Experts Share Practice Management Tips for Arkansas Physicians on Arkansas Medical News Inc.

Experts Share Practice Management Tips for Arkansas Physicians

By: JENNIFER BOULDEN

Mary Andrews

When it comes to streamlining costs in times of tight purse-strings for medical practices, the best advice is often counterintuitive: spend more.

Allocated wisely, experts say, investment in things like automated systems and in employee development can translate into significantly more long-term savings than cutbacks save in the short-term.

The need to trim costs is a pressing issue industry-wide. It's not new that physicians are concerned about the profitability of their practices, but Mary Andrews, director of practice management at Practice Plus, says there are now more reasons than ever for healthcare providers to be concerned, given the uncertainty of the Medicare reimbursement system's future, continual federal and state regulatory changes, tightening insurance company policies, rising energy and supply costs and what many see as a slowing economy.

"There are so many pressures on medical practices right now," Andrews said, "practice management really takes a concerted, strategic effort by physicians and their office staffs to find a balance that works for them."

The following are strategies physician's offices can employ to stretch and best allocate their practices' resources.

Have a plan.

Too many physicians go into practice without completing the first basic principle of running any small business: writing a business plan, says Michelle Stockman, director of the Innovation and Entrepreneurship Center in Fort Smith. "One of the first things that any business, even a medical practice, must do is write a business plan. You've got to understand how your cash flow works, how medical reimbursement works, and how regulatory changes are going to affect your revenue stream. You've got to know how to set up contracts, tell what acceptable charges are and what unacceptable charges are, how to code for those charges and deal when the insurance company inevitably rejects those charges. There's a whole lot of complicated business to understand. Delineating the factors that are going to eat into your revenue and having a written plan to generate cash flow while maintaining quality of care despite those factors is a first, necessary step for any size practice."

Automate wisely.

Despite some studies that show use of billing, electronic health records and other automated tools do not necessarily increase quality, experts maintain that the right tools are one of the wisest investments a practice can make. "The amount of effectiveness you get out of a system is highly dependent on the system you purchase and the fit for your office. No one system, however sophisticated, meets everyone's needs," said Billie Jean Davenport, director of practice management for the Arkansas Medical Society. "Physicians certainly need to do their homework in finding a system that fits their needs for their specific practice. With the right system, you'll have an outlying expense, but it truly will save staff time, money, reduce errors and even increase the quality of care."

Andrews says finding the best software can be an intimidating task: "At Practice Plus, with all the resources we have, it's taken us 18 months to thoroughly look at the options and find a company, Next Gen, that best meets our practices' needs. Even then, we have things we want the software to do that it can't, so the company's programmers are working with us to add specific functionality we've requested," she said. "If you're just going out and buying something blindly, you're probably going to get burned."

Davenport recommends looking for electronic billing systems that proof claims before they leave the office, reducing staff time spent correcting errors and chasing revenue. "Making the office electronic and efficient is probably the biggest thing physicians can do to save money," she said.

Pool resources and negotiate for what you need.

Many Arkansas practices are stretching their resources by joining large corporate purchasing companies. There is strength in numbers, By joining together, practices can purchase office and medical supplies with increased buying power. "This is something that's just becoming really popular in the state," Davenport said. She added that physicians now have the power to negotiate contractual agreements with insurance payors to get the best rates payable to the physician. "AMS has good relationships with the state's payors, so I spend a lot of time helping our members negotiate better deals," she explained.

Enforce best practices.

Having streamlined workflows and sound policies only works as well as your staff knows to follow them, Andrews said, so keeping a detailed and updated (read: not dusty) policies and procedures manual for your staff can be a great boon to both quality improvement and training. Likewise, a written job description for all staff can ensure everyone understands their roles and expectations, Stockman said, and makes it easier to manage employees and hold them accountable for their performance.

Hire physician assistants or nurse practitioners to stretch physicians' time.
Stockman said a committee on physician recruitment is looking into bringing more physician assistants to the Western Arkansas area. "If an office has a physician assistant on staff, that PA can see patients with common ailments, freeing the physician to concentrate on the more serious cases or the practice management issues. It's a great use of resources, particularly since physician assistants cost so much less than physicians," she explained.

Train, cross-train, and train again.

It seems simple, Davenport said, but is an all too often neglected principle: The better staff is trained, the better they perform.

"Number one, we need to ensure at the get-go that we're providing good orientation and the training they need to be able to do their job," Andrews said, "and then we need to follow that up with regular training opportunities to learn more soft and concrete skills." She said Practice Plus trains all clinic managers and leaders at least once a month on both industry developments and leadership skills. In addition, all Practice Plus leaders upon being hired, take a mandatory class on the "21 Irrefutable Laws of Leadership," based on the book by John Maxwell. "It's the foundation for all of our leaders and gives us a common language of leadership that's very important to us."

Davenport said cross-training staff is an essential cost-saving measure. "Extensive cross-training among employees helps to reduce staffing needs. Practices are able to utilize employees more effectively and in more than one area, and it provides job growth opportunities for staff."

Emphasize great customer service from everyone.

"There's a lot of competition out there, and an easy way to lose patients is to fail to give them a great experience," Andrews said. "If they leave your office feeling indifferent about the service they received from the staff, they are prone to defect as soon as another doctor or service comes along." She said customer service was a "huge, huge" priority for Practice Plus, with a massive customer service initiative started in 2006 that is delivering impressive results. Whether it is the receptionist, nurses, billing clerks or schedulers, everyone in the office needs to be on board to deliver great customer service and know how to deal with difficult patients and recover from subsequent service interruptions with grace and professionalism, she said.

Hire the right people.

A practice is only as successful as its team, so before spending valuable resources training and investing in employees, make sure they are the ones you want in the practice. Stockman said many doctors have little experience in conducting interviews. "I recommend buying one of those interviewing books for job seekers," she said. "Even though they are written for the interviewee, those give you a great idea of the kinds of questions you should be asking, and the kinds of answers you should expect. There's a lot of pre-hiring work to do, as well. What kind of person do you want working in your office? What kind of personality will fit in, and what kind of background and education should they have?"

Andrews said, "One thing that makes a big difference is a candidate's willingness to put patients' needs first. We've built a lot of customer service questions into our recruitment, whether it is for physicians or employees. We want to make sure that we're hiring employees that have a heart for service. If you don't have a heart for service, you really shouldn't be in healthcare."

Retain the right people by investing in them and their workspace.

Supplementing fair wages with great benefits packages can be an enticement to new employees, but also a retention strategy. "Everyone's looking for good benefits now, so even if you can't increase the salary, spend a bit more on the group benefits, and it can pay off," Davenport said.

Recognizing and rewarding good work doesn't have to be costly, Andrews said. "A simple thank-you, a simple smile can do a lot, as can showing you value employees by having good communication, regular staff meetings, and involving them in decisions by getting their input."

Overcrowding is a concern in many practices, so making sure staff have adequate space can translate into increased productivity and satisfaction. Comfortable, attractive furnishings and workspaces, updated tools, and even small things like providing free snacks and sodas to staff can make a difference.

"We've found an amazing correlation between the staff satisfaction and patient satisfaction," Andrews said. "When the employees are happy with their jobs and enjoy their workplace, it's contagious, and often directly translates into higher patient satisfaction scores. It's critically important that we're treating our employees just as well as the patients. "

Davenport said spending money on employees, whether through training and continuing education opportunities, benefits, raises, tools or building a better workspace is rarely wasted. "Sometimes physicians try cutting back on how much they invest in employees, but I think that in the long run that restriction in good employees is unfortunately reflected in the bottom line," she said. "Great, loyal employees are the beating heart of any successful practice."