Basics in a Healthcare Practice Shouldn’t Be Boring or Burdensome

What do we mean when we refer to a “best-run” medical practice? The Medical Group Management Association (MGMA) analyzes its well-known annual surveys (Cost Survey and Physician Compensation and Production Survey) to identify top performers in four areas:

• Profitability and cost management;

• Productivity, capacity, and staffing;

• Accounts receivable; and

• Patient satisfaction.

The MGMA publishes a supplemental report (Best Practices of Successful Medical Groups) recapping key data and featuring case studies from representative practices. In researching these feature stories, I’ve been privileged to conduct interviews with physicians and administrators who have led their groups to levels of success to which many of the rest of us only aspire.

In e-mail exchanges and telephone interviews, I heard about creative ideas and innovative processes that resulted in happier patients, smoother operations, greater physician productivity, and richer bottom lines. But one common thread bound these stories together like a theme song: Without exception, each practice leader I interviewed revealed diligent attention to fundamental management principles.

For some, attention to basics has become second nature—they have programmed it into their professional natures and management styles. That’s not to say they’re less than deliberate—rather, they consciously keep fundamentals as the first priority.

What Fundamentals?

Talk to enough experienced practice managers, and you’ll discover a generally recognized list of practice management fundamentals. They may disagree about which ones are the most important, but the lists they produce will be remarkably similar. One of the better resources for identifying and learning about these basic principles is Fundamentals of Physician Practice Management by Frederick J. Wentzel and Jane Wentzel.(1) Frederick Wentzel is academic director of St. Thomas University’s MBA program in Medical Group Management.

This book’s table of contents would serve well as a curriculum for self-study in the art and science of running a medical practice. But several chapters in the middle of the book provide a list of basics that you can consider “high priority” areas of management:

• Financial Management

  • Historical Perspective of Accounting and Finance for Medical Groups

  • Budgeting and Budget Planning and Evaluation

  • Financial and Operating Ratios

  • Medical Group Valuations

  • Retirement Benefits for Physicians

• Staffing and Staff Management

  • Staff Planning

  • Compensations and Benefit Programs

  • Performance Appraisal and Evaluation Systems

  • Employee Education Programs

  • Employee Relations and Conflict Resolution

• Information Systems

  • Information System Implementation

• Business and Clinical Operations

  • Practice Operations

  • Patient Flow and the Provision of Services

  • Measure to Monitor Performance

  • Additional Service Analysis

  • Use of Non-Physician Provides

The list is certainly not exhaustive, but it’s a good start (the book has additional sections on quality and safety, risk management and compliance, as well as other critical areas). Many items simply name a category under which you would have to determine the “basics” yourself, but if you’re wondering where to begin, the list provides one possible “roadmap.”

Wandering from the Roadmap

Different administrators have different priorities, interests, strengths, and weaknesses—but we all have similar goals. We are charged with overseeing day-to-day operations; ensuring that patients, physicians, and referrers have a smooth, satisfying experience at our practices; and that the revenue cycle operates effectively. We must promote efficiency and productivity while controlling costs and minimizing waste.

If those goals are neglected, the administrator had better keep his or her résumé up-to-date, because the physicians won’t tolerate it for long. And rightly so! A dysfunctional, inefficient practice won’t produce enough revenue and won’t serve the community very well.

Some practice managers take these daily challenges in stride—always on top of what’s happening in the front office, back office, and clinical area. They enjoy supervising people, fixing problems that arise, and making each day run as smoothly as possible. Often, they don’t enjoy the other end of practice management—strategic planning, contracting, marketing, and similar administrative tasks.

Those who enjoy such “big picture” tasks often find those day-to-day operational duties tedious and exhausting. Often they are more comfortable behind the desk or at the computer than they are when standing elbow-to-elbow with workers at the front lines. In the end, you really need both to succeed as a practice, as a doctor, or as an administrator.

When we managers allow ourselves to be drawn only to our natural strengths to the neglect of “the other stuff,” we risk leaving our roadmap—that list of critical, top-priority tasks—behind. Smart practice leaders figure out where their strengths (and weaknesses) lie, and deliberately bring someone (or ones) along to complement their work. In other words, they hire someone skilled in the tasks they don’t like to do.

A Practical Example

How does this principle work out in the “real world” of medical-practice daily life? Let’s consider an area that’s often out of balance in a typical practice: job descriptions. Creating and maintaining accurate descriptions for every job at your place feels like a mundane, boring task that can almost always wait until “later.” (Of course “later” never comes.)

On the other hand, you might find great satisfaction in getting your job descriptions—as well as policies and procedures, employee files, managed care contracts, and other critical documents—in order. It’s easier for you to spend time on spreadsheets and important documents, even though the practice needs more MBWA (management by walking around). You intended to get out on the floor this morning—but suddenly it was lunchtime. Then before you knew it, it was the end of the day.

Best-selling author (Good to Great, HarperCollins, 2001) and executive coach Jim Collins asks clients, “Are you more comfortable managing ideas, or managing people?” He finds the answer to that question critical in sorting out an executive’s strengths and weaknesses. We practice managers need to ask ourselves, “Am I more comfortable behind my desk, or mixing it up with my staff?”

One is not better than the other. But if you “know thyself,” you will recognize where you need to supplement your efforts. If you prefer to focus on the big picture administrative work, hire an effective assistant with daily-operations strengths. If you’re a “shirtsleeves” manager, bring along someone you can trust to manage as much of the behind-the-desk work as you can appropriately delegate.

You’ll have to adapt this principle to your particular organization. How you implement it in a mid-sized or larger physician group will look very different from the way you would apply it in a small, solo practice. In a smaller practice, you’re less likely to have the luxury of creating a new position or hiring another administrative staff member. That means you have to apply the principle to yourself with stalwart self-discipline. You have to overcome the human tendency to allocate too much time to the work that interests you the most.

The “boring, burdensome basics” will mean different tasks to different administrators. Successful managers—the ones at the helms of the best-run practices—consistently make sure that they apply the same resources and efforts to those tasks as they spend on their favorites.

Reference

1. Wentzel FJ, Wentzel J. Fundamentals of Physician Practice Management. Chicago, IL: ACHA’s Health Administration Press, 2005.