Learn How To Create A Budget For Your Medical Practice

In medicine, the mention of the word profit is often viewed or interpreted as a dirty word. It is as if the word does not belong in the lexicon when health care is addressed.
 Broke doctor
I argue (in the context of the private medical practice setting) that profitability is a medical practice’s responsibility for one simple reason. If the medical practice (also known as a business) doesn’t deliver profits, health care providers are unable to provide for those in need.

Why Profits?

Profits pay for infrastructure, technology, education and human resources, all of which translate to superior pediatric care when employed correctly.
Another way I like to put it is by saying,

 

…a broke doctor does do anybody any good.

 

Calling vs Profits

Indeed, our medical businesses differ from other companies in that we care for children. And the notion of withholding medical services or restricting access to a sick child merely by the patient’s parents inability to pay for health care services is simply not in a pediatrician’s DNA.
However, it is important to accept the reality that without a way for a doctor or the practice’s income to outpace expenses, health care providers are unable to provide services of any kind. At least not for the long term.

Is there a solution?

How do we reconcile these two competing issues? On one hand, it is necessary for a medical practice to deliver profits if it wants to remain sustainable. On the other, we have an intrinsic motivation to put the patient’s needs first.
I am glad you asked.
These two dichotomies can co-exist – and even flourish – alongside each other. There is indeed numerous tools and principles rooted in business that can help medical practices manage what otherwise appears to be opposing forces.

A Resource You Don’t Want to Miss

Today, I want to tell you about a resource I’ve been working on to help your office obtain financial success, while simultaneously providing unsurpassed pediatric care to your patients.

To help you succeed in your financial success, I’ve written a comprehensive eBook on budgeting that walks you through the process of creating a budget for your medical practice. The materials also cover basic principles necessary to put the exercise into perspective.

Budgeting is a major component of financial success. Moreover, financial success is essential to the continuity of care.

To read more about this offering, click on the image below.

Medical Practice Budgeting
Click on the image

I do hope that you buy the book, but more important, that you find the eBook helpful, useful and valuable.

The Value of Having Core Values

The airline passenger was upset with the flight crew. So she wrote a letter to the CEO to inform him she did not approve of how the crew was making jokes while doing the pre-flight safety checks.

In her letter to the CEO, she made clear that security announcements ought to be taken serious because of how important they were.

 

Airline Customer Service Values Core Values Business CultureAs it turns out, the passenger that wrote the letter was a frequent flyer of the airline. Surely a customer the airline wants to keep. Right? So how did the CEO respond?

“We’ll miss you” and added, “Rest assured that this company, like all good airlines, take safety very, very seriously.”

Most CEOs would have probably sent an apology letter saying things like it was not their intention to offend her; he’d look into to the matter; they value her opinion and appreciate her business. But not Southwest airline’s CEO.

What Can We Learn From The CEO’s Response?

There are many lessons in the Southwest story we can glean and apply to our practices. However, among the most valuable lesson for me, is the importance of having a set of defined core values.

Why Are Core Values Important?

Core values are used to establish a company’s guiding principles. They serve the distinct purpose of determining behavior and action.

Without core values, employees do not know what is right from wrong. Therefore, they have no choice but to make decisions based on their values. Which, of course, may or may not align with the company’s values.

However, when a business establishes them, they assist in determining the right path. Moreover, they give employees a reference in fulfilling business goals.

Southwest Airline’s Core Value

Embedded into Southwest’s company culture, is a set of core values. Here is how they define it for their employees:

We believe in Living the Southwest Way, which is to have a Warrior Spirit, a Servant’s Heart, and a Fun-LUVing Attitude.

No Apologies

For Southwest, working hard and playing harder is one of the company’s guiding principle. Fun is part of what the airline is all about. That is why the CEO did not apologize on behalf of the employees. The employees were embracing one of the company’s unwavering value.

Core Value For Salud Pediatrics

One of our practice’s cornerstone principles is profitability. This may seem obvious or inherent knowledge considering our practice is a small business.

But for us, profit is a core value because our financial gains are the driving force behind our ability to fulfill our mission to advocate and care for children in our community.

In other words, profitability is essential to our ability to provide health care services. Without it, we would not be able to stay open. Thus profitability is a responsibility to the community we serve, not merely a requirement for our business.

Prepared To Lose A Patient

Recently, a parent from our practice questioned our policy that requires patients to leave a credit card on file with our practice.

After explaining the reason for the policy and addressing her concerns about identity theft, the mom was still apprehensive.

I told her that her concerns were legitimate and that I understood where she was coming from, but that the policy was non-negotiable. I explained to mom that we felt so strong about the importance of the credit card policy, that we were willing to lose her family as patients.

Policies & Procedures vs. Core Values

We all have rules in place. Even Southwest, with their FUN-Luving attitude, has them. Going through the pre-flight safety announcements is one of many, I’m sure.

Having systems in place ensure efficiency and safety, among other things. But It is impossible to come up with a scheme for every single potential situation. There will always be situations that fall outside of the “policy.”

Core values, however, can be used in situations that fall outside the parameters of policies and procedures.

Does your practice have a core value statement?

If so, what does it say? Are you prepared to lose patients over it?

 


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21 Questions To Put You and Your Medical Practice Back On Track

Things have changed since the beginning. You are now so wrapped up in the day to day that you’ve lost your North, your purpose, your original destination.

It used not to be this way, but it seems like the practice has lost its focus.

Screen Shot 2015-01-09 at 6.02.01 PMLosing focus was not intentional. You started out with a clear vision, worked out the details and began. You remained disciplined and consistent. You were not distracted easily, you kept an eye on the ball and made sure things were addressed effectively and efficiently.

However, along came bumps on the road, mishaps, unforeseen circumstances, misunderstandings, performance issues, competition, reduction in payments and the vision, the original purpose, got buried.

Now, there is so much stuff going on, so many fires to put out, that you only have time to focus on the immediate, the urgent. No time to step back and re-assess. Not even enough time to align priorities or the important.

IS THIS YOU?

I do not know about you, but we’ve been there as a practice. We’ve felt before as if the practice has lost its north. My guess is that if you practice has been around for some time; you can relate. In fact, whether in the medical field or otherwise, many companies go through similar challenges.

Early in 2008, Howard Schultz, founder of Starbucks, is on record saying he felt the company had veered off its original path and as a result, he announced he was returning as CEO.

Steve Jobs’ return to Apple in 1995 was motivated by similar reasons. The company had spent the previous 10-years drifting and was on the brink of bankruptcy. The board brought Jobs back to realign the organization and restore it to its original innovated breakthrough company it once was.

HOW TO GET BACK ON TRACK?

Like Rocky Balboa returning to the old neighborhood after being defeated, we thought it was best to go back to the early days of the practice to get us back on track. We went back with the purpose to recall the essence of our practice.

However, merely remembering the old days was not enough. So we took the time to draft questions that would remind us of our north, but also is identify priorities and determine next best steps.

Below you will find 20 questions we wrote to help us gain the clarity and the insight that would lead us back on the correct path.

  1. In one sentence, what exactly is it that your practice provides (take care of patients is not a valid answer. Dig deeper to find the essence of what your practice offers)?
  2. Why do you/we come to work every day?
  3. In one sentence, why do parents bring their kids to the practice?
  4. If you closed your doors to the practice tomorrow, would anybody notice?
  5. Who would be most likely to miss you?
  6. What is one thing that is is preventing your practice to accommodate more patients?
  7. What is the one thing that is preventing the practice to have a full schedule?
  8. If you could ask a parent just one question about your practice, what would that question be?
  9. If your practice’s revenue stream suddenly stopped today, how many days would you have before you run out of money?
  10. If someone unexpectedly handed you $250,000 what would you do with it?
  11. If you were forced to hire someone today, who would you hire?
  12. What would you need to do, to ensure, the new hire contributes enough revenue to cover their expense?
  13. If you were forced to hire another person tomorrow, who would you hire?
  14. What was different about the person you had to hire immediately versus the person that you had to hire the next day? In other words, why was the first hire first and not the other way around?
  15. If you had no choice, which department in your practice would you outsource and why?
  16. Which employee would make your stomach sink if they gave you a 2-week notice.
  17. Alternatively, which employee would make you say “yes!” if they gave you their notice?
  18. If you have two columns on a piece of paper, one labeled urgent, and the other important, what would you write in each column?
  19. If you could get one solid hour with a guru you respect, what would you discuss?
  20. How would you define a great day in the office?
  21. What is it exactly that is preventing you from having a great day, every day, in the office?

ONWARD

I am sure there are many ways to jolt a company back on course, however in my experience, businesses that have lost their way, veered off their mission or forgot their purpose regain it by asking critical questions.

Asking the right questions lead organizations to put their current circumstances into perspective, prioritize issues and determine what is the next-best-step for the organization.

For us, the questions did not answer all of our problems. The questions did not immediately place us back on track. However, they led us to admit things we had been neglecting, brought awareness to the tough decisions we were avoiding and in several instances, helped us decide to abandon projects because they were not in alignment with our practice’s vision.


 

Can you think of another question that would fit with the list that I have? What would you add? Also, if you experienced something similar, I’d love to hear your story.

How Well Do Parents Know What You Do As a Pediatrician?

It’s hard to appreciate the value that pediatricians provide when one is not aware of exactly what it is that pediatricians do.

During the summer months, I posted on our practice’s Facebook page, a note encouraging parents, to schedule their children’s wellness visits.

Although the message was for our entire Facebook community, I wanted to catch the eye of parents with teenagers. Don’t know how well you manage teens in your office, but in our office, we have decent wellness visit numbers with younger patients. The teen population?

Not so much. Once the teen years kick in, we mostly see them when they are sick.Screen Shot 2016-02-26 at 11.48.51 AM

I wanted to encourage parents to make their wellness visits but also throw in a subtle nudge to parents with teens.To get their attention, I opened with this line: Did you know pediatricians are trained to treat children from birth to adolescence? Then I went on to talk about the importance of wellness visits etc.

Something interesting happened. The post outperformed other Facebook post. It received more likes that than the ordinary. But that the surprise me. What surprised me the most, were the comments from parents.

One mom said, “it’s good to know the pediatrician can see my teen.”

Another said, ” Timothy is going to be so happy when I tell him Dr. B can still see him.”

WHAT WAS THE LESSON?

It’s an age-old lesson. It’s a lesson on assumptions and what happens when we make them.

That simple, otherwise ordinary status update, got me thinking about how well (or not) we communicate what it is that we do as pediatricians. If so many people weren’t aware that pediatricians can treat teens and beyond (0-21), what else don’t they know? The irony is that our website is tagged with the line “Pediatric & Adolescent Medicine.”

OPPORTUNITY

We clearly have a communication problem. And I would argue that our lack of proper communication about what it is we do as pediatricians (more than runny noses and giving shots) is why many parents don’t see the distinction between a retail clinic and a pediatrician.


 

It’s hard to appreciate the value that pediatricians provide when one is not aware of exactly what it is that pediatricians do.

 


 

The good news is that there is a significant opportunity for pediatricians to cover a lot of ground. How so? By using social media channels to educate our community about all the great services we are trained to provide.

I also believe that leveraging this opportunity could aid your practice in differentiating itself from the competition.

WHAT IS YOUR COMMUNICATION STRATEGY?

Since I realized there was a chasm between our assumptions and the reality, I’ve been intentional about informing our community about the training, knowledge and expertise our pediatricians can address.

Some of it may seem too obvious for those of us that do this every day. Like explaining the importance of wellness visits.

But the truth is, some parents don’t know about yearly wellness visits. They assume that because the child no longer needs shots, they don’t need to go to the doctor.

Beyond promoting wellness visits, I use many of the things included in the Bright Futures guidelines as a way to highlight that a visit to the pediatricians is highly comprehensive.

And by educating our population, I’m also marketing our practice in a unique way. Instead of mentioning in a promotional piece that we accept most insurance plans, I may mention that how we can provide family support, safety and injury prevention, or mental health.

MARKETING STRATEGY

Not only is promoting and sharing this information relevant and valuable to parents, but I also think it is an excellent way to differentiate ourselves from the MinuteClinics or other medical services that overlap with pediatrics (i.e. Urgent Centers, Family Practice, Telemedicine).

YOUR CHALLENGE

Think about your medical practice’s communication strategy, or lack thereof. What is your practices unique selling proposition? What problems do you solve that others don’t? Then think about how best to communicate your message. Also, consider the channels you’ll be delivering your message. By channels I mean, traditional advertising, email campaigns, social media, etc.

Remember, each channel is unique, thus requires you to craft the message differently.

I’ll leave you with this… times are changing. That is certain. And we have two options, two paths to choose from. Disagree with how things are changing, or find ways to agree with the shifts in a way that benefits you and your practice.

Let’s Talk About What Happened In Vegas

My friends from the Pediatric Management Institute (PMI) put on another great practice management conference in Las Vegas last January.Screen Shot 2016-02-21 at 10.55.37 AM

The content was excellent, thanks to the fabulous faculty PMI brought in.

The topics varied from customer service principles to fundamental changes happening in the health insurance industry and how those changes are – or soon will be – affecting doctors’ financial bottom line.

Below are a few highlights and notable points that resonated with me.

ANCILLARY SERVICES | INCOME DIVERSIFICATION

Dr. Jeanne Marconi presented an account of how her practice diversifies income streams by incorporating ancillary services into her practice.

Admittedly Dr. Marconi’s comprehensive – almost overwhelming – plethora of services (they even offer in-house exercise training programs for children with high BMI) is probably too much for the standard practice to implement.

But for me, her talk wasn’t an invitation to follow her footsteps, but instead, provide insight into what is possible, what can be done and what is available to practices.

Dr. Marconi dished out several challenges to the physicians in the crowd. But the one that resonated with me the most was her call for pediatric practices to challenge the status quo, expand their minds, think creatively (or to use a cliche, think outside the box) and begin to think about ways to diversify practice’s revenue streams.

HOW HEALTH INSURANCE COMPANIES ARE PAYING DOCTORS

Susanne Madden arrived in Vegas with her extensive knowledge and expertise of the health insurance industry.

Screen Shot 2016-02-21 at 11.10.10 AM
Dr. Jeanne Marconi and Susanne Madden

She presented attendees the sobering reality of how health insurance companies are adjusting, changing – even experimenting in some cases – with their models to continue delivering value to “their” shareholders. And by value, she means lower cost and higher profits.

Susanne underscored the importance of implementing quality measures such as P4P, HEIDIS, PCMH into our medical practices. But not for the reasons you might think.

While many of these health insurance programs are currently in place as rewards (e.g., enhanced or incentive payments) for medical practices that achieve quality measures thresholds in patient care, Susanne highlighted that these programs will soon become a requirement for practices.

What does this mean exactly? Insurance companies will soon stop offering enhanced payments programs to practices for achieving PCMH level III certification (or other types of incentives). Instead, they will reduce payments to doctors don’t meet PCMH certification.

As if that wasn’t bad enough, she added that many payers are evaluating providers based on how much the provider costs the company in benefits payouts.

How is that different than what they do now?

The difference is that they are not looking at the practice as a whole, but rather evaluating each provider individually.

The implications are that if you have physicians in your practice that don’t adhere to designated quality standards, payors can potentially pay each doctor in the practice different amounts.

HOW MUCH CAN WE AFFORD TO PAY AN EMPLOYED PROVIDER?

PMI’s very own Paul Vanchiere gave two of his hallmark presentations. The first one focused on customer service using the acronym KIDS (Kindness, Integrity, Dignity & Service).

His second talk was my favorite. Why? Because Paul took a complicated, MBA, executive consulting level exercise (determining how much can your practice afford to pay an employed provider) and distilled it into an easy to follow, step-by-step, process, which only requires one to understand a few financial concepts and enter value sets into a spreadsheet.

BROADEN YOUR CODE REPERTUAR

Dr. Rich Lander went over the fundamentals of proper coding. In addition to reviewing the differences between coding Level 2, 3, 4 & 5 for a sick visit, Dr. Lander stressed the importance of documenting “time” correctly in a patient’s chart.

Screen Shot 2016-02-21 at 10.56.21 AM
Joanne Blanchard and Dr. Richard Lander

Dr. Lander shared multiple clinical scenarios that we often encounter with patients. But some of the codes he suggested I wasn’t all too familiar with. I couldn’t recall if we used them.

So I wrote down a reminder to myself to check how well (or not) providers at Salud Pediatrics were using the full scope of codes available.

NO PRESENCE, NO INFLUENCE

Dr. John Moore – a new PMI faculty member – brought us up to speed with some of the new social media trends (Are you familiar with SnapChat and how kids are using it?)

Screen Shot 2016-02-21 at 11.10.19 AM
Dr. John Moore and Paul Vanchiere

One of the points that Dr. Moore articulated that I appreciated the most was the importance for pediatricians to embrace social media.

He said something that I’ve been saying for a long time; which is, had pediatricians adopted social media at a faster clip, the pro-vaccine vs. anti-vaccine arguments would have been balanced. Moreover, there was the potential to stifle the anti-vax movement.

CHANGE IS THE NEW STATUS QUO

You can always count on Chip Hart to deliver great wisdom and insight. Chip also gave two talks.Screen Shot 2016-02-21 at 10.56.11 AM

I’ve heard Chip speak many times, but this time, I felt his talks were different. Chip’s talks had a subtle, tough-love tone to them.

While addressing the challenges practices are facing today, he stressed that pediatricians have faced similar challenges before. He mentioned that during all previous tectonic shifts (aka industry changes) naysayers shouted out the demise of private practices. Much like many are shouting today.

Chip eloquently argued that not only are the doomsayers wrong, but that pediatricians are actually in a better situation than most think.

Chip wasn’t disregarding the challenges or downplaying the potential threats. We are indeed going through tough times. But these tough times were an opportunity to transform and reinvent our practices, he argued.

My takeaway was: If the plan is to defend the status quo and hedge the long-term success of your business on account that you have the initials MD after your name, thus somehow inoculated from change, the end is certainly near for you.

MEETING, CONNECTING, NETWORKING, SOCIAL LEARNING

Attending a seminar like this to learn from the speakers is certainly worth the price and the time. But more often than not, the icing on the cake, at least for me, is the immeasurable, intangible value I glean from networking.

The people who attend these events are the smartest and brightest in my opinion (and I’m not talking about the faculty, although they are good too).

Whether attendees are veterans in managing practices or opened their first private practices last week and believe they have no clue what they are doing, the truth is, there is opportunity to learn from everybody.

The faculty makes the trip worthwhile. But I would say the attendees make the event special.

Next year I hope to see you there. Especially if you didn’t get a chance to attend this year.

Place: New Orleans
Dates: Jan 27-28th 2017

 

10 Questions You Need To Ask Before Starting A Project To Ensure Success

The best strategy one can embrace before beginning a project is to gain clarity on the task at hand. And with these 10-questions, you’ll gain the perspective required to ensure your project gets off to the right start.

Imagine all of the sudden you decide to go on a camping trip. So you round up your spouse and the kids, jump in the car and head out. No supplies, no route, camping equipment, site, food or proper clothes. When asked about all these things, you respond by saying, “We’ll figure it out as we go along.”

I’m no camping expert, but I know that this is a silly way to go about camping. Talk about a recipe for disaster.

Screen Shot 2015-08-30 at 4.17.50 PMBut here is the thing… even though most people would never go on a camping trip without determining a site beforehand, planning out the best route, deciding how much food they’ll we need to take and how many days they will stay, I’ve seen first-hand many practices that have embarked on more than one project with the same carelessness.

“What is the plan for the transition?” 

“Too busy right now. We’ll figure it out as we go.” 

I’m no project management expert, but that is a silly way to about conducting a project at one’s practice. No wonder many projects end up taking longer, are more expensive and cause more headaches than expected.

To get a better understanding of the project, we should ask ourselves these questions:

1 – What is the project?

It is important to write down the project because writing it down actually means something. If you have it in your head, you don’t really have a project. You just have an idea.

2 – When is it due?

The more specific, the better.

3 – Who is responsible for this project to succeed?

You can add all the team members, but ultimately, there has to be somebody that is THE responsible person.
Who is your customer?

4 – List the names of people that you are trying to please.

It could be your boss, your patients, your parents, voters, the board of directors or anybody else. It is important to list them because there is a good chance that you might lose sight of why you are doing this project. And when you do, it is helpful to know who you are doing this project for.

5 – Who are the authorities, influencers and gatekeepers?

List all those names under this question. These are the people that actually matter. Everybody else, you can ignore.

6 – Who is essential to the success of your project?

In every project, there are always key people that must embrace the project for it to succeed. List the individuals or committees or groups of people.

7 – What does perfect look like?

Often times, we start out a project without really thinking about what the end results is supposed to look like. Consequently, we lose direction. For this question, it is important to be as specific as possible.

8 – What does failure look like?

Failure is an important aspect of project that one must consider. For starters, failure is almost a sure thing. Thus, understanding what it looks like helps one steer away from it.

9 – How would you plus it?

Here is the stuff you put down when one says, “you know what would be cool?” List 5 or 10 things that would make your project that much better.

10 – How would you minus it?

Just like adding little things to make your project a little better, there are other things that you ought to consider that don’t add anything to the project. These are the things that if you take away from your project, you will actually improve it.

The best strategy one can embrace before beginning a project is to gain clarity on the task at hand. And with these 10-questions, you’ll gain the perspective required to ensure your project gets off to the right start.

Seven Reasons Why You Don’t Want To Miss This Pediatrics Practice Management Seminar

My friends at the Pediatric Practice Management Institute (PMI) have an awesome seminar that you don’t want to miss.

Why should you not miss it?

Glad you asked.

I have lucky number 7 reasons why you should not miss this seminar.

OAK.0021 – YOU’LL BE AWESOMER

I know awesomer is not a word. But it gets’s the point across. Here is the deal, no matter how experienced you are at managing a practice, there is always something new you can learn.

2 – YOU’LL LEARN NEW IDEAS

Managing a private practice can be a lonely world. There aren’t that many of us. And most of the time we are locked up in a back room (used for both your office and storage) trying to figure out how to keep the ship afloat.

Without exposure to a variety of points of view, you will miss new ideas and trends that can impact future results.

3 – YOU’LL GAIN EXPOSURE

Paul and his team at PMI have put together a superb curriculum. The educational materials will certainly expose you to new ways of managing your business (e.g., private medical practice) and help you discover how to be more productive.

4 – YOU’LL MEET COOL & INTERESTING PEOPLE

Here is the way I see it. The practices that tend to go to practice management seminars are precisely the practices I want to learn from. And PMI’s seminar provides a great opportunity to network with the best practice in the country.

5 – TALK TO CONSULTANTS AND VENDORS

Not only will you have access to a community of like-minded people that have similar struggles, have similar challenges and practical, hands-on advice, suggestions, and solutions, you will also have access to the industries top consultants.

Don’t tell them I said this, but if you ask the right questions, to say… Chip Hart, I bet you, you’ll get thousands of dollars worth of practice management advice for <ahem> free.

Keep in mind that experts in the field are some of the best people for you to get to know if you want to learn more about the current health care business climate as it relates to small, private, independent, pediatric practices.

6 – YOU’LL DISCOVER

You will undoubtedly discover innovative ways to help your practice remain competitive in today’s fast-paced, hectic private-practice.

7 – IT’S VEGAS BABAY (NOT A TYPO)

Did I mention it was in Vegas?

All work and no play can get old fast. PMI’s conference can add a layer of enjoyment to managing your career growth by mixing a social aspect into your learning and industry branding efforts.

Never underestimate the power of a little fun mixed with some interesting people!

BUT THAT IS NOT ALL

Use the promo code “PediInc” and save $75 off your conference fee.

Conference Details:

  • WhenFriday, January 29, 2016 at 2:00 PM –  Saturday, January 30, 2016 at 5:00 PM (PST)
  • WhereTropicana- Las Vegas
  • Sign Up: Click on the Eventbrite logo below to sign up

https://www.eventbrite.com/e/pediatric-practice-management-conference-las-vegas-tickets-18689205918?ref=ecount

Don’t forget to use the promo code PediInc to get $75 off

Are You Following These 10-Steps Before Terminating A Physician- Patient Relationship?

This post was originally published on the Verden Group’s Blog. Written by Sumita Saxena, Senior Consultant, The Verden Group

It unfortunately can happen to anyone: You go above and beyond to provide your patients excellent care with uncompromising accessibility, and yet something somewhere goes wrong and the relationship quickly deteriorates.

Screen Shot 2015-08-29 at 12.13.02 PMAfter trying your best to mend the problem it becomes clear – the relationship has broken down beyond repair and for whatever reason you reach the tough decision to terminate the patient from the practice.

Before you act and send notice, please take a look at some helpful steps we have compiled for you to consider as you navigate this difficult subject.

Step One: Try to Work It Out With Your Patient.

Practically speaking, when faced with a difficult patient situation, the best course of action is to avoid a unilateral termination of the physician/patient relationship by addressing the problem quickly.

Communication is the key.

The patient should be advised of the situation and given a reasonable opportunity to correct the problem. You should make it clear that failure to correct the problem may result in the dismissal of the patient from the practice.

Step Two: Review the Applicable State Medical Licensing Rules.

State licensing boards govern the practice of medicine and the relationship between a physician licensed in that state and his or her patients. Accordingly, it is essential to review the medical board rules carefully before you terminate a patient from your practice.

Step Three: Consider AMA Guidance. 

The American Medical Association (the “AMA”) has provided guidance on terminating the physician/patient relationship. According to the AMA’s Code of Medical Ethics, physicians have the option of terminating the physician/patient relationship, but they must give sufficient notice of withdrawal to the patient, relatives, or responsible friends and guardians to allow another physician to be secured.

The AMA recognizes that there are times when a physician may no longer be able to provide care to a certain patient, including when the patient refuses to comply, is unreasonably demanding, threatens the physician or staff, or otherwise is contributing to a breakdown of the physician/patient relationship.

According to the AMA, terminating a physician/patient relationship is ethical as long as the proper procedures are followed.
The AMA has given the following advice for the termination process:

  • Giving the patient written notice, preferably by certified mail, return receipt requested;
    Providing the patient with a brief explanation for terminating the relationship (this should be a valid reason, for instance non-compliance, failure to keep appointments);
  • Agreeing to continue to provide treatment and access to services for a reasonable period of time, such as 30 days, to allow a patient to secure care from another person (a physician may want to extend the period for emergency services);
  • Providing resources and/or recommendations to help a patient locate another physician of like specialty; and
  • Offering to transfer records to a newly designated physician upon signed patient authorization to do so. American Medical Association (AMA), “Ending the Patient-Physician Relationship,” http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/ending-patient-physician-relationship.page

Step Four: Check Your Payer Contracts and Policies. 

A physician who is a participating provider (under contract) with the patient’s insurer (commercial or government payer) may be obligated to notify the payer and comply with additional requirements. You should review your provider contract(s) and policies in order to determine if the payer has a policy on patient termination.

For example, some insurance carriers require 60 or 90 days notice before dismissal (as compared to the 30 days notice required pursuant to certain state laws) and some require prior written notice to the carrier to enable the carrier to contact the patient.

There also may be specific requirements concerning pregnant or mental health patients. Medicare, Medicaid, and other government payers have strict policies on terminating a patient that should be reviewed before terminating a governmental plan beneficiary.

Step Five: Review Your Malpractice Carrier Requirements. 

Some medical malpractice insurance carriers have adopted rules or recommendations for terminating the physician/patient relationship. Accordingly, you should review your malpractice policy or contact the malpractice carrier when establishing the procedure for terminating the physician/patient relationship.

Step Six: Send Written Notification to Your Patient.

You should send written notification advising the patient that he or she is terminating the patient relationship. The notification should comply with the licensing board’s rules and the requirements of the applicable payer and the your malpractice carrier. Ideally the patient notification should be prepared or reviewed by experienced counsel before sending to the patient.

Step Seven: Provide Continuity of Care.

You should ensure that you provide the proper continuity of care when dismissing a patient from your practice, including any requirements under state licensing rules, their payer contracts and their malpractice policy. The AMA guidance recommends that the physician provide the patient with resources and referrals for other sources of care.
Step Eight: Do not Charge for Patient Records.

A physician who terminates his or her relationship with a patient should not charge the patient for copying the patient’s medical records.

Step Nine: Consider Risk Management.

Additionally, you should perform a risk management analysis before terminating the physician/patient relationship. You should consider the possibility (even if the patient’s position is without merit and you will ultimately be successful) of patient complaints, disciplinary investigations, litigation, or other action initiated by disgruntled patients.

Step Ten: Establish a Set Policy on Patient Terminations and Train Staff on the Policy.

In order to avoid any potential issues with former patients, the practice should have a set policy in place for the termination of the physician/patient relationship, including a sample termination letter. The policy should be applied to patients consistently and without discrimination. The staff should be trained on the policy and should document compliance with the policy.
By following the above steps you can be proactive and diligent in mitigating your risk if such a situation ever arises with a patient.

A Vital Aspect Of A Medical Practice That Practice Managers Cannot Afford To Overlook

A wise person once said, “a gentle answer deflects anger, but harsh words make tempers flair.” Therefore, the best way to dismantle anger, frustration, disorderly, disruptive or unruly people, is by employing respect, candor and kindness.

When we talk about managing our practices more efficiently, we think about negotiating with insurance companies, proper coding, practice financials, revenue per visit, E&M code distributions and a bunch of other objective things.

I find it interesting, however, that we put so much focus on maximizing revenue and minimizing cost, but ignore a topic that far consumes our time. And arguably is more important to the “health” of a pediatric practice than the things we consider “best-practices.”

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The topic I’m referring to is “people.” Specifically employee and parent/patient interactions.

Poorly managing how people interact with one another can have far-reaching consequences and be far more devastating than say, a bad payor contract. But how much time do we spend on honing interaction with people of our practices?

Medical practices revolve around people. We all know that we spend more time with co-workers than we do with our families. And due to the nature of our business we are engaging with people hundreds of times a day.

Most of these interactions go without notice, but many result in conflict. And the ones that result in a conflict (all it takes is just one) carry the potential to rip through the fabric of your practice.

LET’S TALK ABOUT A CONFLICT FREE WORKPLACE

The unhealthy tension in a workplace is disruptive and highly counterproductive. Unresolved conflict ruins a company culture. And a weak company culture is like a bad cough. You can’t hide it.

Consequently, addressing tension in the workplace is just as important if you want your practice environment to be a collaborative, mission-driven, high performing practice.

HERE IS WHY THIS MATTERS TO YOU AND YOUR PRACTICE

Happy employees enhance the company’s culture. Content, conflict free employees make for a better workplace, as well as create a pleasant experience for parents/patients visiting the practice.

All this translates to patient/parent satisfaction.

TIME TO EXAMINE

Now, think about how your practice employee treat unruly parents? Does you or staff become defensive or perhaps condescending? Do you unintentionally patronize them using tone, language or body language?

How about coworkers or your practice partners? During conflicts, do you push back as hard or harder as they push you? Are you passive aggressive? Do you have contempt for them? Are there harbored resentments, unaddressed conflicts, unsettled disputes?

THE FIRST STEP

Now, disagreements, arguments, tension, miscommunications, hurt feelings, etc. are unavoidable. The only way to eliminate those kinds of issues is to live by yourself (and even then you have to deal with yourself). We will always have issues with parents, co-workers, partners, and vendors. It’s just part of working with people.

But the key to a conflict-free workplace lies in how each of us reacts to the tension.

Our behavior during or after the conflict will ultimately determine if the issue perpetuates or is resolved.
Think about someone you don’t like. It could be a co-worker or even a relative. Now think about how your behavior is affecting the relationship. Is your behavior making things better or worse?

THE SECOND STEP

When things get emotional and, conversations go from casual to critical, the worst of us usually comes out. Pushing back starts us down a bad path that is often hard to recover from.

We know that being defensive, condescending -or my favorite, sarcastic- doesn’t lead to a path of resolution. But these three things do set us up on the right path:

Respect, Candor & Kindness

Sounds simple. Too simple in fact. But what is the alternative?

A wise person once said, “a gentle answer deflects anger, but harsh words make tempers flair.” Therefore, the best way to dismantle anger, frustration, disorderly, disruptive or unruly people, is by employing respect, candor and kindness.

I’m not suggesting this is easy. Some people get on our nerves. You may even feel the urge to provide too much candor. Other situations are unfair and responding with respect and kindness is difficult. And the truth is some don’t deserve your respect.

But even so, fighting fire with fire doesn’t make things better. But fighting fire with water gives us a chance to resolve.

So the next time things start to get heated with a parent or even a coworker remember, that how we approach a conflict will largely determine the outcome.

Expert Advice Part Deux. What To Look For When Considering Office Space For Your New Clinic

In a recent post, I wrote about what a physician ought to consider when deciding on a site for their new practice. If you missed it, click on the previous post and you will find it.

In this post, we are unpacking practical wisdom as it relates to office space. This wisdom, however doesn’t come from me (I know. Sorry to disappoint). The practical wisdom comes from Dr. David Horowitz.

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Dr Horowitz is a pediatrician in North Carolina. He recently posted the content you are about to read on the AAP’s Section On Administration and Practice Management (SOAPM) listserv.

After reading Dr. Horowitz post, two things came to mind. First thought was, this is great insight. I wish I would have had this advice when we were looking for office space. Second thought, I think Dr. Horowitz has done this a few times.

I reached out to him and asked permission to post his post here on PediatricInc. I don’t need to tell you his answer. Otherwise, I would not have a post.

Below are Dr. Horowitz comments, questions and insight one should have in mind when evaluating office space for a new medical practice. Enjoy.

  1. Do not underestimate square footage. As as with computer hardware, you often need 25-50% more than you think you will.
  2. Will you have room to expand?
  3. How many exam rooms will you get? Peds is a high volume (ideally) practice. 3 exam rooms is probably necessary. If you are fast 4 is better. With a full schedule, 2 will slow you down significantly.
  4. Is the rest of the office kid friendly? Just like you would with your own toddler, you need to look around the office from a kid’s perspective to find hazards.
  5. Are the sharps containers on the counter where the kids can reach them?
  6. Is the trash out of reach in the exam rooms? I have had the situation where a 3 year old got into the red bag trash.
  7. If sharing office space with another doctor, will the clinical staff be competent to deal with kids or will you hire your own?
  8. Is there enough parking for seeing 4-6 kids per hour.
  9. Is the waiting room big enough to accommodate an additional 8-15 people per hour as no kid travels alone.
  10. Vaccine storage space: is there a medical grade refrigerator?
  11. At minimum you need a fridge with a temperature monitor and stable temperature and not one that the staff keep their lunch in.
  12. General storage space: will you have any. This is one area where you need twice as much as you think you do, even though it is expensive on a per sq. ft. basis.
  13. Lab and x-ray availability: is it kid friendly and how far away is it from your office?
  14. Will the billing be handled in-house or will you outsource?
  15. If billing is done in-house, will the biller have a space to work?
  16. EMR vs Paper charts: it is much easier not to have to switch from paper to EMR, but paper sure is cheaper up front when one is starting out and income may be an issue. This means you need room for charts.
  17. If you go with EMR, does the office have the needed speed for data transfer and adequate wireless set up?

Thanks Dr. Horowitz for your insights. Even though this list isn’t meant to be comprehensive, I think it provides valuable, practical and shovel ready (as they say) advice.


Do you have anything to add to this list? What are some of the pitfalls you encountered that may help others steer clear as they begin this journey?