Are Practice Management Consultants Worth Hiring?

In the end, the practices who invest in themselves are, almost always, the top performers. You’ll see among best performing practices, that many have engaged – and continues to engage – consultants on matters that are outside their expertise.

This is a guest post from Chip Hart. Chip is a frequent contributor to PediatricInc and former co-host of the highly revered Pediatric Management Awesomecast. When Chip isn’t protecting independent pediatric practices against evil conglomerates, naysayers, and the League of Shadows, you can find him at PCC doing… something (I’ve never figured out what is it that he does at PCC, exactly). 


I will never forget the scene. I was the lonely consultant in the dark and shag-carpeted basement “conference room” of a large pediatric practice and was giving them a stern lecture about their pricing. The practice hadn’t updated its prices in years and was undoubtedly losing money. Lots of it.

Chip Hart and Brandon Betancourt
Working really, really hard.

After my explanation of RVUs and why 105% of Medicare wouldn’t cut it, the senior partner – well, the loudest one, anyway – looked me in the eye and said, “OK, that sounds smart, let’s just raise our prices.” It was the response I was hoping to get.

The youngest and newest partner jumped in quickly, “What?! How can you listen to this guy?”

Uh oh, I thought. His voice cracked, “…I’ve been telling you this same information for almost two years and he just waltzes in here and says ‘Correct your pricing.’ and you do it just like that?”

I honestly thought he was going to cry in frustration and relief. 10-minutes of back-and-forth among them ensued. I just stayed out of it. At the end of the year, the additional $250,000 they collected erased the discomfort and awkward part of the memory for them.

I didn’t forget, however. I remember sitting there thinking, “This poor practice lost hundreds of thousands of dollars simply because they were unwilling or unable to listen to themselves. They had to hear it from someone else.”

HOW DOES THIS HAPPEN?

The answer is both obvious and convoluted. I have often said that the most important and difficult task for any small business is to find and hire good people. Unquestionably, this challenge extends to the hiring of practice management consultants.

Pediatric practices successfully hire consultants all the time without a tremendous amount of consideration – realtors, attorneys, I/T – but when it comes to getting help on the inner workings of the practice, the majority of pediatric offices too reluctant to ask for help.

And when they do ask for help, it’s often ineffective.

Every practice I visit codes imperfectly, yet some practices lose tens or even hundreds of thousands of dollars a year as a result of their inability to address the problem.

Most practices could use help negotiating with insurance companies, yet remarkably few of them do. Many practices need help with a compensation model or managing a challenging partnership, yet most of them just live with the problems and hope it will go away. And so forth.

Physicians, unfortunately, are uniquely susceptible to mis-using consultants, even if it is simply to not use them enough.

You expect most vendors and consultants to try to take advantage of you – all doctors are rich, right? – while having trouble admitting that you cannot solve all of your own problems.

Combine those aversions with the impecunious nature of most pediatricians, and there is no surprise that I meet practices every week who would rather lose another $15,000 this year due to a poorly designed superbill and bad pricing than pay a consultant half that amount to fix the problems.

HOW AND WHEN DO YOU KNOW YOU NEED A CONSULTANT?

There is no magic formula, but try these parameters on for size:

  • When there is an issue that your partnership cannot resolve, or when a neutral third party can facilitate a necessary change in your practice, consider a consultant.
  • When you are not an expert in the matters that affect your practice or if there is simply another party who might be more effective and efficient at addressing the matters, consider a consultant.
  • When your practice is losing more money on an issue than it would cost you to fix, consider a consultant.
  • When the amount of money you would pay a consultant is less than the amount of money you would generate seeing patients, consider a consultant.

Those last two examples are often conjoined in a death spiral of inaction. Many of you don’t want to pay a consultant $20,000 to renegotiate a contract increase of $50,000 annually because “you can do it yourselves.”

Yet, you don’t do it. Or you start the project and sink 10, 20, 40 hours into the task – often worth more to the practice than what you would pay the consultant – and then never complete the job.

Pediatricians, as business owners, are notoriously bad at examining the return on their potential investments and usually focus far too heavily on only the costs.

Pretending to be 100% self-sufficient serves no one except, perhaps, the insurance companies. Your patients don’t benefit, your lifestyle suffers, and you leave money on the table.

HOW THEN DO YOU HIRE A PRACTICE MANAGEMENT CONSULTANT?

First, hiring a consultant involves a lot of common sense. You want a written contract that spells out the terms of your obligation.

The terms should clearly outline your expectations, identify the fundamental goal, and determine conclusion of the contract. Ultimately, it involves a relationship of trust and confirmation. Some suggestions that go beyond the generic:

1 – Pediatric practices are different, don’t let a potential consultant tell you otherwise.

Most medical practice consultants live in the Medicare world and look for “alternative income sources” that just don’t exist in pediatrics.

More importantly, the attitude and (often unspoken) philosophies of pediatric practices differ from other medical specialties. Find someone who knows pediatrics.

2 – Work with a consultant on one or more smaller projects and build up to a strong relationship.

Before you leap into that full payer-mix and negotiation mission, see how well you work together on something smaller, like simply reviewing the state of your existing contracts. If you are not getting the kind of performance you expected, better to have not committed so heavily.

3 – Don’t be afraid to use different consultants for different needs.

Just as you may not be an expert on RBRVS or pediatric compensation models, your consultant may not know it all, either.

Although some consulting resources pride themselves on their breadth of experience, depth is usually more important. A good consultant might look at your practice and identify work that needs doing. A great consultant can identify work that needs doing, but suggests another resource.

4 – Even after you have chosen a consultant, keep an eye out for conflicts of interest.

Although they are impossible to avoid and sometimes even lead to efficient work (like one consultant recommending another), conflicts are often poorly revealed in the industry.

5 – Use your network of pediatric peers to help vet your consulting needs.

Surely, if your potential consultant expects to work with you, he or she can provide you with pediatric references whom they have helped with similar issues. SOAPM is an excellent place for a sanity check.

In the end, the practices who invest in themselves are, almost always, the top performers. You’ll see among best performing practices, that many have engaged – and continues to engage – consultants on matters that are outside their expertise.

Deceptively Easy Way to Improve Your Practice, Guaranteed

On a piece of paper, write down this question:

Image-1

It doesn’t have to be written exactly like I wrote it. Any variation will do. Then, make copies. Several of them. For the next few days or even weeks, hand each parent that comes to visit your office the sheet of paper with the question on it. While they wait, they will have plenty to think about out. You can ask them to use the remaining space – as well as the other side – if they require more than just a few lines.

I just saved you $5000 in consulting fees. Not to mention provided a way for you to have specific and practical ways  to make your pediatric office 10x more awesome than it already is.

You’re welcome…

Awesome Webinar: Fixing Revenue Leaks For Small Medical Practices

Webinar-Graphic1We interrupt this scheduled programming to inform you that I’ll be doing a Webinar this Tuesday December 18, at 2 pm ET / 11am PT.

The topic?  Fixing critical revenue-cycle leaks for small medical practices.

The webinar is hosted by FiercePracticeManagemet and it will examine how to fix causes of revenue cycle leaks.

Topics of discussion will include:

  • How to optimize every point of your revenue cycle, from appointment-setting to collecting on past-due accounts.
  • A review of common billing and denials-management deficiencies and how to fix them.
  • Tips for managing the increasingly prevalent bucket of self-pay collections.
  • Strategies for boosting time-of-service collections.
  • How to hire and train employees who take true ownership and responsibility over the practice’s revenue cycle success.

You can sign up for the webinar by clicking “HERE”.

 

How can you become a change agent in your medical practice?

The other day I was catching up with a friend of mine. He was telling me that he was a bit frustrated at work because the people he works with aren’t as efficient as he’d like them to be. He went on to say that management wasn’t open to making improvements, listen to new ideas or open to change.

I told him that he was describing a classic leadership (you don’t have to be in charge to be a leader) problem; which is, getting people to change.

It seems that whether you’re on the employee side or the employer, fundamentally, if you’re a leader, you’re always in this predicament.

I shared with him that despite running our own business, we still face the “change” challenge; except this time around, it comes directly from our employees. They resist change sometimes.

On my way home, I thought about how I could help my friend as well as formulate some of the things I could also do, to overcome this issue of people resisting change.

When I got home, I sent him a message with these nine points:

1) Garner support. One has to find it somewhere. One can rarely promote change without support.

2) Appoint supporters. One can’t do it all. Getting a few people to take the lead on certain projects from the pool of those that support your cause should be explored. This will also give people ownership and responsibility. Oh, and accountability as well.

3) Start small. 20 different “improvements” may be too much to handle. Especially when motivation isn’t that high to begin with. Pick a small improvement and work your way up.

4) Document success. Document the successes you have with your “small” improvement projects. If you can show how much you made things better, you’ll be able to make a better case to promote and actually make change.

5) Don’t depict the promise land, yet. A leader that I respect a lot once told me that a leader’s role is to move people from here… to there. So what leaders often do, is, depict how wonderful “there” will be once they get there (often described as selling the vision). But people/staff usually like it “here,” despite the wonderful things “change” or “there” may bring. People prefer to stay comfortable with what they know. So what do you do? It is not always effective to show how great “there” will be, but rather, show how bad it will be if one stays “here.”

6) Staff have answers. A couple of weeks ago I asked our staff, if you were in charge, what would be the one thing you’d change in our office? Surprisingly, some of the suggestions were actually easy to implement. For example, one MA said that by rearranging nurse visits on the schedule on Wed and Sat (when there is only one doc and half the staff) we could improve patient flow.  The front desk agreed, decided on where to put the RN visits on the schedule and done.

There are several lessons in this little story for me, but for our topic today the point for me is, there are many improvements that can be made without an “executive” committee being involved.

7) Trials. If  you are almost certain your way is better, ask the person you are trying to influence to give you a chance to try your method out. If it doesn’t work, no harm done. If it does, then you’ll be able to make a better case for your changes.

8) Asking for forgiveness is better than asking for permission. My approach has always been, if I’m going to get in trouble, I’d rather it be for doing something rather than for not doing anything. This means, be a leader and be like Nike, Just Do It!

9) What can you change in yourself? Also think about some of the things you can change in your actions and your behaviors.  Often, we think about how we can change others, but rarely do we think about things one can change in ourselves that garners the change we want in others.

What other things would you add to help make “change” happen in your organization?