10 tips for avoiding practice management "hypertension"

More than ever before, physicians and managers are feeling the stress of running a practice, which can lead to many forms of “practice management hypertension.” Though most medical schools do not teach business principles to physicians in residency, it is just as important to invest in education about the business side of medical practice as in the clinical aspects.

Here are tips to lower your blood pressure and successfully navigate the pitfalls of running a practice.      

1. “EMR Implementation Hypertension”

• Evaluate the stability and longevity of each software company you are considering, as well as their support services.
• Research current year KLAS (an independent rating ) EMR rankings for small medical practices;
• Redesign your workflow before beginning implementation;
• Have your checklist of elements and ask each vendor to respond;
• Integrate your Billing/PM system with EMR for greatest value;
• Designate a “super user” at each practice location;
• Invest in training - don’t underestimate the time it takes to learn to use a new system. Lighten your schedule when going live and never on Monday.

2. “Healthcare Reform Hypertension”

• Educate yourself on managed care risk principles - ACOs, medical homes - a new form of capitation;
• Collect data to analyze costs and track utilization via purchase of relational database software;
• Take the time to develop patient handouts explaining managed care and clearly communicate that patients are responsible for knowing their own covered benefits;
• Realize the opposite financial incentives hold with bundled payments or capitation  – invest time keeping patients healthy, well and not utilizing services for unnecessary care. Prevent readmissions;
• Remember that everything, including your time, is a cost and look for ways to reduce costs.

3. “Cash Flow Hypertension”

• Learn benchmark A/R, staffing and line item overhead expense ratios for your specialty and try to keep expenses within norms provided by the Medical Group Management Association, or your AAO specialty society studies;
• Use your profit loss report to monitor practice health; each line item for actual expense should have a column next to it dividing it into revenue received each month and cumulative year to date to determine the percent to revenue each line item represents;
• Five days after the end of the month, your office manager should prepare an internal profit loss statement, accounts receivable report and collection ratios report. Hold the billing staff, billing service and office manager accountable for achieving MGMA A/R ratios or better results;
• Prepare a budget every year by November to project revenue and expense. Underestimate revenue and overestimate expenses to determine what you need to do to make the same net income with this scenario;
• Implement cash controls and separate duties of staff involved in the transaction of cash to avoid embezzlement. Never let staff sign checks or have online access to bank accounts.

4. “Malpractice Hypertension”

• Attend malpractice insurance carrier loss prevention courses;
• Excellent communication skills and patient rapport is your biggest prevention mechanism. Assess your skills and obtain CME in this aspect of your practice;
• Prepare written informed consents and patient education materials in easy-to-understand language;
• Have lab tracking, referral tracking and medication flow sheets to ensure patient results, referrals and medications do not fall through the cracks;
• Document thoroughly and carefully. Purchase EMR/PM software that matches documentation elements with coding or use preprinted forms/chart stamps/ checklists to simplify documentation. Remember, “if you didn’t chart it, you didn’t do it.”

5. “Personnel and Labor Law Hypertension”

• Educate yourself and your office manager on current labor law, particularly overtime, exempt vs. non-exempt, SF sick leave policy, sexual harassment and wrongful termination prevention;
• Prepare a written personnel policy manual and give to all employees. Require a signed statement that they received, read and understood the policies and place in their personnel file;
• Manage staff by following the policies and applying them consistently and fairly;
• Prepare a written evaluation review for employees yearly. Set performance expectations and incentive programs;
• Invest in initial and ongoing training of employees;
• Praise and thank employees, remembering the rule “Praise in Public, Reprimand in Private.”

6. “Medicare Fraud and Abuse Hypertension”

• Educate yourself as well as the practice’s manager and billing and insurance personnel. Attend coding and Medicare reimbursement classes;
• Perform internal chart audits for prevention;
• Document according to Medicare guidelines;
• Prepare a written compliance plan, even if you outsource billing.

7. “OSHA/HIPAA Compliance Hypertension”

• Prepare a practice-specific OSHA manual;
• Attend a training course and designate an OSHA staff member compliance officer;
• All staff must have two hours of documented annual OSHA training on blood borne pathogens each year;
• Include in the personnel policies that failure to adhere to OSHA regulations is grounds for dismissal;
• Have a complete HIPAA compliance plan in place, not just the form the patients sign.  Use Encryption for email and text communication with patients.

8. “Mergers, Acquisitions, Foundations, Practice Integration Hypertension”

• Don’t merge, join, sell, acquire or integrate without determining practice and business philosophy, similar values and compatibility first;
• Don’t rush the process;
• Seek advisors including legal, accounting and consultant advice;

9. “IPA/Health Plan interaction Hypertension”

• Get to know the right people within the organization. Try the “catch more flies with honey” approach first;
• Seek ways to obtain power and better rates. Merge into integrated groups, specialty IPAs etc.;
• Analyze your contracts yearly with top ten CPT codes and top ten payors. Renegotiate or drop the poor payor contracts;
• Track claims reimbursement and have staff doggedly follow-up and double check claims;
• Ensure staff have time for appeals and denials follow up;
• Don’t be afraid to use the grievance process.

10.  “Physician/ Manager Burnout Hypertension”

• Recognize the signs of burnout before it is too late;
• Take vacations;
• Learn time management principles;
• Learn to say no;
• Delegate;
• Look for ways to recapture the joy of medicine.