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.
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.
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.
I do hope that you buy the book, but more important, that you find the eBook helpful, useful and valuable.
I have lucky number 7 reasons why you should not miss this seminar.
1 – 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.
When: Friday, January 29, 2016 at 2:00 PM – Saturday, January 30, 2016 at 5:00 PM (PST)
Where: Tropicana- Las Vegas
Sign Up:Click on the Eventbrite logo below to sign up
Don’t forget to use the promo code PediInc to get $75 off
People always ask me if I do practice management consulting.There was a time when I did. But for the past two or so years, I’ve responded by saying no. I enjoy consulting and love to do it, but I had to stop because of the time commitment.
Recently, I was talking with a loyal reader of PediatricInc about this very topic and she suggested I do remote coaching.
My friend, who owns her practice, explained that she doesn’t necessarily need a comprehensive on-site consult. “I just want to ask a question about my practice or run things by someone familiar with practice management,” she said.
She went on to say, “…you know doctors don’t get training on business, management, marketing, collections…. having somebody to reach out to that has the business and practice management training would be valuable.”
“Like a practice management coach?” I asked. And she said, “ yeah, that is a good way to put it.”
We talked a little while longer. By the time we finished up, my loyal reader and friend had convinced me.
Today I’m announcing a new service on PediatricInc called PMB Coaching for those pediatricians and/or managers that want my perspective on practice management, discuss in detail a blog post, run something by me or provide another set of eyes.
Chip and I have been traveling. We’ve also been extremely busy at each one of our jobs. So finding the time to schedule the AwesomeCast has been difficult. But we finally found some time to talk about a few things.
In this episode, you’ll hear about a recent trip I made to the East Coast where I visited several practices. The purpose of my trip was to observe and learn. I wanted to observe first hand how these practices functioned. Things like how many staff members they had and each person’s role, explore how practices used their EMR and PM systems to improve work flow, as well as how they’ve incorporated other services into the practice among other things.
I don’t answer these questions in the podcast, but rather discuss with Chip why I thought it was a good idea to make this trip and describe some of the immediate benefits as a result of my tour.
Today on the AwesomeCast, we had the pleasure to talk to Dr. Robin Warner.
Dr Warner is a solo doc outside of Cleveland. Chip and I were interested in talking to Dr. Warner for several reasons. For starters, we wanted to learn about her experience as a solo doc. We also uncovered some interesting patterns that I think are great lessons for those of us that have smaller practices.
Dr. Warner also shared a project she has been working on that I think is absolutely brilliant. Here is a hint… she is embracing the smartphone craze, leveraging people’s attraction to on-line games and using it to provide deliver awesome pediatric medicine.
Stick to the end of the PodCast. There are a lot of nuggets that if you aren’t paying attention, you’ll miss.
For today’s AwesomeCast, we get to talk to Dr. George Rogu. If you have spent time on SOAPM, you know who Dr. Rogu is. A troublemaker. That is right. For those of you that don’t know, Dr. Rogu works for RBK Pediatrics in Long Island, NY.
I think this episode is going to be one of my favorite episodes of all time. I learn so much from Dr. Rogu. I even took notes. Dr. Rogu shares with us his experience negotiating with big payers. You will not want to miss the technique he used to pester executives at the insurance company and how one day he got a call from the insurance company executives asking him to tell his patients to stop calling them. He also gives great advice on how to prepare and execute contract negotiations with insurance payers.
We also spent time talking about technology and the approach Dr. Rogu has taken in order to find the best of the best as it relates to technology.
It is a great AwesomeCast. You should definitely listen or watch the YouTube video below. I think you’ll want to take notes on this one.
To listen to the AwesomeCast, click below.
You can also download the audio version of the episode on iTunes
Meaningful Use and ARRA have brought a huge interest in practices adoption Electronic Medical Records for the very first time. But there is also large number of practices that are in the process of going through the process of switching to their second EMR.
In fact, our practice is one of those practices ready to make the transition.
Chip and I thought it would be good idea to talk to somebody that has gone through the transition and learn a little more about how this process works, what are some of the considerations we must remember not to forget, and a few lessons learned.
Today, our special guest is Dr. Seth Kaplan, who transitioned from his original EHR and tells us about the lessons he learned.
We have a fairly wide-ranging discussion, but there is some focus on a popular issue, the “credit-card-on-file” topic. We also touch on practice independence, insurance contract negotiation, and more. There is some real gold here! Make sure you visit ManageMyPractice.com while you are at it!
As always, you can find our discussions in many ways:
Software demos are notoriously biased. EMR representative will generally show you the stuff that works really well. They will show you the stuff that will make you say, ooh, aaah.
Nothing wrong with that. When I’m showing something off, I want to share the best of what I have too.
But one of our main jobs as leaders of our medical practices, is to shift through the nonsense and get to the nitty gritty.
So how do we know, from a practical stand point, that the software we are evaluating can handle real world examples?
The best way to understand if a piece of software will work for you is to see it in action. Not from a representative’s point of view, but from a practice point of view.
I know what you are thinking… but I don’t know what questions to ask the EMR rep that will help me get a practical sense of how the EMR works.
Wonder no more. Suzanne Berman, MD, SOAPM member extraordinaire, wrote down 11 Questions that I think will really put an EMR through a ringer. As you will see from her questions, she emphasizes the importance of seeing how the system performs extracting data.
Take a look at these questions and have them ready the next time you meet with an EMR vendor.
“Show me how I recall all asthmatics who haven’t had a spirometry in >6 months.”
“The next time this family calls or comes in, SOMEONE needs to get a correct mailing address. Please mark the chart on all the siblings so it will alert the next time someone opens the chart.”
“Show me all patients who are behind on their checkups.”
“Which of our patients don’t have a current Framitz Flopulitz form on file?”
“I need to pre-order my flu vaccine for next year. I need a breakdown of how many VFC vs payable kids, 6 to 36 months vs big kids we had last year and how many shots/mist we gave; then I need this year’s numbers to extrapolate.”
“I saw a kid with something like this last year — the specialist recommended a great treatment regimen, that I’d like to try again. Nuts, can’t remember that kid’s name. I do remember charting “Spoke with Dr. Matheson” — the specialist. How can I look through all the charts for a teenage girl seen in 2011 where the phrase “Spoke with Dr. Matheson” appears?
Me, Dr. Speedy, and Dr. Talksalot are all vying for a limited number of shared exam rooms. Which of us a) has the most visits; b) runs on time vs. behind; c) has the most patients in the office at once [i.e. does the most double/triple sib appts]?”
“How many active patients do I have? Exclude cross-cover patients, patients who’ve transferred, patients who we discharged, and patients we haven’t seen in X months. Oh yeah, and please show age distribution.”
“How do I mark this kid’s chart as “African-American child adopted by Caucasian couple — do not ask “are you mom?” when family comes in — sensitive issue” so my receptionists stop putting their foot in their mouths?
“I’m doing a sick and a well visit on the same day. Where do I chart the different bits?”
“How can I find all kids who got vaccinated with Lot X? The mfr is recalling that lot.”
Of course you are free to add your own questions based on situations you’ve encountered. Oh, and don’t assume this is all the due diligence you have to do. Search the web. There are tons of articles that can help you with this process as well.
Lastly, I’d like to mention that data input is also important. The program ought to feel intuitive and easy to input data into. But don’t forget the data output. This is often an overlooked aspect of the EMR evaluation.
What question or request would you add to this list?
Dr. Suzanne Berman is a general pediatrician in private practice in Crossville, Tennessee. Her family works, lives, goes to school, worships, and buys stuff from Walmart all within the 38555 zip code. Dr. Berman is a regular contributor to the Survivor Pediatrics blog. To read all her post, click here.
For this post, we are going to be looking at how we can leverage what we already know from our experience of implementing and managing an EMR system in our office.
If you missed the previous post, scroll back or click on this link.
Chip, for those of us that are thinking about replacing our EMR, surely we can take advantage of the lessons we’ve learned and use them during this transiton, right? What are some of those lessons?
Take advantage of the fact that you should have suffered through the learning process of managing your IT infrastructure at this point. If your remote office connection is finally broad enough, you’ve nailed down the tablets you like to use, and your wireless interference issues are resolved, your second EHR experience will benefit greatly as a result.
If it happens that you still have significant hardware or networking problems with your existing EHR, you should make every effort to resolve them before your new EHR is in place or you will drag your bad experience into the new world.
Now that I’ve figured out my wireless challenges and hardware needs, what is next in terms of leveraging our experience?
When you migrated to your first EHR, you had to answer important questions about the flow of people through your office, many of them for the first time. How do we get paper into the EHR? How do we find our nurses? How do we manage orders? Who is in charge of our clinical protocols?
Use this understanding to your advantage and identify how your new EHR will fit into your existing patterns.
Work flow needs, check. What else?
This time around, you know how much and what kind of training you need. Chances are that you didn’t get enough training the first time around. Or that you had access to sufficient training but not everyone – particularly the doctors – took advantage of it. Recall how your first EHR on-line went and mandate full training for the new EHR.
No matter how cool the new EMR appears, there seems to always be featrues that the docs love in the old EMR that the new EMR doesn’t have. What can we do about that?
Every EHR has features in it that the users love, even if the balance of the EHR feature set is negative. Isolate those few features you can’t imagine living without and discuss them with your new vendor. Perhaps the new EHR has a similar or even better feature set.
The real trap to look for here are those features that have become a definitive part of the flow in your office that will no longer exist, for better or worse. You will need to figure out how to redirect the flow in your office before you go on-line.
One of the things that bores me to tears in business, is having to read contracts. But of course, contracts are very important. Especially the ones you have to sign. Talk a little bit about what to look for in our new contract with our new EMR vendor?
Your last EHR contract may have made things difficult. If there are any terms from your existing EHR client that made things difficult for your practice, such as the inability to extract data from your own EHR, now is your chance to do it right.
All this time we’ve been talking about the EMR, but what about the practice management system?
The often overlooked project in any EHR installation is the relationship with the billing process. At the very least, all of the questions you’ve addressed relating to your EHR need to be addressed, again, with your PM. Will you need to change PMS? Do you have new third party relationships to manage (such as a clearinghouse)? Are there features of your PMS that you can’t live without or will require significant retooling once it changes?
Too many practices overlook the impact of a system change on the most important department in the office.
I hope you found this discussion useful. By the way, I know Chip tried very hard to keep this discussion vendor agnostic. If you work for an EMR vendor or have switched EMRs and have something to add or correct Chip on, feel free to drop me a note.