they can't get done.

In most practices, managers are dealing with operations ranging from making sure the office is staffed for the day, bills are being paid, revenue is being collected, financial records are being maintained, the facilities are clean and maintained and, most importantly, patients are seen appropriately and have a positive health care experience they can relate to their friends and family. At any given time, any or all of these things may be going on in addition to a myriad of other operational issues.

Knowing what is being done on a daily basis, ask if they are involved in trade organizations like the Medical Group Management Association or specialty associations for managers. When do they have time to think about the future? Do you take the time to talk to them about where you want to go with your practice? If you answer "No" to any of these questions, the result might be that things may be working fine for now, but you may not be ready for the future.

In the meantime, claims may get rejected because of a coding change (ICD-10 is here), incentive money is being lost, more and more focus is being placed on pay-for-performance requiring better documentation and processes and other issues that will affect you long term are being lost in the shuffle. In addition, there are Meaningful Use requirements to stay on top of, Physician Quality Reporting System incentives/penalties to manage, and the need to prepare for the changes in payment models coming over the next few years.

Examples of what you will be dealing with in the years ahead include a major push by Medicare to merge the various quality and financial programs in existence. What payment options will you participate in or miss. Could the designation as a Patient Centered Medical Home help you receive bonuses from Medicare? The answer is "Yes."

Many changes will really begin impacting you in 2018. That's two-and-a-half years from now and requires preparation starting today. Blue Cross and Blue Shield of Alabama has a strong incentive program in existence for primary care and some specialties. To put a value on this consider that a 5 percent increase in payments for cognitive services for primary care physicians may mean an increase in annual revenue of $7,000 to $9,000 from BCBS. BCBS already has their program in place where that increase could be up to 30 percent. What could you do with an extra $40,000 to $60,000 per year, every year? Then, on the expense side, what new tools and ideas exist for you to take advantage of to reduce operating costs? We all have a tendency to think things will not happen to us. However, the need for compliance plans, employee policies, appropriate insurance, and other items that are not income producing but, rather, income protecting, should be obvious.

Medical managers are not endowed at birth with the knowledge and background to deal with all these issues. Their education may give them the basics, but all education needs to be ongoing. Like any other professional, they have to have their own education and support options to stay on top of issues. Too often, managers miss out on education opportunities because of time and cost.

If there's an MGMA chapter near you offering monthly luncheon meetings and your manager does not have time to go, how can you help create a situation where they can attend? If the answer is, "they can pay for it and attend when they have time," that does not fall into the realm of encouragement. Instead, spend the extra money (a small investment) to have them join their local and state MGMA chapters or the many specialty associations for managers and attend meetings. Not only is the education in the meetings important, but also the development of information and support networks provides additional sources of information.

If your manager is swamped, and you don't want to pay for more staff, do you have available external experts who can assist your manager on an as needed basis? This is often available through your accounting firm or through independent consultants. These organizations can help audit processes, develop plans and implement new programs. A fair question to ask here is, will utilizing an external service make or save me money? Ask them and have them show projections.

The business side of health care is complex and changing. Planning for the future is critical. There's a saying that, "If you don't know where you are going, any road will get you there." This is true of any kind of business. It means having a thought-out plan based on information. It doesn't have to mean a plan that has to be developed over a weekend planning session, but one that has buy-in by the major stakeholders in the organization. It needs to be clearly stated and one that is flexible based on changes that are occurring constantly.

The bottom line - treat your operations as a business and supply it with the education and resources needed for success.

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