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.

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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.

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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?)

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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

 

Do You Struggle With Budgeting?

Budgeting Practice Management Budgeting is no easy task. It is cumbersome, slow, frustrating and most

often wrong by the time you finish with it. Most of us are really bad at budgeting, therefore we avoid it like the plague.

But we should all agree that budgeting is very important and quite frankly a must when running a business.

The way that I’ve approached budgeting for the practice over the years is by keeping it as simple as possible. And then, once I’ve mastered the simple, or at least feel comfortable, I’ll add another level of complexity.

If you are feeling a overwhelmed about this budgeting thing, I’m gonna share my KISS budgeting process. Hopefully, you’ll realize it isn’t that difficult

So here we go.

EXPENSES

Start by determining your expenses for the previous year and write that number down. Some people include only the operational cost (ie rent, employee salaries, advertising, medical supplies), while others include owner’s salaries, malpractice health insurance etc.

Because we are keeping it simple, we are not going to debate which one is better than the other. So pick your total yearly expense number – whatever that may be – and don’t worry about which one has more merit than the other.

FORECAST

Think hard about the year ahead. Do you think you will spend more or the same amount of money in the coming year? Things to consider that will increase cost: moving the practice, adding staff, adding a physician, buying equipment, advertising more, buying an EMR, transitioning to another practice management system.

I would also throw in here how much money you’d like to put away for a rainy day. For example, a rainy day fund in case ICD-10 transition goes worse than we anticipate.

NOTE: Always account for more than what you think you’ll need. Remember that cost always rises. So even if you think you are going to replicate the previous year, take into account price increases from your vendors, employee raises or even a payer paying less for a CPT out of the blue.

REVENUE PER PATIENT

Once you have that “cost” number, you’ll need to know your average payment per patient seen.

Formula: Total Revenue (12-month period) / Total Number of Patients Seen (12-month period) = Average Rev Per Patient.

COST/AVG REV PER PATIENT

Take the cost number you came up with and divide it by the average rev per patient. What does this result gives you? Number Of Patients.

Cost / Average Rev = No. of Patients

This Number of Patients result is in essence the amount of patients the practice has to see in order to cover your cost.

GET FANCY

If you want to get a little fancy, you can divide the No. of Patients number into number of months, weeks or days the practice is open. This will give your practice specific patient counts that will help your practice stick with the budget.

 Few things to keep in mind.

Many things can alter a practice’s Rev Per Patient number. For example, if the practice start seeing more of the patients that carry less than ideal insurance plans, your average will drop.

If you happen to see more of the better paying patients then your average will increase; which may result in having to see less patients a day stay within budget.

If the practice miscalculates cost or doesn’t anticipate a big expense, the numbers will shift as well.

Types of visits will also sway the numbers. Office visits generally pay less than wellness visits.Remember, we are talking about averages. Averages are, well, they are averages.

Now, I’m not suggesting this budgeting method is perfect or comprehensive. But at the very least following these steps will put you on a better path than doing nothing at all.

The point of this exercise is to try to help those of us that struggle with budgeting, or have no idea where to begin, and to think about how to approach this in a less overwhelming way.

Second, the simplistic approach will motivate readers to give it a try. Doing some budgeting is better than none at all.

Has Your Medical Practice Lost Its Empathy? Here Is How To Regain It

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Empathy, of course, is an important part of what we do. Right? I mean, how else could we restore health, help children reach their full potential and cure them if it is not with some sort of empathy?

In my last post, I talked about how empathy was part of our practice’s core values but that from time to time, we forget to have it.

We start out with it, but we either get comfortable, annoyed, caught up in the day-to-day that we tend to forget why we do what we do in the first. place.

So how do we regain the empathy we once had?

Joanna, my better half, wanted to re-ignite our empathy at our practice. But she didn’t just want to preach it. She wanted something more practical that would resonate with our team members.

She gave each of our 10 employees (including the 2 other providers), a question to answer. Here is small sample of some of the questions.

  • Think about how you would feel if your child’s teacher calls you in because she want to talk to you about YOUR child without knowing what it is about. Describe to us what would go through your mind in the hours leading up to the meeting.
  • Think about the time you were up all night. Now think about how you felt the morning after. Did you feel good, ready to take on the world? Where you in a peppy mood? Or were you a little more irritated than usual, moody and with less patiences? Share with us your feelings.
  • Think about the time when close family member was waiting for potentially unpleasant news, like results on a biopsy or a MRI. Describe to us your feelings, your mood, your thoughts or what came to mind during the time you were waiting to get the news. How did you feel? What made the wait worse?
  • Think about the a time you were in a restaurant, and you sat at your table for more than a reasonable amount of time without the server coming over to check on you, take your order, give you the daily specials or acknowledge your presence in any kind of way. What goes through your mind when something like that happens? 

Each person was asked to respond to their own question and to give us their thoughts. Joanna didn’t let them off the hook easy. She probed and asked follow up questions in an effort to unpack each person’s feelings. All staff members expressed words like scared, anxious, nervous, apprehensive, uneasy, tired, moody, bored, and impatience, among many, many other adjectives.

Once we went around the room, Joanna started to make the connection. She emphasized that parents that come to see us are in similar situations as the one she asked them to respond to and as a result, have the same feelings the employees described. She also explained that in places where we are not comfortable, we tend to become more anxious, moody, nervous and sometimes angry.

Add to that insomnia or poor sleeping habits, and it is easy to see why people act the way they do. The problem is that our work environment doesn’t give us those types of feelings, thus we have to remind ourselves that for parents, our office is one of those unfamiliar, not-know-what-to-expect kind of places.

More often than not, as people that work day in and day out in a medical environment, we forget that for the parents we serve, our practice is a place of uncertainty. It is a place where we can potentially give bad news.

This is place where even a well-visist, which is supposed to be a good thing, can be an anxiety filled experience. And for parents, the fear of the unknown can be disarming.

And yes, moms (and dads) may not be on their best behavior when they arrive for their am appointment, but we should perhaps give her the benefit of the doubt and remember she was probably up all night and not in the peppiest of moods.

By the way, I’m not suggesting that we excuse foul language, insults, disrespect or anything along those lines. That type of behavior us unacceptable regardless of a parent’s state of mind.

Over the years, people have defined the word empathy differently. According to a Wikipedia article, the definition ranges from caring for other people and having a desire to help them, to experiencing emotions that match another person’s emotions, to knowing what the other person is thinking or feeling, to blurring the line between self and others.

Regardless of which definition you identify with, I think we should stive to find ways not to lose it. Joanna’s exercise  is just one example. For us, it worked. The exercise brought us back on point. For you, however, it might be something else.

That’s fine. But find it and keep it. Because sooner or later, empathy is going to be so rare, that patients will think it is a super power.

I’d love to hear what your thoughts are regarding this. Do you think that this is a worthwhile effort for your practice? Do you agree with me or disagree. If you do disagree, tell me why.