11 Straightforward And Practical Tips To Improve Your Practice’s Bottom Line

It is our responsibility as captains of our ships, however, to equip our practices and our staff members with the necessary tools and information if we want to have any chance of overcoming these real threats.

You do not have to be a marine captain to know that there are countless potential dangers navigating waters.

With a little imagination you know there are many risks. Some hidden, like currents, while others are painfully apparent (i.e. howling winds, waves and torrential storms).


Compass Direction GuideWe know there isn’t anything the captain can do to eliminate weather conditions or enforce her will on ocean currents.

However, we can all agree the captain has control over the vessel. We can also agree that the captain has the responsibility to equip the ship and its crew member to its maximum potential if they have any intention of overcoming environmental threats.

Running a “profitable” practice is indeed becoming more of a challenge. For many, it is uncharted territory. And while there are many extrinsic reasons – like decreasing insurance payments, high deductible plans, and the increased cost of providing care – that are contributing towards the “remaining profitable” challenge, the truth is, there is little – if anything – we can do to eliminate those threats.

It is our responsibility as captains of our ships, however, to equip our practices and our staff members with the necessary tools and information if we want to have any chance of overcoming these real threats.

Below are 11 STRAIGHTFORWARD and practical tips you can implement immediately to help you navigate these rough waters.

  1. Review fee schedules regularly to ensure your fees reflect market conditions in your region.
  2. Adjust fee schedules for certain procedures to improve providers’ competitiveness.
  3. Review all E&M charges by a certified coder before submitting claims.
  4. Hire coding consultants for annual chart reviews to ensure accurate coding.
  5. Monitor and report payments of your top insurance-payers.
  6. Run reports to understand payments by different networks or other contract types.
  7. Renegotiating (or consider dropping) contracts with payers who have low payments.
  8. Monitor how long it takes for charges to be entered and claims to be submitted to make sure claims are being filed timely.
  9. Consider provider training or implement random audits to ensure billing slips are completed clearly and accurately.
  10. Review your practice’s policies for routing super-bills to ensure claim submissions are sent as soon as possible.
  11. Implement processes so your billing staff works missing super-bills, claims, denials, consistently.

Imagine for a moment navigating open waters without navigation tools. Now, imagine what would happen if conditions were less than excellent?

If your boat ran off course or worse, capsized, would you blame the environmental conditions? Or would you take responsibility because you didn’t have the proper equipment and tools to navigate in challenging conditions?

#22 Holiday Special Episode [Pediatric Practice Management AwesomeCast]

Chip and I put together a holiday edition of the AwesomeCast. We decided to merge two holidays and discuss: 1) What we are thankful for; 2) New year resolutions.

Don’t worry. We discussed both of these topics in the context of practice management. So don’t dismiss this episode. Chip shared 3 resolutions that I think were great. I wrote them down so that I would remember to include them in my “things that I need to do in the next year” list for 2014


You can listen to the AwesomeCast by visiting the links below:


Pediatric Practice Management Media Cast 

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Four Easy Steps To Successfully Create Bad Goals

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If you have kids, you know that for whatever reason, they like to do the exact opposite of what we tell them.

If you ask your child not to climb the furniture, you can almost be guaranteed that when you walk back into the room, your 6-year old will be on top of the furniture.

Any sentence that begins with don’t, stop, sit down, calm down, get up, come here, is in essence an invitation to do the opposite.

More than once, I’ve encouraged bad behavior in an effort to get them to do the right thing.

“Put your tongue on that sizzling skillet and let me know if it is hot? Go ahead. Do it!. C’mon, I really need to know!”

Naturally, the kid that was standing too close to the hot skillet and wouldn’t step back when I said,  get away from the hot skillet, responds by saying: No, I’m not doing that…. are you crazy? Pfffft, I’m stepping away.

Funny thing is, adults are like children.

With that in mind, I’m going to teach you how not to set goals in your medical office.

And I’m going to strongly recommend that you follow these incorrect ways of setting goals so that you will, well,  do what it is you do when people tell you to do something.

Four Ways On How Not To Set Goals

  1. Be as general as possible. – Why be specific when being general is just easier? In fact, my recommendation is that the more general you can be, the better. Announce goals as vague as possible. This way, you can keep your staff guessing.
  2. Don’t worry about measuring success. – Evaluating and comparing is hard, I know. You have to do math and stuff. Besides, if it is meant to be, it will happen. So forget about determining your practice’s capacity as ascertained by a silly purpose.
  3. Forget about timeliness. – Here is the thing, we are all very busy. We have tons of things to do. Cramming a project, a mission a strategy or an objective in a specific time frame dampens the free spirit in all of us. What is the rush? Why stress out? There is enough time and you will get to it sooner or later. Right? If I say I’m going to do something, I’m going to do it. No need to remind me every six months, I say.
  4. Don’t write anything down. – When you put things on paper, we get an anxious sense of commitment. But if you don’t write goals down, they remain a dream. And dreams can come true you know. But the real reason behind this tip is to avoid embarrassment. Finding your written goals in a drawer 2-years after writing them and knowing you didn’t get them accomplished ensues feelings of failure. That isn’t good.

I can’t stress enough how important it is to follow this advice. Don’t delay. Get on it immediately.

#20 Key Performance Indicators Smart Practice Managers Measure [Pediatric Practice Management AwesomeCast]

Screen Shot 2013-11-07 at 7.42.08 PMFor today’s AwesomeCast, I invited my friend Paul Vanchiere from the Pediatric Management Institute. Apparently, Chip had more important things to do… Pfff. Family. So he was MIA for this recording.

If you don’t know about the Pediatric Management Institute, make a note to visit. Paul and his team are doing some really cool things to help pediatric practices manage their business better.

Paul knows a few things about key performance indicators, why they are important, and most important, how to calculate them. So I sat down with him and asked him a few questions regarding the topic.

On the AwesomeCast, Paul shares with us an area on his website where you can find explanations, formulas, examples and descriptions for all the key performance indicators.

For details check out this link: Calculators – KPI 

And if you want to learn about the seminars Paul and his crew is doing around the country, visit: PMI Seminars

Here are other ways you can check out the AwesomeCast:

What A Mud Run Can Teach You About Managing Your Medical Practice

photoA few weeks ago, I completed my very first mud run.

A mud run is a 5K run with obstacles and mud, lots of it. Imagine a military style obstacle course with climbing walls, balance beams, mudslides, mud pools, mazes and all kinds of fun and crazy stuff.

Doing a race like that brought a lot of personal satisfaction. It was a lot of fun and I would probably do it again. But the mud run – and the events leading up to the race – also did another thing for me. It reminded me of an important principle that we often forget in life and in business.

Let me share with you how I was reminded of this important lesson.

I workout somewhat regularly; so I wasn’t too nervous about completing the race once I signed up. But at the very least, I knew I needed to keep up my current workout and healthier eating habits.

Not too mention the fear of having my family – particularly my 7yr old boy – see dad (the almighty one), gas out before the end of the race also kept me going. I couldn’t have my reputation as a Jedi Night be questioned, if you know what I mean. 

Committing to the race, however actually gave me further motivation. The race was like fuel to my mind to maintain discipline with my workouts.

Not only did the fuel help me push myself harder, it also came in handy when I didn’t feel like working out. More times than I can count, I was tempted to skip my workout. I’d say to myself it was too hot, or I was too tired or I had too many things to do at home. But as soon as I started to find excuses to bail, the mud run commitment would pop into my head.

So what did I do? I’d get my butt out the door and go workout. And on race day, boy was I happy I was disciplined in my preparation. My work outs paid off.

So where’s the lesson; where is the business principle that I was reminded of?

The lesson or principle I was reminded of was the power of setting goals for yourself and your practice.

I was reminded that unless we commit to set specific goals and or objectives for ourselves and our medical practice, we rarely find the motivation or discipline to reach milestones, make improvements or push ourselves to do better.

If you want to improve, accomplish, achieve, implement, increase, or whatever it is for you, you have to be intentional about it. A specific, measurable, attainable, relevant and time-bound goal is the only way to help you and your practice stay on track. 

A Challenge

The end of the year is approaching. We are in the last quarter of the year.  So I’d like to challenge you to think about and write down two or three things you want to accomplish by year end in your practice.

It may be something you’ve been putting off since the beginning of the year or perhaps it is that idea you’ve been meaning to implement but by the time you finish all the day to day stuff, you are out of gas.

Regardless of what it is, write it down (be very specific about it), and set yourself a time line to accomplish your practice goal. Maybe even share it with your peers, friends, boss, pet dog… I’m serious too (not serious about the dog). Accountability helps as as well.

If you take my challenge, I’m confident you will have an awesome sense of satisfaction knowing your made a commitment, worked towards keeping that commitment and completed what you have set your eyes on.

And as a bonus, your Jedi Night skills will surely not be put into question.

#18 Is the Independent Physician a Dinosaur? [Pediatric Practice Management AwesomeCast]

ExtinctionNot too long ago, you couldn’t avoid reading in the media about how the independent doctors  were becoming extinct.

Pundits and experts in the field stressed that if independent doctors, those that own their own practice, didn’t join, sell, merge or retire all together, they were going to walk the same path as travel agents, video stores and mom-and-pop own book stores.

I’ve subscribed to a different thought.

I’m crazy enough to believe that there will always be a place for the small independent practice.

Sure, practices will have to adjust, figure out new ways to meet the demands (just like any other business) of a changing healthcare landscape.

But I’ve argued that even though travel agents aren’t around anymore, airlines, hotels and car rental companies are. Even though video stores are a thing of the past, Hollywood hasn’t stopped making movies. If anything, we have access to more video content than ever before.

But it has been a hard sell (not that I’m really selling anything) to convince people that the end of the world for private practices is not a certainty for all.

Recently, I’ve received great news from the consultant fronts. In conversations with Susanne Madden from the Verden Group, Mary Pat Whaley from Managemypractice.com and the Pediatric Practice Management AwesomeCast’s very own, Chip Hart with PCC, it seems that the independent private practice pediatrician is on the rise.

They all have shared with me that in recent months, their offices have field numerous inquiries from pediatricians looking to breakaway from the, let’s say, industrialized, corporate, factory style medicine, and start their own practice so they can practice medicine on their own terms.

Chip and I couldn’t wait much longer to talk about this topic because it is an area we are both very interested in. So for this week’s episode, we dedicate almost a full hour on the topic of being an independent physician.

We talk about what it means to be independent, the different kinds of independency (yes, there are several kinds), what are some of the trends out there and what to look for when exploring other options for your practice.

Here are other ways you can check out the AwesomeCast:

You Can Take Away Our Lives, But You Will Never Take Away Our Freedom

Braveheart_1My co-host on the Pediatric Practice Management AwesomeCast, is working a project that I think many that read this blog will find interesting.  I’ll let you read it directly from Chip’s original post:

Over the past couple of days, I’ve been working with some friends on a concept publication entitled “Independent Pediatrics.” The idea is to share the myriad stories of what it’s like to practice pediatrics independently – the challenges, the success stories, the future.

This will be as commercially agnostic/invisible an endeavor as possible and I’m going to be looking for people and practices with great stories. Kinda’ like “The Moth” or “This American Life” for pediatrics, but printed and WWW-based for this round 🙂

The premise, as far as I’m concerned, is that independent pediatricians are _not_ dead or dying. In fact, if you check in with the consultants, we appear to be in the midst of a renaissance.

I don’t have all the details yet, but we are in a rush to produce something in time for the NCE (what are we thinking?). I’m looking for some particular content and I’m being told that I can’t simply make up quotes, sigh. So, I’ve whipped up a 4? 5? question survey for independent pediatricians and their employees to prime the pump of our material.

If you have 5 minutes, or less, I’d be grateful if you could give me something good to chew on:


Thanks for your consideration and when there is something to see, I’ll share it here.

This is a topic that I’m very interested in, considering that the practice I work for, is in fact, an independent practice. Not only that, we want to remain independent. So I’m encouraged that Chip and his friends are taking on this endeavor.

By the way, in an upcoming episode of the AwesomeCast, Chip and I spend about 55 minutes discussing this issue. I think you are going to find it very interesting and valuable. So stay tuned.

Do Your Patients Expect Something for Nothing?

iStock_000000385270SmallI would say yes.

However, I would submit that the reason our patient’s expect something for nothing is our fault, not theirs.

The truth is, we’ve given away so much over the years. And now that we want to charge for things (that have always cost us) like forms, after hour phone calls, and other things, people think we are now wanting to collect for things that they were lead to believe had no value.

Not to mention they often think we are nickle-and-diming them now.

But some practices have been very careful about not falling into this trap of giving away their time and their resources.

Take Village Pediatrics for example. Dr. Gruen and Dr. Gorman charge parents between $150 and $325 (depending on how many children) for a plan they call the added benefits plan. Here is what their website says about the plan:

This modest per-child administrative fee includes services that may be non-covered or non-reimbursed by your insurance company and are typically billed for at other medical offices. Such services include: e-prescribing, unlimited school/camp forms, as well as 24/7/365 access to the doctors without the use of a phone triage service. This fee has allowed Village Pediatrics to offer prompt and personalized care without dramatically increasing our practice volume, dropping insurance plans, or significantly raising our cash fees.

Why would parents pay above and beyond their health insurance premium every year to visit Village Peds?

Because Village Peds from the beginning decided to take a stance and tell parents, what they do has immense value. The time they spend with patients/parents in and out of the examining room is of great value. And if patient/parents want access to Dr. Gruen’s and Dr. Gorman’s valuable time and expertise, parents are going to have to pay for it.

I say, Good for them!! I applaud Dr. Gruen and Dr. Gorman’s efforts in establishing a practice that focuses on providing value worth paying for.

And my guess is that nearly 100% of Village Peds families pay the fee. Because all the other families that didn’t see the value, don’t have their children seen at Village Peds.

Here is the hurdle for me.

When I first read  the things Village Peds  offers  as a part of their added benefits plan, I said to myself, we can’t start charging like they do.  Why? Because all the things on that list our practice already provides without getting anything  for it.

Who’s fault is that? The patients/parents?

No. This is our mistake.

For those of us in the private health care world, we need to get over the fact that people are going to complain about paying for something they used to get for free. Heck, I don’t like to pay for something I used to get for free either. So we can’t hang that over our parents.

Furthermore, I’d emphasize that it is our responsibility to educate our parents that there is HUGE value in everything we do (both inside and outside the examining room).

If we don’t educate them, parents will continue to expect what they’ve always gotten. Which is something for nothing.

This is something I’m gonna start thinking about more. Especially if the plan is to remain an independent private practice.

Is Your Company’s Culture Hindering Your Profitability?

1-IMG_0089I come from a non-medical business world where most conversation centers around profit, revenue, budgets, marketing, sales and things like that.

In the private  practice world, mentioning profit or revenue is almost prohibited as if it was a kind of taboo.

I remember being a little taken aback when people in the healthcare business would talk about “profit” and they would lower their voices and look around and whisper the words “making money” to ensure nobody outside of our conversation heard the money reference.

In our practice, we take a completely different approach. In our practice, we don’t apologize for our pursuit of profitability.

We are very upfront with both patients and our staff about the need to be profitable.

We view “profitability” as a responsibility.

Why? Because a broke doctor doesn’t do anybody any good.

Profitability allows the practice to hire the best docs, hire the best staff, buy the best equipment, send staff to training, pay for docs’ CME’s and all the other things that go along with ensuring patients receive the best medical care possible.

Top notch medical care is expensive.

We believe so strong in this, that in our practice, we discuss profitability in practice’s core values document. Here is an excerpt from our company’s charter:

In order to carry out our mission, we recognize that every staff member must take every opportunity to decrease cost, to increase efficiency, and earn revenues that support our team, our practice and our patients.

In today’s health care climate,  practice employee must be comfortable with talking about money. They need to know that not only is it okay, but a necessity.

Thus, I suggest it is important to “bake” revenue into the culture of the practice.

Fundamentally, this approach sets the expectation. Employees understand that collecting copayments and balances at the time of service is vital to the practice’s mission.

By openly talking about money,  employees understand that the money that comes in to the practice isn’t the doctor’s money, but it is everybody’s money. Collecting from both insurance companies and parents is where the practice gets the money to pay everybody’s salary.

In primary care, this is even more critical because we are in a low margin, high volume business.

And it isn’t just collections. Keeping down cost an unnecessary expenses is just as important. In pediatrics, for example, drawing up vaccines incorrectly, dropping a dose on the floor or simply keeping poor inventory can make the difference between profitability and loss.

Want to avoid revenue leaks an increase profitability? Start talking about money.

Embed it into the practice’s culture.

Please don’t misunderstand me with this point. I’m not suggesting that we only think about money. That is not what I’m suggesting. After all, we are still healthcare providers and things like empathy, caring, understanding, healing, compassion and sacrifice are all part of what we do day to day.

But what I am saying is that if there isn’t enough “margin” docs and their staff won’t be around to be empathetic, caring, compassionate and heal patients. In other words, we can’t help people in need if the practice is also in need.

#13 What Will You Do With All That Money? [Pediatric Practice Management Awesome-Cast]

For this episode of our pediatric awesome-cast, Chip and I discuss a series of little items that have piled up over the last few weeks.

We discuss pediatric practice management seminars, the avoidance of autoposting and eligibility checking, the compensation model survey, and some important considerations for those expecting the ACA-Medicaid-Payment-Adjustment boost this year.

In fact, the ‘gold’ of this episode is probably in the middle, so make sure you listen or watch all the way through!


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