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.

Is It Worth Being A Member Of The American Academy Of Pediatrics?

I asked a newly graduated pediatrician if she was going to renew her membership with the American Academy of Pediatrics.

Her response did not surprise me. She said, “…probably not. I see no point in being a member.”

As far as she was concerned, there wasn’t an upside ( or value ) to belong to the Academy. I knew what she meant because I share her feelings.

Screen Shot 2016-06-05 at 10.48.49 AMRecently I came across an email that challenged my stance regarding the value the American Academy Of Pediatrics provides to pediatricians.

I wanted to share the email just as I read it. Below are the unedited comments from Dr. Suzanne Berman and Dr. Christoph Diasio regarding the meeting.

I had the privilege of attending the 3rd Immunization Congress in Washington DC with some of your favorite SOAPM types: Rich Lander, Geoff Simon, Christoph Diasio, Drew Hertz, Joel Bradley and uber-awesome AAP staffers Lou Terranova and Elizabeth Sobcyzk.

We had an opportunity to describe what works and doesn’t work with pediatric vaccinations, and lessons that can be applied in the adult world (where they do not vaccinate like we do).

Rich Lander spoke eloquently about the need for calling it PAYMENT not REIMBURSEMENT and people listened!

He presented the business case for vaccines. For the whole rest of the time, people would start to say “reimbursement” and then caught themselves and said: I should call it payment! I need to update my slides!

Geoff Simon and Drew Hertz spoke about some of the practical aspects of immunization delivery in large health systems and the implications of alternate payment models in vaccine delivery.

Geoff also talked about the challenges of providing vaccines across state lines (PA/DE).

Joel talked about the need for VFC to turn on 90461 and the need for local Medicaid and VFC programs not to do their little unsupervised strange things.

Suzanne Berman, MD

Dr. Diasio chimed in and added this:

There’s so much the AAP in general, and SOAPM, in particular, does quietly in the background- it is important to share this.

I am sure it will surprise none of you that I was continuing to beat the drum for removing the VFC flu vaccine delivery disparity.

Suzanne is humble- her talk on “the stupid things insurance companies/Medicaid agencies do re: vaccine payment” was terrific and included descriptions of dysfunction that I had never heard!

We touched on 2D barcoding uptake, but this was more related to trying to fix registries and increase communications.

We did discuss trying to create incentives/funding for EMR companies to support barcode readers

Christoph Diasio, MD

I have been particularly vocal about the Academy’s presumably disregard towards the numerous challenges pediatrician face in light of the AAP’s recommendations and children’s advocacy initiatives.

When I read this, the first thought that came to mind was, I think I am misinformed. Then I thought, so are numerous pediatricians, like the newly grad I mentioned.

I then thought to myself, the word needs to get out. Pediatricians need to know what the AAP and committees such as the Section on Administration and Practice Management (SOAPM) are doing on behalf of pediatricians, not just children.

Reached out

I immediately emailed Dr. Suzanne Berman and asked her permission to publish her email. I then spoke to Dr. Christoph Diasio – SOAPM Chairperson – and also asked him if I could add his commentary.

They responded with a resounding:

NO WAY. NOT IN A MILLION YEARS.

I am kidding, I am kidding. It was the opposite. They replied within minutes saying yes.

Times are indeed tough

I am preaching to the choir when I say that independent pediatricians are facing difficult challenges. However, it is reassuring to know that people are working behind the scenes advocating for children by advocating for those that provide for children.

It is my understanding that highly influential people attended the meeting. There were high ranking AAP representatives as well as influential people from the CDC.

Thanks

So, not only did I want to inform those that are not fully aware of what type of initiatives their AAP membership dollars go to support, but also wanted to give a big thanks to all that attended the meeting and all those that worked behind the scenes.

Thanks for looking out for us. And keep up the good work.

For the rest of you, go and renew your AAP Membership.

Do You Know About The Section On Administration and Practice Management ?

The Section on Administration and Practice Management (SOAPM) is the home at the AAP for pediatricians who want to improve the efficiency and profitability of their practices and the care that we provide our patients.

You know that feeling you get when you visit a great restaurant, vacation at an awesome resort or perhaps see a great stage show and you can’t help but to tell everybody you encounter they have to check it out too?

I get that feeling with SOAPM.    I’ve mentioned SOAPM before on the blog, but for those that know, SOAPM is one of the best – if not the best – resource for pediatricians that have an interest in learning the ins and out of practice management.

One of my favorite SOAPM member is Dr. Christoph Diaso. Recently Dr. Diaso became chairman of SOAPM. So I thought, why not have him tell PediatricInc readers about how great of a resource SOAPM is.

I reached out and he agreed. Enjoy.

Q – What is SOAPM? 

The Section on Administration and Practice Management (SOAPM) is the home at the AAP for pediatricians who want to improve the efficiency and profitability of their practices and the care that we provide our patients.

Q – Did you just say the P word, profitability? 

No margin is no mission! It’s fun to have the financial strength to be able to improve your technology or add additional services that are desperately needed.

Q – And what might those services be?

Depends on the practice, but integrating mental health or lactation consultants into your practice is at the top of my list!

Q – What is it about SOAPM that makes it so interesting for you?

We have an incredibly active and passionate listserv that provides outstanding education about real world problems.

Q – Can you provide a few examples of real world education topics that are discussed on the listserv?

Sure! We discuss things like how to improve employee performance, which CBC machine to use, how to negotiate with payers and deal with regulatory oversight.

Q – Sounds like you cover a lot of topics? 

Every day incredibly valuable practice management tips worth thousands of dollars are dispensed for free! Our listserv is the heartbeat of the AAP.

Q – So how does SOAPM distribute all this valuable educational material?

SOAPM provides this education through the listserv, webinars, and through our excellent section programs at the NCE.

Q – You recently became chair of SOAPM, what are your goals for the section? 

SOAPM has a wealth of knowledge to offer Pediatricians in all arenas, whether practice owners or employed doctors. My goal as chair is to continue to expand the SOAPM membership and to improve the practice of pediatrics.

Q – You mentioned employed physicians, SOAPM isn’t just for practice owners?

SOAPM currently has members in every possible employment situation and is not just for private practice doctors!

Q – Besides private practice doctors and employed physicians, are there any other groups that can benefit from SOAPM?

We particularly welcome young physicians who are interested in learning about practice management since that is usually a knowledge gap for most trainees.

Q- Can practice managers join?

We recognize the amazing contribution of our practice managers and have an outstanding practice manager section with their own listserv.  Every PM ought to belong!

Q – The AAP seems to be more academically focused, completely opposite to SOAPM’s “no margin, no mission” mantra. How does the leadership of the  AAP view SOAPM? 

I agree that some perceive the AAP this way, although I disagree with that perception.  The AAP has become much more responsive to practice issues in the last several years and much of that is due to SOAPM’s advocacy and increasing membership. No margin is no mission is no Pediatricians for children!

Q – What types of advocacy initiatives are you referring to?

We are working on a number of projects currently such as improving VFC flu vaccine delivery, representing pediatric concerns to NCQA PCMH and trying to improve the ABP MOC process.

Q – Any final words?  Please join us and participate in improving the practice of pediatrics!

AAP NCE: Top Secrets from a Pediatric Practice Manager

There is no doubt that our medical practices are getting more complex. In addition to managing patients, insurance, billing, collections, EMRs, EOBs, and statements, just to name a few, we also have to ensure we remain profitable.

So how does one stay on top of all these things without losing sight of our objectives? How do we continue to manage our day-to-day tasks while implementing ICD-10? How do we ensure that our of patients are immunized while going from paper charts to electronic charts?

Next week, at the American Academy of Pediatrics National Convention and Exhibition held in New Orleans, I will be presenting on a few concepts that will help us, as leaders of our practice, manage complex transitions, like ICD-10 or EMRs implementations, while still ensuring our practices are managed efficiently, effectively and profitably.

I’ll be talking about how we sometimes put too much emphasis on the urgent, the easily measurable,  and the immediate as opposed to the more important things like, for example, building cohesive teams.

I’ll give you this little teaser…

Think about Fortune 500 companies. These organizations have the best MBAs money can buy. These companies are staffed with Ivy League trained employees. Yet many of them fail terribly  at managing transitions. Is it because they are dumb? Is it because they don’t know how to follow a GANTT chart?

Come by my presentation and I’ll tell you why most companies, including medical practices, fail miserably at managing transitions.

The title of the presentation is Top Secrets from a Pediatrics Practice Manager – Managing Transitions While Maintaining and Efficient Practice.

I’ve requested for the doors to be bolted down considering this is Top Secret material. So you will not want to be late if you are planning on attending.

Just kidding of course, but I would appreciate it very much of you would consider attending the sessions. My top secret session will be held on Friday Oct 19th at 10:00 am.

Below is the 2012 Practice Management NCE flyer developed to highlight SOAPM & PPMA sessions (SOAPM and PPMA is code for cool, innovative and progressive practice management stuff) and to serve as a sample itinerary for members interested in attending practice management related programs.

Click on the link to download the flyer.

If you are a faithful reader of this blog, please stop me and say hi. I’d love to meet you.