Practice Management—3rd in Series of 3, Top 7 and Early Lessons from Covid-19

The “practice” of Medicine is an ongoing evolution that has adapted to HMOs, managed care plans, Obamacare, PPOs, concierge doctors, consolidation of hospitals, consolidation of medical groups, consolidation of insurance companies, and many other changes. It is undergoing rapid change because of Covid-19.

Fellow Health Partners, a highly respected Medical Billing and Solutions company based in Long Island, NY, has focused on Best Practices for enhanced Practice Management. This is the third in a series of articles. The first and second articles can be found here.

They analyzed medical practices, spoke to successful and highly respected Practice Managers, polled patients, questioned medical providers, spoke to insurers, and tried to get a picture of what it takes to run a successful practice today as well as what it will take going forward. The key findings are:

  1. Know your customer. Providers. Staff. Patients. What are their needs, hopes, wants, fears? The customer comes first. (see#7 below)
  2. Know yourself – Sole Practitioners or Group. What are your strengths, weaknesses, and meaningful difference compared to other practices (location, skills, etc.)?
  3. Visualize. Know where you want to go. Get help on a business strategy. Use experts to help facilitate and identify “next steps”. Build a marketing plan to help.
  4. Capitalize and Use Metrics. Have access for sufficient capital for growth. Don’t be undercapitalized. Learn how to “read” numbers and use them. Some examples include:
    a. Benchmarking. Reimbursement and claim efficiency against peersb. Monitor. Revenue impact of no show and cancelled appointmentsc. Watch A/R. Patient balances, denials,
  5. Understand Management. Grow people who grow good people. Recognize that management is about supporting and directing the team. Get educated to help them learn and grow. Recognize that management is a skill and not a “feeling”.
  6. Automate Whenever Possible. Understand tech tools – texting, iPad check in, telehealth, remote monitoring, etc.
  7. Service and Sell. Relentlessly improve the patient experience. Ask patients how you’re doing for them (or have a member of your team ask them). APPROPRIATELY, ask for referrals (check HIPPA to be sure you don’t violate it). Asking “appropriately” is a skill and can be taught and learned. It is not a “feeling”.


Early Lessons from Covid-19

There are storm clouds on the horizon and there is going to be a change in the way practices are managed, some of which may be advantageous for both provider and patient.

The biggest anticipated changes are…

  • More telehealth
  • More technology for remote monitoring
  • Helping patients manage their fear (of coming for surgery, etc.)
  • Potential for less “real estate” – office space, exam rooms, etc.
  • Practice management changes – remote management of staff, contactless payments, remote patient data gathering, etc.
  • More focus on the real cost of “in-house” services such as billing, staffing, patient interactions, etc.
  • Potential reduction in volume of services for providers (and innovative ways to increase the volume, which might include referral management, marketing, etc.)
  • Potential fall in income for providers
  • Merger and acquisition increases
  • Move from inner city hospitals to suburban ASCs for surgery

Phil Marino, Administrator of Brooklyn Surgery Center, is concerned that “seasoned, experienced staff will continue to resign or retire early during this crisis, which means fewer experienced people on the front lines and a lack of experienced mentors.” He says, “ We will need to enhance our focus on hiring and training new staff to help eliminate any potential lapses in qualified personnel.”

He adds, ““On a basic level, infection control is paramount and, for now both patients and medical staff are extremely compliant in following Infection Control guidelines. Moving forward surgery centers need to continuously re-evaluate their policies related to patients and staff safety. The guidelines for Covid-19 are changing constantly as more data is available.

“Patients will remain extremely apprehensive about having a procedure during the crises. Surgery centers need to reinforce to the patients and staff they are very capable in controlling a safe environment.

“Some pertinent factors in controlling the center’s environment are: the appropriate spacing out of the schedule; social distancing patients in the waiting area; limiting family members and escorts; and maintaining a strict vetting process that starts in the physician’s office, continues with per calls, is reinforced upon arrival, during registration and finally pre-op.”

There is also pressure on income.

James McCullagh at Northwell Health says, “The fee for service model is stressed and shared risk models are becoming more pervasive. Physicians find it harder to stay independent and medicine may become less profitable for specialists.”

Michael Brown, CEO of Fellow Health Partners, mentions that Practice Managers tell him that “ensuring staff and patient safety is paramount. New considerations such as continually evaluating employee and patient health, controlling patient access and flow, embracing Telehealth beyond the pandemic, implementation and acceptance of work from home, will impact how we do business. The hardest thing for physicians is likely to be the reduction in the volume of services that can be provided as social distancing becomes the norm. They will need to work more in order to maintain income.”

He adds that one Practice Manager told him, “With technologies getting between the patient and physician, interaction with the physician is lessened, so your front desk people have to be so slick” – a word that means “done or operating in an impressively smooth, efficient, and apparently effortless way.”

Judy Faulkner, CEO of EPIC, has been quoted as saying, “There is a strong possibility for future mergers, acquisitions and layoffs as hospitals and health systems have been forced to spend more money on Covid-19 care while canceling many surgeries and other appointments.”

Nicola Hawkinson, CEO of Spine Search, foresees a “surge in the ambulatory surgery market, remote work, less reliance on paper and notes which means working in the EMR, increased documentation because ‘you can’t just tell the person at the next desk’ when you are working remotely.”

It’s a brave new world for Practice Management, exciting, challenging, and a bit unpredictable.

Under pandemic conditions, “management” skills will be more important than ever, including managing interpersonal relationships in person and remotely.

Financial skills will be honed as providers look for every dollar, judgement will be tested with new technologies, and compassion will be front and center as people cope with a new virus, stresses on their medical insurance, higher financial responsibility, and the curious effect of telehealth on human interaction and relationships.

Finally, marketing and referrals will become more important than ever, requiring enhanced criteria to effectively choose the most effective help for growth.

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ABOUT FELLOW HEALTH PARTNERS

We are Fellow Health Partners, a Medical Business Solutions company, with a very strong grounding in Medical Billing. Every day, our team interacts constantly with Practice Managers, physicians and other skilled medical providers, insurance companies, and patients. All day long, we experience what works for successful practices and what’s getting in the way of success for less successful practices. And, we help practices become more successful, even if they are already doing well. Without digging deep into the details (although we’ll discuss them happily with you), we thought it might be helpful to share aspects of how to make a practice more successful, regardless of size.