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Practice Management Expert Laurie Morgan on Better Practice Management

Practice management Sometimes it helps to get a fresh perspective – especially when tackling the challenges of managing medical practices that are experiencing major transitions.

Cue someone like Laurie Morgan, senior consultant and partner at Capko & Morgan, who didn’t start her career in health care.

Prior to joining Capko & Morgan (then Capko & Company) in 2010, she had careers as a senior executive for a large, global technology media company and in media start-ups, and also worked as a consultant helping smaller companies grow.

“My passions in of all these experiences were operational excellence, effective marketing and helping managers develop their skills,” she says. “I focus on all these things in my work at Capko & Morgan.”

Today, she enjoys combining all the analytical discipline and leadership skills she developed as a corporate executive with the hands-on attitude she needed as an entrepreneur to address the specific and unique problems facing medical practices. With corporate media experience in the tech industry, she also loves being able to help her clients navigate that world a little more confidently. Laurie’s even written a series of eBooks called Management Rx.

We recently spent a few minutes chatting with Laurie about the challenges facing medical practices today and what they can do to face them with confidence. Here’s what she had to say:

Tell us about Capko & Morgan. What services do you offer? Who should be using them?

Our medical practice clients rely on us to objectively analyze their practice operations and recommend ways to be more efficient and profitable, with happier staff and patients.

It’s just the nature of medical practice management today that the pace of change is very fast (and the pace of daily operations, too!), and it’s often difficult for a practice manager or physician owner to do thorough, data-driven analysis themselves. Even practices that are healthy can benefit from this perspective; there is always something to learn, and small improvements can make a huge difference in practice profitability.

But, of course, practices that are concerned about decreasing profitability, or dealing with operational problems like declining collections and billing problems, staff turnover, scheduling difficulties/long wait times, etc., can see a much more dramatic turnaround from implementing changes as a result of an objective, professional analysis from C&M. Often, we also help practices implement important changes and provide coaching for practice managers through the process.

Another related area where we can help practices is post-acquisition integration – helping larger groups figure out how to absorb acquired practices without losing momentum and morale, and analyzing the problems that almost always come up because these integrations are so difficult.

Of course, besides working directly with medical practices, we enjoy reaching a larger audience with our writing and speaking; my partners and I have authored many publications, and we all enjoy presenting at conferences and via webinars. It’s a great way to reach out to more people than we could possibly work with one-on-one through our consulting.

What are the biggest frustrations or pain points your clients are hoping you can fix?

Probably the biggest source of pain is the decline of profitability that so many practices have experienced in recent years. Related to that, many practices have seen A/R soar, mainly due to much higher patient balances. The shift toward more patient financial responsibility means that practices have to think differently about patient collections; often, they don’t know how to stop money leaking out that way. It requires a fresh look at all of a practice’s revenue cycle processes, starting even with scheduling and the front desk. But the good news is, fixing these kinds of problems can quickly pay off enormously in both profitability and patient satisfaction.

Two other major pain points are scheduling problems and workflow problems. Once a practice has more than five or six providers, scheduling can start to get very complicated, especially if the specialty requires hospital call. These problems can get pretty thorny when providers also have many requirements of their own that impact the schedule; and scheduling problems can be very costly both to practice finances and to patient access. Fixing them can quickly become a very high priority for a practice.

Workflow problems can be difficult for a practice to diagnose themselves. Small problems can balloon quickly and feel very overwhelming, creating a lot of stress for providers, staff, and patients.

What are the most common mistakes you see your clients making? What do they need help with the most?
Some of the biggest mistakes including trying to save money by cutting staff too aggressively; well-utilized staff are key to making providers as productive as they can be. Another is relying too much on gut and not enough on data. An example of this we see all the time is no-shows.

Practices believe their no-show rate is lower than it is, because they’re so busy; this is especially likely when a practice has multiple providers. But a quick audit of the schedule often reveals the no-show rate is much higher than anyone thought. Using data when evaluating practice performance is essential; it’s just too likely your impressions will be incorrect, especially when you’re very busy.

Another mistake we aim to help practices with is under-utilizing technology. Most practices adopted EHR technology mainly because of Meaningful Use – not because they were thinking about how to use it to make their practices more efficient. As a result, they’re often unaware of the tools included in the system that could help them be more efficient and serve patients better. The process of EHR adoption has also left many practices leery of technology, so they’re reluctant to try new tools that could help them be more efficient and profitable. But there are so many new things coming available that were market-driven, especially tools for billing and the front desk such as check-in kiosks and patient payment solutions. Many are very easy to implement and can make a huge difference in practice efficiency and profitability. We focus a lot on helping practices work out how to give these new things a try without fear and without disrupting daily operations.

What advice do you find yourself repeating over and over again when it comes to making a practice more profitable?

There are a few things.
One, be more data-driven. Don’t make decisions without data. Start using the data your PMS and EHR are collecting for you; it’s right at your fingertips. (Of course, it’s also imperative to be sure you’re inputting data accurately. Garbage in, garbage out.) Be very insistent on getting good data about your billing, whether you have an in-house biller or use a service. Insist on having access to reports whenever you need them; and, if you don’t know how to analyze them, learn how. Your EHR can help you market your practice as well as diagnose your own workflow (provided you’re entering the data accurately). If you don’t know how to get the most out of these systems, ask your vendors! Sustaining a relationship with your tech vendors is essential to getting the best out of your systems.

Two, the revenue cycle starts with scheduling and the front desk. Many practices have siloed billing, especially if they outsource it. But the revenue cycle is a team effort; your biller or billing service can’t do it alone.

Three, be open-minded about technology. There are new products coming out that can’t rely on government incentives to get you to try them; they will succeed only if they help you meet a need. Products to help with patient payments and check-in are particularly exciting. Stay in touch with your tech vendors to know what they’re introducing, and what third-party products they integrate with.

Four, marketing does not equal advertising. The most important marketing you’ll do for your practice involves only effort, not a cash outlay. It all starts with making sure you can be easily found in the places patients are looking for physicians – online directories like Google+, Healthgrades and Vitals, and, above all, the directories of all the health plans you participate in.

What about when it comes to improving efficiency?

I love looking holistically at practice workflows and finding ways to make things run more smoothly. One of the habits I see at practices that I urge them to break is the tendency to focus on keeping people busy. Being busy is not the same thing as being productive; a little idle time is better than being busy with make-work. A little bit of slack in the system creates capacity for when the practice gets unexpectedly busy or when a special project needs to be done. On the other hand, if staff have been overloaded with busy work, you may end up adding people to meet daily needs. It can be very difficult to see what is busy work and what is essential when people have been doing the same tasks over a period of time; it’s best to avoid creating unnecessary work in the first place.

One example of this: some practices are reluctant to use phone trees and allow patients to direct themselves to the best person to help them. They feel uncomfortable taking that work off the plates of receptionists – what will they do with the extra time? But the cost is that patients spend more time on hold and there is more risk of an important message not getting to the right person. The practice may feel they’re getting more “work” from the people answering the phone, but it’s less efficient and much less convenient for patients calling in.

What technology or innovations are you most excited about for how they can help medical practices?

I’m most excited about technology’s ability to help practices be more efficient, like check-in solutions that allow patients to pay their copays or complete their forms. These tools have the ability to cut staff work, reduce errors and improve collection rates. And many tools work well alongside each other; it’s not like an EHR or PMS, where you only get to use just one.

What are the most important issues you’re following in practice management today?

I’m really curious about how the wave of acquisitions that has happened over the past few years will work out. I predict that some of the acquired practices will find they prefer independence and want to re-establish themselves in a few years. Other practices are still weighing whether they need to be part of a larger group, and large groups and hospitals are weighing whether they need to make acquisitions. And, as I mentioned above, learning to work together and operate efficiently is a big challenge for recently-formed larger groups. All of these things are fascinating; whether you’re aiming to stay independent or teaming up with a larger organization, there are management challenges and opportunities galore.

You’ve worked extensively outside of the medical field, too. What best practices from other industries do you think might help medical practices perform better?

I’d like to see practices invest more in training, especially in training administrators. Some practices fail to see management as a discipline or a profession in its own right; I’d love to see that change.

I’ve also noticed is that medical practices sometimes hold back from trying new things and innovating. I believe this reflects both the high level of regulation in the industry and the fact that revenue comes largely through third parties. These are big challenges and big differences versus other industries, so conservatism is natural; but I still think that practices are a bit more passive than they need to be.

I’ve also already mentioned how helpful I think technology can be, but many practices are unfortunately a bit jaded about it. However, there are many new things out there that are not very costly or risky to try, such as the front desk tools I’ve mentioned. Companies in other industries are much faster to try new technologies that can help them be more efficient or market better. I’d like to see practices learn from that.

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