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.

Here Is Why You Can’t Afford To Miss The Next Practice Management Seminar

Last weekend I had the privilege to present at the Pediatric Management Institute (PMI) seminar in Oakland, CA. It was the first time presenting at a PMI event. Paul Vanchiere and his team put together a great seminar.OAK.001Not only were the topics informative and relevant, but the speakers did an awesome job of presenting the material in practical ways. Dr. Richard Tuck, such as, presented on various coding topics including ICD-10. Tough assignment. But he made it work.Dr. Nelson Branco gave attendees a look a different emerging pediatric models, Chip Hart walked us through the process of setting up a practice’s fee schedule, Sumita Saxena from the Verden Group gave us a lot to think about with regards to potential legal pitfalls in areas like human resources and PMI’s very own Paul Vanchiere covered a couple of topics, one of which was budgeting.Best of all? Seeing 65+ doctors, office and practice managers eager and enthusiastic to learn, explore, discuss and share ideas. As I caught up with old friends and met new one, it was clear that times are indeed challenging. But in spite of all the different issues independent practices are confronted with (e.g. hospital consolidations, large networks getting larger, acquisition, managed care, rise in hospital employed physicians), one thing was for certain; nobody in attendance was there to defend the status quo.

OAK.002I heard a lot of great stories. From a young physician that decided to open up her own solo practice so that she can, among other things, practice pediatrics on her own terms, to the group of practices in Chicago that decided to band together to form a super group to leverage the administrative synergies that come from working under one entity. These are just two examples of many.

There was one bad thing about the seminar that I can’t keep to myself. And that is, there weren’t enough pediatricians (and their staff) in attendance.

I think a seminar as rich as the one PMI put together ought to have been attended by thousands of pediatricians.

Why? Because the need for pediatricians and their staff to learn how to manage their practices better or as I like to called it, learn the business of pediatric, is more important than ever before.

OAK.003It goes without saying that just because your business is a medical practice you won’t be affected by the same market dynamics that other business have. But unlike other businesses, the stakes are higher for pediatricians.

Why? Because our customers (parents and patients) are depending on us to succeed. Otherwise, who is going to give the personalized, here-we-know-your-name type of care they’ve grown accustomed to?

The truth is it will be difficult to succeed staying on cruise control. The status quo is almost never a great long-term strategy.

If I got a chance to talk to you during the conference, I want to thank you for the inspiration. You’ve renewed my enthusiasm .

OAK.005And for those of you that could have made it but decided not to, I really hope you commit to attend a practice management seminar this year (at the very least, a coding and billing seminar). Your staff, your partners, your patients and the community you serve will be glad you did, even though some of them will never know it.

Until then.

Pediatric Practice Management Seminar You Don’t Want To Miss

The content in many practice management seminars or conferences are either too generic (the one size fits all medical specialty approach) or too specific (subspecialty focused) in my view. As a result, it makes it difficult sometimes to figure out how to apply the lessons from other medical specialties to pediatrics.

If only there was pediatric specific seminar, where everybody in attendance speaks yScreen Shot 2014-11-21 at 10.10.07 AMour language (the language called Pediatrics), are aware of my specific challenges and when I receive advice, tips, suggestions or recommendations, it is provided with in the context of pediatrics. Wouldn’t that be great?

Well, our prayers have been answered.

My friends at the Pediatric Management Institute have put together an awesome line-up of speakers (Disclosure: I’m one of the speakers. But I’m not including myself among the awesome ones), presentations and case studies for a one day seminar in the San Francisco/Oakland area that you will not want to miss.

This one day seminar packs a lot of information. Here’s a glimpse of the topics that will be discussed:

  • Coding, The Basics and Beyond
  • Set Your Practice Prices Fairly and Easily
  • Brave New World: Future Pediatric Models
  • Key Performance Indicators for Pediatric Practices
  • Easy Methods to Collect Patient Balances
  • The 5 Legal Issues To Watch Out For In a Pediatric Practice
  • Top 10 Coding Lost Opportunities
  • Five Concepts to Maximize Your Marketing
  • When to Add Another Provider to Your Practice
  • ICD-10, Ready or Not!
  • Patient Recalls
  • Budgeting for a Pediatric Practice

Whether you are an expert in practice management, employed by a large health organization or just starting to learn about how to properly manage a medical office, this seminar offers a valuable learning opportunity.

But wait… there is more!

The PMI team is holding the seminar at the Holiday Inn & Suites Oakland Hotel Airport , which as the name implies, is right next to the Oakland airport. No need to rent a car or arrange for additional transportation. You’ll be right there. Fly in. Attend the seminar. Fly out.

For a PDF on the topics, speakers, location and date (Saturday January 24, 2015)  click on the link: Pediatric Management Institute Seminar

Psst…. one more thing.

If you use the code “PediatricInc” when you register, you will receive $75 off your registration. How cool is that? This offer is exclusive to PediatricInc readers. Now you can bring someone along and save $150.00. If you bring one more person, you’ll save $225.00… it’s like the gift that keeps on giving. 🙂



A Birthday Celebration


Wanted to take this time and wish everybody a Merry Christmas.

I’m a believer. So for me and my family, this day is a special “birthday” celebration.

For those that don’t share a similar faith, I think it is still worthwhile to embrace the Christmas spirit of love, peace, joy, family, community, friends, sharing and gift giving. All good things on their own.

Until next year.

Earn 2 Free Passes to Attend a Pediatric Practice Management Seminar

Screen Shot 2013-12-15 at 5.41.58 PMDuring last AwesomeCast, Chip and I talked a little about different New Years resolutions that practices could adopt. I shared a few that have been on my plate which focused more on building culture.

Chip had some really good ones. In fact, I wrote down a couple so I would remember to add them to my list.

But one  I thought was especially good that Chip offered was to send staff members to a seminar. 

To learn why this is a good idea, you’ll have to listen to the AwesomeCast. But to participate in our contest, keep on reading.

As it turns out, our buddy Paul Vanchiere from Pediatric Management Institute is putting together several seminars around the country. So Chip offered to give 2 free passes to one of the seminars hosted by the PMI.

Here is what you need to do.

Share your best ideas for your New Years Resolutions and the winner get two (2) free passes to the PMI pediatric practice management seminar of their choice. Head over to Chip’s blog at chipsblog.pcc.com for details about the contest.

For more information about the PMI seminars:

Updated: Illinois Attestation for Medicaid Payment Increase? We Are a Go

Earlier this week, I posted that the State health service of Illinois had not published how doctors could complete the attestation required to qualify for the medicaid payment increase.

Well, the next day I received an email that read:

Dear Illinois Health Connect Providers, The Illinois Department of Healthcare and Family Services has posted a new Provider Notice to the Physicians Provider Notices page. You may also view the Physicians Provider Notices page from the link below. http://www.hfs.illinois.gov/physicians/

Regards, Illinois Health Connect Provider Services Department

The attachment included in the email can be found by clicking on the link: Increased Payment for Primary Care Services

You have until the end of the month to complete the attestation. Don’t delay.

Illinois Attestation for Medicaid Payment Increase? Not Yet

stateAs some of you know, The Affordable Care Act includes a historic investment to expand access to Medicaid for children. As of January 1, Medicaid payment rates are raised to at least Medicare rates for primary care and immunization services.

While this increase is part of existing federal law, eligible pediatricians must sign up to receive it: States may have their own reasonable deadlines for pediatricians to sign up (“self-attest”) for the increase, and many of these deadlines are happening within the next month.

This is awesome, except, the State of Illinois has yet to publish how IL doctors ought to go about getting the payment increase.

I emailed the Scott G. Allen, MS, Executive Director of Illinois Chapter, American Academy of Pediatrics and he emailed me this notice that they sent out to their members.

Dear ICAAP Member:

The email below from the national AAP advises members to self-attest to receive Medicaid payment increases.  Unfortunately, the Illinois Department of Healthcare and Family Services (HFS) has not yet established its guidelines for how providers can self-attest nor announced other details about the rate increases.  So at this point, you will not find information on the AAP or ICAAP web sites, and no action on your part is possible.  However, ICAAP will alert members as soon as HFS has released information on how to self-attest and what the deadline is.  We encourage all members who serve Medicaid clients to apply for these increases.

ICAAP and its partner medical associations have discussed this rate increase and urged HFS to act, at both individual meetings and Medicaid Advisory Committee meetings, beginning last year.  We have made recommendations to them and received some assurances that providers (rather than managed care or other third parties) will directly benefit from the increases, as required by the Centers for Medicare and Medicaid Services.  We have also been told they are making progress in determining rates, attestation processes, and other details but do not expect to receive final information for at least a few more weeks.  Technically, the state has until the end of March to determine and promote its processes.

AAP and ICAAP are actively promoting this because participation and showing a positive impact may be critical to our future to seek an extension on these rate increases.  Unfortunately, the impact of other changes in Illinois – specifically our Medicaid reforms which include moving 50% of the current patients to managed or coordinated care programs in the next two years – may complicate efforts to determine if these rate increases had any impact or positive results.  However, ICAAP generally supports that payment at Medicare levels or higher is more appropriate than our current Medicaid rates and will lead to increased access to quality care for Medicaid patients.

When ICAAP receives additional information, we will let you know.  Recognizing that some of your colleagues may not be members of the Chapter in good standing, and therefore may receive the national AAP email but will not receive this email, please share with others as appropriate.


The ICAAP Executive Committee and Staff

Nothing worse than knowing that the only thing you can do, is do nothing.

Why We Selected Physician’s Computer Company As Our New Practice Management Vendor

We decided to switch our practice management system. We selected Physician’s Computer Company as our new vendor.

I’ve been a fan of PCC since I learned about them and I’ve always said that had we known about them before buying all of our IT, we would of gone with them. But we had made a huge investment in IT before learning about PCC and it didn’t make sense to move things over back then. We were already too vested in our infrastructure to make a drastic transition like that. But as usual, things change and we felt it was time to make the move.

Here is a little back story.

Why I’ve always liked Physician Computer Company

For starters, they have made our business, their single business. Meaning, they are exclusively a pediatric driven organization. Not only that, they’ve been doing pediatrics for 30 years. I think there is something to be said about that.

Because they’ve made pediatrics their business, they know it better than we know it ourselves. Sure, we know our own practice. But they know the business of pediatrics better than we do. There is huge value in that.

Another cool thing that you get when you sign up with PCC, is benchmarking. I like to think of them as the MGMA of the pediatric world. What they do is look at the data from all their [pediatric] customers and use it to benchmark your practice.

As if the benchmarking isn’t cool enough, they are also in a position to help your business maximize your clinical goals. For example, by looking at one’s immunizations rates and comparing them with their data, they can tell you if this is an area you could improve on. Here, here and here are some example of what I’m describing.

This probably is going to sound cheesy, but what the heck. When you buy into PCC, you get a partner that delights in knowing you are winning as a practice. Their goal is for you to be the best practice (both clinically and financially) you can possibly be.

I haven’t seen the company’s written values, I have no doubt this is a core value of the company. Why do I believe this? Because I’ve seen PCC take a hit on a sale or even lose a customer in order to meet the needs of the customer.

You know it is a core value when they are willing to be punished for it.

The decision wasn’t easy

Despite riding high on this company, it took me a long time to make a decision to move things to PCC. In fact, I was on fence for a very long time (the only thing I regret about the process so far is that some people at PCC saw what a little wuss I was about taking the plunge; but please keep that info between you and me. I have a reputation to uphold :-).

I was hesitant to make a decision for several reasons.

For starters, we liked our PM. It has been working fine for us. Although it didn’t have all the bells and whistles I wanted it to have, the system was flexible enough to let me work around its limitations.

We were also very comfortable with our Practice Management support. Our IT guy, Mike Schwartz is a boss! But moving to PCC would mean we would probably have to part ways with him.

Leaving Mike’s expertise, common sense and no-sense practical decision making — which helped us save money while maximizing our practice’s efficiency so many times — was going to hurt.

Another thing that was going to hurt, was leaving our billing company. David Brown and his team at Bookkeeping and Business Service  (BBS) have been exceptional partners. They’ve always understood that our success is their success.

I also think that the set-up we have with BBS has turned out to be a great strategic move that would have not worked had BBS not been on board with my ideas.

Many companies will tell you that the customer is the most important thing, but it isn’t always true. Let me tell you that for BBS, it is true.

Here is another reason why I hesitated

PCC offers outstanding service, and even though they may be willing to take a hit or two in the best interest of their customers, they aren’t Mother Teresa. What do I mean? These guys are expensive; they are NOT a non-profit.

I understand that this level of service comes at a price. So that wasn’t an issue for me. The issue was, could I achieve the same level of productivity for our practice without spending so much money?

It is like deciding to work-out on your own or join a gym and hire a personal trainer.

Another big part of this is that change is no fun. As much as I advocate it and tell people to embrace it, I’ll be the first to acknowledge that thinking about a transition like this made me apprehensive. Let’s face it, the status quo is very comfortable and there is no doubt that a transition like this will disrupt everything.

It would fundamentally change our practice in more ways than one. Were we ready for that? More importantly for us was, did we need to make this transition?

Where do we want to be?

A few years ago, Joanna and I had some challenging times in the office. These challenges prompted us to take a look at the practice from a different perspective.

At that point we had been in business for seven years, so we asked ourselves, if we had to start all over again, what would we do different? We also thought about where we wanted to be as a practice in seven more years.

The answer to those questions led us to the conclusion that we needed to align ourselves with different partners that understood are needs, our challenges and our objectives a little better.

Not to say that our previous vendors didn’t understand our needs or didn’t’ help us overcome our challenges. But we were at a different point in our practice life and felt it was time to move on.

So here we are today.  Locked, loaded and ready to make this happen. We are shooting for a go-live date between November or December of this year. But we’ve already begun the preparations. I’m sure I’ll have more stories to tell as we embarque in this new journey.

Stay tuned!

Editorial Note – There might be a possibility that our billing company, BBS might make the move with us. So we might not have to part ways with this after all. 

PediatricInc: Top 10 Post of 2011

In case you missed them, here are the top 10 post for 2011.

  1. Is Your Front Desk a Command Center?
  2. Top 11 Pediatric Facebook Pages
  3. Patient Collection Letters, What is Your Approach?
  4. Medical Practice Advertisement
  5. Tip #3, How To Save $80,000
  6. How Social Media Can Transform Your Medical Practice
  7. Can Costco and Your Medical Practice Have Something in Common?
  8. Does Your Medical Practice Have a Problem with Bad Debt? Here is a Solution
  9. Ten Hidden Cost When Implementing an EMR
  10. Seven Reasons Why Medical Practices Have Yet to Adopt EMRs

The list is ranked by total traffic. Funny what people find more interesting. Usually, my top 10 are not the same. Here are some of my favorites:

  1. What Can A Practice Learn from Bon Jovi?
  2. 10 Practice Management Reports You Haven’t Thought of
  3. Can a Medical Practice Learn from an Airline?
  4. Small or Big: What is the Future of Small Private Practices
  5. How Do You Approach No Shows?

Did you have any favorites you’d like to share with us? Which one did you find the most helpful? Leave a comment down below. I’d love to hear from you.

Survey To Identify Delays in VFC vs. Private Shipments

If your pediatric practice participates in the VFC program, you are aware that VFC generally ships their vaccine later than one’s private vaccines.

As many of us know, this delay becomes a burden during the flu season. For example, in our practice, we often receive our private flu shipment a month, sometimes nearly two months, before VFC vaccines.

I always thought this was an Illinois issue, but apparently, the delay happens all over the States.

There have been variable delivery times with large lags in VFC vs. private stock in recent years. Thus the AAP Immunization Program is conducting a survey on when practices received their influenza vaccine- private and VFC.

I think this is great because the survey helps pinpoint the problem areas.

The AAP was the only one to collect this information last year, and consequently made some significant strides toward identifying where the problems are.

The Immunization Program is conducting a survey again to see if changes have been made for the better this year.

Below is the link to the survey. I encourage you to fill it out. You will need information on hand of what types and quantity of vaccine was ordered, as well as dates and quantity of vaccine received.


Dr. Diaso from Sandhills Pediatrics in North Carolina had this to say:

This is a real opportunity to give input from the front lines and reduce the bureaucratic disparity of care that has been existing in many states for VFC vs private flu vaccine.

They are planning to announce this survey to the broader AAP membership this year in chapter listservs, Smartbrief, etc. So please help the cause by completing the survey. And if you don’t have time, have one of your nurses or office manager complete it for you. They probably have a better idea of many of the answers anyway.