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EBOOKS Practice Management for Healthcare

STEVENS
FOR THE Professionals PRACTICE MANAGEMENT
ENGINEERING Drew Stevens COLLECTION
LIBRARY “Medical practices are very complex and different from general
Drew Stevens, Editor
Create your own businesses. As a doctor you not only have to be an expert in your
Customized Content field but also need to understand and deal with rapid changes in
Bundle  — the more healthcare, new governmental policies, insurance changes and
reimbursements, referring physicians and hospitals, and, most
books you buy,
importantly, how to interact with patients. Drew Stevens has
the higher your

Practice Management for Healthcare Professionals


developed an impressive, comprehensive step-by-step strategy
discount!
that leads to a successful healthcare practice. This is a must
read for anyone in the medical field concerned about increasing
THE CONTENT patient care, revenues, and their position in the market.”

Practice
• Manufacturing —Sudhir Jain, MD FACC MBA,
Engineering Associate Professor of Medicine, Washington
• Mechanical University School of Medicine St. Louis Missouri

Management
& Chemical
Engineering Healthcare is one field that remains a growing industry, ­according
• Materials Science to the U.S. Bureau of Labor. As the youngest baby ­boomers
& Engineering
• Civil &
Environmental
continue to ascend in age, the need to employ ­
­ qualified
health care personnel to both prevent and treat ­medical issues
­increases. BLS suggests that there will be substantial growth of
for Healthcare
Engineering
• Electrical
people in the healthcare field, from practitioners to operations
personnel in administration and technology. Yet, many in the
field struggle.
Professionals
Engineering
This book provides relevant, pertinent, and focused
THE TERMS i­nformation to aid a new or existing practice. The author, a
• Perpetual access for ­well-respected international practice management consultant
a one time fee and medical practice coach, offers insights to revive a ­struggling
• No subscriptions or practice. He provides frameworks, templates, and scripts that
access fees practices can immediately use.
• Unlimited
concurrent usage Drew Stevens, PhD, works with struggling physicians and
• Downloadable PDFs transforms them into wealthy professionals. He works with
­
• Free MARC records medical practitioners and their practices to build leaders,
­
­manifest brands, and orient the practice into a profitable and
For further information,
a free trial, or to order,
sustainable entity. Stevens is an international keynote and
­plenary speaker and in the last 25 years Dr. Stevens has made Drew Stevens
contact:  over 9000 presentations to audiences throughout the world.
sales@momentumpress.net

ISBN: 978-1-60650-697-4
PRACTICE
MANAGEMENT
FOR HEALTHCARE
PROFESSIONALS
PRACTICE
MANAGEMENT
FOR HEALTHCARE
PROFESSIONALS

DREW STEVENS

MOMENTUM PRESS, LLC, NEW YORK


Practice Management for Healthcare Professionals

Copyright © Momentum Press®, LLC, 2016.

All rights reserved. No part of this publication may be reproduced, stored


in a retrieval system, or transmitted in any form or by any means—­
electronic, mechanical, photocopy, recording, or any other—except for
brief quotations, not to exceed 400 words, without the prior permission
of the publisher.

First published by Momentum Press®, LLC


222 East 46th Street, New York, NY 10017
www.momentumpress.net

ISBN-13: 978-1-60650-697-4 (print)


ISBN-13: 978-1-60650-698-1 (e-book)

Momentum Press Practice Management Collection

Cover and interior design by Exeter Premedia Services Private Ltd.,


Chennai, India

10 9 8 7 6 5 4 3 2 1

Printed in the United States of America


Abstract

Healthcare is one field that remains a growing industry according to the


U.S. Bureau of Labor. As the youngest baby boomers continue to ascend in
age, the need to employ qualified health care personnel to both prevent and
treat medical issues increases. BLS suggests that there will be substantial
growth of people in the healthcare field, from practitioners to operations
personnel in administration and technology. Yet, many in the field struggle.
Aside from advances and alterations in healthcare administration and
regulations, one of the largest issues in medical practice is the lack of
business acumen. Doctors and staff are well educated in clinical issues but
operating a medical practice requires leadership skills, human resource
strategy, and most importantly, the acquisition, conversion, and retention
of new patients. Without these skills practices will suffer.
Enter The Handbook of Practice Management published by
­Momentum Health Press and written by Drew Stevens, PhD. The book
provides relevant, pertinent, and focused information to aid a new or exist-
ing practice. Stevens, a well-respected international practice management
consultant and medical practice coach, provides information to revive a
struggling practice. Dr. Drew, as he is known amongst clients, provides
frameworks, templates, and scripts that practices can immediately use.
“Medical practices are very complex and different from general
­businesses. As a doctor, you, Natalie, not only have to be an expert in your
field but also need to understand and deal with rapid changes in health-
care, new governmental policies, insurance changes and reimbursements,
referring physicians and hospitals, and, most importantly, how to interact
with patients. Drew Stevens has developed an impressive, comprehensive
step-by-step strategy that leads to a successful healthcare practice. This
is a must read for anyone in the medical field concerned about increasing
patient care, revenues, and their position in the market.”
Sudhir Jain MD FACC MBA
Associate Professor of Medicine
Washington University School of Medicine St. Louis Missouri
vi  •   Abstract

KEYWORDS

best practices, medical consulting, practice management, practice man-


agement books, practice management consultant, practice management
course, practice management group, practice management marketing,
practice management program, running a medical practice, running a
medical business, small business management
Contents

1 Practical Issues for Practicing Physicians 1


1.1 What Is the Best Way to Begin? 3
1.2 Is It That Easy or Am I Missing Something? 4
1.3 Fiscally Friendly 7
1.4 The Myths of the Medical Practice 10
Reference12
2 Finding The Best Location 13
2.1 Following the Path 15
2.2 Office Design and Layout 17
2.3 A Quick Review of Commercial Lease Agreements 18
2.4 Summary 20
3 Credentialing and Getting Started 21
3.1 So Where Do I Start? 22
3.2 Are There Other Applications Where Credentialing
Might Be Necessary? 24
3.3 What to Watch for 25
3.4 Are There Other Ways to Get Paid? 26
4 Proper Business Planning 29
4.1 Practice Acceleration Business Model 30
©

4.2 Practice Success 32


4.3 Additional Items 39
5 Marketing for Doctors and Staff 41
5.1 Fantasy and Reality—Where Perception Fits 43
5.2 Marketing Mindset 45
viii  •  Contents

5.3 Placing Distinction in Your Marketing Mindset 46


5.4 The Seven Laws for Building Relationships with a
Marketing Mindset 47
5.5 Marketing Acceleration—Nine Steps to a Marketing
Mindset and Pathways to Patients©49
5.6 A Quick Word About Websites and Website Conversion 71
5.7 A Quick Word About Social Media 74
References75
6 Developing The Patient Experience 77
6.1 People, Process, and Aesthetics 78
6.2 Tips for Dealing with Difficult Patients 81
6.3 Responding Successfully to Specific Patient Expectations 84
6.4 Red Flags That Tell You Things Just Aren’t Working 88
6.5 Practice 89
6.6 What Gets Measured Gets Repeated 90
6.7 Conclusion 93
6.8 Summary 93
7 Staff Development 95
7.1 How to Get Staff Motivated 96
7.2 It’s All About Commitment 98
7.3 Repetition Might Kill Them and You 100
7.4 How to Handle Conflict and Confrontation 102
7.5 Create a Culture of Concern 104
7.6 Create a Strategy 106
7.7 Will They Ever Get Motivated 107
References109
8 Human Resources for Doctor and Staff 111
8.1 Planning Your Practice’s Staff 112
8.2 People Make a Difference 113
8.3 The Benefits of an Employee Manual 114
8.4 Work Rules and Performance Standards (Standards of
­Workplace Behavior) 117
8.5 How to Manage Staff the Right Way 119
Contents  •   ix

8.6 The Starting Line—The Front Desk 121


8.7 Remember to Reward and Recognize a Job Well Done 125
8.8 A Final Word in Human Resources 132
9 Practice Management Technology 137
9.1 Practice Management 138
9.2 Scheduling and Patient Management 139
9.3 Website 140
9.4 A Quick Word About the Social Media 143
9.5 Software That Aids Your Reputation 144
9.6 What Is Reputation Management? 144
9.7 Is Reputation Management Worth It? 145
9.8 How Do I Begin? 145
10 Trends in Physician Practice Management 147
10.1 Burnout 148
10.2 Independence versus Employment 150
10.3 Insurance and Dictatorship 152
10.4 iPatient 153
10.5 Staff Retention 155
10.6 Risk Management 158
10.7 Records 159
10.8 Confidentiality 160
10.9 Office Management 161
10.10 Technology 161
10.11 Government 162
References163
Week 4—Finances 165
Index 181
CHAPTER 1

PRACTICAL ISSUES FOR


PRACTICING PHYSICIANS

If you are brilliant, ambitious, and gifted in science, you may consider
becoming a doctor. If so, think twice. According to a new survey by
personal finance site NerdWallet, most doctors are dissatisfied with the
job, and less than half would choose a career in medicine if they were
able to do it all over again.
There are many reasons for the dissatisfaction, says Christina
Lamontagne, vice president of health at NerdWallet. Most doctors enter
the field thinking they’ll be able to spend most of their time healing the
sick. Yet the paperwork burden on doctors has become crushing, and
could become even more complicated under the Affordable Care Act.

“Administrative tasks account for nearly one-quarter of a doctor’s


day,” Lamontagne said. “With additional liability concerns and more
layers in health care, we can understand the drain this takes.” (Krist-
off 2013)

If clinical time is not counted, it is easy to say that becoming a


physician includes well over 5,000 hours of study even before taking
the boards. While there is a tremendous amount of preparation that
medical schools put students through for understanding, applying, and
diagnosing patient symptoms, there are not many schools that prepare
doctors, in any discipline, to run a practice. Those physicians who do
not opt to work in hospitals or hospital run clinics end up operating
their own practice—running their own business. Without proper resour-
ces or tools this could lead to insurmountable failure. The rationale
behind this book is to provide both the new and upcoming physician
and those who have been in practice some foundational tools that aid in
practice efficiency.
2 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

The fact that you are becoming a physician or have become a physi-
cian has little significance in terms of business success. For many years
both the organizations SCORE and SBA (small business administration)
have determined that almost 90 percent of most small businesses fail
within the first five years with the number of failures decreasing only
marginally over the next seven years. Operating a practice is exceed-
ingly difficult. Should you desire to become a solo practitioner or even
get involved in a multidisciplinary practice, you will face issues in hir-
ing talent and, perhaps, in terminating that talent at some point, opera-
tional issues such as fiscal responsibility and budgets, marketing issues
to help provide and increase patient volume, and finally risk manage-
ment and ethical issues. As if all this weren’t enough, you will have to
meet pharmaceutical reps, deal with insurmountable paperwork from the
federal government and managed care, and also keep up with medical
issues, technology, and running the business.
The aim of this book is to help you not only to understand the jour-
ney but also to assist you in developing it and perfecting it so that you
can operate the practice of your dreams. Operating a practice requires a
laser-like focus. Admittedly, there will be times when your action will
be spontaneous, but your practice requires a framework, which you
must use as your guiding spirit. This means that from time to time, fam-
ily, friends, and employees might become irritated with the time and
energy you spend on your career, but the rewards are worth it. What is
necessary is for you to create a model and for others to fit into it.
When I mentioned a model you might think of a picture frame
where you have borders on the top and on the sides. You might also
think of it as a box that you might purchase at an office supply store
that has a top, a bottom as well as its sides. Whatever the analogy
you’d like to use, the point is that your practice requires a very particu-
lar framework. The reason for this is that there should be two major
ideologies behind developing this model:

. You should actually have a passion for the practice you want to
develop and the model should be such as to drive you to
achieving that. For example, you don’t want to treat certain types
of individuals who make you crazy nor do you want to work a
practice that that has no medical interest. My cardiologist, for
example, is an absolutely wonderful doctor. However, he was
originally interested in internal medicine and found a mentor who
found his passion was heart ailments. If your passion does not
PRACTICAL ISSUES FOR PRACTICING PHYSICIANS . 3

work you, your model should be such as to get you up every


single day and drive your passion!
. The model should be such as to let others find you and fit
themselves into your plans. As an example, word of mouth and
reputation, which is exceedingly useful in helping prospective
patients find you, is something I will discuss later in this book.
Therefore, patients, employees (staff), vendors and others should
fit well into your model.

1.1 WHAT IS THE BEST WAY TO BEGIN?

In conducting presentations before major associations and organizations,


I typically tell physicians, physicians’ assistants, and staff that in order
to operate a good healthy practice you really have to focus on three
major conditions:

A. Market—You must absolutely understand the demographics that


you service or desire to service. Obviously, part of this begins
when you’re in medical school and you choose your area of
focus, for instance, obstetrics, oncology, or even pediatrics.
However, everything begins with the prospective patient so you
really have to have an understanding of the market so that you
can attract prospective individuals to you in a myriad of ways.
B. Message—As you develop your practice you will need to develop
a message that can be delivered to your market. Unfortunately,
many patients tend to stereotype physicians based on their titles
and even their hospital affiliations. Therefore, it becomes
increasingly important to develop messages based upon value that
will attract the market to you. Much of this content will be
delivered to you in a separate chapter in this book, yet, it is
important that you begin to think on these lines now so that you
understand what it takes to rise above the competition.
C. Message modality—Once your messages are finalized, it is then
incumbent upon you and your staff to send those messages out to
potential markets. Understand that many patients have many of
the tools today that you and I utilize to find products and
services. To illustrate my point, consider the use of the Internet in
looking for electronic products, homes, or even automobiles.
Individuals today search over 1 trillion times per year on Google
4 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

to discover new trends to fulfill their needs. Therefore, your


potential patients will also use similar tools to find doctors. You
will then need to discover for yourself how to get proper
messages across to your potential market.

1.2 IS IT THAT EASY OR AM I MISSING


SOMETHING?

The information given earlier is more a guideline than anything else. In


truth, developing or reigniting your current practice is more about your
mindset than anything else. There are several statistical studies and even
television shows such as “Shark Tank” that discuss the difference
between an entrepreneur and the small business. Each situation will
indicate that the mindset to become a successful business owner is prev-
alent. But what does this signify to you, whether you are starting out or
hoping to reignite your business.?
First and foremost, the physician of today truly has to understand
fiscal responsibility—both in the present and the future. The doctor of
today must understand the value of his services and how to invoice
them so that he/she gets paid promptly. Managed care, cash, or even
concierge practice is insignificant; today’s physician must charge appro-
priately for the value that he provides to his patient, invoice that patient,
and get paid. Ask many doctors today and they will tell you that they
are bleeding from expenses because they’re not charging enough for the
value of their services. There are many others who would not be able
tell you what their account receivables are from managed care services.
This is why today’s physician must truly understand income and
expenses and profit and loss and should even be able to forecast the
income for the year ahead so that they can understand how they will
make money.
It is understandable that many doctors would rather just treat
patients and not get involved with fiscal issues. Although I don’t nor-
mally recommend this, because doctors should have some degree of
specificity, then it will become necessary for a spouse or an exception-
ally good practice manager to manage the practice. However, if the doc-
tor decides to delegate the fiscal responsibility totally to someone else,
there must be an exceptional degree of trust between the doctor and that
staff member. In my 25 years of consulting there are too many stories
of the front desk and practice managers taking away droves of money
PRACTICAL ISSUES FOR PRACTICING PHYSICIANS . 5

from physicians. It is best to be a terrific business owner rather than a


statistic.
Second, the right mindset would mean you deal with patients first. I
recall a quote from the famous management guru Peter Drucker who
stated, “The purpose of a business [practice] is to create and keep a cus-
tomer [patient].” Look at any business that suffers today in America;
they suffer because of two main reasons: (a) too much focus on revenue
and numbers and (b) ethics. And, it matters little what the industry
is—healthcare, information systems, utilities—these issues are abundant
because so few focus so little on the customer (patient) experience and
customer (patient) retention.
The most important, often overlooked, issue in healthcare is patient
service. Today, patient-to-patient influences are stronger than ever
before. With the proliferation of the Internet and instant connectivity,
patients are able to instantly spread information about healthcare practi-
tioners and their offices.
Here are three ways to prioritize patient service in your medical
practice:

1. Have the right mindset


During my collegiate business studies, I discovered a quote that
personifies the achievement of every business. Peter Drucker
stated, “Every practice is in business for one reason: the customer
[patient].” All activities and internal functions are dependent on
acquiring and retaining patients. Simply put, healthcare
practitioners require a laser- like focus on patient service.
Second, doctors tend to become involved in a myriad of tactical
issues that can alter focus and create stress. Therefore, they need
to be confident about their achievements. And, they must
continually maintain confidence in their staff even during volatile
times. This also includes operating the practice using prudent
risk. The comfort zone becomes too important in a practice with
set procedures, and it is very difficult for owners to move away
from it.
2. Have the right people
Patient service depends heavily to proper communication. When
doctors and staff communicate in effectively with one another
and with patients, the service fails.
Patients, both current and prospective ones, are pleased by good
communication. The more you tell them, the more comfortable
they become. Remember they are investing in your sage advice
6 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

on health. Communicate to them the rationale for paperwork,


procedural issues, signatures, and so on. Ensure the phones are
answered promptly and with professionalism. Finally, when
patients are serviced appropriately they inform others of their
positive experience. Such feedback helps to decrease marketing
and advertising costs while also retaining current patients.
Also, spend time and get to know your patients and their
families. Patients want a provider they know and trust. When
healthcare practitioners rush from treatment room to treatment
room, it indicates an inward focus, which puts off patients.
Always remember:
Patients are the most important people.
Patients are not dependent on us.
Patients are not an interruption of our practice.
3. Care for your space
Individuals always judge books by their covers, and patients are
no different when it comes to how they perceive your medical
practice. On a recent appointment with a supplier, I could not
find a spot to park my car. All employees’ cars were in visitor
spots. On visiting another potential client, I entered the main
lobby of his office, and it looked like a hurricane had struck the
office recently. These images leave a one with a certain image of
the company’s operations.
In other words, pictures speak a thousand words. The reception
area must be tidy, organized, and exemplary of the service you
provide. Staff should dress professionally and, preferably, have
nametags. It took five trips to my current cardiologist before I
even knew the name of his receptionist.
The cacophony of competition is very strong; the power of
patient service should not be underestimated. With many
competitive practices and patients having the power to influence
other patients, the kind of service provided is the marketing
differentiator. Ironically, many healthcare practitioners look at
how many patients they see per week. You might want to
consider how many patients don’t see you because of poor
patient service.
PRACTICAL ISSUES FOR PRACTICING PHYSICIANS . 7

1.3 FISCALLY FRIENDLY

Financial Management with an understanding of where the practice is


and where it is going. There are excellent computer programs on the
market such as QuickBooksÓ that allow you and the practice manager
to understand the state of the practice. These computer programs
quickly illustrate income and debts while allowing you to automate
checkbook balances, bills to vendors, and reimbursements to patients as
well as the ability to generate financial reports to understand the state of
the practice.
One does not have to run many reports, but there are several reports
worth mentioning that help you understand the healthiness of your prac-
tice. The first is the balance sheet. The Balance Sheet represents a quick
snapshot in time of the practice. This provides the practitioner with a
statement of assets and liabilities. Assets are items such as cash on
hand, furniture, equipment owned, and other items and, perhaps, even
long term items that will convert to cash. For example, assets include
cash and equivalent, account receivables, and any inventory you paid
for in supplies. Liabilities are what you are liable to repay, such as debt,
leases, and so on. These include plant, property, and equipment leases.
The interesting thing about a balance sheet is that it helps you to under-
stand the financial health of the practice in both the long and the short
term. A balance sheet will help the doctor understand liquidity, financial
flexibility, and financial strength.
There is also the Income Statement, which is a source to help under-
stand the practice’s profitability. There is a simple equation to under-
stand your profits, that is, revenue minus expenses equals your net
income. The result indicates your actual remaining cash after expenses
and what you get to keep, save, invest, and so on.
The Profit and Loss Statement provides a quick summary of the rev-
enues, costs, and expenses incurred during a specific period of time
such as a quarter or an entire fiscal year. This will provide a good
assessment as to the value of the practice at any one point in time.
These are just some of the many reports that a doctor and practice
manager can review. My advice, however, is to engage with a good
accountant and financial planner to better understand your financial
position as well as to guide you in the best practices for your particular
practice.
Before you venture into building these reports, you might consider
four very useful resources. As I mentioned there are a number of
8 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

computer software packages that have prebuilt templates to assist you in


understanding the strength and limitations of your practice. In addition-
ally, if you like being even closer to the numbers, you might consider
using a spreadsheet with templates available from either MicrosoftÓ or
any other vendor that has templates for financial management. You also
might consider the services of both an accountant and a financial advi-
sor. The former will conduct a monthly audit of your books and handle
your expenses and the latter will help you with frugal financial manage-
ment. No matter what you use, it is highly recommended that you do
not skimp in this vital area of your practice. Your fees will range from
a few hundred dollars in software to several thousand in personal serv-
ices, but your savings in time, stress, and payments will be well worth
it!
First, as mentioned, operating a practice is more than just providing
treatment: you are now operating your own business. And doing so
may not allow for the quick home as office remedy. You will need to
research and locate commercial space that will fit your style and your
practice. In addition, you will need quite a bit of start-up capital in
order to fund the lease and all the equipment required.
Typical start-up costs might be as small as $50,000 or may exceed
over $250,000 depending on the location, market, and equipment
needed. And if that has not scared you enough, the equally compelling
issue is where to open.
One of the first things to do, even before you see a banker, is to
research your market demographics to determine if your market can
support a new chiropractic practice. Although we will discuss marketing
information later in this book, it is important to understand how demo-
graphics will interfere with your survival. For example, in St. Louis,
Missouri, there are well over 500 chiropractors for only 2.5 million peo-
ple. That means that for every one chiropractor, there are 5,000 possible
patients. Now, most will say that is a good number to have in patient
volume. This is true if they are all interested, and we know they are
not.
The next thing you will need to look for is a proper location. As
they say in retail, it is all about location, location, location. To have
patients requires visibility, and if your site is not accessible it may as
well be invisible. Therefore, it is important to choose a location that is
easy to get to, has ample parking, is well lit, is located in an active area
such as a strip mall or semi-attached building to a mall, and offers good
signage.
PRACTICAL ISSUES FOR PRACTICING PHYSICIANS . 9

Next, you will need to think of office design. Yes, being a business
owner requires you to be a part-time decorator too. There will be the
need for a large waiting room, reception desk or counter, rest room, and
easy accessibility to the treatment rooms. There should be enough space
to fit equipment, patients, and comfortable furniture. Remember, this is
your place of business, not the living room, so everything needs to be
professional, clean, and comforting.
Once you decide on location and furnishings, it will then be time to
engage in the most imperative aspect of your practice—patients. While
we will cover a large part of this in the marketing chapter, it is vital to
know that your mission every day (should you choose to accept it) will
be consistent and relentless marketing. As a chiropractor, you are in the
marketing business, which requires meeting an inordinate amount of
individuals who will possibly become your patients. In fact, a large part
of your time when you are not treating patients will be spent in finding
them. This will require attendance at regional events, networking clubs,
and any other place where you can shamelessly promote your practice.
And once you begin to treat and gain an influx of patients, you will
then need a different kind of help. Similar to what I stated earlier about
finances being the difficult side of the practice, being a leader is not
any easier. You will be responsible for hiring, training, terminating,
mentoring, and communicating to as few as one or as many as, perhaps,
12 employees. Aside from your patients, employees are your greatest
assets and critical to your success.
Good leadership requires terrific communication skills, good hiring
skills, and good direction to ensure all your employees understand their
roles and responsibilities. If you treat them right, you will have a loyal
and productive staff while also ensuring you have less turn-over among
your staff. Effective leaders not only say they want to do the right
thing, they follow through with appropriate actions. They “walk the
way they talk.” To be an effective practice leader, then, is to set the
right example, serve as a role model, make your actions speak louder
than words, stand up for what you think is the right thing, and show
the way, while keeping the objective in mind and espousing positive
beliefs. The most inspiring doctors are those who lead by example—by
their words and by their behavior. You’ve probably heard the old say-
ing, “Do as I say, not as I do.” This is fine in personal situations but
will fail miserably in a professional one. You must make sure that what
you say and what you do are always in sync.
10 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

1.4 THE MYTHS OF THE MEDICAL PRACTICE

One of the ideologies that you must come to quick grips with is that
you do not need a business plan nor a pile of documents to get started.
That is not to say that there will not be tons of paperwork with respect
to payer mixes and reimbursements. The reasoning behind this thought
is that business plans are simply for those seeking money for business
expansion or business capital. At the start of their careers, most practi-
tioners are going on rounds either in hospitals or even clinics before
venturing into a solo practice. In additional, since the great recession of
2007 to 2009 most banks have ceased to give loans to business profes-
sionals including medical practitioners, thereby reducing the need for
most business planning documents. That is not to say that at some point
such documentation will not be necessary; however, it is not vital to
starting your venture as a medical practitioner.
The second issue is whether to buy or lease space. So many practi-
tioners are attracted by the most pristine locations or the very best office
buildings or by contemporary designs that appear to be the coolest. It is
best to stop worrying about the most perfect choice of location. What is
most important is the type of practice you will focus on and a place
that will be easy for patients to visit. Although you may have found the
perfect site in the perfect corner of a great building, you must recognize
the fact that what you really need is the best location, that is, a nucleus
or rather a hub near where your prospective patients are located. There
is so much time, energy, and money wasted on commercial office space
and signage with the end result that patients don’t visit. The single most
important idea—something that will be discussed later in this book—is
where your patients are located and what is the easiest way for them to
come and visit you. For example, if most of your patients are elderly,
then you want to be located close enough to highways and byways or
even Senior living centers. If you intend to be a pediatrician or are a
pediatrician, then you want to be located close enough to elementary
and secondary schools so that parents can easily adjust their schedules.
And finally, if you plan to become a specialist and service the professio-
nal business community then it is best to be located where the patients’
businesses are located so that they have easy ingress and egress to your
location You must have got the point that you need to be located close
enough to your prospective base so that you can build a community,
market frequently, and network consistently having become a familiar
PRACTICAL ISSUES FOR PRACTICING PHYSICIANS . 11

brand. In additional, you want to ensure that you are in a location where
it is easy enough for patients to find you.
Lastly, there is a myth that says that you have enough money in a
bank account should you desire to start a practice, venture out on your
own, or even buy a practice. While there are some standard business
procedures that help to mitigate any risk, you need to understand that
becoming a private practice doctor is more about undertaking a risk
rather than the amount of money you have saved to begin the practice.
Honestly, there is no right or wrong; the biggest issue is having enough
put aside so that you can pay rent and utilities and eat. At the end of
the day you should have enough money so that you can survive. How-
ever, as a rule of thumb, it will be good to have three to six months’
worth of earnings saved away so that you can get started. Yet many get
by with less than that. If you desire to venture into your own private
practice then don’t wait for the perfect situation—simply do it! This
issue will be covered in a later chapter.
Suffice it to say that you do not have to acquire a tremendous
amount of information to be a thriving practitioner. The reason for
developing this book is really to give you some common sense princi-
ples and foundational ideas that have not been not covered during your
clinical health years. There is no one single statistic that can be used to
say who does well and who doesn’t; yet, having the right foundational
skills will make you a better business-oriented doctor in the years to
come. The whole purpose of this book is to actually provide you with
the skills and techniques that will help you to retain your passion and
energies to treat the ill. The greatest joy that is seen in life is when indi-
viduals actually enjoy the fruits of their work and the benefits of their
labor. Becoming a doctor is an exceedingly daunting task. We know
that there are arduous hours of study, clinical rounds, training, mentor-
ing, and continued study. Yes, qualifying to be a doctor is a difficult
journey, but a journey just the same. You got into this line of work for
two purposes (a) an overwhelming desire to cure the sick and (b) a pas-
sionate interest in a specific line of health. Like the football athlete who
loves to carry the ball, the dancer who loves to plié, and the singer who
enjoys performing in front of crowds, you too should enjoy your work.
Let the remainder of this book help you find the light and help you
love the work you do while making it much easier to enjoy it.
12 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

REFERENCE

Kristoff, K. September 10, 2013. “$1 Million Mistake: Becoming a Doctor.”


CBS MoneyWatch. http://www.cbsnews.com/news/1-million-mistake-
becoming-a-doctor/ (accessed January 28, 2015).
CHAPTER 2

FINDING THE BEST LOCATION

It has always been said that the best practices and the best businesses
are successful because of location, location, and location. Whether you
are situated in a busy intersection, a busy strip mall, or an independent
building, location will be key to your success. There are numerous rea-
sons why location is helpful. These include but are not limited to the
following:

. Access—As with any business the more convenient it is to find


your location, and parking space nearby, the better for the
patient. The consumer (patient) today requires as much
convenience as possible. Coincidentally, research in this area
suggests that most patients today will select the chiropractor
within a 10 to 15 minute drive of their homes or professional
institutions. In addition, there must be ample parking space as
well as an easy way to get back to main thoroughfares.
. Building space—One of the largest expenses at the beginning of
any practice is the cost of a commercial building as well as the
buildout for your anticipated location. Office space today,
depending upon urban areas, can be quite minimal to quite
expensive. However, typically most medical offices have the
convenience of parking, space for patients with disabilities, and
elevators for an aging demographic. In addition, many buildings
provide terrific signage on kiosks so that new prospective
patients can find you easily.
. Openness—Many patients today enjoy the ability to sit and relax
in spacious waiting rooms and treatment rooms. This will be a
key factor in trying to establish a five-star experience for your
patients.
14 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

. Safety—In our present litigious world, patients and consumers


are always concerned for their safety. Buildings, parking lots,
stairwells, and elevators should all be well lit so that patients feel
comfortable visiting you either early in the morning or late in the
evening.

The fact is you want to be located where your practice will be con-
veniently accessible to your prospective patient base. Finding the proper
location is truly one of the most important investments in your practice.
It will be an identifying factor for both those who know you and those
who don’t. So it is best to pick a location that is adjacent to or sits on
highways or byways so that people can get to you easily. However,
finding these terrific locations may be quite daunting for anyone decid-
ing to move from hospitals or clinics or the physician simply desiring
to go out on his or her own. Therefore, it is highly recommended that
you find a good commercial real estate agent, who can be tremendously
helpful in locating your desired space. With defined parameters, the
agent can scout out suitable options quickly for you. After all, that is
the agent’s job!
Prior to meeting with any commercial agent, it is best to do some
research on your own so that you have some idea of what areas will be
suitable. In addition, you should consider several factors even before
meeting with this professional. First, you should have a clear estimate
of your monthly income to determine how much rent you can pay or if
a mortgage is possible. Second, as I mentioned previously you should
know the geographic parameters of the desired location. I also suggest
that you include secondary and tertiary parameters in case your primary
locations are unavailable. Third, you should also look for the square
footage you believe you’re going to need. This includes, but is not lim-
ited to, your waiting area, your front desk, your treatment rooms, and
even your office. I recommend you talk to several other physicians in
your area of specialization or even others located in the area to get
some idea of the space that you might require. Understand, however,
there is no right or wrong, you simply need enough space to accommo-
date the number of patients who will be visiting you hour by hour.
With this in mind, as you venture out to discover a commercial real
estate agent please keep in mind that these agents are simply liaisons
between buyers and sellers. Typically, most agents will ask you to sign
an agency contract so that you understand what side of the transaction
they represent. In certain situations they will represent the buyer; in
FINDING THE BEST LOCATION . 15

others they will represent the seller. You have to ensure that you are
represented as a buyer so that you are able to negotiate properly and
professionally for your prime location. In addition, you must also under-
stand that you will be bound by many of the state laws, local interests,
and local responsibilities. Therefore, you should gain access to a com-
mercial agent who truly understands the area so that there are no hidden
surprises when signing agreements. The commercial agent should have
no problem with closing responsibilities and obligations as they can
view both sides of the transaction.
Understand that commercial agents are individuals and, at the end
of the day, are simply professional salespeople. Depending on the con-
tract that you sign you should be able to terminate your agreement if
there is any sign of ethical discomfort with the agent. That is why I
suggest you take the time to find someone you are most comfortable
with. I truly believe that you need someone who is a buyer peer, under-
stands your issues, and is willing to bat for you given the right set of
circumstances.
One other item worthy of mention here is that you are still free to
seek out properties on your own. Although you have an agent working
for you, there is nothing stopping you from conducting your own
research. Yet, depending upon your contract, should you find the right
property, the agent may have to get involved and would be entitled to
whatever commissions there are. For these types of issues I always rec-
ommend either engaging an attorney or definitely reading the fine print
of any agreements that you sign.

2.1 FOLLOWING THE PATH

Without getting heavily involved in a lecture on real estate, I would like


to mention a few things you must understand when it comes to finding
good commercial real estate space. Commercial real estate, unlike resi-
dential real estate, falls into several categories. As you can imagine real
estate can be categorized as industrial space, retail space, such as you
would find in the strip mall, large skyscrapers, such as downtown office
buildings, hotels, and even open land. Commercial real estate is then
further divided by grades—type A, type B, and type C. Without going
into great detail, type A would be the most pristine, typically the most
contemporary, and offering the most updated amenities as well as
located in prime areas. Given that definition you will note that you will
have to pay more to be in the best location. Therefore, when working
16 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

with an agent or even looking by yourself, understand the grading scale


because this is going to affect your rent as well as your mortgage.
Once you understand what fits into your budget, your next step will
be to understand the amount of square footage that you will need. As I
write this book I cannot determine your personal needs on space, but
suffice it to say you’ll need at least a 12 ft.  15 ft. waiting room
which doesn’t include the front desk, a front desk area and then some
other area for office files or your patient records, a 10 ft.  10 ft. office
space for your consultations and paperwork and at least four to six
patient treatment rooms depending on your business. Just taking an
average of many of the private practices I’ve been to both as a patient
and as a consultant it might be reasonable to say that your practice
would require between 1,500 and 3,000 ft.
Once you’ve found the perfect place, in that perfect corner, in the
best building in the world, it is almost always guaranteed that you’re
going to have to make changes to the physical layout unless you are
renting or purchasing another physician’s practice. Yet, even if the office
were previously owned by a physician, similar to a residential home,
you will want to make some cosmetic changes such as painting the
walls, carpeting, wallpapering, door openings and so on. Unless you are
renting or purchasing a shell you’ll almost always have to effect
changes.
If you have ever purchased a pre-existing home you know that
almost anything and everything is negotiable. This includes the roof,
the carpets, and perhaps even lighting fixtures. The same is true for any
commercial lease or purchase. Typically most landlords and leaseholders
are almost always willing to negotiate with a potential buyer so that the
space is utilized. Empty commercial space, especially after the great
recession of 2007 through 2009, is a plague any commercial property
owner would prefer to avoid. So always be willing to negotiate, if pos-
sible, with the cosmetic updates to your desired property. These include
but are not limited to some repainting and recarpeting, perhaps even a
deferment or discounts on monthly lease payments and down payment,
and many other amenities.
When negotiating for new space, and this is where your commercial
agent will really have to be your Advocate, you might ask the lease-
holder or property owner to help you with the buildout of the shell. The
big concern here is that if you are leasing or buying new space in a
new property or perhaps new space in an updated property that has
nothing but a shell, it requires you to work with an architect and other
contractors to get the interior to match your vision. The big issue here
FINDING THE BEST LOCATION . 17

is that at some point you’re going to want to start treating patients, and
working with architects and contractors is exceedingly time-consuming
and may take you places where you might not want to go. In addition,
the building is certainly going to have some restrictions so you really
need to understand what the lease requires before you even sign.

2.2 OFFICE DESIGN AND LAYOUT

Whether you work with a contractor or are attempting to remodel exist-


ing space, you should bear in mind, as I mentioned earlier, some simple
rules of thumb for the space that you will need. I mentioned earlier that
I’ve worked for several doctors and been a patient myself, so I have
seen what works and what doesn’t. Recall that the first thing that a
patient is going to see is your waiting area, so you want it to be warm,
comfortable, and, most of all, inviting. Assuming for the moment that
you will have between 10 and 15 waiting room chairs or couches, a 12
 15 or 20  20 waiting room would be sufficient for your needs. This
room will also be the place where patients check in so you want to
have an open and friendly check-in counter. The counter need not be
too long but should be long enough and wide enough so that patients
can sign proper paperwork and speak openly to your front desk staff.
Typically that space can be 10  10.
The next area that patients are going to see is your examination
room. These examination rooms need to be large enough to accommo-
date a table, a counter for writing, a sink so that you can wash hands
before an examination, a place for the physician’s stool, and then, any
storage for equipment, medical tools, and even supplies. Remember that
in today’s society all doors, including those of examination rooms, need
to accommodate individuals with disabilities. So the building that you
lease must be ADA compliant so as to accommodate individuals in
wheelchairs or with other assistive devices. And, many patients who
visit you, will typically have another support person and so the room
should have a chair for them to sit comfortably in. With this in mind an
examination room should be no smaller than 10  10 or even 10  12.
In addition, think of other devices, resources, or tools that you might
want to have in your room in the future. This can include, but is not
limited to, computer equipment, laser equipment, and even X-ray equip-
ment. Don’t always think about only of the present but think also about
the future so that you can plan for it.
18 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Finally, you will need to also consider storage in short rooms, tele-
phone, and computer networking rooms, an X-ray suite, unless you’re
going to outsource X-rays, and a break room assuming you have a large
enough staff to support it. Yet, do not forget the most important room
that not only your patients are going to need but you also will
need—the bathroom. At some point you will need to use it as will your
patients, and it is best to have one located within reason.

2.3 A QUICK REVIEW OF COMMERCIAL LEASE


AGREEMENTS

As you read through this book, realize that no legal advice is being
offered, nor am I a commercial real estate agent. It is always best to
contact a competent and experienced individual who can guide you
with the key items you need to understand when signing for commercial
leasing space. Your agent and your attorney will be able to provide you
with the intricate details and processes necessary to negotiate a lease for
you. With this in mind, please realize that the following are some of the
general things that you might see in a lease agreement.
Term—The term is similar as when you seek a residential apartment
or take on lease an automobile or other physical property and is no
more than the length for the primary consideration of gaining space
between you and the building owner. The term of the lease would be a
fixed period of time whether the property is being leased or even pur-
chased. Realize that this term will affect your cost per square foot, any
interest rates tacked onto the properties, and, perhaps, any increases to
your monthly or annual payments.
Full service or triple net—As a lessee of the property a full-service
lease usually includes the costs associated with the property. This may
include services such as janitorial services, general utilities, taxes and so
on. No matter what, you’re always going to be responsible for the gen-
eral maintenance of your space and the general utilities of the address
space such as telephone, computer equipment, and even salaries. A tri-
ple lease, then requires that you, as a lessee, pay utilities associated
with the lease space and then contribute to the common area mainte-
nance, such as property taxes, perhaps landscaping, and even lighting.
Remember each lease is different; so you always want to ensure you
have read your lease properly and you are aware of all factors.
FINDING THE BEST LOCATION . 19

Leaseholder improvements—In certain commercial properties this


includes the buildout of your office space or simply remodeling to pro-
vide a facelift. The leaseholder improvement allows you, as a lessee, to
make improvements in the space as you see fit. There will be certain
allowances on an annual or leasehold basis and, again, this is com-
pletely up to the lease holder.
Building accessibility—Remember commercial office space is just
that—commercial. The hours of operation will vary depending upon the
number of tenants in the building and the demography of these tenants.
Most commercial buildings are typically operational from 7 a.m.
through 6 p.m. Monday through Friday. As a physician you want to
ensure that your patients will have easy access to the building during
normal operational hours.
Building security—With many of the threats in contemporary soci-
ety, many office buildings now staff their buildings with private secur-
ity. The fees for the security may be included in your monthly lease
payment. This should be spelled out in your lease agreement. In addi-
tion, building security should be quite familiar with you and your pro-
spective patients so that everyone feels comfortable upon entering or
exiting the building.
Tenants—It is always in the best interest of the landlord to rent pro-
fessional space to professional people. But remember that people are
people. You cannot always be protected from the practices of other ten-
ants who might be quite disturbing. City zoning regulations will typi-
cally for many encumbrances and offer some protection but before
signing any lease make certain you understand who your next-door
neighbor will be.
Additions and exclusions—From time to time and depending on
your negotiations you might ask for certain items to be included in your
lease or some tenants to be excluded. For example if you are an ortho-
pedist, a general practitioner, a pediatrician, or even an allergist you
may request for an exclusivity that precludes anyone similar from oper-
ating in the building. This helps to avoid competition and provides you
the exclusivity needed in the neighborhood. On the other hand, there
may be times when your practice, depending on your area of specialty,
might require special equipment. This may include, but is not limited
to, magnetic resonance imaging equipment, soundbooth for audiology
such as any ear, nose, and throat surgeon has, or simple X-ray equip-
ment found in the proprietary office. Each lease agreement is different
so understand what you will need to negotiate the best terms.
20 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

2.4 SUMMARY

Aside from your choice of specialty, the selection, design, and location
of your space will significantly impact your future work. This is a sim-
ple decision that will shape your future destiny. There is no such thing
as perfection; so don’t worry about the perfect location, the perfect
space, and the perfect square footage. Once you feel settled, negotiate
the best possible space for you and your prospective patients. Finally,
ensure you choose a space that you can grow with, your patients can
grow with, and, most importantly, you can afford both now and in the
future. This space will be a large chunk of your expenses, and you
want to ensure that it doesn’t constantly thief catcher income so that
you can enjoy a nice life and live comfortably once you have made this
choice.
CHAPTER 3

CREDENTIALING AND
GETTING STARTED

Once you have decided to open the doors to a new journey into a solo
practice the need to decide how to get paid will arise. In the medical
field there are just a few options and in most situations your hands will
be tied by the insurance industry. Therefore it will become vital for you
to establish relationships with a variety of governmental agencies as
well as managed care organizations. In order to get started you will go
through a lengthy process known as credentialing, which is nothing
more than an application process that allows you to obtain reimburse-
ment privileges with insurance carriers.
The larger issue for you when beginning your practice, especially
after you have stepped aside from a clinic or a major hospital, is to
decide how you want to get paid. Therefore it is up to you to choose
from the variety of available carriers. Unfortunately, the only way to get
paid in the medical profession is to establish yourself by credentialing
with the proper authorities. Simply put, if you don’t you won’t get paid.
By now, if you’ve been practicing for a while or have asked questions,
you will understand that there are two ways to receive payment: via a
participating provider or via what is called a nonparticipating provider.
The difference between the two is that if you are credentialed with a
participating provider you will be reimbursed full payment for services
you have rendered the patients. With the nonparticipative provider you
will accept a reduced rate but then you have the option to bill the
patient for the remaining balance. As you can gather, there is a treasure
trove of paperwork in either case.
You might ask which is the best piece for the puzzle, at this point.
The answer is actually based upon your demographic, your level of
treatment, and your office staff. It is best to choose to participate in a
plan based on where a majority of your patients exist. In one of the
chapters of this book, marketing is discussed and you will learn that it
22 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

is best to set up a practice based upon the value that you can provide
the target market. This is similar to the previous chapter where we dis-
cussed location and establishing a base where your most active patients
will reside. With that in mind those demographics will also help you
choose the best reimbursement program for you. To a certain extent you
must understand that your location and your payer mix will coexist
when establishing the practice.

3.1 SO WHERE DO I START?

For those who are unaware of the credentialing process, this is a matter
of looking at your medical background and educational and clinical per-
spective and matching them to an insurance payer. The insurance com-
panies will want to ensure that your background is congruent with the
type of insurance they carry and the reimbursement processes they
have. Please understand, however, that the information being provided
here is not legal advice. The process is constantly changing and it is
best to constantly check with local and national resources to ensure you
have the most accurate and current information.
Having said that, no matter what your specialty, you have to apply
for a national provider number. This is actually a unique provider iden-
tification number that is used by Medicare and Medicaid. This unique
provider number is similar to a tax identification number or even your
Social Security number. This number identifies you as a physician who
provides services. Please note that the receipt of this number complies
with federal law requiring all physicians who contract and claim pay-
ments should have this number. Moreover, as medical records become
more electronic and as the number of patients increase, this unique
number will help you file claims quicker as well as get paid quicker!
However, a word of warning for not only the national provider iden-
tification number but also for all credentialing procedures; this is a
lengthy process. And, you will not be able to practice unless you have
the number and the credentialing established. Each state differs quite a
bit from another in terms of its credentialing procedures and the number
of individuals applying for unique numbers depends upon the numbers
graduating and transitioning from general employment opportunities.
Therefore it is suggested that you allow for at least 6 to 12 months for
this process to conclude. I know this sounds rather daunting but you
better have this process established, sooner rather than later, so that you
have fewer issues down the road.
CREDENTIALING AND GETTING STARTED . 23

Before we get into general reimbursements it is best to have a quick


word about Medicare and Medicaid programs. At some particular point,
your demographics will age or might even be out placed due to some
tragic event. Some of these patients, as they age, will more than likely
utilize services from Medicare and Medicaid, which allow them to
obtain medical treatment at lower costs. Medicare and Medicaid, as you
may know, are federal programs designed to provide treatment to indi-
viduals who are short on funds or even underinsured. Unfortunately,
there is a lot of paperwork required in claiming these reimbursements,
and they are the worst kind of reimbursements to claim. There are
physicians I know who prefer to avoid Medicare and Medicaid like the
plague—and there are others who are resigned to accept. There is no
right or wrong as to whom you desire to treat and why. However, you
did take the Hippocratic Oath with a resolution to treat patients who are
ill, and at some point this may include under serviced individuals.
The decision to treat Medicare and Medicaid patients is entirely up
to you. Yet, it is also dependent on your demographics. Patients will
travel even long distances if necessary to doctors who can heal them. In
many situations, most patients will not travel more than 10 to 20 miles
to find an appropriate doctor in a suburban setting. This changes in
urban areas due to higher population levels. It is best to look into the
demographic base and make a decision based on that. It is also best to
check with local governments because there may be state laws requiring
you to carry Medicare and Medicaid. My recommendation, no matter
which way you choose, is to actually accept everything so that you
have revenue coming from multiple sources without discrimination. I
mentioned earlier that each one will have a treasure trove of paperwork
and require massive follow-up to ensure reimbursement receipt, but real-
ize you will have multiple sources.
Once you have decided on Medicare and Medicaid as well as other
private insurance carriers the next big step begins. This is the comple-
tion of an enrollment form. Each state is different so it is necessary to
understand what the state’s insurance commissioner’s office has avail-
able for you. In certain situations, there may be a state form and a uni-
form or universal credentialing data source. No matter whom you use,
you will have to fill out an application to begin the process of enrolling
in the variety of independent private insurance organizations. There is
good news, however!
Given where we are in today’s contemporary society, there are a
myriad of websites and apps that make the enrollment process much
24 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

easier than ever before. This is not to say that some are not antiquated
and still require paperwork, but some do but allow an electronic appli-
cation. You will need to fill it out completely and also have your
national identifying number with you so that you can submit the form.
Let me give you a quick analogy. Have you ever visited the motor
vehicle office to either register for a driver’s license, purchase a new
automobile, or transfer the title of your automobile to another. In many
situations is very easy because you have with you what you believe are
all the forms. But, you really need to read the fine print! If you look
carefully you will not only have to have a copy of your driving license
but also personal property taxes, utility bills, and some other identifiers
that prove that you still live at your existing residential address. How
many times has one sat in a motor vehicle office for what appeared like
hours and then needed to leave because one did not have all the infor-
mation? The same is true of an enrollment form for credentialing—as
my mother-in-law says fondle and review. Before you hit the submit
button in an electronic application, or even before signing a manual
form, it is necessary to look at all the data to ensure its accuracy; this
only expedites the process. And finally, it is always important to follow
up because in many situations the insurance companies are never going
to call you. If you’ve not received any information within 60 to 90
days of submitting the form, then you should be calling the payer to
understand any obstacles.

3.2 ARE THERE OTHER APPLICATIONS WHERE


CREDENTIALING MIGHT BE NECESSARY?

An additional area of application as well as revenue is to tie up with


laboratory services so that you can actually conduct an array of tests on
patients. This includes but is not limited to blood, urine, toxicology
results and so on as, in an independent private practice, it is very expen-
sive to set up a sophisticated laboratory to run tests. In our contempo-
rary society there are a number of regional and national chains that are
typically transparent to the patient while allowing the physician to offer
more services.
Once you decide the type of specialty and the services you’re going
to offer, it is best to review those routine exams that you might want to
establish. You will also need to see if such services can be reimbursed
through the individual insurance carrier. In addition, you must under-
stand what the costs will be from the laboratory, such as the cost of the
CREDENTIALING AND GETTING STARTED . 25

test, the equipment costs associated with test, any supplies that might be
associated with the test, any training that might be required to help
interpret the test, and whether or not any goals or volumes are required
by the laboratory. For example, I know one independent laboratory in
St. Louis, Missouri, that provides quantity discounts to physicians based
upon the number of monthly tests ordered. It is always best to check
with the laboratory to understand the process.

3.3 WHAT TO WATCH FOR

Assuming for the moment that you have adopted a partnership with an
insurance payer, there are several things to consider before you make
your final decision. These include but are not limited to whether or not
you have a dedicated representative to work with your office, how often
that representative might come to your office, and actually might contact
you to provide support. You should also consider whether you will
require a full-time representative to work with that particular company
and whether, and this is most important, you’re going to receive clear
instructions and resources to utilize the services. After all, the relation-
ship with the payer is a reciprocal one and there should be enough
resources to understand how you need to submit a claim and how you
would like to get paid.
As mentioned earlier about electronic enrollment, many insurance
payers today are also actually utilizing electronic medical records and
other forms of electronic claims to help expedite verification of patient
benefits, but displayed symptoms, and reimbursement verification.
Albeit there is a major concern about cyber security in contemporary
society, it is safe to assume that all portals and verification processes
are compliant with HIPPA regulations while also providing a smoother
process throughout. That said, when working with the payer, it is
important to understand what the technology requirements are so that
your systems and support are congruent to their needs. Additionally, if
there is incongruence with your practice management system and their
electronic remittance, you may not get paid! Therefore it is good to
understand whether the payer does actually conduct electronic funds
transfer, whether the payer does offer online benefit verification systems,
and most importantly what practice management systems the payer
works with so that you can clear your pre-authorizations and rooms
sooner rather than later. Remember, the endgame here is to make certain
that you get paid!
26 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

3.4 ARE THERE OTHER WAYS TO GET PAID?

As you can imagine, the topic of private payer reimbursement is a sen-


sitive one. State and federal laws are constantly changing and, since
insurance companies are private, so too are policies and practices. To
that end, many physicians have been dismayed by the chronic obstacles
in getting paid, while others are simply annoyed by bureaucracy. You
have a gift, which to a certain extent is an application turned into an
occupation. And, you want to be paid for the services that you render.
The endgame for this chapter, and for your occupation, is to help
you with material wealth and discretionary time. After all you want to
be paid for the value that you provide, and when your value is dis-
missed you grow dispassionate. That is why some, though not many,
physicians have opted for cash services. By that I mean they will only
accept cash payment for services rendered. They do not accept any
form of insurance reimbursement. Yet, and this is not only for doctors,
it also dismisses a wide variety of demographics. This is because with
rising medical costs many individuals cannot pay for all the services.
Imagine having to pay hundreds of dollars, if not thousands, for oncol-
ogy testing, cardiac testing, and so on. With the high cost of hospital
stays today, imagine the cash costs for an individual for a hospital stay
of three days for birthing or even for gall bladder laparoscopy. These
costs are exceptionally high and the average individual will not be able
to pay out of his pocket.
Another methodology which has become useful in recent times is
what is known as concierge services. This concept was publicized many
years ago during a highly acclaimed television show featuring a doctor
who treated very wealthy individuals in Long Island, New York. There
are four basis models of concierge healthcare. The most basic version is
travel medical assistance. An example of this is the number on the
back of your American Express Black card that you call to connect you
to an operator to help with aeromedical evacuations and provide access
to a database of foreign physicians and hospitals. Private health advi-
sories—another version—adds on services such as comprehensive indi-
vidualized physical exams, electronic medical records, access to second
opinions, and help with complex disease management. A third variation
is the private physician practice. This is essentially a doctor as an
annual retainer to provide rapid call backs and a higher level of per-
sonal interaction.
CREDENTIALING AND GETTING STARTED . 27

The most comprehensive form of concierge healthcare is referred to


as the total care platform. It’s the Rolls Royce model of medical care
that includes all the services already noted plus a number of additional
ones such as custom medical contingency plans and calendared longev-
ity plans. The most compelling and personally tangible additional serv-
ice these concierge healthcare providers deliver is immediate routine
and emergency telediagnosis and treatment. (http://www.forbes.com/
sites/russalanprince/2013/05/30/what-is-concierge-healthcare/)
The benefit of concierge medical services is that doctors only see a
certain number of patients at any one particular time. Therefore, con-
cierge medical services may have only 50 to 100 patients at any one
time for an extremely high retainer fee. For example I know one medi-
cal doctor in Arizona who has no more than 150 patients who pay
approximately $10,000 per year for his services. They have full access
to the doctor 24 by 7 and he has access to clinics and hospitals within
his reach. Patients then pay for any out of pocket costs and even pre-
scriptions, but they have a one-to-one relationship with the doctor. All
of this is contingent upon demographics as well as the type of individu-
als you want to treat. So it is highly recommended that you decide first
who you want to treat and how, before deciding on your payer mix.
It may sound daunting and seem like way too much information to
take in all at once, but there are a number of helpful resources that will
aid you in the credentialing process. One of these resources is the Cen-
ter for Medicare and Medicaid services, which can be found on the
Internet at www.CMS.HHS.gov. In addition it is highly recommended
that you check with your state and local medical societies to determine
other resources that may be available for you. The largest piece of
advice would be: take the time, do not make rash decisions, and evalu-
ate who you want to trade with and how you want to make your
money.
CHAPTER 4

PROPER BUSINESS PLANNING

It is typically found in the medical field that:

. Third party practices determine how much your work is worth.


. Third party practices tend to control your fee structure.
. The third party can change what they pay you at any time.
. Third party practices constantly change rules, codes, billing and
so on creating more work, more paperwork, more stress, and less
outcome for you.
. Third party practices limit your exposure to your patients. They
can tell you how often you can see your patients and when to
end your relationship.
. Third party practices await payment from patients so much so
that they will be constantly in arrears to you.
. Third party practices are risky because one type of payment plan
they offer creates full risk and exposure, while another limits
methods of passive, aggressive, and sometimes creative income.
. Third party practices are not solo operations but rather ball and
chain operations since there is constant attachment to one type of
payee.
. Third Party practices are those defined by practices operating
under reimbursement from insurance companies.

Under this type of model, there is a constant stream of constraints


and less likelihood of success. Therefore, it is necessary for you to
develop a business model that allows the practice to be sustainable and
work under the most difficult environmental factors. When the focus
moves from reactive to proactive, the practice becomes less stressful
while also achieving a higher level of success.
30 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Business strategy may not be a science, but using the right method
with the right materials in the right place at the right time can create
explosive results. When you think about great companies, in addition to
great practices they all share one consistent theme—business modeling.
Companies such as The Cleveland Clinic, The Mayo Clinic, Subway,
Amazon, and so on—the list is endless—use models to ensure that they
remain on track and deliver to their end users their emotional desires.
With over 31 years in the field of business helping others, we find
that a good efficient and relevant practice encompasses nine items that
create a positive cash flow every time. Although personality, behavior,
and culture all have a role to play in good group dynamics, the practi-
cality of these nine items helps to build success. To accelerate the prac-
tice we believe in the model given below.

4.1 PRACTICE ACCELERATION BUSINESS


MODELÓ

. Purpose: It is vital for your practice to serve some purpose.


What is the focus of the practice, who are the individuals you
will treat, and how will you treat them? It is necessary to ensure
all these remain congruent with your mission and vision.
. People: There are two things that must always be on top of your
mind when operating your practice—what will support you and
who are your perfect patients? Too many practices operate by
hiring any warm body that walks in the door. You will require
good people to support your efforts. You cannot operate a
practice in a vacuum.
. Performance Loops: Benchmarking is critical to the success of
any practice. Honestly, it is daunting to find so many practices
that do not monitor new patient volume, cash flow, and accounts
receivable. The Fortune 500 companies would not exist if not for
benchmarking. You must review the important variables that
affect the business.
. Products/Services: Ask any medical practitioner and he or she
will tell you that they make adjustments. However, when you
really drill down, revenue can come from laser, stem, massage,
physical therapy, acupuncture, acupressure, and some even sell
third party products such as vitamins, water, and therapeutic
pillows. All of it adds to the bottom line and the sooner you
PROPER BUSINESS PLANNING . 31

decide on those pillars that will help you the better your practice
will run.
. Passive Income: You need to decide how to gain revenue from
sources other than treatment as you can only visit with so many
people per day.
. Payment: Never be a prisoner of the insurance game if you do
not have to. Decide upfront the type of cases, the type of cash,
and the terms by which you get paid. Never leave this to chance
or time. You must immediately decide how you will bring
revenue to the practice and how quickly that revenue gets into
your bank account.
. Promotional Methods: We are almost at the most vital chapter of
this book and the significant portion of your practice. Marketing
and promotion will always be necessary and you must devote 20
to 30 percent of your time to creating the activities necessary for
others to understand your practice.
. Processes and Protocols: This requires aligning the medical or
healthcare practice physician, private or not, with his or her
marketing and practice philosophy. With this in mind the
processes and procedures that encourage congruency between a
patient’s needs and expectations with those of the medical
practitioners and their practice must be put in place.
. Periodic Feedback: No practice is successful without the benefit
of evaluation and feedback. The best practices will have a
support team and group of advisors who can aid the direction,
recovery, and future performance of the practice.

Table 4.1 Stevens Consulting Group strategic business planning model

Practice Acceleration Business ModelÓ Your input


Purpose
People
Performance loops
Products and services
Passive income
Payment
Promotion
Processes and protocols
Periodic feedback
32 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Now that you understand the purpose of and the method to build a busi-
ness model to help in your future success, it is time for you to either
(a) build one or (b) redevelop the one you have. Table 4.1 is a template
that you can quickly complete with succinct bulleted information. Alter-
natively, you can review the Appendix in this book and find a template
for your immediate use.
Do note that these things will take you some time and there is no
need to rush through this particular exercise. However, once you have
completed this exercise you will feel as if your practice has direction
and, importantly, purpose. I also want to address a question that I get
asked often, and that is why should one write all of this out, and why
waste time and money on it. That is a good question and has a very
simple answer. The rationale for writing all of this out is to ensure you
get your thoughts and goals on paper so you have something concrete
to follow. As smart as they were, even Einstein and Jonas Salk had
notes, and so should you. Writing out your model helps you to consis-
tently and relentlessly communicate your message to your patient base,
while also ensuring that your staff or outsources comprehend what
needs to be done and when.
I recall running into a prospective client for my coaching services.
Dr. Jonathan was struggling like mad with over nine patients per week!
I immediately asked to see her business plan and model. She did not
have one. I asked to see her marketing and promotional activities; she
did not have one. Then I asked to see her invoices and she did not have
time because she was busy trying to find a code for her new patient.
The time …7 hours! When you do not have a plan, then plan to fail.
Even as you use a map or compass to hike or drive to a destination,
you need a model to ensure success. According to the Bureau of Labor
and Statistics, 96 percent of small businesses (with 1 to 99 employees)
that enter the marketplace survive for one full year. Unfortunately, simi-
lar data for physician practices is difficult to find but the data is
weighted heavily against a positive outcome. Yet, access to resources
such as those listed in this book, some coaching, and good research,
will provide the information you need to develop your practice and will
help you beat the odds and have a thriving practice.

4.2 PRACTICE SUCCESS

In addition to the information contained above for the Practice Acceler-


ation Business Model, the medical practitioner as well as the practice
PROPER BUSINESS PLANNING . 33

should have a model for interoffice relationships with patients. Recall


that medical or healthcare practice, private or not, like any other profes-
sion is a relationship business. Since medical or healthcare practice, pri-
vate or not, is an intangible service, the only thing binding the medical
practitioner and staff to the patient is a culture of
unending patient experience or patient centricity. Building these rela-
tionships takes much time and effort. Athletes practice, students prac-
tice, musicians practice, physicians also should practice, but do they
really? If you desire proper relationships and the proper method to
develop a great business model for your practice, perhaps now is the
time to treat your profession like an athlete does. Therefore you must
practice it.

P People make a differ- Remember that at all times people are the
ence front and center of your practice. Peter
Drucker wrote this in his 1954 book The
Practice of Management. He said, “There
is only one valid definition of business
purpose: to create a customer. The
customer is a foundation of a business
and keeps it in existence. The customer
alone gives employment. And it is to
supply the customer that society entrusts
wealth-producing resources to the busi-
ness enterprise”. When you treat them
correctly, they inform others. The staff
become marketing avatars by their ex-
ceptional customer service and by treat-
ing patients like royalty. As your staff
interact with patients it is their culture
that retains or distances patients. Use
your staff as magnets to metal.
R Relationships inside It is necessary for you to build relation-
and out ships wherever, however, and whenever
you are with someone. Your patient base
only increases with your ability to extend
your network. This requires that you,
your patients, and your office staff work
synergistically to continually build your
community. In other words your process
must be outbound so that your market-

(Continued)
34 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

ing reaches out to new individuals each


and every day. This is discussed more in
the marketing chapter but it is vital that
all efforts support the acquisition of new
patients.
A Attention to retention An absolute must for any doctor. Reten-
tion helps develop the practice. It is one
thing to provide immediate care and get
the patient out of pain but another to
keep them on a healthy maintenance
schedule. Therefore you should always
be thinking and have the patient thinking
about the future and not only the
present. David’s practice helps to get
patients out of pain immediately, but he
does not offer any maintenance routine.
As such his weekly revenue is volatile
because patients visit “only when they
are in pain.” This leaves the diagnosis to
the patient. It is 88 percent less costly to
retain existing patients than to discover
new ones. Create routines that place
individuals in three phases: (1) immediate
pain care, (2) moderate paincare, and (3)
Maintenance care for being pain free.
C Culture is king The way you and your staff dress, the
code of ethics you follow, the office
procedure, the manner in which patients
are greeted, rescheduled, and billed, are
all part of the practice culture. This stops
and starts with the doctor. One of the
reasons why so many businesses fail is
not so much about poor products and
services but simply about poor culture.
The leadership the doctor shows must
have three vital elements: (1) commu-
nication, (2) feedback, and (3) recogni-
tion. The staff will look to be led and if
there is no one to do so, they will follow
anyone who will stand at the podium.
Running a practice requires more than

(Continued)
PROPER BUSINESS PLANNING . 35

just treatment—it is about leadership


and effective communication.
T Treatment plans Know whom you will treat and why.
Always have a picture of your perfect
patient and how you treat them.
Createavisionforhowyouwantyourpatie-
ntstobetreated,forstafftobetreatedandfo-
rdevelopingandimplementingapositiveof-
fice culture.
I Invite others The idea of the practice is to develop
relationships that in turn will increase
patient volume. Networking and meeting
patients who are interested in how you
treat and whom you treat should be on
top of your list. The more individuals
you meet the larger the pipeline and this
always needs to be full so that you can
create a regular flow of income.
C Consider delegating The doctor cannot treat, bill, code, book
and help appointments, and so on all the time.
There needs to be a time when practice
procedures are delegated to others. The
inability to delegate is a contributor to
the lack of productivity. Many doc-
tors—even managers—think that when
they delegate something, it is a sign of
weakness. To a certain extent, delegation
is actually a sign of control. Doctors
don’t delegate because it takes a lot of
effort up-front. This means attempting to
reach and trust people and getting others
to do what you want them to do.
Your skills are better used in developing
other new ideas. By doing the work
yourself, you’re failing to make best use
of your time.
E Evaluate consistently No practice survives without using bench-
marks and plans for evaluation and
improvement. The best practices always
address issues to create better methods of
practice.
36 • PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Now that you understand the overall modeling and strategy of your
business, it is now time to discuss the important issue of how you will get
paid. After all, you did not get into this profession to treat patients for free.
You want to get paid for the value of your services and to ensure your own
¿QDQFLDOVXFFHVV8QIRUWXQDWHO\WKLVDUHDLVDVWLFN\ZLFNHWIRUPDQ\GRF-
tors simply because they want to treat and do not enjoy getting immersed
in accounting. Yet, what’s important to understand is that without hav-
LQJ¿QDQFLDODFXLW\\RXPLJKWEHZRUNLQJWRRKDUGDQGQRWUHDSLQJWKH
¿QDQFLDOVXFFHVV\RXGHVLUHDQGDOORZLQJRWKHUVWRFRQVWDQWO\KDQGOH\RXU
DFFRXQWERRNVEHFDXVH\RXDUHWRREXV\PLJKWOHDGWRVRPHRQHFKHDWLQJ
\RX)RUH[DPSOH,ZRUNHGZLWKDGRFWRULQ,OOLQRLVZKRFDOOHGPHIRU
DVVLVWDQFH EHFDXVH KLV IURQW GHVN UHFHSWLRQLVW KDG VWROHQ RYHU 
simply because he was “too busy” to review the monthly numbers.
:KDWIROORZVWKHQLVVLPSOH¿QDQFLDOLQIRUPDWLRQWRJHW\RXVWDUWHG
with understanding the multiplicity of issues in a private or group practice.
My intent in this chapter is to provide you some generalized information to
JHW\RXVWDUWHGEXWUHDOL]HWKDWLQGHSHQGHQW¿QDQFLDOSURIHVVLRQDOVZLOOEH
UHTXLUHGWRHQVXUHWKDW\RXKDYHWKHSURSHULQÀRZVDQGRXWÀRZVIRU\RXU
SDUWLFXODUSUDFWLFH,WLVDOZD\VEHVWWRVHHNVRXQG¿QDQFLDODGYLFHHYHQ
DV\RXZRXOGVHHNDGYLFHLQWUHDWLQJDSDWLHQWZLWKDSDUWLFXODUV\PSWRP
7KHGLVSOD\DERYHLVIURPD0LFURVRIW([FHOZRUNVKHHWWKDWLVSUR-
YLGHGWR\RXLQGRZQORDGDEOHIRUPDWZKHQSXUFKDVLQJWKLVERRN6LPSO\
SXW WKLV ZRUNVKHHWLV SUHVHQWHG LQ D GDVKERDUG VR WKDW\RX FDQ TXLFNO\
review at a glance the number of patients who visited with you during
WKHZHHNWKHDPRXQWRIUHYHQXHLQÀRZVVSHQWIURP\RXUUHLPEXUVHPHQWV
HLWKHU E\ FDVK FKHFN RU FUHGLW FDUG DV ZHOO DV \RXU PRQWKO\ H[SHQVHV
8QGHUVWDQGWKDWWKHUHDUHQXPHURXVSUDFWLFHPDQDJHPHQWVRIWZDUHDYDLO-
DEOHLQWKHPDUNHWWRGD\WKDWPLJKWKDYHWKLVLQIRUPDWLRQDYDLODEOHKRZ-
HYHUWKLVZRUNVKHHWLVEHLQJSURYLGHGLQRUGHUWRSUHVHQWWKHLQIRUPDWLRQ
to you and in case your practice will not be utilizing any software.
No matter what you use, it all starts with the number of patients who
visit with you on a day-to-day basis. Coincidentally, the number of patients
visiting you must then be tightly integrated into the number of referrals or
RWKHUPDUNHWLQJDFWLYLWLHV\RXFRQGXFWWKDWEULQJSDWLHQWVLQWRWKHSUDFWLFH
,WLVTXLWHVLPSOHDFWXDOO\WKHQXPEHURISDWLHQWVZKR¿OO\RXUZDLWLQJ
room is the result of how many individuals not only need treatment but
DOVRNQRZ\RXUQDPH:KLOHZHZLOOFRYHUWKHLPSRUWDQFHRIPDUNHWLQJ
and relationship building in another chapter, the fact is your waiting room
cannot grow serendipitously. You, or someone you hire, must be actively
involved on a daily basis in bringing individuals into your practice. That’s
QRWWRVD\WKDW\RXKRSHWKDWSHRSOHJHWVLFNRUWKDW\RXKLUHVRPHERG\
WR PDNH VRPHERG\ VLFN <RX VLPSO\ QHHG WR WKLQN OLNH PRVW DXWR WLUH
PROPER BUSINESS PLANNING  •  37
38 • PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

F RPSDQLHVRUHYHQRLOFKDQJLQJFRPSDQLHVWKLQNQRWHYHU\RQHQHHGVWLUHV
RURLOHYHU\GD\EXWLI\RXNHHS\RXUQDPHRXWWKHUHWKH\ZLOOHYHQWXDOO\
pop in. Doctors are no different. Therefore, within this spreadsheet and on
WKHGDVKERDUGZHDFWXDOO\PRQLWRUWKHQXPEHURIPDUNHWLQJDFWLYLWLHVFRQ-
ducted daily to ensure that the waiting room is full on a consistent basis.
$VZHFRQWLQXHWRUHYLHZWKHQXPEHURIPDUNHWLQJDFWLYLWLHVLW¶VDOVR
KHOSIXOWRORRNDWWKHSDWLHQWYLVLWDYHUDJH,QRWKHUZRUGVZHORRNDWWKH
number of visits you have monthly and then divide that number by the
number of new patients seen. This number is helpful to understand how
many new patients visit with you monthly versus the number of existing
patients.
+RZHYHULQUHYLHZLQJPRQWKO\QXPEHUVPXFKDVPDUNHWLQJDFWLY-
ities are important to the growing health of the practice, the next most
important number is the actual cost per patient. We need to ensure that you
are actually charging enough money for your services. Albeit insurance
companies control much of this, yet you do have an opportunity to put
in a cost for your treatments. And, should you choose to charge cash and
become a concierge doctor, you will need to understand how to charge for
WKHYDOXHRI\RXUVHUYLFHV²WKHUHIRUHFRVWSHUSDWLHQWLVDIDFWRU6RKRZ
do you actually determine cost per patient?
2QHRIWKHYHU\¿UVWWKLQJVWKDW\RXQHHGWRUHYLHZLVDOO\RXUPRQWKO\
H[SHQVHVDQGWKHQEUHDNWKHVHFRVWVGRZQWRDFRVWSHUGD\DQGWKHQXOWL-
mately a cost per hour. In the following portion of the spreadsheet I have
FRSLHGLWKHUHLQWKHERRNVRWKDW\RXFDQXQGHUVWDQGKRZZHPLJKWUHYLHZ
VRPHRIWKHVHLWHPV,I\RXUFRVWIRUUHQWLVSHU\HDURUSHU
PRQWKWKHQ\RXZLOOZDQWWRORRNDWZKDW\RXUGDLO\FRVWVDUHIRUWKHOHDVH
of this commercial property. You will note in the spreadsheet that this is
SHUGD\$VVXPLQJDQHLJKWKRXUWUHDWPHQWGD\WKDWPHDQVWKDW\RXU
cost per hour to lease this space is six dollars, and if you are seeing three
to four patients per hour this fee is then divided between those patients.

Items Notes Yearly Cost per Cost per


amount day ($) hour ($)
(manual
entries) ($)
Rent Yearly   
8WLOLWLHV Yearly   
Payroll expenses Yearly   
Insurance Yearly   
2I¿FHVXSSOLHV   
PROPER BUSINESS PLANNING • 39

0DUNHWLQJSURPRWLRQ   


Legal fees   
Accounting fees   
Computer technical   
support
;UD\¿OPDQGSUR-   
cessor maintenance
Professional organi-   
zation membership
(PSOR\HHEHQH¿WV   
SDFNDJH

At this point, you might be saying to yourself, why is any of this


important. It is not only important, it’s urgent for the simple reason that if
you do not consider all of your costs which include, but are not limited, to
VDODULHVEHQH¿WVIRU\RXDQG\RXUVWDIILQVXUDQFHFDSLWDOL]HGHTXLSPHQW
costs, sanitation issues as well as any other costs associated with your
RI¿FH\RXPLJKWEHORVLQJPRQH\RQDSHUSDWLHQWEDVLV:LWKRXWVRXQGLQJ
WULWH,NQRZ\RXGLGQRWJHWLQWRWKLVEXVLQHVVWRORVHPRQH\VRLWLVEHVWWR
completely review your costs on a monthly and annual basis to ensure that
you are charging all the necessary fees to cover your expenses. For exam-
ple, in the complete spreadsheet that I am providing for you, assuming for
WKHPRPHQWWKDW\RXUIHHSHUSDWLHQWLVRQDUHYLVLWIRUDQ\WKLQJVXFK
DVDUHFKHFNDQG\RXDUHFRVWSHUSDWLHQWH[SHQVHVSDUWLVSHUSDWLHQW
WKDWPHDQVWKDW\RXDUHPDNLQJSHUSDWLHQWDIWHUWKRVHH[SHQVHV,Q
WKLVH[DPSOH\RXDUHDFWXDOO\PDNLQJPRQH\<HWZKDWPLJKWRFFXULILQ
IDFW\RXUFRVWVZHUHSHUSDWLHQWDQG\RXQHYHUUDQWKHQXPEHUV"<RX
ZRXOGORRNDW\RXUEDQNDFFRXQWDWWKHHQGRIWKH\HDUZRQGHULQJZKHUH
LQ WKH ZRUOG WKH PRQH\ ZHQW DQG ZK\ \RXU VLJQL¿FDQW RWKHU LV VHHNLQJ
a divorce and why you hate what you do. This is why it is imperative to
constantly review numbers to ensure that you have a handle on handling
any and all of your expenses.

4.3 ADDITIONAL ITEMS

7KHUH DUH WZR RWKHU WKLQJV WKDW \RX PLJKW ¿QG XVHIXO ,Q ZRUNLQJ ZLWK
numerous practices over the year and attempting to teach them business
methodologies I typically use an approach similar to what I would for
40 • PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

DQ\ VPDOO EXVLQHVV PDUNHWLQJ RU VHOOLQJ SURGXFWV DQG VHUYLFHV 2QH RI
WKH¿UVWDSSURDFKHVLVWRDFWXDOO\GHYHORSZLWK\RXUSUDFWLFHPDQDJHURU
\RXURI¿FHPDQDJHUDQDQQXDOVDOHVIRUHFDVW7KLVLVDUDWKHUHDV\H[HU-
cise that can be done in a Microsoft Word document or a Microsoft Excel
VSUHDGVKHHW6LPSO\GHYHORSDFKDUWIURP-DQXDU\WKURXJK'HFHPEHUDQG
forecast the number of patients you believe will visit with you for that
SDUWLFXODU\HDU$VVXPLQJIRUWKHPRPHQWSDWLHQWVVHHQLQD\HDULW
LVUDWKHUHDV\WRGLYLGHWKLVQXPEHUE\DQGSODFHWKLVQXPEHULQWRWKH
chart. Then, utilizing your standard treatment fee you can automatically
decipher your intended gross income.
Another methodology is to utilize a similar process and produce the
SUR¿WDQGORVVVWDWHPHQWDVSUHDGVKHHWZLOOEHHDVLHUIRUWKLVSDUWLFXODU
H[HUFLVH7KHSUR¿WDQGORVVVWDWHPHQWLVVLPSO\DIRXQGDWLRQDORYHUYLHZ
use your sales forecast of what your intended monthly and annual income
is and then subtract all of your listed expenses from the gross revenue. The
aim here is for you to completely understand all of your expenses, which
includes but is not limited to utilities, lab fees, clinic and hospital fees, and
DQ\RUDOODVVRFLDWHGFRVWV,WLVEHVWWRZRUNZLWKDQDFFRXQWDQWWRHQVXUH
that you have everything you need listed.
$TXLFNQRWHKHUH7KHLQWHQWLRQRIWKLVODVWH[HUFLVHLVWRHQVXUHWKDW
you completely understand not only how you will get paid but how much.
Therefore educating yourself in both income and expense analysis will
DVVLVW\RXLQEHFRPLQJDPRUHSUR¿WDEOHDQGKDSSLHUGRFWRU:KHQ\RX
DUH XWLOL]LQJ \RXU SDVVLRQ DQG JHWWLQJ SDLG IRU LW \RX¶OO GH¿QLWHO\ EHWWHU
enjoy the fruits of your labor.
CHAPTER 5

MARKETING FOR DOCTORS AND


STAFF

Marketing is not about brochures and other collateral materials. Market-


ing is a state of consciousness in which the doctor and the practice cre-
ate relationships. Physicians and staff are all marketing professionals.
They must all operate to create relationships with patients. Marketing
concentrates on relationships, and the manifestation of these relation-
ships equates to brand equity. As patients learn about the practice and
learn to appreciate the personnel and the culture they consistently return
to them. The repetitive visits help to build the brand while lowering the
cost of acquisition. This is vital to the practice because patients invest
in relationships with those they know and those they trust.
Brands are instantly recognized and identified. Several national and
regional surveys have shown that people (patients) choose a brand not
because of price but simply for its name alone! People will make a pur-
chase and choose a vendor solely for the brand. When I have a cold, I
reach for a Kleenex, when I dine out I request a Coke, and when I need
a copy, I seek a Xerox. And, similar to these examples there are some
brands that have become part of the pop culture. Imagine picking up
the phone one morning and having a patient call you for an appoint-
ment because they were asked to do so! That is the power of a brand
name.
There was a time when people would say “We are the Cadillac of
the …. ” Cadillac had a cache that all desired. Today people say we are
the Mercedes of the business. You would not hear many people say,
“We are the Taurus of the business.” If they did they would be full of
bull! Over the years Cadillac lost its reputation to other brands such as
Jaguar, Mercedes and so on. People believe they get what they pay for.
42 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

The value of a brand is that people will purchase for the brand’s
own sake and not after much market research and discretion. Mary Kay
Cosmetics gives Cadillac’s to top selling representatives with a purpose.
I was in Dallas to receive one in 2005. I will never forget the faces, the
aggressiveness, and the desire of those attendees waiting to receive their
Cadillac! The allure of the Cadillac indicates its brand value in the MK
consultant’s eyes. Additionally, brands make products or services very
attractive, and that attraction is often so strong that normal discrimina-
tion, skepticism, and price sensitivity are subordinated. A great example
is Coca Cola. Without its original contents (cocaine) and without selling
a can, Coca Cola is worth over $80 billion. They are the top selling
brand in the world. Brands by their nature help to reduce perceived
risk. When brands are strong, their very presence symbolizes a psycho-
logical reward.
Finally, your ability to build a brand confers a host of blessings
such as patient loyalty, price inelasticity, and long-term profits. A loyal
patient is nine times more profitable than a disloyal one. Further an
existing patient who is affected by your brand value helps to obtain
new patients for you more efficiently, through referral, than a new one.
Building a brand does not happen without expense and without time
being spent on its acquisition. Research shows that it costs 200 to 400
times more to build brand equity but the long-term effects are worth it.
Therefore it is imperative to implement branding as part of the practi-
ce’s strategic focus.

Table 5.1 Top 100 brands

Rank Brand Size


1 Coca Cola 68.7
2 IBM 60.0
3 Microsoft 56.6
4 GE 47.7
5 Nokia 34.8
6 McDonalds 32.2
7 Google 31.9
8 Toyota 31.3
9 Intel 30.6
10 Disney 28.4
Source: Interbrand 2009 Survey http://www.interbrand.com/best_glo-
bal_brands.aspx
MARKETING FOR DOCTORS AND STAFF . 43

5.1 PERCEPTION IN BRANDING

There might well be a better computer manufacturer than Dell and there
are probably better food chains than McDonalds. There are even better
gymnasiums than Gold’s. That is not important, what is important is the
perception of the patient. Brands are fickle because perception is fickle.
Branding happens by default! Therefore, it is imperative to create
the brand that promises you will provide to the maximum possible ben-
efit. Tiffany’s happened by default. Their brand states you get the blue
box if you purchase for a certain amount. The brand is so strong
patients do not care so much about the purchase as they do about stand-
ing in line to obtain the valuable Blue Box.
Perceived value crystallizes branding. The price is not considered
when perception is high. Here are some examples of how branding
helps in patient acquisition. With Volvo, people purchase safety, with
Levis, comfort and style, with Gucci, style and luxury. Perception stems
from the ability of the individuals to link their needs with value. Addi-
tionally, what promotes perception is emotion. People do not make
rational decisions; they are emotional. Perception moves people. Percep-
tion creates action.
The following is a list of myths about marketing that requires clarifi-
cation for branding.

First, sales is not marketing and marketing is not selling. These


terms are often confused. Marketing is about capturing the
customer and offering value. Selling is exchange of value for
money.
Second, people make rational decisions. There is a maxim from
one of my mentors who states, “Logic makes them think,
Emotion makes them act!” (Weiss2000). Purchases are made
from emotional reactions. The excuse of logic is no longer
relevant in a world where prospective customers are confronted
with clutter.
Third, marketing must rely on features and benefits. Folks, those
days have left us for now. People buy value not features and
benefits. Value stems from customer relationships and meeting
the needs of customers.
Fourth, changing advertising assists marketing and sales efforts.
Not necessarily true. The relationship is enhanced by value.
However, there is an issue with the number of times contact must
44 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

be made with a customer—nine. With the receipt of over 8,500


messages per day there is too much clutter and it is vital that
different ways are used to ensure brand visibility.

For you to begin to build a brand you must have several items in
your marketing toolkit. However, when building a brand, it is vital that
your focus is outward. Your intention is to show how you improve the
condition of your patient. What are the results a patient gains in coming
to you? Once your focus is on results you also need to consider the fol-
lowing points.

. Market: Does a need exist for the service or product that you
offer? There are instances when a marketer can create a market
but this is more difficult. It is vital then to understand how your
service niches itself in the market. For example, with its flair for
mobility, Apple continues to manifest its brand.
. Expertise: It is incumbent upon you to foster the skills and
abilities necessary to deliver to the market. These skills must
match the needs of the patients. Examples include logistics firms
and distribution companies such as Amazon who are clearly
unmatched in competitiveness.
. Passion: You must love what you do. Branding requires you to
believe and act as if you’re the best alternative.
United Parcel Service constantly brags about what brown can
do.
. Differentiation: So as not to be seen as similar to an array of
alternatives, what do you deliver and provide to prove that you
are drastically different from the rest? Is your message repeatable
by others? For example, Ford, quality is the first point of
emphasis or the former Avis ads that recommended itself because
they “try harder.”
. Testimonials: Do patients speak about you? When patients tell
others of your strength, marketing collateral is unnecessary. How
do others view you and what do they say?

When you begin to build a brand you will notice immediate changes
in your business. A good brand will assist you in obtaining new
patients. Prospective patients will be attracted to you. Your current
patients will also want to remain with you. Your image and value will
remain and patients will ignore noisy interruptions from competitors
MARKETING FOR DOCTORS AND STAFF . 45

based on your value. Finally, you will comprehend what you do and
create better dialogue with others interested in your services. Your artic-
ulation works like a global positioning system and guides you to better
opportunities in less time.

5.2 DEVELOPING A MINDSET FOR MARKETING

If you are like most doctors, then you will certainly have three big
fears: death, taxes, and public speaking. However, I would like to add
one more: marketing. Most doctors do not think about it, do not like to
do it, and would rather have someone else take care of this crucial
responsibility. Yet, if doctors are not keen on building business, then
there will be no person to treat. Ah yes, a Catch 22 situation. This is
like saying, which is more important, the chicken or the egg?
With this in mind, doctors must have a marketing mindset. Yes,
your mindset must change from where you are today and shift toward
business development. Admittedly, this is no easy task but it is impera-
tive to make the shift so that your practice progresses from merely sur-
viving to thriving.
Think of it this way. Marketing is always present everywhere. From
the moment you awake until the moment you fall asleep you are
immersed in marketing. You watch the news, open a box of Granola,
brush your teeth, and get dressed. In that minimal time you are intro-
duced to products and services that can be delivered to you or can be
purchased by you because of marketing and its related activities. Mar-
keting is required to bring valuable products and services to you. After
all, marketing is required for the acquisition and retention of customers
like you. Further, marketing helps to provide you the products and serv-
ices you want as well as need.
None of these can happen unless you have a marketing mindset.
What is a marketing mindset? As mentioned earlier in the chapter, mar-
keting is an exchange of information that helps to establish relationships
so that customers (patients) understand value. Value in the marketing
world especially for medical professionals is the relationship and trust
built around the benefits of care provided and the sacrifice(s) necessary
for the patient to receive these benefits. Value is not about quality, prior-
ity, or anything else other than a set of philosophical and psychological
inferences that create the processes of practice resulting in patient satis-
faction. And, to establish the processes, marketing uses a series of activ-
ities to institutionalize this philosophical attitude into the practice.
46 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Therefore, marketing requires a new mindset or quality, providing value,


information, communication, feedback, idea exchange, and most impor-
tantly patient service.
A key aspect of the marketing mindset is to build relationships.
Realistically we can say that you are in the medical profession but,
pragmatically to grow a thriving practice, you are actually in the busi-
ness of building relationships. To help nurture and grow your practice
you should get involved on a daily basis with activities that take you
further into your local community so that your practice grows. More
important than advertising, the key to establishing a practice based on
value is relationship.
Doctors, who are above average, will differentiate themselves by
creating relationships so as to build rapport with the patient. For exam-
ple one might argue that consulting a doctor is a commodity business
much like buying eggs at a local grocer or obtaining a haircut at a local
barber. However, there is a reason why customers shop in specific pla-
ces—relationship. We can argue that there are some services such as
laser, acupuncture, and so on that aid a practice because of their distinc-
tive products and services. We might even argue that certain physicians
can differentiate themselves based on price but the marketing mindset
requires more of an intangible than tangible benefit. Patients align prod-
ucts and services with a fee, therefore the value they associate is the
exchange of the fee for the value (benefit) received. Incidentally, this is
the definition of selling, something discussed a bit later in this chapter.
But suffice it to say that the fee is related to the tangible gain. There-
fore, these are commodities and they pay a fee.
The doctor who is into relationships and creates a marketing mind-
set is different. The best patients do not associate a relationship and
trust with a fee; their value is incalculable. Relationships then have
intrinsic value and no amount of money can be equated to the trust and
respect inspired by the doctor, and prospective patients would not dare
place a fee on them. These relationships then last lifelong, downplaying
barriers of resistance while also creating more awareness of and brand
for the doctor.

5.3 PLACING DISTINCTION IN YOUR MARKETING


MINDSET

To help you foster relationships, understand that personality and behav-


ior must also be part of your overall functioning. For example, I can
MARKETING FOR DOCTORS AND STAFF . 47

take two different doctors and place them in the same medical profes-
sionals program. They attend the same classes, get the same grades, and
even get the same grade in the exam. However, their relationships with
patients will be different depending on their innate skills.
There is nothing better for growing a profitable practice than trusting
patients who want and need your services. They believe in their heart
that you will get them out of immediate pain and ensure that it does not
return. This trust is something not easily achieved by others and this
relationship must be guarded like the Hope Diamond or Crown Jewels.
Arguing with patients, treating them poorly, not returning calls—any of
these things can sour a relationship that takes years to build. Creating a
mindset is not only worth it, it is a must for your practice. When you
develop a mindset of value, of relationship, and of desire you build a
wealth of opportunities both for the present and the future.

5.4 7 LAWS OF RELATIONSHIP IN MARKETING

There are many who will that suggest relationship building is based on
personality and behavior. In fact, social scientists for years have offered
droves of research on how personality and behavior impact relation-
ships. However, there are other areas that affect the manner in which
people interact. More importantly, the following laws are concepts that
foremost in the mind for doctors who seek to build trusting and long-
lasting relationships with their patients.

1. The Law of Value: Value has long been discussed in the


marketing and business development world. With many doctors
to choose from, patients seek value so as to mitigate time and
expense in getting proper help. Value is the benefit that patients
receive as a result ofthe trust and respect for service that they
develop. In today’s competitive market, value provides intrinsic
fees for services as well as the differentiation of services. When
doctors build value-based relationships, they have a strong
defense against competition.
2. The Law of Constant Contact: Social Media and software known
as Customer Relationship Management (CRM) allow a multitude
of ways to constantly remain in contact with present and former
patients. Although trite, “out of sight”, is “out of mind.” There is
too much competition and the Internet makes it too easy to find
another doctor or another way to ease back pain or stiffness.
48 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

When you remain in constant contact you can not only be


differentiated from the doctor down the street but also be
remembered immediately when patients require your services.
3. The Law of Testimonials and Case Study: While this chapter is
meant to help you with your business development there are
times when contrary methods work better than conventional ones.
Many physicians develop websites, blogs, Facebook™ pages and
so on telling stories and facts related to medical professional
care. Prospective patients desire to hear more about your brand of
care. With that in mind, it is best to collect and integrate into
your marketing as many testimonials and case studies as possible.
This implies that you must have former patients boasting of your
efforts in their cases to new patients who desire to know how
you can help them. Additionally, patients actually want to hear
from others because the word of mouth (WOM) marketing helps
to break down barriers and build higher levels of trust and
respect.
4. The Law of Short Term Transactions: If you are like many, your
phone rings incessantly from cold callers who want to sell you
goods that you have little need for. Not only are these calls
intrusive but they are also transactional. Each person on the call
is only interested in one thing—getting you to say yes to
something before the end of the call. Physicians cannot perform
in this manner. Each interaction from meeting at a networking
event to perhaps the Report of Findings helps build the trust
factor. Each discussion helps to continue the discussion, which
develops the relationship that influences the business aspect. The
more doctors think of continuing relationships the better for
longer-term success of the practice.
5. The Law of Availability: The medical profession is a service-
based business, and most business in the United States is service-
based. Yet how many times have you, as a patient, made calls,
left voice mails and sent emails all to be ignored, forgotten, or
downplayed by your recipient. There are too many physicians or
their staff who conduct business in this fashion. One can never
cease to wonder at the different ways in which patients are often
ignored. Therefore, be “patient-service” savvy. Ensure that all
aspects of your practice engage in this important art to help you
retain your most vital asset.
MARKETING FOR DOCTORS AND STAFF . 49

6. The Law of Community: As you might have noticed during the


Marketing AccelerationÓ discussion, building a community is a
large factor in creating value for patients. When others in the
community know you better, they understand your practice, your
methods, and your values and want to know you even better. The
only way to ensure that others know your value is to get into the
community and show it. Some of the best ways to do that is to
get involved in local community activities such as religious,
athletic, and civic events. Many of these take very little time and
money and will make you the “Vicar of Value” because of the
awareness such volunteerism brings. You might make
contributions, sponsor a local event or even offer to mail
envelopes or lick stamps. No matter what your involvement,
large or small, your stewardship will be rewarding.
7. The Law of Recommended Resources: Physicians need not
always be a dictionary of answers. Being a valuable resource for
additional health and wellness information will make you more
valued by your patients. They will honor the information you
provide and appreciate your concern for their welfare. This alone
will make you a valuable asset.

5.5 MARKETING ACCELERATION—NINE STEPS


TO A MARKETING MINDSET

Step One Developing Awareness


Step Two Building a Community Around Awareness
Step Three Deciding Who Is Your Patient
Step Four Establishing the Mix to Define the Brand
Step Five Defining Uncontrollable Factors in Developing
Your Practice
Step Six Communicating Your Message with Value
Step Seven Messages Congruent with Patient Behavior
Step Eight Creating Pathways to Patients—Marketing Mag-
netism
Step Nine Evaluating the Marketing Action Plan
50 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

5.5.1 STEP ONE—DEVELOPING AWARENESS

One of the many things that is fascinating about Apple is not so much
its computers or its mobility products but rather the number of patrons
who visit their retail stores. By far the busiest shop, in any large mall,
is the Apple store. Apple has more than 300 stores in 11 countries, and
its retail division has become a hugely important part of the company’s
business, selling millions of iPods, Macs, iPhones, and iPads.

Apple’s 373 retail stores generated just over $4 billion in revenue


for its fiscal third quarter ending June 30, 2012, a 17 percent
increase over the previous year. Eighty-three million customers vis-
ited Apple Retail stores during the quarter and many of them were
new to Apple products. (Gallo 2012)

These are amazing statistics representing a huge window of oppor-


tunity for the company and an even larger one for physicians. You
might not see the relevance but here is how.
For Apple to be the beneficiary of any purchase, individuals must
know about Apple. Apple must be visible to its benefactors. Therefore
Apple realizes that from a strategic perspective they are in the technol-
ogy business but realistically they are in the marketing business. For
them to create the level of interest they have had for years requires a
relentless pursuit of being visible in the communities that make up their
demographics. And, Apple realized this from the start.
For years Apple was dominated in the personal computer market by
competitors such as Microsoft, Hewlett-Packard, Compaq, Dell, and
others, to name a few. Yet Apple, and at the time their founder Steve
Jobs, realized to be known required them to relentlessly pursue a variety
of marketing channels.
Physicians require to take similar action. For example, as one drives
through any busy thoroughfare, one will take note of numerous fast
food chains, retail stores, and yes, even physicians. With all the deco-
rated marquees, there is one device that makes one of these more attrac-
tive than the rest—marketing. Marketing is the driver, as explained at
the beginning of this chapter that creates relationships that provide
value. And, the only way to create these relationships is by creating
awareness.
Patients have to be first aware of you before they understand your
value. Awareness is important since it is the key to creative marketing.
MARKETING FOR DOCTORS AND STAFF . 51

Further awareness eliminates advertising as a tactical component of mar-


keting because individuals seek your services because they are aware of
your existence. Awareness, in a sense, helps to manifest brand. To fur-
ther exemplify my point consider the continued popularity of Apple. In
January 2007 at the MAC Conference, Steve Jobs made a keynote pre-
sentation about the status of Apple and then introduced the iPhone to
the world. Rumors had been circulating for some time but no one had
seen the phone of the future. Then without much fanfare Mr. Jobs took
out a prototype of the phone from his pocket, visually introducing it to
the world in the next few moments. Then without further comment he
placed it back in his pocket.
For the next six months, the blogosphere of many international peri-
odicals was flooded with rumors and speculations about the iPhone, but
Apple never commented on it nor did it place any advertisements on
the product anywhere. Then almost six months to the day, Apple
released a distribution date; more than 175,000 units sold on the day of
release and, perhaps, quadruple that number was waiting or searching
the Internet for one. That is brand and that is awareness.
While patients might not surround your practice like customers sur-
round an Apple product, but it is safe to say that awareness helps to
build the attraction required to develop your brand. For you to grow
your practice from one that survives to one that thrives requires a belief
in becoming visible to your regional community. The more visible you
become the easier it will be to help you grow your practice, increase
patient volume, attract new patients, and completely outpace the
competition.

5.5.2 STEP TWO—BUILDING A COMMUNITY AROUND


AWARENESS

As you can see awareness is vital to building your brand but furthering
your contact with your community will solidify its base. When you
look at an iceberg, you notice only the top of the formation but notice
what lies under the sea. Similarly, your foundation is the community
that consistently speaks of your brand. This is how it is done at Apple,
at Marriott and at many establishments whose brands you come to
know and love. As your community learns to appreciate your brand,
they tell others about it.
There are several ways to help build your community base but by
far the best way is by WOM. WOM marketing is defined as marketing
52 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

conducted by those patients, who know of and appreciate your brand,


telling others about it. WOM has been used since the beginning of
time, from those selling spices and silks in biblical times to merchants
today who want to solidify their customer base. Simply put WOM is
simple, costs nothing, and provides huge rewards to doctors in the med-
ical profession who use it.
WOM does not always need to begin with patients. The process
itself begins by the doctors and their staff becoming active in their local
communities.
Finally, the proliferations on the Internet (and we will speak more
about this at the conclusion of this chapter) helps further spread what
others say about you. At the time of writing of this book, sites such as
Facebook™ TwitterÓ and You Tube owned by GoogleÓ enable news to
travel far and fast. Many companies and other practices use these serv-
ices to help develop community contact. And with over 900 million on
Facebook today (2012), this is not only a large link to make your pres-
ence felt but also a very inexpensive one.
It is not what is used but more importantly how and when. It is
important that you use similar services in your community so that they
serve as the vehicles necessary to increase awareness of your presence.
The more others speak well of your practice the easier it becomes to
build the community the easier it becomes to make your presence and
brand visible.

5.5.3 STEP THREE—DECIDING WHO IS YOUR PATIENT

Thus far there we have discussed the need for visibility to build brand;
however, remember this cannot be done in a vacuum. Brands, and more
importantly your practice, cannot be built without knowing whom to
market to. Unfortunately when beginning a practice many doctors
believe that (a) everyone knows about the medical professional, (b)
everyone needs medical professionals, and (c) everyone can afford med-
ical professionals. All these are untrue. For any of your marketing needs
to be relevant, you require a perfect patient or rather a direct link to
your target market.
Target marketing is a concept that requires you to develop the prac-
tice for a specific niche. It is much better to go deep before you go
wide. First, and most importantly, when you develop a target you zero
in on those patients who more specifically understand and appreciate
MARKETING FOR DOCTORS AND STAFF . 53

your value. Second, as these patients are treated they tell others helping
to reduce your marketing.
In thinking of how to build a target market it is best to view the
world as one large pizza or dessert pie. One can never eat it in its
entirety. You cut a small piece depending on your hunger. Target mar-
keting works in a similar fashion. You want to, first, view the world in
its entirety, and then make decisions on that portion of the world that
will appreciate the value provided.
There are four methods to dividing the market—what I typically call
three girls and a boy—because three of the methods deal with demogra-
phy and one starts with a “b”, namely, benefit. They are:

. Geographic segmentation—based on location


. Demographic segmentation—based on measurable statistics, age,
race, sex, religion, ethnicity
. Psychographic segmentation—based on lifestyle preferences and
their attitudes, interests, desires
. Benefit segmentation—based on values and beliefs as well as
desired benefits
. Geographic: To understand how to implement a geographic
segmentation you need to know where you are located and how
far your patients will travel regionally to find you. It is important
that you know zip codes or townships and municipalities around
you. It is also recommended that you use services found online
from either ZipSkinny.com or the Bureau of Labor and Statistics.
Either of these services provide details by zip code to assist you
in locating your perfect patient.
. Demographic: The only way to define whom you will market to
is by thoroughly researching the important statistical information
found in the census data from your geographic areas. Your
research must review age, race, religion, income, education,
marital status, family size, religion, gender, profession, and
numerous other information to better align your practice with the
right demographic. For instance, you might like to work with
women aged 35 and above who are professionals, single, and
with an income of $85,000. This is the data that will help you
zero in on developing a proper profile.
. Psychographic: Psychographic profiling helps the practice to
identify those areas that are personal to the demographic. This
information provides data on the kind of personality that patients
value. If age identifies your patient mix, then psychographics
54 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

helps by limiting the practice based on those lifestyle concepts


patients most value. For instance, you might only desire to work
with individuals who are into healthy, active lifestyles and enjoy
the benefits of medical advice.
. Benefit: This concept allows the doctor to focus on the benefits
of the service offered. There are different audiences for different
perceived benefits. For example, many like to use a mouthwash
not only because it cleans the mouth but also because it tastes
good while also providing additional care to the teeth that is not
provided by brushing. The medical profession is not just about
keeping people out of pain, but also about teaching proper
posture, providing better mobility and flexibility as well as
possible cures for allergies.

As physicians begin to view their markets more myopically they


begin to view the practice from the eyes of the patient. As doctors draw
close to the perfect patient, marketing becomes easier as there is a more
acute focus on their wants and needs. And, as the focus zeroes in on
the target, the attraction, acceleration, advertising, and experience
becomes easier. Targeting helps the practice become more competitive,
different, and value oriented.
Finally, depending on how long you want to be in practice you
need to remember that demographics and interests change. The process
of target marketing is never static but one that requires constant review.
To ensure your success, it is always best to review trends, seek advice,
and listen to the interests of both prospective and current patients. The
longer you keep your ear to the ground, the longer you will be engaged
in markets that are interested in your value.

5.5.4 STEP FOUR—ESTABLISHING THE MIX TO DEFINE THE


BRAND

5.5.5 STEP FIVE—DEFINING UNCONTROLLABLE FACTORS IN


DEVELOPING YOUR PRACTICE

No matter what you do and what you plan for, there will be certain
issues that will impact the practice. There is no way to control the exter-
nal environment that continually molds and reshapes the target market.
There are numerous obstacles that are uncontrollable elements of the
marketing environment that continually evolve and create changes. The
MARKETING FOR DOCTORS AND STAFF . 55

only way to react to certain changes is to be prepared for them. Unless


you remain close to trends and understand the external factors you will
not be able to handle change. The goal in reviewing the following seven
factors is to seek out the strengths of your practice and the limitations
that are affected by these seven factors as well as opportunities and
threats.

. Politics: We live in a world of uncertainty and as such the


political environment is constantly changing. And, as we know
politics is divided as certain individuals take sides and others
attempt to control national and regional issues for numerous
reasons. As our nation fluctuates in its political ideology there
can be constant changes in healthcare codes, laws, compliance,
and reimbursement. Physicians must be constantly alert to the
changing political environment because it will affect their
business. Unfortunately there are times when political pressures
will impact not only the business but also some of the other
uncontrollable factors such as economic and legal issues.
. Economics: No matter the country or continent, economies, like
politics, are in constant flux. Part of the reason for the constant
change is that money is constantly being used. There are always
changes in foreign exchange, government bonds, and
commodities, due in large measure to the standard
microeconomic theories of supply and demand and even market
speculation. You might think that this sounds like an economic
lesson or may wonder what any of this has to do with medical
professionals. Well, a lot! With the constant fluctuations of
inflation, recession, deflation, and so on patients have difficult
choices to make. For example, for many the recession of 2008
was devastating. A cardiologist was recently speaking to one of
his colleagues telling him that patients were either cutting
medications in half to last longer or not taking them at all. In
fact a pharmacist informed me that some diabetics stopped taking
insulin because they had to choose between about food, utilities,
and medicine! Realize that patients have little choice in bad
economies, especially in regional areas. Some may take aspirin
or just deal with the pain before they seek medical professional
care. This is where it is helpful to review your demographic data.
. Technology: No matter what, technology is always changing and
healthcare is one of those industries using new software,
hardware and so on. The emergence of electronic records is not
56 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

only revolutionary but also becoming the norm, and as such


these changes will affect your practice. In addition, technology
seems to have a shelf life of approximately six months or less.
Unless your practice keeps up with the constant changes in
technology you might actually be left behind. There are many
today who still use paper systems (SOAP notes) to chronicle
patient information. While this is fine for some, the constant
coding changes, reimbursements, and challenges of insurance
repayments are constantly changing. Technology will aid your
practice with efficiency but, like everything else in the practice,
requires constant review and updating.
. Competition: It does not matter where you setup shop—even
places such as Tahiti and the Azores. You must understand that
there is nothing new under the sun and at some point you will
face competition. Just within a 20-mile radius of a large
midwestern medical professional college there are over 325
physicians. That is quite a bit of competition. And there are
approximately 200 per class graduating every year. You need to
remember you are not alone in this profession and never will be.
. Natural Resources: Depending on your region, patients will
cancel and reschedule appointments. Snow, rain, hurricanes and
so on will always affect your practice; so make a note of these
issues as you begin to develop your plan. Always think of
contingencies related to seasonal and other environmental issues.
. Legalities and Regulations: Changes in the political environment
lead to changes in the legal environment. Laws are written and
then interpreted in several ways, especially at the national and
regional levels. There are laws that allow patients and doctors
certain freedoms such as the patients’ ability to choose any
doctor; however, there are also limits to the freedom, for
instance, restrictions in making patient records public. Laws, like
the weather, constantly change and must be reviewed often to
understand their impact on the local environment. Think of
changes in HIPPA laws or how restaurants are able to serve
minors, smokers and so on. While the laws ensure physicians
help the economy, there are times when these laws can also
impact competition, revenue, and success.
. Socio-Cultural factors: We live in a multicultural, multigendered
and multigenerational world. When we look at socio-cultural
information we think of how and why people live and behave as
MARKETING FOR DOCTORS AND STAFF . 57

they do. Physicians can’t afford to ignore this important area. In


fact, this nuance can help or hinder your target market selection.
This is an area that cannot be overlooked since your marketing
messages will impact positively or negatively your value in your
market. The wrong use of words, colors, and terms can insult,
stereotype, or miscommunicate your message. In a global world,
you need to “think globally but act locally.”

As you research and implement these strategies you will notice your
marketing is keener, more focused on your target, and well equipped to
thwart competitive pressures. There is no secret formula to handle
things beyond our control in the environment but there is a good mis-
quote of Carl von Clausewitz, also attributed to the heavyweight prize-
fighter Jack Dempsey, “The best defense is a good offense.”

5.5.6 STEP SIX—COMMUNICATING YOUR MESSAGE WITH


VALUE

I work with many doctors and practice managers. When I ask them
what they do, they immediately give their title. Each states, “I am the
Office Manager,” “I am a Doctor,” “and I am a Doctor .” If I were a
patient and heard this I would immediately say, “So what?”
During a recent networking event, new members were asked to
introduce themselves to the audience. As each one spoke, not one per-
son stated what he or she did or explained why members might be
interested in them. Rather each introduced themselves in stereotypical
style giving their name, profession, and company name. It was a long
and boring session with no valuable information.
As I mentioned earlier, you need to think in terms of value and dif-
ferentiation. When you position yourself as different you heighten your
visibility in the community. The idea here is to begin to think of your-
self as separate from the market so that you can rise above to the com-
petition and attract more attention to your practice. Positioning is a way
of defining for the market how you want to be viewed and how you
communicate this message so that prospective patients will pay atten-
tion. Positioning is very helpful when competition is very similar and
you are seeking methods and messages to illustrate differences. For
example, many people think there are few differences between physi-
cians even as they believe there are little differences between insurance
58 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

schemes; but we all know that there are subtle as well as flagrant
differences.
Attempting to determine what prospective patients think is not easy.
More importantly, positioning requires that you think like a patient and
not a doctor. This is vital to success for two reasons: (1) it is necessary
for you to think in terms of benefits and results to the patient and (2) it
requires you not to be prescriptive, for example, do not use medical jar-
gon. Lay language is more helpful rather than using words, mnemonics,
and phrases that prospective patients are unfamiliar with and will not
stop to understand. Therefore, you must think very hard about the bene-
fits you offer prospective patients and the way in which you offer them.
The essence of this exercise will enable you to create what is known as
an audible message or value proposition so as to accurately articulate
your message to future and current patients.
So what then is a value proposition or audible message and why is
it important? A value proposition is a pithy statement that promotes the
practice to patients using outcomes and results. This brief statement
helps to define the benefit (s) that a patient receives by coming to you.
It is outcome-based and focuses all attention on outcomes not the proc-
esses and methods. Most importantly, it removes the stereotype and
titles from introductions, conversations, and marketing messages.
Most practices and their doctors lack a useful value proposition.
Research illustrates that many firms (93 percent) focus on processes and
not patient-outcomes. In other words ask practitioners what they do and
they explain the prescriptive side and fail to discuss the benefits offered.
Examples include:

. We provide flexibility training.


. Our assessments assist with obesity identification.
. We provide X-rays and screening services.
. Our model incorporates supplements and nutritional analysis.

These are not value propositions. While they give information about
the practice, they do nothing but focus on the practice and its mitiga-
tions. The entire purpose of a value proposition is to focus solely on the
benefit to the patient.
The reason for having an audible message or value proposition is
because there is way too much noise in the market.

Everywhere we turn we’re saturated with advertising messages trying


to get our attention. Walker-Smith (President of the Marketing Firm
MARKETING FOR DOCTORS AND STAFF . 59

Yankelovich) says we’ve gone from being exposed to about 500 ads
a day back in the 1970s to as many as 5,000 a day today. (Johnson
2009)

The patient is bombarded by ads. Think of this example—you


attend a music concert and like most individuals you might shout in
jubilation for the star. The same might be seen at any athletic competi-
tion. While you and your peers are screaming, you hope that your star
notices you, but no such luck. That is marketing in today’s competitive
world; loud, obnoxiously inaudible, and nondistinguishable. Value prop-
ositions and audible messages cut through all this clutter and noise and
make prospective patients listen to you.
Be mindful, this is not an elevator speech. A value proposition suc-
cinctly addresses the patient’s concern. And it helps to articulate the
brand. A perfect example is the FedEx ad—“absolutely guaranteed to
be there overnight”. This is one of the most powerful value propositions
in the world and FedEx is one of the best brands in the world.
There are other reasons for writing a value proposition:

Distinguishes you from the competition.


Distinguishes you and the organization in distinctive markets.
Provides a better source of lead generation.
Accomplishes quicker time to market.
Enables you to expediently get in front those needing your
services.

Here is an example to develop a value proposition:

1. A poor value proposition:


We help create a fit individual
2. A good value proposition
We have a 7-Step program for better abdominals
3. A great value proposition
We dramatically accelerate results that match your individual
fitness desires

The concept for developing a statement is not difficult to achieve,


yet takes patience. It is vital to look at practices from the patient’s point
of view. The best way to begin is to ask yourself some questions such
as:
60 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

1. “What does your practice do that from a benefit and results


perspective stands head and shoulders above any competition?”
2. What results will patients achieve with you?
3. How passionate is the practice in meeting patient’s needs?
4. What are your core values that provide results to patients?
5. How does the practice minimize patient risk and provide a return
for them in time, health, money, and wellness?

These are only a few of the many questions that can be asked to
begin crafting a message. Do not expect to obtain a statement overnight,
yet do not labor over it either. If you desire better results for your mar-
keting efforts it is best to begin by asking questions focused on patient
value. If you cannot find the answers, the best sources are your patients!
Testimonials and case studies are great examples. Take their statements
and simply develop them into benefit-based sentences.
It is important to understand that no magic formula exists for the
creation of a value proposition. The drafting of an articulate message
might make split all the difference between a cursory review of your
brochure and an interested study of it. Craft a new message, speak of
value and results, and watch the gap between your competitor widen.
Consider the following to help craft your audible message.
Answer the following questions specifically but succinctly.

1. What is unique about your brand and what you offer? Write this
down. In addition, write down the first thing that comes to mind
when others want to know what you do. However, return to the
previous sections to help develop statements based on patient
needs and perceived value.
2. What do you do that is different from competitors? Write it down
as succinctly as possible. Use adjectives and adverbs when
possible.
3. What is the best choice for your optimum patient? What is the
output or results to the patient? How is the patient position repute
improved? Look at the master list of words in the appendix.
What words can you incorporate into your current value
sentence.

Examples include:

. Dramatic
MARKETING FOR DOCTORS AND STAFF . 61

. Accelerate
. Speed to Market
. Expediency
. Proficiency
. Compliant

Finally, assuming you have correctly identified the target market and
have articulated the issues and possible solutions you can provide, place
your best effort in the areas of the small box provided. This will allow
you to formulate a sentence that will create your audible message. I
have provided you the definitions first, another table with a sample and
then a blank table for you to complete.
Descriptions

Target audience Place here your target market in a descriptive


form such as I work with men and women
aged 40 to 54 that ….
Issues they face What is it that patients face?
Point of difference What is the differentiation that you provide?
(outcome)

Sample

Target audience I work with men and women aged 35 to 50 who


are professional business individuals
Issues they face Who suffer like crazy because they work long
hours and in environments that are very
stressful.
Point of difference We offer an 8-step process that dramatically
(outcome) refocuses energy so that they become more
mobile and carry less stress in less than 21 days!

Now it is time for you to give it a try!

Target audience
Issues they face
Point of difference (outcome)

(Continued)
62 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Target audience
Issues they face
Point of difference (outcome)

5.5.7 STEP SEVEN—MESSAGES CONGRUENT WITH PATIENT


BEHAVIOR

You have moved your business development to an entirely new level


with your focus on a target and on your audible messaging. However,
the work is not over; it continues because it is critical to have a thor-
ough knowledge of patient behavior. This is the process where you
learn how your patients will make decisions about choosing and using
your services. Your knowledge in this area will help you to understand
what processes influence behavior so that you can develop messages
and tactics that are congruent with those desires.
Realize that individuals make decisions based on two basic prem-
ises: wants and needs. Not everyone wants a doctor but they might
need one. And not everyone needs a doctor but they might want one.
Once you consider whether the prospect wants or needs your services,
you must determine the Dominant Acquisition Motivation. The Domi-
nant Acquisition Motivation defines why the patient wants or needs the
service. Although there are thousands of reasons why buyers make a
purchase decision, the most compelling motive ultimately will move the
prospective buyer from mere consideration to action. Dominant Acquisi-
tion Motivation is that most compelling reason.
What I am suggesting here is that doing business with the doctor
and the practice is merely psychological. Yes, all decisions for making
service acquisitions are based on some level of psychology. These
include perception, motivation, beliefs, and attitudes. These factors have
been items that patients have used over time to interact with the world
that has helped them form opinions on products, services, health, well-
ness, and doctors. Unlike other issues that are influenced by the per-
son’s environment, patients’ interactions with the world are influenced
by psychological factors.
The influences we speak of include family influence, traditions,
beliefs, reference groups, culture, and even social class. The manner in
which you were reared by family and your lifestyle when you matured
impact your perception of the world around you. Decisions you make
MARKETING FOR DOCTORS AND STAFF . 63

today, like those of your patients, are made based on the bias of your
surroundings and opinions and influences of those around you. For
example, if you grew up in a home that influenced frugal behavior with
an attitude for saving, you might be less influenced by particular brands
and place a higher value on price. Or if your background placed empha-
sis on certain foods you might be more attuned to practicing a vegeta-
rian diet. No matter what, your perceptions were seeded the moment
you were born and that is true of your patients are too. Knowing these
things will help you to understand what will attract others to you and
what puts them off.
Additionally, there is also some level of psychological need that
accompanies consumer behavior. If you recall when you attended under-
graduate school you may have read the works of the social scientist
Abraham Maslow.
One of the best-known theories explaining the actions of people,
their motivations, and their desire is called “Hierarchy of Needs.” Dr.
Maslow hypothesized that people are satisfied, based on the attainment
of each level of the lowest order. As the individuals’ needs are met at
one level, they reach another level, thereby raising the individual’s prog-
ress to higher-level motivators.
Maslow set up a hierarchical theory of needs. The animal or physi-
cal needs were placed at the bottom and the human needs at the top.
This hierarchic theory can be seen as a pyramid, with the base occupied
by people who are not focused on values, but on just staying alive. A
person who is starving dreams about food, thinks about food, and noth-
ing else. Each level of the pyramid is somewhat dependent on the pre-
vious level for most people.
Dr. Maslow’s theory for patient behavior:

1. Physiological Needs: Biological needs, such as oxygen, food,


water, warmth or coolness, protection from storms and so forth,
are the strongest because if deprived, the person could or would
die. This is where marketers will show runners who drink sports
drinks for refreshment or ads that show food to satisfy hunger.
Physicians might zero in on water to hydrate the body and
muscles as well as nutraceuticals to provide nutrition for the
body.
2. Safety Needs: These are felt by adults during emergencies or
periods of disorganization in the social structure (such as
widespread rioting). This is a great place for physicians to
64 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

illustrate the need to review X-rays and screens to search for


signs of bone fractures or cancers.
3. Love, Affection and Belongingness Needs: This is the need to
escape loneliness and alienation and to give (and receive) love
and affection and to experience a sense of belonging. This is
where physicians can aid individuals with posture and wellness
programs not only for their physical wellness but also for them to
feel better and thereby more confident and more acceptable to
those around them.
4. Esteem Needs: This is the need for a stable, firmly based, high
level of self-respect, and respect from others in order to feel
satisfied, self-confident, and valued. If these needs are not met,
the person feels inferior, weak, helpless, and worthless. This is
where many are attracted to certain brands because of the value
and esteem they represent. Examples here include Mont Blanc or
Mercedes but this can also work against certain doctors who
carry a stigma because of their therapies and those who use them,
celebrities, for instance.
5. Self-Actualization Needs: Maslow describes self-actualization as
an ongoing process. Self-actualization is something that everyone
desires to reach but many rarely do. It is an ongoing process and
many marketers need to focus here so that the service brings out
the best in every individual in the practice.

Many patients today are motivated primarily by social, ego, and


self-actualizing needs. Everyone needs to be loved, to be accepted, and
to belong. Individuals join social, religious, fraternal, and educational
organizations to fulfill this psychological need.
As we know, patients strive to reach higher and higher levels of the
pyramid. Physicians need to identify the hot buttons that will create
emotion, and most importantly the action to help them consult a doctor.
Psychology, with all the other factors combined, helps to create emotion
and it is this that gets patients to act.
Gaining a better understanding of patient behavior will enable the
doctor to zero in on those needs to help make a decision on medical
professional services. When you understand the collective nature of val-
ues and beliefs and how they influence behavior and decisions you can
create marketing messages congruent to those beliefs so that the pro-
spective patient will make decisions in less time.
MARKETING FOR DOCTORS AND STAFF . 65

Finally, there are two other factors that are discussed at length later
in this book but provide additional assistance in influencing patient
decisions. First there is a wonderful resource known as “Influence—The
Laws of Persuasion” by Dr. Robert Cialdini. He describes seven laws
that he believes helps to influence individuals make decisions. His laws
will aid you in developing proper messages that influence decisionmak-
ing and help to discredit any buyer’s remorse. Second, never discredit
the role of customer service in the patient behavior process. In today’s
competitive market, patient-to-patient influences are very strong.
Patients seek out advice from other patients who have used your serv-
ices. They want to understand the benefits through the eyes of another
patient and not through the doctor’s propaganda. Third, in addition to
customer service, the blogosphere and the Internet are incredible in
passing on good and bad information on your practice. Fortunately and
unfortunately, your practice is as good or as poor as the last Tweet,
Facebook comment, or email. All of these influence decision making
and they are critical to ensuring patients will be attracted to your
service.

5.5.8 STEP EIGHT—CREATING PATHWAYS TO PATIENT-


S—MARKETING MAGNETISM—THE KEY TO PROPER
AWARENESS

At this point developing a marketing plan helps to organize all of your


thoughts and ideas into a comprehensive document so that you can cre-
ate a strategic roadmap for your business development. By reviewing
your objectives and defining the outcomes you can document the tactics
required to help meet that performance. The marketing plan is a care-
fully crafted document outlining those activities (many of which are
mentioned in this chapter) to help you work toward the common goals
of the practice.
The plan, when written, will help the practice to review the market-
ing environment against the practice plans to ensure all obstacles are
noted. Once the plan is written it serves as a reference point for the suc-
cess of all activities to acquire and retain patients. Finally, the plan
allows the doctor or the Medical professional Assistant to review all
possibilities and problems the practice may encounter.
Much of the marketing plan is addressed in this chapter but a quick
overview of what is to be included and the manner in which to write
one follows.
66 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

1. Executive Summary: A high-level summary of the marketing


plan. This is typically two to three sentences describing what you
want the practice to be and how you will get there.
2. The Challenge: This is a brief description of the practice, the
services you will be offering, and how you might want to
achieve some of the goals you desire.
3. Situation Analysis: In this section is listed the practice and a few
of the patients and the competitors that you intend to go after. A
good way to review some of the issues is to conduct (a) a
SWOTT analysis and (b) a thorough review of the competition
and the services they offer. It is also suggested to list some of
your differentiated traits so that you can niche the practice from
the competition.
Two other concepts that will be very helpful for you are listing
the uncontrollable environmental factors that are have been
described earlier in this chapter as well as a specific and
thorough SWOTT analysis of your practice so that you can
decide how it aligns with competitive forces.
4. Target Market Segmentation: This has been discussed in detail
earlier in this chapter so it is helpful to list all of the data
necessary to describe your demographic, psychographic, and
benefit segmented list.
5. Alternative Marketing Strategies: List and discuss the alternatives
that were considered before arriving at the recommended strategy.
6. Selected Marketing Strategy: Discuss why the strategy was
selected, then the marketing mix decisions (4 Ps) of product,
price, place (distribution), and promotion.
7. Promotions: This area will be discussed a bit further in the next
section but this is the area where all the activities and tactics
necessary to drive business development will be discussed. This
section will be vital to your success as all the activities listed will
provide the attraction needed to bring patients to you.
8. Conclusion: Summarize all of the above.
MARKETING FOR DOCTORS AND STAFF . 67

5.5.9 STEP NINE—PATHWAYS TO


PATIENTS—ATTRACTION—CONVERSION—RETENTION

Today’s markets are cluttered and very competitive. Advertising alone


in the United States makes up almost $300 billion in revenues for
advertising agencies and periodicals. That means while many physicians
believe that advertising is the de facto standard for promoting business,
it is available not for your interests but to gain the most revenue possi-
ble for magazines, newspapers, television stations, and so on. Further,
the more your practice advertises the more your competitors also do.
This only floods the market and confuses prospective patients.
What is needed today is a multilayered approach to gaining the
attention of those who might be interested in your services. With so
many things in their way such as billboards, placards, magazine ads, tel-
evision commercials, radio commercials, text messaging, cell pho-
nes—need I say more, patients are on overload. Advertising research
tends to show that the average consumer (patient) has an attention span
of seven seconds. Can you imagine seven seconds to capture the atten-
tion of your prospective patient? That is not much time.
What all this means to you is that your practice approach must have
its hands in numerous activities so that no matter wherever, whatever,
and however a patient needs to see your services—they can! The con-
cept known as Integrated Marketing Communications is nothing more
than a multitier, multilayered approach to communicating your brand. In
other words you need to ensure your multiple messages attract attention
and getpatients to your practice. The more you engage in this concept
the more attention you will capture, ensuring that patients connect with
you and not the other way around. What is more interesting is that the
more the activities that are created there is less effort needed for the
practice because the marketing perpetuates the market, creating expo-
nential growth.
The following list of activities is not mutually exclusive. Sometimes
it is hard to use all instruments simultaneously. Having said that, choose
those that are congruent to your interests and those that can appeal
instantly to your patients. They are presented here in no particular
order.

1. Speaking: One of the best methods to introduce your expertise is


to tell others about what you do. Rotarys, Kiwanis, Chambers of
Commerce are constantly in need of experts. Contact these
practices or others to discuss content to enlighten their members.
68 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Participants are attracted by new and interesting content. There is


a reason why Steve Jobs and Bill Gates are chronic keynote
speakers and their brands continually manifest. You might speak
at a local ladies auxiliary or a youth fitness class. Choose
avenues where your patients will be present.
2. Writing Articles: There are more newspapers in circulation today
than ever before. There is a multitude of newsletters, web sites,
regional business magazines, and local newspapers starving for
decent material. Articles need not be more than 500 to 1,000
words. With good content and a solid byline your message can
be in the hands of hundreds or thousands. All individuals have
something to offer and periodicals are always searching for
content. Every practice and doctor is an expert in his or her
respective business.
3. Website: The proliferation of the Internet allows others to
discover your content and determine your value. Fees are
inconsequential and the business world requires a website to
show your sincerity to patients. With over 300 million websites
today there is a need to be with the competition, and patients
expect you to have one. Patients research you before they call or
contact. In fact, research in this area has shown that Google
searches number over 4.7 billion in any particular week. The
Internet today is yesterday’s Yellow PagesÓ.
4. Blogs: Similar to articles, having a Blog serves two purposes: (1)
remaining in constant contact with current subscribers and (2)
enabling you to reach new patients at relatively no cost. The
blogs differ from articles in the immediacy of availability and the
frequency with which your content can be posted. Proctor and
Gamble has a blog, its penetration helps to reach over 1 million
people daily, and the feedback has been successful in creating
new products and services. Blogs allow you to provide your
expertise in a particular area and get your knowledge out in the
market to those that seek it.
5. Lunch and Learn: These concise information sessions last no
longer than 30 minutes during a corporate luncheon and feature
your content. Benefits are a live audience, interested attendees,
and low cost of acquisition. The intent is not only delivery but
also possible business from attendees. Many fitness professionals,
insurance, and service practices use these successful venues.
Research companies around your region that would be interested
MARKETING FOR DOCTORS AND STAFF . 69

in gaining some insight into health, wellness, and other areas of


corrective health. Have them bring a sack lunch and you speak
for a short time on some health topic of interest to them.
6. Booklets: Typically focused on one topic, these small content
rich pieces feature your advice on one particular topic, for
example, nutrition. Booklets can be used for potential patients as
handouts or products to be sold at special events. Booklets are
low cost and can be produced at a local printer. These take just a
few moments to develop and provide tremendous free value.
7. Products: When patients become enamored with your content
your style, and most importantly your results, they want you!!!
Products such as CDs, DVDs, books, booklets, hooded
sweatshirts, and so on make way for great passive income.
8. Networking: Chambers and associations exist for a valid reason.
Others become aware of your service, and after using your value
proposition they desire more information. Recall that individuals
conduct business with those they know and trust. Local
communities are tremendous aids and help build quick
relationships.
9. Cause Marketing: With the increase of focus on ethics and social
responsibility, many practices give back to the community while
teaming with nonprofits. “Teaming” with a practice that seeks
similar goals as yours alleviates marketing costs. One of the best
cause marketing campaigns is the Susan G. Komen practice.
Beginning in the early 1990s this nonprofit collaborated with
numerous corporate entities and became preeminent in creating
breast cancer awareness.
10. Trade Shows: Trade associations and exhibitions are terrific
places to showcase your brand. Trade Shows require effort,
focus, and a myriad of issues can fail if the show is not worked
out properly. However, exhibitions are great venues for meeting
new patients, and maintaining contact with existing ones.
However, do not enter a trade show without a proper game plan
and key performance indicators.
11. Pro Bono Work: What committees can you work on or what
associations do you know of in need of your passion and talent?
This type of work gets you very involved in your community and
creates the visibility required to potential patients. Other than
time there is minimal expense to you and much return on
investment.
70 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

12. Referrals: The sweetest sound any doctor can hear are
encouraging words from existing patients who know and
appreciate your value. When they tell others, your advertising is
lesser and more become attracted to you. And when requested in
multiples there is never a need to advertise and promote again
since your current base informs the world of your great results!
13. Newsletters: Printed monthly or quarterly and sent to existing and
possibly prospective patients this information packed value must
be easy to read and full of great suggestions patients can
instantly use. Provide good intellectual property so that people
become interested in waiting for the next edition.
14. Teaching: Education is everywhere. From online to community
center associations and universities are constantly seeking subject
matter experts to present data to students. Teaching allows you to
manifest your brand, gets you in front of an audience of potential
patients, and allows you the opportunity to research information
for future presentations.
15. Alliances: There are many people who honor and believe in
medical professionals but you may not have met them. This
includes anyone from medical practitioners to physical therapists,
coaches and beauticians, even attorneys who handle personal
injury. Take time to meet as many of them as possible to help
grow your brand above and beyond your own capabilities.
16. Sponsorships: Different from advertising and passive listings such
as directories and Yellow PagesÓ, sponsorships get your brand in
front of very targeted audiences such as runners, bikers, cancer
survivors and so on. Find organizations that can appreciate and
help you get your name in front of those who need it.

The market today requires you to be visible; that is how people get
to know of you and use your services. When you are invisible you are
ghostly and hidden. When you use the power of integrated marketing
communications you create duplicity of channels to manifest your
brand. Exploit as many channels as possible to grow your brand, create
noise, and attract future markets to you.
MARKETING FOR DOCTORS AND STAFF . 71

5.5.10 STEP TEN—EVALUATING THE MARKETING ACTION


PLAN

Athletes who want to see the signs of their success must get out of the
stands and into the field of play. So too marketing requires a consistent
stream of activities that allows your practice to remain on top of the
mind. When your actions speak for themselves, your brand proliferates
and creates better opportunity for others to know about you.
What many doctors fail to do from time to time is organize the day
and set priorities to ensure that all work is monitored. What is important
is what gets measured gets repeated; so there needs to be assurance that
you are monitoring activities to ensure your success. What follows is a
table for you to fill in quickly each activity you intend to conduct
weekly and the day you intend to do it on. This will allow you to
understand where your leads are coming into the pipeline and where
your new patients are coming from.

5.6 A QUICK WORD ABOUT WEBSITES AND WEB-


SITE CONVERSION

Given the current state of technology and the Internet, it has become
increasingly important for any doctor to be in tune with the Internet
today. If this were written 10 to 15 years ago, it could have been said
that the Internet is nothing more than a static electronic brochure.
Today, however, it is a credible source for prospective patients to dis-
cover more about you and actually engage with you. Periodically, I
obtain emails and blog comments from people who are interested in the
services that I provide and so can you. So what can you do to make
your site more interactive?
In order to justify the purpose of creating a site it is best to have a
strategy similar in design to your overall marketing strategy. There must
be a purpose for the website proper messages to appeal to the demo-
graphics that you are attempting to get attention from have to be posted
there. With over 300 million websites there are simply too many today
that are competing for similar space, audiences, and attention. There-
fore, you want to plan as carefully as possible to appeal to those who
would be interested in your services.
The first operation for your site would be to choose the type of
pages that you want to have and the messages for each of the pages.
For physicians just beginning this process, I suggest the following:
72 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Home Page, About Us, Services Offered, Case Studies, Products, and
Contact Us. Frankly, this is all you need. You should believe in the
KISS method. Keep it simple, keep it succinct, and keep it scintillating
so that it creates the actions you desire from the prospective patients.
With this in mind there are some rules to developing a purposeful
website so that you gain the levels of success you desire.

1. Research the most popular keywords possible to understand those


words used to find your site. For instance you might have people
searching for “Missouri Doctor, Logan Student or even Brooklyn
New York Back Care.” A great resource for reviewing this data
is available for free on the Internet and it is called Google
Keyword ToolÓ.
2. Every page must be not only short but should have a purpose.
Each page must have the following formula attached to it; (a)
your value proposition, (b) lots of white space so that it is not
cluttered, (c) some pictures that are clear but nothing over the
top, (d) good fonts so that information is easy to read, (e) using
the formula of placing the most important information “above the
fold” so that prospects do not have to scroll to find it, and (f) an
action step. Every page must not only have a purpose but it must
also tell your reader what you want them to do and get them to
do something. Unfortunately most individuals remain on a page
for less than seven seconds so you need enough information to
keep them there and get them to do something.
3. Create some type of free marketing magnet so that individuals
might leave you a name and email. This will allow you to create
a lead generation system without having to pay for lists and use
many of the other marketing activities mentioned above. By the
way a marketing magnet is a free gift such as a white paper,
audio, vitamin, analysis, massage, anything that you can provide
that has value and that someone wants.
4. Know what the issues are and why people come to see your
page. Can you identify the struggles they face? When you
identify their issues you can speak more articulately to them so
that your page actually has a conversation with the person. It is
as if you are speaking with them electronically.
5. One idea to gain about building your website concerns the entire
essence of this book and that is building a customer-centered
relationship. So when you design and develop this site you must
design it so that it can be read, has a professional tone and
MARKETING FOR DOCTORS AND STAFF . 73

verbiage, and is able to prove how you provide value to the


intended audience.
6. When building your home page create something with the
following outline so that it focuses on output and returns to the
patient. For example:
(a) Problem—Tell them what is not working. Provide a paragraph
or two and let them know what is at issue right now.
(b) Solution—Tell them how it could be. Provide a paragraph or
two to let them know what utopia might look like when the
problem is resolved.
(c) How come?—Provide a question as to why they have to
resolve this. You might provide a paragraph or two that
provokes them or even agitates them enough to question why
they haven’t taken care of the situation.
(d) What you need to do—Provide an approach that’s has been
proven to work. In a short paragraph give them a general
solution that’s been proven to work without giving too much
prescriptive information. You might provide a deep
understanding of methodologies or even business practices
that allows individuals to understand how you and your
organization can assist them in reversing the role.
(e) Call to action—Provide proof that you can help them. Write
an exceptionally strong statement that includes your core
marketing message or your unique selling proposition or even
your value proposition that convinces the prospective client
how you and your organization are the only one that can help
resolve the issue that the client is currently facing.
7. Your About Me page should be personal, conversational, and
similar to the way you speak. Provide some flair and some
pictures so that patients can find out why you got into the
medical profession. Answer what you can do to help them and
then tell them about your family and your practice.
8. When you provide information about your services, stay away
from using technical, scientific, and medical information. Not
many understand or ask about terms such as subluxation, motion
points and so on. And many will not ask. More important is that
every person who visits is concerned about one thing and that is
how you can help them. The best practice is to write in lay terms
with the patient in mind without sounding completely like a
doctor and sounding more like a trusted individual.
74 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

9. Think in terms of conversion not in terms of website hits. While


hits are important the fact is that what really counts are the
number of individuals who actually convert into patients. Having
said that, there are reasons why people will not convert into your
patients. These reasons include (a) your niche is not clear, (b)
your results are not specific, and (c) there is a lack of clarity in
your systems and processes. When you create a link between the
issue, the solutions, and the demographic you more accurately
convert individuals more successfully.

Last but not least is that a website is a work in progress and need
not be perfect. What you need to think of is that the website is the
adjunct to the practice not the purpose of it. Therefore, take your time
to strategize well but once you are ready, implement it. Do not sit on
the sidelines constantly judging and ridiculing because you will create
paralysis with the analysis. Then as you begin to formulate analytics
around your systems, you can make any needed alterations.

5.7 A QUICK WORD ABOUT SOCIAL MEDIA

Last year, 68% of Americans using social networks said that none of
those networks had an influence on their buying decisions. This
year, only 36% said that there was no influence. Now, 47% say
Facebook has the greatest impact on purchase behavior (up from
24% in 2011). Incidentally, Twitter dramatically underperforms in
this category at 5% (Qualman 2012).

Social media today has taken over many of the nuances of the Internet
allowing others to communicate without barriers of any kind.
As social media develops we see the growing fascination as well as
the preponderance of evidence of increased noise. While there is merit
in some use of the social media, much of it is personal and seems to
continually clutter important information on the Internet. Yet, for physi-
cians the influence and the reach of the social media is not something
to be ignored. With over 900 million people on FacebookÓ and over
150 million on LinkedinÓ and over 1 billion Tweets per day there are
too many individuals using Social Media to ignore its use. Yet like web-
sites there are some things to recognize.
MARKETING FOR DOCTORS AND STAFF . 75

1. Social media does assist in creating a community since it allows


an electronic flow of communication from one to many
individuals seeking services such as yours.
2. Social media does require some degree of focus. While there may
be limited control there is no reason to build pages on Twitter,
Facebook, or any media where your patients are not located. If
you realize that marketing requires your use of geography to lock
into your target market social media requires a similar approach.
I know of many who have wasted time and energy building
pages and sites with very low interest and volume. Make certain
you efforts are well worth it.
3. Remember that the social media, unlike websites, has very
limited control. You may receive unsolicited feedback on
services, treatments, blog posts and so on. Ignore those that make
little impact on your life.
4. Finally, follow the trends. Determine what is interesting for your
readers and community and what isn’t. Do not get caught up in
too much social media that takes you away from the most
important focus of your practice—building it.

Many years ago Albert Einstein stated, “Insanity: doing the same
thing over and over again and expecting different results.” If your prac-
tice is not growing and you are continually doing the same thing and
not getting results why bother. Physicians invest a lot of time into their
craft and deserve better rewards. Those seeking to gain better results
simply need convert from the medical professional business to the mar-
keting and relationship business.
The only thing holding back your practice is the resources and the
implementation. Implementation is difficult since it requires change
from the comfort zone. It is a whole new world with more limitations
than ever—the worst being time. Take time to discover new methods to
grow your practice. Take time to implement something new. Take time
to minimize your labor so that you might reduce your costs.

REFERENCE

Gallo, C. July 21, 2012. "7 Sure-Fire Ways Apple Store Converts
Browsers into Buyers." Forbes. http://www.forbes.com/sites/
76 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

carminegallo/2012/07/25/7-sure-fire-ways-apple-store-converts-browsers-
into-buyers/ (accessed July 12, 2015).
CHAPTER 6

DEVELOPING THE PATIENT


EXPERIENCE

Many years ago, while researching for a client, I discovered a quote


that personifies the achievement of every practice. Peter Drucker stated,
“Every practice is in practice for one reason—the patient [patient].” All
activities and internal functions rely on acquiring and retaining practi-
ces. This important concept is needed to ensure that physicians focus on
the area of acquiring patients.
I truly believe that there are three reasons why the patient experi-
ence is so important to any medical, clinical, or healthcare practice.
They are the following:

. Less Cost: As your current practice inform existing patients of


your products and services, the patients become marketing
leaders through buzz marketing. Costs decrease as advertising
becomes unnecessary.
. Increased Productivity: A cooperative culture leads to higher staff
productivity. When people get along they service patients better.
. Less Labor: The increased use of social media and the Internet
enable (content) patients to quickly connect with others who
might be interested in your services. Patients do the work for
your practice.

Let me be clear, patient service is one of many things practices can


do to remain close to patients and obtain new ones. However, there is
overwhelming evidence today to state that the Internet and other tech-
nologies allow for patient service mistakes to ruin your practice’s repu-
tation. Ignoring the issue can quickly harm shareholder return, creating
obstacles to your success and increasing competitive pressures.
So what are some of those factors that help to contribute toward aid-
ing a practice with its patient service?
78 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

I think it boils down to three components: people, process, and


aesthetics.

6.1 PEOPLE, PROCESS, AND AESTHETICS

People: No matter what the practice, the first interaction that any patient
has with an individual is with the people that you hire. This begins at
the front desk always and down to the office staff. You need to have
people with innate skills who can do their job as if their lives depended
upon it.
Processes: Let me give you a great example. Several months ago, I
required surgery for retinal detachment and to keep this story short I
also developed a cataract during that period. Once the retinal surgeries
had healed, I required an ophthalmologist and made an appointment to
remove the cataract. Rather than have me arrive at the office three and
a half days early to complete all the paperwork that medical practices
require, the office manager sent me a link where I was able to complete
all of the required paperwork online—on my time and at my pace! This
is what I mean by processes—we need to make it easier for the patient
so that the experience is overwhelming each time.
Aesthetics: Practices want to visit in a clean and socially responsible
environment. This includes the lobby, parking lot, and other places that
patients might see. Patients constantly judge a book by its cover; there-
fore, it is important to ensure that your house is always clean. This also
includes the look and feel of your website and blog. And your voice
mail system. Makes things easy for the patient.
One of my favorite patient service stories is when we moved from
New Jersey to St. Louis approximately 12 years ago. Prior to our move
I had a practice appointment at the New York World Trade Center. I
was dressed in a suit and tie along with a brand-new pair of Johnson
and Murphy shoes. I had those shoes polished to a shine for the meet-
ing. After concluding the meeting I returned home to place the suit and
shoes away so that they can be packed for our move.
Nine hundred miles and three weeks after our move I had an
appointment in St. Louis. Without thinking I walked to my closet and
dressed in a suit and tie. I immediately went to lace my shoes on and
could not find them. After two hours I gave up and went to my meeting
with a suit…. and sneakers!
DEVELOPING THE PATIENT EXPERIENCE . 79

After the meeting I continued to search for those shoes but could
not find them. It was almost two weeks and still nothing was found. I
placed calls to the moving company thinking the box was lost and
finally putting in a claim. After a lengthy argument with the moving
company they decided my claim was bogus. They said and I quote,
“we apologize for mislabeling and poorly packing your boxes; this is
not quality work we usually perform. Although it is our preference
never to disagree with the patient in this case we must!”
Now you might think that that is the end of the story. It was seven
years later during Thanksgiving when my wife asked me to get the
tablecloth from the breakfront for dinner. I reached down in the bottom
drawer and grabbed a brand new shiny pair of Johnson and Murphy
shoes!
Get into the mind-set of your patients—what do patients really
expect?
Patients today are much smarter than many think. They are most
specifically concerned about value and trust. With many physicians to
choose from and easy access to their websites it is hard to distinguish
one from another. The key differentiator, therefore, is patient service.
Patients want to ensure that they are treated well from the moment
that they are serviced. This implies that practices should develop a
patient culture—this includes everyone from the front desk to treatment
room. In fact, a patient really expects to be treated as the focus of the
practice and not as an interruption of it.
When working with customers (read patients for your practice) there
are four very specific things to be considered to help your practice
become more savvy about customer service.
The first starts with people. The people you hire must be passionate
about servicing customers. This means smiling when they enter and
even engaging them in conversation that creates a peer relationship.
Getting to know them and becoming genuinely interested in their situa-
tion is very good for the practice. Examples here include Zappos and
Southwest Airlines. The service staff assigned to you are engaging from
the moment they begin conversing with you and make you feel
welcome.
The second issue that customers are concerned with is support.
When they call to get service, customers expect a real person to answer
the phone. They don’t expect to be placed on indefinite hold where
they are confronted by a maze of voice-operated options. Customers
become very annoyed by the number of prompts they must provide in
80 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

order to get the assistance needed. How many times do you call some
companies and get press one for English, two for another language,
then press one for sales, two for service, now enter in your account
number, then hit 3 if you know your child’s first name. Many utility
companies use these systems, but they are lengthy, confusing, too
annoying, and most importantly not service savvy. Customers actually
want to speak with real people!
The third issue is that customers want to know how you can help
them as a trusted advisor. Customers seek solutions to problems and
there is expectation that you could offer help based on your previous
experience. Examples here include instances like advise on how to
instantly repair appliances that are broken or help with software that
will not open or save.
Customers also want to be a part of the process. This includes being
a part of product announcements, new product enhancements, repairs
and maintenance, and perhaps even insight into new products. When
you make your customer a part of the practice and create a partnership
there is a better relationship and more trust. As the trust builds they tell
others of your honesty, helping to create more practice for you and less
attrition in the customer ranks. Customers want to stay with you; you
just need to show them a bit more love!
Every single contact your practice has with its patients either culti-
vates or corrodes your relationship. That includes every letter you send,
every ad you run, and every phone call you make. This includes contact
with the first-person they meet to the senior officer.
If you think about it your practice is only as good as your worst
staff. In addition when you treat your staff poorly, this actually becomes
a domino effect to your overall asset—your patients. This is a sobering
thought simply because patient service is as much an internal function
as it is external. Imagine entering a store and hearing the screaming
manager or sarcasm amongst two or more staffs—or you hear the staff
speak poorly about a former customer. Would you return to the store?
Do you treat your customers in the same way the Ritz-Carlton does
its clients? Ladies and gentlemen servicing ladies and gentlemen.
The idea here is that patient service excellence is really about servic-
ing individuals as ladies and gentlemen. This means looking at situa-
tions through the eyes of your patient. Have you really walked through
your own patient service strategy? What does it look like at the other
end? Can you see yourself as your own patient?
One of the best methods for doing this is to develop a mystery-
shopping program. If you are not familiar with this, all one needs is to
DEVELOPING THE PATIENT EXPERIENCE . 81

arrange for a stranger to shop at your establishment the way a customer


would. Have them call in or visit and take notes of all that they
experience.
Similar to how the Ritz or Marriott or the Four Seasons Hotels treat
thier guests, it is best to handle each patient with tender loving and
five-star care
Another aspect of customer service excellence is to allow the staff
to feel empowered in their positions. Simply put, one of the goals of
customer service training is to allow staff feel as much a part of the
practice as you. Encourage your staff to see situations from an owner’s
point of view. This might require not only better servicing practices but
also servicing with a keenness that looks at return on investment for the
practice. I understand that many might be concerned about offering too
many discounts or giving things away for free, but when staff can make
certain good quick decisions to make patients happy, without your
involvement and without going through layers, there is less aggravation
for the patient.
There is not enough money in advertising and promotion to supple-
ment these stories. Research has proved that it is 81 percent more effec-
tive to keep a happy, satisfied patient than acquire a new one. Do all
you can to see the practice from your patients’ eyes so that you can
lessen barriers to patient aggravation.

6.2 TIPS FOR DEALING WITH DIFFICULT


PATIENTS

If we keep in mind that the purpose of the practice is to acquire and


retain patients this will ensure that our culture and our staff will always
focus on excellence in patient service.
Yet for all the time and concentration in patient service sometimes a
patient can take be hard to please. It’s important to understand that is
not always the practice representative’s fault but merely the problem
with a difficult patient. Many practices have difficult patients. It is help-
ful to be aware of two things: (1) some patients do expect the world
and, no matter what, expect you to bend over backwards for them and
(2) some people sometimes are just rude or aggressive to oth-
ers—including family; so never take it personally. So let’s discuss some
tips about dealing with difficult patients.
Personality Style: It’s important to understand that some people depend-
ing on their personality and some behavioral issues will always be
82 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

somewhat difficult. Take for example any of the gate agents, pilots, or
even baggage handlers for any airline. In most instances their main pur-
pose is to get people to their destination in a safe manner. They don’t
control the weather, they don’t control air traffic control, and they don’t
control the many hiccups that occur. However, there are those passen-
gers that seem to think that the airlines exists only for them and for
nobody else. They think planes are waiting only for them and not for
the other 140 passengers. The seats are designed for them, the cargo
spaces, the weather—need I continue?
The thing is to recognize such people by their behavior. If we do
not identify their behavior we get caught in a maze and have difficulty
helping them quickly resolve the issue. A quick review of personality
traits using resources such as the SELF-Profile or books such, as
“Please Understand Me” by David Kiersey can be very helpful.
Remember too that we live in a multicultural, multigenerational and
multigendered environment. This too has a bearing on service. We need
to better understand how to become persuasive and effective communi-
cators. Resources from Robert Cialdini or Philip Horan can be effective
here to learn how to communicate in a multi-impacted world.
Objectivity: There are times when both sides lack information. Pausing,
exhibiting patience, and asking good questions can aid in resolving con-
fusion. Patients want to tell their story and few want to listen. Listening
is an important skill to master. Learn the art of asking questions based
on objectives and measurements for success.
Personalization: Never allow issues to get personal. Patients sometimes
need to vent their feelings and that is okay as long as personal feelings
are not involved. Let them blow off steam but when they get personal,
(1) suggest that this is a professional discussion and colloquial language
and anger will not be tolerated, (2) suggest a time out, and (3) request
some backup when it does get unruly.
Empathetic: It can prove useful to sympathize with the patient and com-
prehend their frustration. Gain as many facts as possible so that you can
help them.
Be Willing to Negotiate: Sometimes patient service is a negotiation.
Everything in life is. It is helpful to understand the art and science of
negotiation. Do not worry about win-win and other ideas like that, only
make sure that the patient feels reassured and the issue is instantly
resolved.
Do realize that patients have expectations beyond the standards set
by practices. They will complain just to complain. Federal Express
operates with the purpose of ensuring that packages get to their
DEVELOPING THE PATIENT EXPERIENCE . 83

destinations overnight. The culture and the individuals exist for one rea-
son only—overnight delivery. Yet many customers will complain auto-
matically if the package is less than five minutes late. Some like to
have more control than the delivery company or feel they do when they
complain.
The patient in effect pays the salaries and all of the operational
expenses with the fees they pay. The staff must rationalize that patients
are the purpose of the practice and therefore, even though difficult, still
require to be treated with professionalism and courtesy. When patients
tend to get unmanageable and the issues seem to be going no place it is
also helpful to change personnel. Sometimes simply changing the staff
member to one who has a different behavior and attitude also helps to
lessen the anger.
Should you or your practice find that you are handling too many
difficult patients and difficult situations you might consider divorcing
your patients. I know to some this might seem very aggressive but there
are instances where unruly patients cost an excessive amount of time
and money. There was one financial institution whose customers con-
stantly called to better understand the net gain or loss on their assets.
Some were calling up 20 times per day. This prevented the investment
adviser from speaking to other customers. The firm ultimately canceled
the troublesome customer’s accounts. If it costs more to service practi-
ces, this eats into profits and productivity.
I also want to suggest the following seven steps when handling trou-
blesome customers.

1. Listen Intently: Listen to the patient, and do not interrupt them.


They need to tell their story and feel that they have been heard.
2. Thank Them: Thank the patient for bringing the problem to your
attention. You can’t resolve something you aren’t completely
aware of or may be making faulty assumptions about.
3. Apologize: Sincerely convey to the patient your apology for the
way the situation has made them feel. This is not the time for
preachy reasons, justifications, or excuses; you must apologize.
4. Seek the Best Solution: Determine what the patient is seeking as
a solution. Ask them; often they’ll surprise you asking for less
than you initially thought you’d have to give—especially when
they perceive your apology and intention is genuinely sincere.
5. Reach Agreement: Seek to agree on the solution that will resolve
the situation to their satisfaction. Your best intentions can miss
84 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

the mark completely if you still fail to deliver what the patient
wants.
6. Take Quick Action: Act on the solution with a sense of urgency.
Patients will often respond more positively to your focus on
helping them immediately rather than to the solution itself.
7. Follow-up: Follow-up to ensure the patient is completely
satisfied, especially when you have had to enlist the help of
others for the solution delivery. Everything up to this point will
be for naught if the patient feels that “out of sight is out of
mind.”

Just like there are bad products, bad staff and bad companies there
are unhappy patients. It is part of practice.

6.3 RESPONDING SUCCESSFULLY TO SPECIFIC


PATIENT EXPECTATIONS

Over time I have found the easiest way to be successful with patient
expectations is to think about patient service from the start. Every prac-
tice needs to consider the importance of patient service as the basis of
its operation. I have discovered that this comes down to four elements.
Let me describe each of them for you.
People: The people aspect, both internally and externally, has to be
considered. Let’s start with internal. This means that the staff must have
innate capabilities for treating people well. This implies that your hiring
practices need to change. Individuals must be hired for talent not behav-
ior. All individuals possess innate skills that cannot be replicated. With-
out the right skills individuals simply cannot be taught proper patient
service. They have it or they don’t.
Maria was a 20-year-old front desk administrator who never smiled
when patients came forward. She never engaged with patients and
seemed to be aloof when approached. Ultimately patients complained to
the physician and she was fired. In fact just prior to her termination 18
patients left the practice. Patient service must be inbred.
Here is an example to express my point. I do quite a bit of shopping
at a local Walgreens and they hired this wonderful woman by the name
of Rosie. She has a personality that suits her name—never a bad day,
always smiling and cheerful. I know people who visit Walgreens just
because of her. She knows my family and many others and when she
DEVELOPING THE PATIENT EXPERIENCE . 85

takes the day off she is missed. I can tell you that she helps to bring
more practice into Walgreens.
On the external side of patient service is the fact that if you treat
people well they will tell others. In today’s competitive society patient
to patient influences are extremely vital for every practice. So much so
that almost every website, blog, or other electronic communication
informs prospective patients through case studies and testimonies. When
you treat your patients well they tell other patients. Your patients
become external marketing avatars thereby reducing your advertising,
promotion, and sales costs. By treating the patients well, a practice liter-
ally saves millions of dollars per year in marketing.
Processes: No one likes to wait. The incredible amount of paper
work that is sometimes required to alleviate patient service issues takes
time and patience. In addition, the relentless use of voice mail with a
treasure trove of voice prompts completely aggravates patients. To help
provide the best service possible, it is best to downplay rote processes
so that patients are serviced immediately. This includes answering tele-
phone calls in two rings, returning calls within a certain time span, and
lastly maintaining professionalism at all times. For many years Nord-
strom’s had a policy of accepting returned items with no questions
asked. I remember once that Nordstrom’s took back tires and they do
not even sell them.
Preparation: There are some practices that never seem ready to take
a patient’s call. There was one instance when someone was informed a
relative was in the hospital and upon calling the hospital, the switch-
board answered as if it were a large-scale hotel in a Caribbean destina-
tion. The person trying to call the patient was placed on hold and worse
yet the telephone operator was extremely dismissive. When it comes to
patient service, a positive first impression must always be a priority.
Property or Aesthetics: Practices must entertain patients as if they
are important guests you are having over for dinner. When you arrive at
Dr. Finlay’s office all periodicals are in place, there are fresh flowers on
the magazine table, and the office manager Patty greets you happily.
When you arrive at Boris’s automobile service station you will not find
a drop of grease or hear loud noises. In fact there is a gorgeous waiting
room with gourmet coffee and Wi-Fi access. Customers are treated as
important guests. In both places customers can literally eat off the floor.
Patients should be honored by your professionalism and sophisticated
efforts. Don’t treat them any differently from how you would a relative
or houseguest.
86 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

When you work from the outside, you help the patient know you
are working for them. As you quickly respond to their needs you
implicitly become psychic becuase you immediately understand how to
respond to patient concerns.
Marriott: This hotel company revolutionized the way the staff, from
desk clerks to chief financial officers, are evaluated based on guest-satis-
faction scores. The result is a culture where uncommon acts of con-
cern—such as a bellhop lending his shoes to a guest—become not so
uncommon. The founders of the companies that make up Marriott’s 19
brands “really believed that if you take great care of your associates,
they’d take great care of your customers”.
It might be simple enough to use some of the techniques that I have
provided thus far. However, there are some additional things I want you
to keep in mind so that you can turn one-time patients into lifelong
ones.
Believe it or not, it is the simple things that encourages patients to
return. As they say, people do judge a book by its cover. Therefore it is
important to always make a positive first impression. One can do so
simply by smiling and becoming genuinely interested in others.
People look at service from the moment that they hear a voice or
see a person. Therefore if you want to make a positive first impression
be certain that your personnel are professional and passionate about
treating patients well.
Here is a toolkit to get closer to patients:

. Doing practice on a first name basis: The sweetest sound anyone


will ever hear is their first name. Anytime you visit with Dr. Paul
you are greeted by first name. Becoming more intimate on a first
name basis allows for more power and trustworthiness.
. Connectivity: In our technology society there is a need to
constantly connect to patients. phone calls, gratuity cards, and
other devices are helpful in remaining in constant contact. You
might use newsletters, conduct blogs, send out handwritten notes,
or use services such as Send Out CardsÓ. No matter what you
use, just remaining in the patient’s mind makes good sense.
. Delight: Remember when you were a kid and you ate Cracker
Jacks? The prize used to surprise us all but today patients desire
more sizzle. We all know the surprise but now want more. So
today we must provide more zing for all patients. Patients today
want to be blown away. I was visiting Starbuck’s recently and I
DEVELOPING THE PATIENT EXPERIENCE . 87

frequently visit one particular shop. As I approached the counter


there was a Venti coffee at the register. My barista saw me
coming from the parking lot, and as I entered we exchanged
hellos. He told me my coffee was waiting. And there was no
charge. Now that is being blown away.
. My physician’s staff takes me to lunch and from time to time
calls just to ask how I am doing. This too is being blown away.
. Discovering other ways to delight and help: Patient service and
the patient experience are not always about transactions.
Sometimes it is about becoming a valued advisor. Practices
desire a trusting relationship and want to return to socially
conscious people. Visit Nordstrom’s and ask for a specific tie,
shoes, or cufflinks. If unavailable the sales representative will
indicate not only the closest store but also provide a competitor’s
name. Sometimes service means just being a helpful advisor. For
example you might refer the patient to another medical
practitioner, offer wellness assistance, or simply be there just to
listen.
. Addressing issues immediately: We cannot always be right
though we would like to be, as no one person or company is
perfect. The entire mission of patient service is servicing patients.
When things go wrong address the issue quickly and do not be
quick to place the blame anywhere. Merely move on and do all
you can to keep the patient comfortable and the relationship
whole.
. Return messages quickly: Patients do not want to wait. They
want answers as quickly as possible. Even Radio Shack the
electronics retailer uses the mantra, “You have questions we have
answers.” Return all calls or emails within 24 hours. I have a
policy of 90 minutes. One day the author and entrepreneur Guy
Kawasaki was sent an email by a potential customer at 10 p.m.;
he replied 10 minutes later. I know doctors who give their
personal home numbers. Do all that is necessary to be
responsive.
. Keep it pleasant: Perry Wright a former broadcaster is known as
the On Hold Guy. During hold times it records one liners,
entertaining stories, and facts that simply keep individuals
returning. This is important since 70 percent of most patient
services issues require wait times that need being put on
telephone hold. Believe it or not, 60 percent hang up.
88 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

It costs 8 to 10 times more to gain a new patient than to keep one.


Exceptional patient service is what patients want and what they come to
expect from practices. Because of the close and personal contact avail-
able, those practices that remain close do much better than those that
don’t. Being patient savvy and exceptional in patient service is simply
just good practice.

6.4 RED FLAGS THAT TELL YOU THINGS JUST


AREN’T WORKING

I had a problem with a new piece of electronic equipment and called


for assistance. The first technician I talked to insisted that there was
nothing wrong with his company’s equipment, that it must be my fault.
When I explained that everything in the network had worked perfectly
until I powered the new item up, he laughed at me. When I asked to
talk to his supervisor, he responded with the infamous two letter exple-
tive and hung up. I called back and spoke with a different tech who
was able to resolve the problem in a matter of minutes and who then
asked his supervisor to join us on the line. When I told the supervisor
of my earlier experience, she asked me to give her one day so she
so that she could esolve the problem. She called back in less than 15
minutes to tell me that she and the call center manager had reviewed
the recording of the call, fired the original technician, and promoted the
second one to a customer service training position.
Let me tell you what the red flags are: (1) you are losing revenue,
(2) you have more complaint calls, and (3) there is more arguing with
patients and there is more stress from the staff. Let’s discuss this some
more and understand how to handle them.
First, it is always good to look at your staff. Listen to determine if
they are arguing more with patients than earlier. This might be a sign
that there is a problem or more importantly personnel are not handling
calls in the best way possible.
Second, many practices have shifted to voice mail. While these elec-
tronic devices are meant to expedite service calls, they tend to infuriate
patients. Many of the telephony companies have moved to voice mail
because of the large amounts of calls that they receive. However the
numerous voice prompts and the amount of data the patient is required
to provide only frustrates patients. If your office is small enough, office
voicemail is not required. Save the money and the agitation.
DEVELOPING THE PATIENT EXPERIENCE . 89

Third, be very cautious about how staff recite policy and procedure.
I read once that a patient was having an issue and they were on the
phone for 30 minutes about billing and coding procedures that they did
not need to get involved in. Save the psychology classes for Dr. Phil!
Fourth, I have seen staff giving more importance to a patient who is
well-dressed or who is ‘seemingly’ rich as compared to one who is
‘seemingly’ the opposite. Judging the potential of the patients by how
they are dressed up or how they look is a huge mistake.
Do not worry about one-time issues but do follow trends. If there
are some red flags in your organization it is best to take action now. Do
not wait for issues to develop and explode. Patients desire immediate
action and these actions help with post and future sales.

6.5 PRACTICE

I travel frequently for business. One parking facility I use personally


greets you, and informs you of what row into which to pull. You do not
need to search for an open space, and if you are in their frequent parker
program, they valet park you when their lot is full. You are met at the
empty parking space by a shuttle bus. The driver helps you get your
luggage out of your car and onto the bus. There is no waiting in one of
those plastic shelters.
Once it was raining, and the driver met me with one of those big
golf umbrellas. Most important—they know my first name!
I have discovered that the key to effective patient service is practic-
ing it. I have found over the course of time that physicians practice,
lawyers practice, musicians practice, and even athletes practice. Each of
them goes about their day practicing to ensure success toward an end
result. Practice people therefore must practice too.
I have developed a proprietary formula known as (Service) Practice
to assist you.

. Insist on a positive first impression: You must be genuinely


interested in assisting others. These include warm greetings on
the telephone or in direct contact. Being positive gets things
moving in the proper direction. The Four Seasons ensures that
every guest is greeted enthusiastically with each and every
interaction. Remember it is passion and empathy that separates
the athletes from the spectators.
90 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

. Develop rapport: Ninety eight percent of every interaction


involves trust and respect. Ensure you establish rapport with
every patient. Your staff is only as good as your back-end
operation.
. Assess the issue: Asking provocative questions is the only way
to get to the heart and soul of every issue. Distinguish fact from
fiction and ensure the patient feels whole when all is settled. Do
what you can to diffuse the issue so all the parties feel better.
. Communicate fully and thoroughly:The best communicators
listen first and speak afterward.
. Manage time effectively (Time management):Patient service staff
are trained to expeditiously respond to issues but can you do this
qualitatively too?
. Take an interest: Gaining interest requires an understanding of
the multigenerational and cultural issues that assist in building
rapport and becoming genuinely interested in others, a famous
Dale Carnegie and Biblical trait. Over the years we have
befriended our veterinarian. Bill has taken care of four of our
dogs, and though it is not often, he actually comes to the house
and sees me in church every weekend. He knows my family and
everything about my kids. When I visit for an appointment I am
there for three hours because we talk and catch up. When you
take interest you become a trusted advisor and friend and not just
a vendor with a service to fulfill.
. Close on a positive note: Always close your calls seeking to
address any open issues and questions on a positive note.
. Ensure you evaluate every patient interaction: Patient service
requires conviction and passion to aid others. Once you complete
your calls, ensure that you also evaluate the call to carry these
themes from call to call. Patients are willing to wait as long as
60 seconds to have their calls answered, as long as reps can
respond competently to their questions.

6.6 WHAT GETS MEASURED GETS REPEATED

Even as location is important in retail, data is vital to every patient serv-


ice program. It is necessary to deal in data, analyze it, and then use it
to become better. Research is always necessary to help understand the
data points for patient service.
DEVELOPING THE PATIENT EXPERIENCE . 91

The one problem however with most practices is that data tends to
sit in a database. It is then necessary that senior management, owners,
and all personnel become involved in not only gathering data but also
analyzing.
Girl Scouts of America constantly researches the societal trends that
affect and influence its reason for being the girls. Fact-finding is a large
part of what the Girl Scouts do on a day-to-day basis. Many organiza-
tions use surveys and other means to ensure that things operate
smoothly. Even websites and blogs today measure how many people
visit and how long they remain on a site.
So the question then is how do you measure patient service? This
can be done in several ways.
First it is easy to measure service by reviewing the level of patient
service calls. As patient service issues are mitigated, the staff will han-
dle less troublesome calls.
Second, as patients inform other patients of the good service pro-
vided by your practice, this ensures that you are doing the right thing
with your patients.
Third one of the best ideas is to have concentrated patient focus
groups. As mentioned earlier in this chapter, focus groups allow for
more attentive and intimate conversations with practices to gain better
insight into what they’re thinking and what they value most. You might
invite four to five patients to lunch or dinner and discover what they
think of the practice and what suggestions they might have.
Fourth, surveys are very good in providing insight into patient serv-
ice. My suggestion, however, would be to use a quantitative study but
gain more qualitative analysis. When patients speak with you, are open
in sharing their thoughts on how you prove your service, and are part
of that experience, the success measurements will go through the roof.
Mystery shopping is a tool that focuses on monitoring and improv-
ing quality and service to ensure consistency with brand standards. It
uses anonymous resources. Here is a quick mystery shopper tool kit:

. Choose your objectives: Understand what it is you want to


improve and what the value is to the department and the practice.
. Methodology: Choose a simple method that allows practices to
respond expeditiously. Surveys, focus groups, one on ones and so
on are all helpful to collect feedback.
. Measurements: Look for true trends and gaps.
92 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

. Communication: Create additional communication and feedback


loops to truly understand patient sentiment.
. Documentation: Document everything to ensure that proper
information is recorded.
. Engage senior management: No matter what, the senior
management must be involved in all mystery shopper analysis.
. Create action: —When completed ensure success by
implementing the new set of standards. Do not wait to put these
procedures in place.

Many retailers use mystery shopping to help score customer satisfac-


tion and worker performance. Even restaurants use mystery shopping to
evaluate quality of food, service, and overall experience. Mystery shop-
ping is a very good way to better understand the practice’s strengths as
well as any limitations.
And you can also measure:

. Quality of service
. Speed of service
. Pricing
. Complaints or problems
. Trust in your staff
. The closeness of the relationship with people in your firm
. Types of other services needed
. Your positioning in patients’ minds

No matter the route you choose to take, you cannot expect to


improve the patient experience without creating measurements. One
must create goals and expectations as well as look for trends. For exam-
ple, if you have 1,000 patients who were happy with the patient service
and one who had a specific complaint about the service received, then
that one patient will not be a good indicator of the service provided.
However, when a practice does develop standards and methods to suc-
ceed, they create a happy and energized patient base. Customers do
practice with companies and people they like. A patient experience
strategy is based on shared values and the ability to understand what
each patient feels is or is not important. The boundary between buyers
and sellers is blurring, with customers acting as brand evangelists and
influencing product selection and even participating in research and
development. Consequently, great service is not just about speed and
DEVELOPING THE PATIENT EXPERIENCE . 93

accuracy but also about warmth and personalization. Service is impor-


tant in all aspects of your company so you must get patients involved.

6.7 CONCLUSION

Ironically customer service is part of every practice, product, and serv-


ice including every industry, even the government. Yes, I have been
sent to the U.S. Postal Service to aid in their service efforts. As much
as selling affects every practice, patient service has an even more pro-
found impact. Unfortunately many practices are chastised and con-
demned for poor patient service. Yet for every bad story there are also
numerous grand stories.
The simplest thing about patient service is that if you treat patients
with professionalism and empathy they will continually return. More-
over, they will tell others. Patient service is the key to your marketing
and profitability success factors. It lowers attrition in practice and it
heightens productivity. There are no secrets or secret decoder rings to
handling patients in the right way. Loyalty cannot be built unless there
is proper patient service. Service must be culturally embedded in the
practice. It must be the walk and talk of your company and it must be
the reason why it exists. If you are unsure of your service then experi-
ence it for yourself, take a walk through your practice and see it
through your patients’ eyes.

6.8 SUMMARY

. The patient is the reason the practice exists.


. Patients are not an interruption, they are its purpose.
. Nothing happens unless a patient is satisfied.
. Use the Practice method for service to ensure constant focus.
. Customer service is as good as your best and worst employee.
. Remember to always win friends and influence patients.
CHAPTER 7

STAFF DEVELOPMENT

The largest issue for any practice, or organization for that matter, is staff
productivity. With economic volatility as well as healthcare changes cur-
rently impacting profits, productivity issues can wreak havoc on practi-
ces already on the brink of zero margins. When staff productivity
falters, operational costs are higher.
The rationale for not attending to the issue is that many physicians
say they are too busy, lack the funds, and lack time for focus. However,
dismissing the issue only brings about added stress to the practice.
Boosting staff productivity leads to improvement in the bottom line-
—productivity and profits.
There are three reasons why staff productivity is vital to every
practice:

1. Lower attrition: The concern is not so much loss of individuals


as it is the loss of knowledge. The concept of brain drain is vital
to a practice intent on preserving patient relationships as well as
those involved in coding and billing.
2. Less infighting: There is always argument in any organization.
However, when the culture is more collaborative and there is
internal customer service, more things get completed on time and
on a budget.
3. Better hiring: Great production stems from having the right staff.
The only method of employment assurance is measuring your
best performers against the average. Albeit there are a few more
recent studies, in 2007 The Gallup Organization estimated that 22
million actively disengaged staff cost the American economy as
much as $350 billion per year in absenteeism, illness, and other
problems. And, when your practice is small and profit margins
are tight, it makes operating a practice a bit more challenging.
96 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Causes of low morale correlate to the practice, its culture, and its
principles. Several factors contribute to employee motivation and organ-
izational morale but based on my own research in my doctoral studies it
is the relationship between physician and his or her staff that contributes
the most. When the relationship is good between both parties work gets
done, there is less stress, less infighting, less animosity, and better treat-
ment of patients.
Taking time to build relationships with the staff through personal
interaction is a key step physicians can take to keep morale high. Staff
need to feel their physicians trust and respect them. Staff need to get
feedback from principals, associates, or their independent contractors to
understand their positive and negative impact. Many productivity issues
stem from the inability of a principal, associate, or independent contrac-
tor to confront staff and offer appropriate feedback.
Rationale—when staff are part of the process they are more engaged
and understanding. When there are divisions between principals, associ-
ates, or their independent contractors and employee, there is isolation
and disgust!

7.1 HOW TO GET STAFF MOTIVATED

Motivation is one of the most frequently requested and researched


topics in Corporate America. One of the key reasons is that employee
engagement is linked to the organization’s productivity. Organizational
theorists from Maslow to Herzberg (my doctoral research has also con-
firmed this) have maintained that there is a correlation between a per-
son’s interest and satisfaction in the job and their desire to do it. If you
think your practice exists in a vacuum, think again. Every practice can
have a sloth, every practice can hire an apathetic employee, and every
practice can have someone who tries to buck the system and argue with
others including you.
The key challenge for physicians is how to encourage staff to con-
tribute inputs to their jobs and to the organization. Get Involved! So
how can you position yourself to build relationships and get involved?
It is easier than you think. First and foremost, the single best thing to
do is to begin to get to know your staff. Take them to lunch or dinner
or simply sit down and engage in dialogue. One of the reasons you
became a physician is so you do not have to enroll in the bureaucracy
that exists in Corporate America. This includes the proverbial border
STAFF DEVELOPMENT . 97

building of office space. There are so many managers who sit in offices
all day marking their turf based on office size or personal title. There is
little time in a medical office for such fodder. Therefore, spend as much
time out of your office as possible. Write your SOAP notes at the front
desk, chat with staff in the front office, take them to seminars and con-
ferences, anything that will allow you to determine how to discover
more information about them and they you.
Another method to build relationships is to explain how each indi-
vidual adds to the collective goal. You need to tell them that it is not
just the physician who cures with treatment, it is the collective whole
based on scheduling, coding and so on. Without any of them, there is
no you! Not to sound trite here but it does take a village to build a
practice because you simply cannot schedule, analyze, treat, code, bill,
and reschedule; need I continue! There is too much to do and the staff
is there to be your right hand. Inform them that they are part of a col-
lective whole and the core relationship built with you and the remainder
of the team is the key ingredient to total practice success.
If you are beginning to obtain good ideas from this information then
you might also want to consider this: you should not have all the
answers but should welcome diverse opinions. When members know
their opinion counts they are more participative, and this allows for
more freedom of thought. Over time, the staff will develop more
involvement with patients and alliances that you cannot and will not see
through your eyes. As the practice builds tasks have to be delegated
and your input will be less available. The staff will be required to make
split decisions because you will be busy, or they may want to offer sug-
gestions based on their observations. Allow them to do so. The more
diverse the opinions, the better the office personality and culture. Practi-
ces do not exist in a vacuum and neither should the staff. Allow them
the opportunity to provide feedback for better efficiency. And their
opinions will help with your inter-office relationships.
As you would have noticed, in reading this book, communication is
a major factor in developing a physician’s practice. There is no better
method for influencing communication flow than an effective team
meeting. Meetings are a great method for discussing policy, procedures,
and patient information. Realize there is no reason to have a meeting
for the sake of having one, but good communication is better for all.
And finally, if you really want to help interoffice relationships then
provide some measure of gratuity and praise. I have mentioned numer-
ous times in this book that my foundation is in sports so I am intrigued
when I see athletes gaining praise in both good and bad times, for
98 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

example, a strike out or a touchdown. The mere thought of coaxing


illustrates a profound relationship between the coach and the athlete.
Even children are taught to extend a gift of thanks or praise during their
upbringing, yet when we get to work all that goes out the window.
Adults also need praise, they need to know if their job is well done.
Adults also need information to make the necessary changes for work
and work efficiency. If you do not tell them, they will not know. And if
you keep it to yourself you are only building animosity or as we say in
my family agida which, being a kid from Brooklyn New York, is Ital-
ian-American slang for heartburn but it can also mean mental aggrava-
tion. It is derived from the Italian agitare meaning to agitate. You do
not need this for yourself or your practice. It is important to celebrate
feedback and success. Get totally involved and watch the spirits soar as
you do. And finally, one great step for success is when it comes from
the patient. Many times patients will provide thanks and praise when
the staff act over and above the call of duty. Ensure you get this in writ-
ing and share it with the staff. You will see that others, if you have
multiple staff, desire to achieve just like the celebrity. This will also
provide the system and tools required to make success a daily
occurrence.

7.2 IT’S ALL ABOUT COMMITMENT

Sometimes all it takes is asking your staff for their input. Empowerment
can be a good way to motivate individuals to accomplish what they did
not think that they would actually want to do. Staff who are allowed to
make decisions have a better sense of commitment and ownership
because it is their decision. After effecting the change they are less
resistant to the change because they instituted it. However it’s important
to understand that getting power doesn’t turn everyone on. Many indi-
viduals just don’t want to be bothered. Thomas thought his team would
be excited about a practice move to self-management. However after
just one meeting he realized how upset everyone was. Those individuals
stated that they were not there to make a decision and that’s what prin-
cipals and Office or Practice Managers are for. His move created anger
and frustration. Eventually Thomas needed to take command.
If you want to develop a culture where everyone provides input and
becomes more committed to the practice, here are a few suggestions.
STAFF DEVELOPMENT . 99

. Determine what strengths and limitations each employee brings


to the table. There are some who enjoy taking over projects
while others enjoy hiding in the stands. There are also many
employees who, because of their personality, seem to enjoy
routine activities such as billing, administration, or office coding
while others need a myriad of items simultaneously. Yet, if you
want to build a higher degree of commitment, it is necessary for
you to know what your staff can do and can’t do as well as what
they want to do and won’t do. While it is always suggested that
what you say goes as the organizational leader, if you can gain
the better buy in by understanding individuals traits this goes
further with individual commitment.
. Train individuals to generate ideas and allow freedom of thought.
Historically some of your staff may be from other practices and
businesses that do not allow certain freedoms so this may be
difficult for some. However, the more open you are to gaining
their input the more trust you build. One of the best paths for
least resistance is a team meeting, which allows more freedom of
thought. Do not step on individual ideas, consider them all and
never have anyone condemn a new idea. The less criticism the
more open the future dialogue.

The problem with many interoffice teams is there is much telling


and little asking. One of the best lessons I ever learned was the power
of questioning. There are questions bearing on a need, questions bearing
on a question, questions bearing on a current event, and virtually hun-
dreds of conversations. Unfortunately as a society we tend to tell more
than we tend to listen but when we question we gain more insight and
more information as well as developing a pathway to understand indi-
vidual motivations. Questioning is a terrific skillset to acquire for any
physician seeking to not only lead a team of individuals but also gain
individual commitment for a better culture.
Employers must also build relationships with team members. Indi-
viduals enjoy and feel safer when relationships are built. Employees
want to be a part of the team, and they want to share in the successes
and failures of the organization. Therefore feedback and recognition are
active ingredients to feedback.
Just as important as recognition is reward. In fact, they go hand in
hand. Employees want recognition for a job well done. Gift cards or
even a simple thank you card are tactics that illustrate the ultimate
100 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

prize–gratuity. The ability to become one with the practice gives the
employee a sense of purpose and need.
Don’t forget to recognize and reward performance. The staff would
want to know their work matters. Suggestions here include sending a
handwritten note to the person to thank him or her for going above and
beyond their regular duties. Getting gift cards that appeal to personal
interests are also helpful. Do bear in mind that gratuity is to be a gift of
personal thanks not something that is a daily occurrence so therefore:

. Don’t overdo it
. Be sincere
. Be specific for the reason of the praise
. Publicize the praise.

The staff want to be happy on the job. They want to be noticed for
a job well done and will take great pains to achieve it. Recognition and
happiness are the catalysts that drive change. When individuals do
something well thank them. Give them praise. You will get more mile-
age from the staff.

7.3 REPETITION MIGHT KILL THEM AND YOU

When there is a concern about boring tasks, physicians actually need to


review issues of both hiring and behavior. The reason for this is that
there are four basic behavior measures where we can identify job
requirements and the individual’s comfort zone.
Individuals are:

. Assertive
. Persuasive
. Tolerant to repetition
. Attentive to detail

Based on these personalities and behaviors, individuals will be


excited about work or get bored very easy. From the person answering
phones to associates or independent consultants, your staff could get
bored very easily with recurring tasks. Even you might burn out from
constant repetition. The fact is that all work, no matter what the profes-
sion, becomes repetitive. The trick is making it exciting and different so
STAFF DEVELOPMENT . 101

that individuals do not get bored and decide they need to leave for bet-
ter adventure with another practice.
Because most medical practices are small, there is no reason why
some of the work cannot be conducted by all the staff. In other words,
the staff could potentially be cross trained so that they learn multiple
tasks in order to diminish repetitive work. For example, the physician
could potentially create an On Boarding Program which is a corporate
method of cross training staff so that they not only become productive
in less time but also can perform in any role aside from the doctor in
case of absenteeism or insufficient help. On Boarding is a terrific
method to enliven boring tasks since individuals can become involved
in any role. Producing cross training enables the physician to alter daily
roles so that the staff conduct boring work minimally, just a few days
per week.
In the 1960s, the super group, The Beatles wrote a song called A
Hard Day’s Night about the intensity of their work and how they
labored from dusk to dawn on songs, writing, and singing. The song
epitomized the manner in which many individuals felt about work; they
worked hard all day and never seemed to get a break. Even some 50
odd years later employees have similar feelings—they work hard and
never seem to get anything done. To that end, some practices are adopt-
ing what is referred to as flextime to allow staff more time to get things
done personally and professionally. Flextime (or flexi time, flexi-time,
originally derived from the German word Gleitzeit which literally means
sliding time) is a variable work schedule, in contrast to traditional work
arrangements requiring staff to work a standard 9 a.m. to 5 p.m. day.
Flextime today is getting more popular in many practices and organ-
izations because many staff feel they burn out very quickly. In 2011
The Wall Street Journal reported that the traditional 40-hour workweek
is now 50 hours or more. With many staff working longer hours there
is no time to balance work and family life.
To have a happier workteam, practices have decided to move for-
ward with flextime schedules. For example, many organizations such as
Best Buy, Disney, and KPMG have adopted this practice and I find
many hospitals, clinics, and medical offices are doing the same. The
opportunity to get things done without having to sacrifice work efforts
provides a better sense of belonging for the staff. Further, the physician
seems to get more production since some of the initial research tends to
show that staff on flextime work just a bit harder to get all their work
completed.
It is found that the benefits of flextime for employees includes:
102 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

. Flexibility to meet family needs, personal obligations, and life


responsibilities
. Reduced commuting and travel expenses
. Decrease in childcare, food costs, dry cleaning, and other
personal expenses

And for the physician and the medical practice:

. Increased morale, engagement, and commitment.


. Reduced absenteeism and tardiness.
. Less attrition.

If you have an unmotivated workteam and are seeking some new


methods to rejuvenate and motivate them, then it is helpful to find those
things that can build culture and provide more flexibility. Getting to
know your staff and providing some levels of flexibility are different
from rote rewards, days off and so on. Physicians today need to be
more malleable to changing socio-cultural and economic conditions.
Today’s employee desires more flexibility yet also desires to become
more important to the practice. Physicians who develop systems that
embody relationships last longer, have less stress, and better employee
productivity.

7.4 HOW TO HANDLE CONFLICT AND


CONFRONTATION

Disagreements among team members primarily arise from two sources:


(1) disagreement on work assignments and (2) personality conflicts in
the team. Too many spend too much money on team building to realize
that taking two men zip-lining with a key of beer guarantees only one
thing—one of them is not coming back! When you have conflict in
your team you need to simply and quickly confront it.
Conflict needs negotiation, and all parties want to come out win-
ning. Mediation is meant to get both sides to concede certain things so
that at its conclusion both sides get something that is mutually
agreeable.
Conflict here relates to power and how much one believes one has
over another. At times, this leads to ethical issues. For example, conflict
comes into play when one staff member withholds information to make
STAFF DEVELOPMENT . 103

another one look bad. Unfortunately there are some who use power and
politics to promote their own interests and are likely to harm the inter-
ests of others. Therefore, conflict must be confronted so that it ends
immediately.
When conflict arises it seems to come from several sources that
include:

. A difference in work style. Some individuals are organized while


others are mere procrastinators. It will be necessary to learn how
to negotiate for time and priorities so that work gets completed
on time. Conflict will arise when staff await coding for insurance
and the doctor is typically late in submitting notes or when the
staff do not answer certain calls from patients allowing others to
answer the line. Anger builds until there is a full-fledged
explosion.
. Personal problems. We all have issues that we must deal with
from ill children, parents, bills, job loss and so on. Yet, all must
compartmentalize and leave their baggage in their personal world
and not impact professionally. Conflict occurs when moody,
damaged individuals come to work and vent their feelings on
others.
. Leadership. Every physician leads differently—from participative
to authoritarian to others. It is different strokes for different folks
and the moment there is a clash in the leadership style there is a
decrease in team effectiveness. Leaders especially physicians
must be democratic, participative, and individual-centered.

As I mentioned earlier, conflict and confrontation really require


negotiation. We negotiate all the time and all are required to be
involved. Do you watch professional football? Did you ever wonder
what happens when the score is 30 – 0? The head coach gets on his
headset like he does throughout the contest speaking with one of his 11
assistant coaches. Football is a chess match and it requires several
minds to decide who will win and who will lose. Use your coaches and
work as a team. Think strategically in terms of the big picture and what
you are attempting to accomplish. By worrying about the tactical issues
such as personality avoidance, or perhaps even getting angry, nothing
will change and the conflict will only escalate.
Additionally, you know you have done something wrong when
someone eyes you differently when you walk into a room. You knew it!
Your guts told you to skip work. You hate this feeling. It just entered
104 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

your mind, what if you just let your employees tell you straight in the
face what a blankety blank you are? On second thoughts, why not just
get the hell out of the office and escape whatever it is? This is a per-
son’s response to stress, also called the fight or flight response. Many
individuals will go through this, as will physicians as bosses, when they
do not want to confront an issue. However, this is your practice, your
patients, and your revenue and when your staff do not get along, you
must confront the issue. Doing so will have them respecting you for it.
Do not avoid confrontation as it tends to linger, and when it does it
becomes an internal cancer that is never cured.
Be willing to explore conflict in a constructive, win-win fashion.
Stand up for things that are important to you, but don’t insist on getting
your way in every discussion. When working together, put personalities
aside and confront issues that arise. Resolve conflicts and walk away
from sessions with regard, respect, and esteem for yourself and your
team members.

7.5 CREATE A CULTURE OF CONCERN

Individuals do not leave poor companies, they leave poor physicians.


When we look at organizations that are successful and engaging there is
fewer turnover and less absenteeism. Exemplars here include Southwest
Airlines, Nordstrom’s, and even Zappos. There is a constant internal
culture of customer service and loyalty. These firms seek to hire upbeat
happy staff, train staff in the importance of customer service, reward
staff, provide positive employee work climates, and regularly track
employee satisfaction. Typically these leaders work as others in the field
and more importantly are equal with their staff. There are infrequent
conflicts because many treat their staff as equals and so must you. If
you truly want to employ an energized staff then you must learn to cre-
ate bold relationships and do the right thing that hires, trains, and mag-
netizes staff.
The only way to ensure that you have less issues and the right indi-
viduals is by hiring the right individuals. Many years ago Jim Collins
wrote a book called From Good to Great where he establishes that hir-
ing the right individuals is the single key to success. I could not agree
more. Physicians or any business for that matter must simply hire the
best. Talent is innate and there are certain things you cannot teach
others, they either have it or they don’t. For example, I can have two
physicians attending similar undergraduate and graduate schools,
STAFF DEVELOPMENT . 105

conducting a clinic in a similar way and receiving the same scores in


the boards. Ironically, each will treat patients differently because of their
innate skills.
The same holds true for Office or Practice Managerfront office staff
and so on. Many a time there are office issues because the staff lack the
skills to deal with issues. For example, Becky called a physician’s office
because she needed to understand from the insurance company why
some of her personal injury treatments were not covered. She was told,
“I’m simply too busy to deal with this, you need to call us back later.”
In a patient’s mind there is no time like the present. And, it makes for a
more difficult work environment when the staff are not interested in
helping you with your vital asset.
Second,

Properly developed training programs can have a dramatic, lasting,


invigorating effect on business, and show an enormous return on
investment as individuals increase their current skills and develop
new ones. This results in an increase in innovative ideas, and more
creative approaches to problem solving. Ashby

Training especially created by a physician creates a bi-directional


exchange of information, communication, and productivity. Research
illustrates that practices that communicate and learn are more produc-
tive, more efficient, and more operational. And, good training, whether
in technical or human skills, contributes to a person’s overall job satis-
faction, because it enables them to perform better. In terms of job pro-
ductivity and work desire, staff are looking to be more employable
within the practice. And that means training and development opportu-
nities in addition to better recognition and employment status. The qual-
ity of the training opportunities constitutes a competitive distinction, as
practices position themselves to attract the brightest and best staff.
Third, good physicians know that they must reward and recognize
the staff. The simple rote recognition and reward will not make it in the
standard practice because too many employees know what to expect.
The only way to increase morale within your own practice is to ensure
that you’re constantly rewarding and recognizing your staff for the good
things that they do. One of these might include gaining testimonials
from your current patient load. A simple gratuity from one of your
patients will send enough emotion to your staff that everyone will want
to compete for a similar prize. More importantly, and as mentioned
many times in this text, a good relationship between you and your staff
106 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

will do more for recognition than any amount of money that you pay.
The staff truly want to see that you appreciate all their efforts and that
you will back them in all that they do. Honoring the staff for their good
efforts will provide your practice a wonderful return on investment.
Simple conversations will always go further than a $1 increase in any
paycheck.
And finally, the best way to ensure an engaging workplace is to
ensure constant reciprocal communication. The best medical practices
allow free-flowing information from both patients and staff to the physi-
cian. Including treatment, never think that you have to have all the
answers and never think that you cannot tell individuals that you don’t
know. Individuals will respect you more if you acknowledge that you
don’t have the answers all the time. Sometimes being in the dark, espe-
cially as a leader, is a wonderful way to illustrate education and real-
time learning. When all of you learn simultaneously, there is more col-
laborative reward because you all get the answers and learn together.
Every day is an education day and each day this education helps to pro-
vide more staff involvement, staff recognition, staff communication,
and, just as important, staff collaboration. When all synergize together,
because of good communication, there is higher morale, higher produc-
tivity, and, simply put, stuff gets done!

7.6 CREATE A STRATEGY

To help drive strategy in your practice you need to first decide roles
and responsibilities. You need to lead and others need to follow. The
problem with some practices is that these roles are, typically, not clearly
defined. This leads to two problems (1) confusion and (2) too many
leaders. Roles must be clearly defined so others know what to do. For
example, Dr. Simmons plans a move from one side of town to another.
Doing so involved many parties. Many of the staff was involved. Yet
Dr. Simmons had to provide tasks for each person because without
them there would be some individuals telling others what to do without
having a full understanding of the impact of the entire move. When
there are too many leaders and no staff nothing gets assembled.
Second, make certain that each member knows the capabilities of
the other members and feels free to call on them for help when needed.
Let others know of the strengths that each individual brings to the team.
Resources should be shared within an organization. This helps individu-
als bring all of their strengths collectively together to resolve practice
STAFF DEVELOPMENT . 107

issues. When everyone works with their strengths, limitations are


actually hidden and there is a higher level of commitment and
productivity.
With this in mind you might also want to share some of the fears
and gaps in productivity with your staff. The interesting point is when
you all understand some of the fears and learning gaps you will begin
to learn from each other. I have been involved in sports for well over
40 years and I am always amazed at the new things that are learned
daily. Medical management works in a very similar fashion. There are
new treatments, there are new ailments, and there are new methods for
operational effectiveness. While admittedly there is nothing generally
new under the sun, there are still methods that we could all learn from
each other and use so that we can eliminate fears while creating better
productivity. Doing so will help drive more acuity in the team because
there is more focus to drive toward the vision and mission of the organ-
ization rather than being distracted by individual weaknesses.
To that end, if you really want the team to remain focused and you
really want to get stuff done, it is important to come up with some
measures of accountability. Accountability is the key to performance
success. When individuals are held accountable they work toward both
the standards of the organization as well as their individual goals. When
individuals are held accountable you can measure what gets done and
what does not. In fact in addition to accountability there is also meas-
urement. What gets measured gets repeated. And when individuals are
measured for what they must produce, they do it well and they will
constantly repeat it. Practicing accountability standards and measure-
ment is the only way in which your practice will move forward and the
only way to ensure that work required is completed. More importantly,
accountability and measurement work hand-in-hand to ensuring that the
team stays focused. When all are working toward a common mission,
and the vision is based on your core beliefs, then there will be higher
revenue gains for the practice.

7.7 WILL THEY EVER GET MOTIVATED

When we discuss motivation there has to be a two-pronged focus: the


practice and the patient. For the patient it leads to a better service expe-
rience and a better relationship with the staff and the doctor. As patients
delight in the dedication and motivation of the staff they become more
aligned with the culture and philosophy of the practice. When they do
108 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

this, it leads to a better experience and, more importantly, more influ-


ence for future treatments and referrals. They save the practice money
by not having to work so hard for new patients or employees. That
leads us to issue to a motivated work team. Sometimes replacing staff
for reasons of productivity and time alone leads to two to three times
the person’s salary that you must spend.
With these factors in mind there are several things you can do to
help mitigate the performance issue and create a motivated team.

1. Constant Communication: Research on staff productivity for over


20 years confirms the importance of employer/employee
relationships. Individuals do not leave companies—they leave
poor physicians. Relationships begin with simple and direct
communication. Take the time to know who is on your team.
2. Crucial Confrontation: The inability to confront individuals about
performance has undermined organizational performance. Morale
diminishes when underperforming employees continually
diminish performance. It is important that managers confront
employees who do not meet expectations.
3. Create Collaboration: Employees respond better when they are
part of the organizational process. They desire to be a part of the
process and have a voice. Luis Arzua (the Chilean miner) took
control from underground, and asked each trapped miner to
contribute to the health and wellness of the team. Every man had
a part in the rescue. Each added to the relationships, best
practices, and most importantly survival! It is simply a matter of
placing the best individuals in the proper positions; everything
else simply falls into place.

Motivation is driven by individuals and the individual team. Some-


times these are the silent choices or even the more explicit. Motivation
is based on not only good hiring practices but also good communication
to ensure all sales agents want to be a part of the team. This means that
physicians must not become complacent and only speak to the staff
once in a while. Weekly team meetings and feedback must be incorpo-
rated into the team plan. These meetings are a good time to discuss the
standards, goals, mission, and values so that all work harmoniously
toward them.
And if you really want to know what gets individuals to move-
—competition. Sometimes just a bit of competition in the office whether
it is in paperwork, phone calls, or even filing helps to increase staff
STAFF DEVELOPMENT . 109

productivity. You’d be surprised how much competition helps to add to


morale and motivation. Staff do not like to lose and some staff enjoy
the feeling of competition with others. So when there are times when
things are not getting accomplished as you desire, and you need to
enliven the workplace with a quick kick in the butt, try some light-
hearted competition to help increase your team’s motivation.

1. Creating competition among staff is good for business as it


creates instant motivation.
2. Never wait to give feedback, keep the positive, keep it real time,
and give relentlessly. Save.

REFERENCES

Brookfield, S., 1995. Adult Learning: An Overview, International Encyclopedia


of Education. Oxford: Pergamon Press. (1995) (http://nlu.nl.edu/ace/
Resources/Documents/AdultLearning.html)
Erikson, Erik H. The Life Cycle Completed: Extended Version with New
Chapters on the Ninth Stage of Development by Joan M. Erikson. Extended
Version. ed. New York: W.W. Norton, 1998. Print.
Guffey, M.E. 1995. Instructor's Manual, Essentials of Business Communication.
Cincinnati, OH: South-Western College Publishing.
Hadden, R. n.d. “Training Enhances Job Satisfaction.” http://www.
contentedcows.com/articles.htm
Maslow, A. 1998. “Hierarchy of Needs Internet.” www.connect.net/georgen/
maslow.htm
Merriam., S. B., and M. C. Clark . 1991. Lifelines - Patterns of Work, Love and
Learning in Adulthood. San Francisco, CA: ERIC
Morgan, G. 1986. Images of Organization. Thousand Oaks, CA: Sage
Publications.
Naisbett, J., and P. Aburdene. 1990. Megatrends 2000: Ten New Directions for
the 1990’s. New York: Morrow.
NISOD (National Institute for Staff and Organizational Development). March 9,
1984. “30 Things We Know For Sure About Adult Learning.” Innovation
Abstracts 6, no. 8. http://www.hcc.hawaii.edu/intranet/committees/
FacDevCom/guidebk/teachtip/adults-3.htm
Peters, T.J., and R.H. Waterman. 1982. In Search of Excellence. New York:
Warner Books.
CHAPTER 8

HUMAN RESOURCES FOR


DOCTOR AND STAFF

In its simplest terms, human resources relates to the strategic manage-


ment of the organization. In this chapter, we are going to discuss some
of the fundamental aspects of managing people at work. In fact, human
resource management, historically, has been known as personnel man-
agement because it deals with the formal systems for managing all
kinds of staff.
There are four vital points that human resources takes on in any
medical practice. First it creates value. People can increase value
through their efforts to help decrease costs or provide something unique
to the patients or some combination of the two. By empowering your
staff, you create the ability to provide more value to your practice and,
a most vital asset, to the patients.
Second, you need to realize that people are a source of competitive
advantage with the skills, the knowledge, and the abilities that they
bring to the job. it is always said that talent is your ace in the hole, and
the best medical practices invest a great deal of time and money, hiring
and training to discover and develop the best and brightest staff they
can, to gain any and every advantage over the competition in their local
communities.
Third, in most cases people are such a source of competitive advant-
age that they are inexpendable to the practice that they work for. It is
very difficult to emulate the best staff in the best run medical practices.
Finally it is very difficult for any medical practitioner whether it is a
doctor or physician’s assistant to run a complete office. Many years ago
during the time of her husband’s presidency, Hillary Clinton, wrote a
book entitled It Takes a Village. It is true, it does take a village to run a
medical practice in contemporary society. There are simply too many
items to be on top of, too many laws to be aware of, and, too many
112 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

patients who need to be treated and billed for services. We will be look-
ing at all of this in this book.

8.1 PLANNING YOUR PRACTICE’S STAFF

As you can imagine, you, as a practitioner, if you are reading this can-
not do it all. If you work for a doctor then you completely understand
that the doctor cannot be Spartacus. Any doctor will attempt to play
God in his or her treatment of patients to help them and their chronic
symptoms. However, the most daunting things that every medical doctor
will have to face are the myriad items necessary to keep a medical prac-
tice operational. This is where human resources actually comes in.
Human resources actually starts with the art of delegation. The doctor
will need to begin to delegate tasks that they are unable to get to and
then bring in the talent that will support the process.
Human resources is really about getting the right kind of people and
the right number of people at the right time. There was a book written
at the beginning of the millennium by the author Jim Collins, who was
quoted in his book Good to Great as saying, “you must have the right
people on the bus.” This is perhaps the single most important ideology
of human resources—obtaining the right people. In addition, the human
resource planning process occurs in three stages: planning, program-
ming, and evaluating.
First, human resource managers need to know what the medical
practice’s business plans are to ensure that the right number and type of
people who can support the future growth and the business plans of the
practice are available. There is nothing more disturbing to any organiza-
tion, including a medical practice, than a poor culture that damages the
morale and termination of individuals who cannot handle the required
job functions.
Second, the organization conducts specific human resource activities
such as recruitment, training, and even performance evaluations. In this
stage it is completely necessary for the medical practice to implement
an organizational policy, job descriptions, performance evaluation plans,
key performance measurements, and promotional opportunities for all
staff. In order to keep the staff happy the human resource function will
require periodic improvement programs for employees so that they feel
empowered and can achieve higher levels of success.
Finally, human resource activities are evaluated to determine
whether they are producing the results needed to contribute to the
HUMAN RESOURCES FOR DOCTOR AND STAFF . 113

medical practice’s plans. Whether it is the doctor or the practice man-


ager, all human resource activities should be evaluated to ensure the
medical practice and its staff are achieving the proper outcomes.

8.2 PEOPLE MAKE A DIFFERENCE

To a certain degree delegation is a sign of control. In the age of reality


television there is a recent series called Hoarders where the premise is
to investigate individuals who hoard a myriad of household materials
for one thing—for control. This is similar to the manner in which the
staff in a practice operate.
In addition, people don’t delegate because it takes a lot of up-front
effort. This means attempting to reach people, trust people, and get
others to do what you want them to do.
After all, which is easier: designing and writing content for a bro-
chure that promotes a new service you developed, or explain, map out
who will do what, determine when they will do so, and ensure they do
it. Which by the way also implies that you must hold them accountable.
However, consider this: your skills are better used in further devel-
oping other new ideas. By doing the work yourself, you’re failing to
make the best use of your time.
By involving other people in the project, you develop those people’s
skills and abilities. This helps to make you a better manager, better
leader, and a better mentor to hold others accountable.
Delegation is a win-win situation when done appropriately. How-
ever, that does not mean that you can delegate just anything. To deter-
mine when delegation is most appropriate there are some questions to
ask yourself:

1. Is there someone else who has (or can be given) the necessary
information or expertise to complete the task? Essentially is this a
task that someone else can do, or is it critical that you do it
yourself?
2. Does the task provide an opportunity to grow and develop
another person’s skills?
3. Is this a task that will recur, in a similar form, in the future?
4. Do you have enough time to delegate the job effectively? Time
must be available for adequate training, for questions and
answers, for opportunities to check progress, and for rework if
that is necessary.
114 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

5. Is this a task that I should delegate? Tasks critical for long-term


success (for example, recruiting the right people for your team)
genuinely do need your attention.

You might be asking yourself why even have a discussion about


delegation? The answer is quite simple, when you delegate, you are del-
egating to individuals who can get the job done—not requiring your
attendance! The human resource process requires that the practice man-
ager, or even a doctor, understand the value of people making a differ-
ence. You see once you have planned your human resources area, you
will then need to begin to focus on staffing the medical practice. This
will require the practice manager to begin the functions of recruitment,
selection, and even placement. Further, it requires that the medical prac-
titioner let’s go! Understanding fully well that this practice is his or her
baby the fact is nothing can be accomplished without having the proper
people in place. This requires a level of trust and, most importantly, hir-
ing the right types of individuals who can do their job as if their lives
depended on it.
With any medical practice then, as with any business organization,
it is incumbent upon practice managers and their doctors to be con-
stantly alert so as to discover the proper talent from within or without
the organization. Recruitment as well as selection should be an ongoing
process that constantly seeks out the proper individuals to fill the pipe-
line and then develop positions based upon need.
Once you learn to delegate and you establish those you trust, you
then place the best people in the best roles and then allow them to do
thier job.or example, the receptionist greets patients, the clinical assis-
tants are focused on patient care, the technicians are focused on any
tests, and everybody else is responsible for each and every one of their
functional areas such as billing and coding. Balancing the workloads
helps to improve the patient experience, promotes quality clinical care,
increases physician productivity, and as a result helps to sustain a more
viable, thriving, and energetic practice.

8.3 THE BENEFITS OF AN EMPLOYEE MANUAL

Once you and the doctor hire staff, you now have employees and this
will require some degree of bureaucracy on your part. As soon as
employees are hired, there will be a need to obtain applications,
HUMAN RESOURCES FOR DOCTOR AND STAFF . 115

resumes, job descriptions, daily office procedures, operating hours, and


so on. Yep, do not ask to get what you wished for because you just
might get it! That said and all whimsy aside, proper systems must be
implemented to ensure that everyone works for the purpose of patient
retention and acquisition.
One of the factors to ensure that all employees work at the same
level is to have a foundation. This provides a written formula of policies
and procedures based on which everyone will work. Often called an
Operations Manual, the document provides the framework on the basis
of which everyone will greet patients, schedule them, bill them, and
oftentimes even get referrals from them.
The operations manual is a tool kit of your practice and details what
you do on any given day. Then as the practice grows it will become
necessary to include several new items for both patients and staff. The
thing to realize is that every practice is different, so every operations
manual is different too. As they say in retail, to maintain a strong busi-
ness requires location, location, location. So too, to maintain an efficient
practice requires documentation, documentation, and documentation.
Therefore, there will be no right or wrong in piecing one together. How-
ever, the following information will assist you in developing a manual,
illustrating some of the vital information to be included and even pro-
viding some sample language so that you can use the content to develop
your plan.

8.3.1 PURPOSE OF THIS HANDBOOK

The handbook is intended to be a communications tool to inform


employees about the policies, guidelines, benefits, and work practices
that affect their employment with your practice. It will helps the
employees understand their mutual responsibilities.

8.3.2 EMPLOYMENT-AT-WILL

Employment-at-will statements are typically helpful in practices when


you want clear rules to indicate that employees are hired and terminated
at will. There is no contract that requires you to keep them for a spe-
cific period, and if they do not fulfill their responsibilities they can be
terminated quickly. This is a useful statement, especially with problem
employees.
116 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

8.3.3 EQUAL EMPLOYMENT OPPORTUNITY

Your practice is committed to equal employment opportunity for all


qualified persons. This is without regard to race, color, religion, sex
(including pregnancy, childbirth, and related medical conditions),
national origin, ancestry, age, physical disability, mental disability, med-
ical condition, family care status, veteran status, citizenship status, mari-
tal status, or sexual orientation, to the extent required by law.

8.3.4 AFFIRMATIVE ACTION PLAN

As a small practice you do not have to have an affirmative action plan.


But realize that as you develop new employees and become larger in
some states it may be required. As such your practice will cooperate
with federal, State, or local government agencies that have the responsi-
bility of observing our actual compliance with various laws relating to
employment. Therefore, your practice should furnish such reports,
records, and other matters as required and (or) requested in order to fos-
ter the program of equal opportunity for all persons regardless of race,
color, religion, sex, sexual orientation, age, national origin, disabled and
(or) veteran status, or physical or mental disability.
The following is a description of some of the more insightful areas
that help in producing a valuable manual for your practice.

8.3.5 WORKING ENVIRONMENT

We all know from experience how important a positive working envi-


ronment can be for doing our work well. Yet none of us can create this
environment alone. We all need to respect one another, cooperate with
each other, and treat each other with consideration. The following poli-
cies provide important guidelines for maintaining a professional, pro-
ductive, courteous, safe, and stress free environment.

8.3.6 DRESS CODE

There should be an appropriate dress code so that patients and others


understand who is the staff and who are the patients. There should be
name tags as well as a certain uniform so that the practice has a particu-
lar look and feel.
HUMAN RESOURCES FOR DOCTOR AND STAFF . 117

8.3.7 SMOKING POLICY FOR THE WORKPLACE

If required by regional, state law, or even a personal preference then a


compliant smoking policy should be provided.

8.3.8 JOB DESCRIPTIONS OR PERSONNEL RECORDS

There is nothing as important as listing for every employee and every


function a complete description of the job position and requirements.
First the requirements should specify how employees will be measured
for their success on the job; second, a good detailed description ensures
that everyone understands the requirements so that there is less chance
to question authority, challenge work, and conflict with patient
development.

8.4 WORK RULES AND PERFORMANCE STAND-


ARDS (STANDARDS OF WORKPLACE
BEHAVIOR)

It is not possible to provide a complete list of every work rule or per-


formance standard. Employees who do not comply may be subject to
disciplinary action, up to and including, possible termination. There are
two categories listed here to provide you with some understanding of a
work rule and standard.
Job Performance: Employees may be disciplined, up to and includ-
ing, possible termination, for poor job performance. Some examples of
poor job performance are as follows:

. Below average or below what the Practice defines as acceptable


level of work quality or quantity
. Poor attitude, including rudeness, or lack of cooperation—this
includes dealings with patients, vendors, co-workers,
representatives of local, State, or federal governments, and so on
. Excessive absenteeism, tardiness, or abuse of meal or break time
privileges
. Failure to properly use and care for all Practice owned or rented
equipment
. Failure to perform all job duties, tasks, and responsibilities.
118 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Standards of Workplace Behavior: Whenever people gather together


to achieve goals, some rules of conduct are necessary to help everyone
work together efficiently, effectively, and harmoniously. By accepting
the employment with the Practice, the employee has a responsibility to
the Practice to adhere to certain rules of behavior and conduct. The pur-
pose of these rules is to be certain that the employee understands what
conduct is expected and necessary.
Tardiness and Absence: If the employee is unable to report to work
for any reason, he or she must call in to the physician or Office or Prac-
tice Managerbefore the scheduled time of arrival with the following
information:

. If the employee will be late, he or she must state why and when
he or she expects to be in.
. If the employee will be absent, he or she must state why and
how long he or she expects to be out.

Performance Evaluations: These formal and informal evaluations


are required to ensure you get the best out of your staff. It is important
that you consistently and relentlessly evaluate staff so that they not only
perform but also perform better than expected. Many physicians tend to
wait for an annual review. One practice I visited with many years ago
had a chiropractic assistant for 18 years and had never provided a
review! This is totally improper. Your staff must use the standards in
the firm to measure as well as achieve individual results based on goals.
Standards spell out an individual’s duties and responsibilities and goals
are the result or achievement toward which effort is directed. To achieve
these aims requires constant communication (monthly basis) so that per-
formance is continuous.
Disciplinary Form:If the staff commit an infraction or violation of
any practice policy and procedure it should require some form of disci-
pline. The violation may include excessive absenteeism, tardiness,
insubordination, professional ethics, lack of customer service and so on.
The disciplinary form should include the date of the infraction, steps
required to alter the behavior, and time frames that ensure revision. A
good reference book for documenting employee infractions is Paul Fal-
cone’s 101 Sample Write Ups published by Amacom.
And, finally, once the operations manual is completed it is advised
to have all the staff sign and date the policy. This ensures that everyone
signing it has read, reviewed, and is in compliance with all practice
HUMAN RESOURCES FOR DOCTOR AND STAFF . 119

policy. Signing the form provides the documentation required in times


of conflict and also holds the staff accountable for all information con-
tained in the document.

8.5 HOW TO MANAGE STAFF THE RIGHT WAY

Did you ever manage a staff but not really manage a staff? Do you
have issues among staff members and are not certain what to do? Do
you find yourself speaking to staff only having them look at you like
Charlie Brown’s teacher? How about shouting into a canyon only to
hear your echo return? Sounds a bit like work doesn’t it? Unfortunately
there are many practices such as this.
The inability to confront subordinates about poor performance,hurts
performance. Many doctors and practice managers freeze because of
some of the following:

. Believe it or not many are uncertain what to do,


. Many do not know where to start and what to begin with, and
. Many would rather hire someone to do this.

8.5.1 HANDLING CHALLENGES TO AUTHORITY

The key to dealing with problem employees who question your deci-
sions requires that you move quickly. Don’t let employee disgruntle-
ment and employee dissatisfaction ruin your staff. If you wait too long,
your good employees will leave, because the work environment may
very well become intolerable to them. Even if it doesn’t come to that,
the undermining of your authority may permanently damage your
authority.
After all, if you are willing to let an underling berate you publicly,
do you think others will continue to maintain their faith in you? Prob-
ably not. Their esteem for you as a doctor/leader will likely plummet,
and, in turn, their productivity and motivation will plummet as well.
What you have to remember is that if you are having an issue you
need to follow HR rules of Verbal, Verbal, Written, Written, and then
finally out. I recommend the use of formal write-ups. If you do not
have a template then use the 101 Sample Write Ups by Paul Falcone.
This is a great resource for writing people, who are belligerent and not
120 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

willing to listen to your authority, up. Mr. Falcone makes the job easier
by providing ready-to-go model documents that cover every kind of
problem you can imagine—substandard work quality, absenteeism,
insubordination, sexual harassment, e-mail misuse, drug or alcohol
abuse, and more.

8.5.2 FORMAL DISCIPLINE AND THE DOCUMENT PROCESS

I mentioned earlier that some doctors and practice managers will not
engage in this conflict because they are uncertain what to do or they are
unsure of the negative consequence. Here is the deal—you need to deal
with it. Performance, good or bad, needs direction and when people do
not do what you want them to do you must correct them—similar to
the puppy that is not well trained. And think of it this way, the reason
why there are issues is because over 80 percent of the time, the issue is
not addressed or corrected. So correct it.
When you detect a performance problem, intervene early. Counsel
the employee and try to determine the cause of the poor performance.
This is critical if the employee has previously performed at an accept-
able or higher level. Look for issues such as lack of training, motiva-
tion, employee “burn out,” or some other cause (e.g., personal tragedy
or conflicts with coworkers).
An employee must have an opportunity to demonstrate acceptable
performance after having been informed that performance has been
unacceptable and informed of what is expected as acceptable perform-
ance. This opportunity is given through a written Opportunity to
Improve. If performance does not improve, you may reassign, demote,
or remove the employee following a prescribed set of rules established
by law.
Here are several things you need to keep in mind. First I definitely
suggest a one on one to help the person understand that there is an
issue and it must be immediately corrected. Provide a neutral setting
and rather than constantly berate them, provide normal accepted stand-
ards and then provide the opportunity for the person to provide sugges-
tions. Doing so will offer less resistance to you.
Here are some easy to remember tips:

. Maintain records of employee’s performance. As soon as you


believe you have a performance problem, document it. Make
sure that there is a strong case showing that the employee is
HUMAN RESOURCES FOR DOCTOR AND STAFF . 121

performing unsatisfactorily in one or more critical elements of his


or her job.
. Notify the employee in writing of: (1) the critical element(s) in
which performance is unacceptable, and (2) the level of
performance that you expect the employee to reach. Make certain
the employee signs it. I also suggest having a witness to ensure
documents are signed and the employee feels as if he or she has
representation.
. Provide the employee with a reasonable opportunity to
demonstrate acceptable performance (at least 60 days, usually 90
days) and offer appropriate support, for example, training,
counseling, and/or supervisory assistance. It is important that you
offer some level of support especially in this wonderful litigious
society we are in.
. At the end of the probationary period, assess the employee’s
performance. If improvement is inadequate, then you must make
the formal steps for removal.

8.6 THE FRONT DESK

In any practice large or small, there is always banter about performance,


marketing, selling even customer service. However one of the most
imperative elements for every medical practice is its front office staff.
The front office is the front line to the customer—the most vital
aspect for any medical practice. If customers are the heartbeat of the
medical practice then front office personnel are the blood and soul. For
instance, the first person that customers speak to or meet is at the front
office. These individuals are the linchpins for customer service, creating
opportunities for others to speak positively or negatively about the med-
ical practice.
The reasons why front office administrators are important are
simple:

1. They provide an initiation to the medical practice and its


culture—the sweetest sound individuals can hear is a courteous
and empathetic person willing to assist them.
2. They provide directional flow—front office personnel are similar
to conductors in a band. Administrators help orchestrate where
calls and directives go and who should handle them.
122 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

3. They assist in cutting through bureaucracy and politics to help


find answers—administrators help wade through a confluence of
papers and calls so that individuals are guided to the answers
sought.

In addition, while there is much talk today about staff productivity


and performance, there is also much talk about knowledge retention. In
no other capacity is there more need for knowledge and direction than
the front office.
Consider for a moment times in your own medical practice when
someone requested a number, a file, or some other material need. How
many times was the front office person called in to help in finding the
answer? I thought so. And with a myriad of communication vehicles,
technological interferences, and simply busyness, front office adminis-
trators are more in need now than ever before. This is especially true of
small companies as they attempt growth and engage in multiple activ-
ities for clients.

8.6.1 FRONT DESK DEMEANOR

I recall a woman, I worked with many years ago, named Joelle, whom
we nicknamed Beacon. Joelle was the light of the company, she was
familiar with customers, vendors, and every staff, she was the spark that
truly began and ended the day.
With that in mind, I want to share concepts and ideas to help create
the spark for your administrators and front office. The following pieces
of information will provide a template that guides your day like a
beacon.
First let me relate a quick story. I recall a time when Bree handled
the front desk for a very prominent physician. Bree was a very nice
young woman but rather introverted. I am fairly gregarious and each
time I saw her I greeted her warmly. However, she did not reciprocate.
Rarely did Bree smile at the front desk and rarely was she empathetic
to clients placing pragmatism over relations. Eventually patients either
complained or simply went to another physician. Given concerns about
revenue and future growth, the physician terminated Bree.
HUMAN RESOURCES FOR DOCTOR AND STAFF . 123

8.6.2 HANDLING PHONE CALLS

Here are some tips for dealing with a high volume of calls and how to
diplomatically place people on hold. Running a successful practice
requires using the telephone to stay in touch with your customers, cli-
ents, and other important practice contacts. And with the numerous
methods of communication such as cell, blogs, and websites it appears
that the phone numbers for practice are sent to everyone in the world so
that they call.
Handling office calls is an important part of the practice but much
like any other task, it takes practice, patience, and, most importantly,
some amount of time management. If you find yourself on the phone
all day and unable to get to other important tasks, here are some tips
for helping you to better manage your telephone time.

. Mixing Personal and Practice: No one will condone the


occasional personal call but if the job entails replying efficiently
to clients then practice is always first.
. Social Calls: When you are with a busy phone system then it is
best is to avoid calls that take your time and attention away from
your most imperative task.
. Get Organized: Never jot phone call notes on scraps of paper!
Ensure you get names and numbers correctly. (i.e., John received
a call from the American Stock Exchange)
. Voice Mail has a reason: If you are busy with little relief (i.e.,
Customer Service, an outage etc) then not every call is answered.
Voice Mail does have a purpose, use it .
. Avoid Social Media and Web Searches: Avoid those things that
distract you and take attention away from that which is
important.
. Procrastination: Avoid it. Some administrators will refrain from
certain calls with Caller ID or do not like speaking on the phone.
Commandment number one of most front office staff—Thou
Shall Answer All Calls during practice as usual.
. Do not panic: Remain calm and reply to one after another
with—Hello this is (Company) and I am (Name). I am just
responding to another one of our members, may I place you on
hold for a few moments? I will come back to you promptly.
Thank you.
124 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Now if the day were not bad enough with tons of calls and paper-
work there are times when there might be some issues dealing with the
public. Some customers are absolutely great while others can get a bit
cantankerous. Here are some simple guidelines for handling and disarm-
ing difficult people—whether they’re rude, angry, or upset.

8.6.3 HANDLING DIFFICULT PEOPLE

Here are some simple guidelines for handling and disarming difficult
people—whether they’re rude, angry, or upset.
Needless to say, there is quite often an inordinate amount of conflict
in the workplace. This exists between staff and staff, staff and employer,
and even customers and staff. No matter what, we are all confronted
daily with having to handle and disarm difficult people. Like in many
other workplace issues, we cannot really deal with conflict if we don’t
take time to understand. And, like many other issues conflict isn’t as
difficult or as messy as we are led to believe. We just simply need to
get past the stereotype.
Conflict has two issues, objectives and alternatives. However the
mistake we typically make is that we look at the content of the situation
or the personalities of the situation or the history of the situation. This
tends to lead us to stereotype.
First, begin with the notion that they are really no evil people, and
that the combatants are not innately malicious. We must simply look at
two things:

1. What is the evidence supporting the position.


2. What is the observed behavior?

It is then up to our how to determine how will you respond to the


situation. Here are some quick guidelines to assist you:

. Awareness - There are four personality types in the workplace as


exoressed in assessments such as Myers - Briggs and DiSC.
Without going through the assessment labels these personalities
can be described as Assertive, Punctual, Demanding, Sociable.
. Check your baggage. Never confront conflict with additional
conflict or even take it personally. It is always best to lean on
professionalism.
HUMAN RESOURCES FOR DOCTOR AND STAFF . 125

. Let the other person run out of steam. Typically most angered
parties need someone to vent their anger on. Simply let them do
so and eventually they will run out of air.
. If they are insulting, inform them that you are a professional and
you will not be spoken to in such a manner. Cussing and rude
behavior is simply a fait accompli .
. Ask questions. Ask someone who is being difficult a lot of
questions so that you can clarify what they’re trying to say,
which can give an insight as to why there is an issue.
. Deal with it. Sometimes it’s not the best solution but it is the
only one you have. Unfortunately some clients or even staff tend
to be more difficult and demanding than others.
. See the best in people. Not all people are bad and it is always
interesting to see things from the other person’s perspective.
. Get support. It is not always up to you to have all the answers.
Sometimes it is best to get the proper support to diffuse the
situation. And sometimes a simple change of personalities and
individuals can diffuse a situation.

8.7 REMEMBER TO REWARD AND RECOGNIZE A


JOB WELL DONE

The largest issue for any practice that stumps growth is worker produc-
tivity. With economic volatility and healthcare reform issues currently
impacting profits, productivity issues can wreak havoc on practices
already on the brink of zero margins. In addition, when worker produc-
tivity falters, costs are higher.
When it comes to productivity, much research has been conducted
that suggests that recognition for a job well done is the top motivator
for employee performance. However, most physicians don’t understand
or use the potential power of recognition or reward. In fact, in research
conducted by our organization over 54 percent of chiropractic office
staff suggest that they would rather work in an environment where they
would receive better recognition.
It is important to understand that when it comes to recognition in
the workplace there is a direct relationship between the physician and
office staff. The better the relationship between the practice owner and
employee the higher the profitability.
126 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

It is imperative to note that individuals do not leave bad practices—-


they leave poor chiropractic owners. It is also imperative to develop
feedback loops. Morale is lifted when individuals are recognized for
efforts. In addition, when recognition feedback commences, employees
desire to do better.
There are several reasons to engage in a relationship that also leads
to reward and recognition.

. Productivity: When individuals are recognized for a job well


done they are much more motivated and perform at higher levels.
. Profitability: The cost to the practice is less when morale and
productivity are high. Passionate employees achieve more work
with less labor.
. Patient Retention: The motivation is stronger if the form of
recognition creates a story that employees can tell others. So
when employees are happy with the boss they tell other potential
employees—even prospective patients.
. Operational Costs: Operational costs are lower when employees
are recognized for a job well done. Happy employees simply stay
on the job longer.

Do not misunderstand me. There are many reasons why recognition


helps with job satisfaction and productivity; however, it is important to
realize that recognizing employees is the right thing to do.
Even if you operate in a small office of 10 or less employees it is
still important to understand how recognition can assist practice morale.
Here are several tips and techniques that will create a high performing
practice for you.
First there is a myth that everyone wants to be paid what he or she
believes they are worth. However, it is also important to understand that
individuals work better when they are appreciated. It is more important
to produce a series of formal and informal recognition programs rather
than use salary to increase morale. If the culture of the practice does
not allow good relationships or even provide good treatment for others,
then paying people more does not change the culture. Employees do
not leave bad practices, just bad doctors.
Here are some other things to consider:

. Gratuity Cards: One of the sweetest things any physician can do


is simply remember a birthday, anniversary, or an important
HUMAN RESOURCES FOR DOCTOR AND STAFF . 127

emotional event. A hand written note or card that conveys your


admiration for the employee will go a long way to creating
passion in the workplace. When individuals know that they are
appreciated, they will have more commitment to your practice.
. Communication: Perhaps the largest issue concerning recognition
is communicating. Due to busyness it is easy to attend to
patients, pay bills, attend seminars, and forget about your most
important asset. Everyone needs a simple atta boy or girl every
now and again. In fact research from several sources indicates
that employees would rather receive constant recognition rather
than a raise.
. Awards: Provide a visible form of recognition to illustrate years
of service, exemplary effort, and so on. Awards illustrate not
only achievement toward goals but also the relationship between
doctor and staff.
. Training and Development: Self Mastery and skills development
are very helpful to office staff who desire to achieve more.
Knowledgeable employees are more passionate. When employees
feel they are appreciated they do more for the practice. This is
helpful in situations where employees have promotional
opportunities.
. Work Life Balance: We live in a crazy busy world providing
numerous personal and professional constraints. Trying to
balance work and family is very difficult creating most
workplace stress. physicians sensitive to staff issues can provide
extra breaks, days off, personal time, and so on So that
individuals do not feel pulled by personal and professional
strains.
. Personal: Take the time to get to know your staff. Ask your
coworkers about their family, their hobby, their weekend, or a
special event they attended. From Dale Carnegie, “Become
genuinely interested in others.”
. Food: Take coworkers or staff to lunch for a birthday, or any
other special occasion. Have a staff meeting at a local restaurant
to show your gratitude for their joint efforts.
. Gifts and Gift Cards: The personalization of gifts and gift cards
will show your knowledge of someone’s personal interests,
something they will appreciate. This requires some research but
will pay huge rewards.
128 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

. Timely Performance: The one technique above and beyond all


mentioned above is the need to provide feedback when positive
performance occurs. Waiting too long diminishes the possibility
of recognizing the employee’s terrific efforts. Give them thanks
and praise immediately. It is not only preferred—it’s expected.

Many practices might use a scattered approach, believing a bit here


and there might lead to some results. Or, they recognize so infrequently
that recognition becomes diminished. Recognition must be consistent
and constant. Integrate some form of recognition at least once per
month.
To help initiate a program create goals and action plans for
employee recognition. You want to recognize the actions, behaviors,
approaches, and accomplishments that you want manifest. Establish
short term and long-term goals for recognition programs. And do not
forget to ask your staff for the proper input. When they are part of the
process they will feel closer to the practice.
Ultimately your staff needs to see that each person is a contributor
to the organization. This requires that recognition is fair, balanced, and
equal. All are to be appreciated. More importantly all should know that
they are all entitled to recognition. It is important to recognize all the
people who contributed to the practice’s success.
No matter what is used, recognition must not be overlooked.
Rewarding recognition too often will make it a right; too little—dimin-
ishes impact. The greatest assets aside from patients are your employ-
ees. Take the time to provide thanks, praise, and admiration for their
efforts and watch the productivity of the practice soar.
Your Wingman (er Person)
I enjoy music and I listen to quite a bit of it. One of my favorite
songs is “You're My Best Friend” by the rock group Queen. The song
provides wonderful lyrics about the joys of a relationship. As I was lis-
tening to the song the other day, it reminded me of the strong relation-
ship that must be built between the medical assistant or practice
manager and the doctor. There are a myriad things to do in any profes-
sional practice and the medical assistant or practice manager can lend a
great hand in offsetting many activities.
However, there are many doctors who refrain from using such help
because of the following:

1. They believe they cannot afford it.


HUMAN RESOURCES FOR DOCTOR AND STAFF . 129

2. They do not have time to train one and would rather use their
spouses or significant others.
3. They do not know how to relinquish control over the business
and trust someone else with running it.

There are many other reasons why doctors will run away from using
an assistant. Yet it is often found that finding the right talent and using
them well can reap great financial, personal, and even spiritual benefits
to the practice.

8.7.1 POVERTY MENTALITY

The question then begs when is it a good time to hire an assistant? The
answer is quite simple. If you find yourself operating a solo practice
and are in the office early and making numerous excuses to leave by a
decent time-say five or six p.m., then it is time to find yourself an assis-
tant. If you find that large parts of your day are spent not in treatment
but handling paperwork and coding issues,then you need to find your-
self an assistant. And, if you find yourself with low patient volume and
little time to market, then you need to find an assistant.
Many doctors will call me for advice and state that they cannot
afford to hire someone because expenses are too high. The true question
is, how much is it costing you in the new and retained business to not
hire proper help? Too many doctors will spend too much time belabor-
ing hiring staff. Part of this is a control issue and part of it relates to a
poverty mentality. To that end this means that you might believe you
cannot afford to hire the help. A poverty mentality forms negative
behavior and negative consequences. It is true that negative communica-
tion will bring about a negative atmosphere. You must believe that you
can afford to hire the help. After all it is costing your business too
much not to have it.

8.7.2 ORGANIZATION

While the medical assistant or practice manager performs numerous


activities, perhaps one of the best is their help toward organization.
Doctors have to deal with numerous pieces of paper, from the report of
findings to soap notes to even insurance paperwork. Walk into any doc-
tor’s office and you’ll see a stack of files and papers that represent half
130 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

a tree. A good medical assistant or practice manager will help keep the
doctor organized. This will be especially helpful as the office continu-
ally grows with patient volume. The doctor, first and foremost, must
treat patients; paperwork is secondary. Therefore, it is the responsibility
of the medical assistant or practice manager to help the doctor organize
his or her day for scheduled appointments, returned calls, paperwork,
and even meetings. The good assistant will place first things first and
help the doctor prioritize.

8.7.3 DELEGATION

An important benefit of a medical assistant or practice manager is the


handling of numerous tasks that the doctor cannot get to. The require-
ment here is that the doctor must physically let go and trust the new
individual to handle tasks the doctor used to handle. Delegation is noth-
ing more than relinquishing control to other individuals. This will
require that the doctors build a wonderful relationship with their assis-
tants and trust that all delegated tasks will be conducted as the doctor
would have done. To that end, the doctor must constantly communicate
what he or she would like to have done and train the individual effec-
tively to ensure success. Most important, the doctors must hold the indi-
vidual accountable, follow-up, and then recognize a job well done. The
power of delegation will actually decrease the amount of labor and
stress for the doctor and create better operating efficiency for the
practice.

8.7.4 MARKETING

There is only one purpose of your practice, and that is acquiring


patients. Your mission and vision must be focused on the acquisition
and retention of new patients daily. After 25 years of coaching and
counseling doctors, it is safe to say that not every doctor desires market-
ing or even wants to put time into marketing. Sometimes it is much eas-
ier to delegate it to someone else. Further, as the practice grows it is
more suitable to delegate it to someone such as the assistant because
the doctor lacks time.
Good medical assistants or practice managers will help the doctors
manifest the brand within the community. They will also help to build
alliances with other medical professionals and vendors so that the
HUMAN RESOURCES FOR DOCTOR AND STAFF . 131

practice has a variety of legs to create brand awareness. A medical


assistant or practice manager, who is passionate about the practice, the
patients, and building relationships, can be the best friend a doctor can
ever have. When used appropriately a medical assistant or practice man-
ager will be the linchpin to every thriving practice.

8.7.5 CODING

Patty called me the other day and mentioned to me that her patient vol-
ume was down. After several moments of questioning I discovered that
she had literally spent over nine hours attempting to find a code in order
to bill a patient appropriately. Anyone in a practice for longer than a
month knows the trials and tribulations of insurance coding. From its
rigidity to the newness of codes (for example the new IDC-10) coding
is painful. Too many doctors attempt this task individually consuming
too much time away from patient care. Additionally, many attempt to
use software that is either too cumbersome or too difficult to use.
Hiring a medical assistant or practice manager can save you
immense amounts of time, money and anxiety over billing and coding.
Granted this is a necessity of the practice; it’s the way that you make
money. However, your time is better spent with patients than it is on
the phone or at your computer. The useful assistant will understand
codes, will be proficient in understanding how to acquire new ones,
and, just as important, will seek repayment from insurance companies
expeditiously.

8.7.6 THE LITTLE THINGS

Finally, there are a number of smaller things that doctors must attend
to. These include, but are not limited to, meetings with the community,
presentations to new prospective patients, meetings with staff, and even
paying staff as well as developing a framework for patient and office
protocols. It would be nice to say that this is the doctor’s job but a
good medical assistant or practice manager can help offload these tasks
so that the doctor can concentrate on patient care. Your assistant can
help fill in the gaps for doing things that must be done and you don’t
have the time to do nor want to do.
In addition, the focus here has been on the general premise of find-
ing a good medical assistant or practice manager. Many of you reading
132 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

this may already have a spouse or significant other working the busi-
ness. If you believe in having the nuclear family assist you with the
business, then that is a successful idea. Yet you must realize work is
work and family issues are family issues. This requires that personal
issues become compartmentalized so that staff and patients are unaware
of the relationship. And, just as important, the spouse or significant
other should be trained and recognized, even as would expect with an
employed individual. The only way to ensure the success of the practice
is to ensure that you treat individuals with respect, dignity, and
recognition.
Fundamentally the addition of an assistant to your staff will save
immense amounts of time and money. Used well, the proper individual
will help to build the framework of the practice and overall patient vol-
ume. They will also help you to get to do things you never have the
time to do. Truly, when you hire a good medical assistant or practice
manager he or she will become the best friend you’ve ever had.

8.8 A FINAL WORD IN HUMAN RESOURCES

The following information is operational in nature but required here in


the spirit of human relations and human resources.

8.8.1 BOUNDARY AND RISK ISSUES IN PATIENT


COMMUNICATION

Operating a practice especially your own is very rewarding. Yet, once


you begin to observe, consult, service, and cure patients,new risks
apply. And, these risks proliferate as you add staff and new patients.
What the doctor always needs to keep thinking about are risk manage-
ment issues.
By and large, risk management is the set of processes and proce-
dures enculturated within the practice that ensure reasonably safety,
security, and confidentiality to the patient. Risk Management also identi-
fies, analyzes, evaluates, and monitors actual and potential areas of risk
associated with patients, always striving toward the prevention of any
malpractice and its associated legal actions. The overarching goal for
every office is to promote the safe delivery of high quality patient care,
without penalty, injury, or accident. Not only is risk management impor-
tant for the doctor but also for every one of his staff.
HUMAN RESOURCES FOR DOCTOR AND STAFF . 133

Sitting at the crux of risk management is culture. The doctor must


establish principles that rely upon ethical principles that incorporate
confidentially, compliance, and constant communication. The risk taker
must concern himself about future liability, the compliance maker
ensures congruence with all laws as well as creating a thriving lifelong
practice.
Establishing a legacy for good moral judgment requires that each
doctor create an environment of trust and respect. Culture utilizes lan-
guage to bridge this gap and it is language that controls the relationship.
To that end, it is all about communication. Believe it or not the first
instances of patient communication and contact can lend themselves to
issues, so better to be safe than sorry.

8.8.2 COMMUNICATION

Laura was shopping in a local grocery store and passed by George


whom she knew as a physician in town. Upon exchanging pleasantries
she stated her neck bothered her and George mentioned his office
address and phone number to schedule an appointment. Incredibly given
the insurance as well as other mitigated healthcare issues, one would
think making an appointment might be more complex, yet in medical
practices, especially when agreeing to provide some treatment, the doc-
tor enters into an informal oral contract. The notion therefore theorizes
George will treat Laura.
Yet, the better method in terms of risk is for George to state that if
treatment is required, Laura should ring his office and schedule some-
thing to be evaluated. There should be no promise, nor exchange of
fees. In addition, George would be better served by stating that to treat
Laura there are some procedures required and an office member can call
to explain those such as “Informed Consent” forms. The patient has the
right to accept or negate any treatment as well as their inherent risks.
The doctor then must inform the patient of the type of treatment, the
number of treatments, the risks involved, the statistics to support those
risks, and the risks related to the negation of continued wellness and
continued care as well as any and all fees. Failure to supply this infor-
mation will get a doctor in trouble.
Once consent is authorized and the doctor treats, then he or she
must communicate and document, all treatments. In as much as the doc-
tor needs to speak, he or she must record every manipulation without
134 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

leaving areas blank, describe how the symptom was addressed, and list
the additional treatments required. Record keeping ensures that both
doctor and patient clearly understand the issues related to proper patient
care, provides the payee information so the doctor can be properly reim-
bursed, aids with any malpractice claims, and provides a historical
record of treatment for future care.
However, in as much as the doctor needs to record, the patient
requires to understand. Doctors can quickly become immersed in techni-
cal speak and medical mumbo that confuses the patient. Therefore, in
order to treat symptoms, doctors must never assume anything and
ensure that all patients comprehend all issues related to treatment so
that both parties agree.

8.8.3 RISK WITH CONFIDENTIALITY

Every patient that you see and treat deserves that all information should
remain confidential. This is not only the required ethical standard but
also federal law. Most doctors today, because of their small offices,
have very little storage and file space. However, when patient files are
left available for others to see or even appointment sheets have patient
names displayed, all these become violation of confidentiality. It is then
incumbent upon the doctor and his staff to ensure that all patients’
details remain private.
First and foremost, all patient files should not be placed at the front
desk but rather behind the receptionist or doctor’s assistant so that
others cannot view them. All files along with their labels should also be
placed down so that only the backside is showing, not displaying
patient information. The staff should make this a routine practice in
their daily work. Furthermore, files that are no longer needed for billing
and coding should be immediately filed.
Second, there are times when employers, family members, and even
insurance companies desire to understand a patient’s diagnosis. Both the
staff and the doctor should always err on the side of caution. No
patients information should ever be released without the expressed writ-
ten authorization of the patient himself or herself. Further, only copies
of the required information should be sent. Never release originals to
anyone.
Third, at the beginning, middle, and end of the day we are all
human beings. We all enjoy chat and even some humor. What this
means to you and staff is that at no time are patient names, diagnosis,
HUMAN RESOURCES FOR DOCTOR AND STAFF . 135

and information to be spoken of amongst family and friends and peers.


This is ground for zero tolerance and immediate termination. Patients
visit with you to be cured of their symptoms and not to be the target of
conversation.

8.8.4 BOUNDARY ISSUES WITH OFFICE PROTOCOL

Whether or not the doctor is a sole practitioner or has staff, it has no


significance when it comes to risk management. In other words, the
office must have a culture of confidentiality and adherence to ethical
standards. What this means to the doctor can include but is not limited
to: scheduling and rescheduling appointments and placing those
appointments in a confidential file, ensuring that every patient has a file
and all paperwork and administrative detail becomes part of that file,
that every file has a diagnosis and a modality of treatment as well as
the patient’s consent for such treatment. In addition, as it pertains to
some of the information above, the patient also understands his or her
obligation to pay, and if it is reimbursement, the insurance company’s
obligation to pay.
Secondly, when it comes to office management, some cultures and
their environments are formal and others less informal. Yet, there is a
gray area when it comes to riddles, jokes, current event information,
political issues as well as touching hugging, and so on. As soon as a
patient engages with the office as well as the doctor, there is a relation-
ship. That said this relationship requires complete ethical and professio-
nal conduct. There are many times when conversations, touching, and
even implications seem to get out of hand. Boundary issues could be
inadvertent but also tragic. Therefore, every single relationship a doctor
has, which includes the staff, must maintain professionalism. Anything
less and the doctor and the staff will be subject to criminal charges.
To that end, doctors and patients of the opposite sex might want to
ensure that a third party remains in the treatment room during the
examination. In addition, the use of jokes, emails, text messages,
forums, Facebook™ and LinkedIn ™ sharing as well as using other
forms of social media in the office must be curtailed.
Some of the methods that can be used to ensure proper protocols
can include, but are not limited to, a clearly written office procedures
manual. This should also include a code of ethics that can also be dis-
played in the lobby or even in every treatment room. Secondly we all
understand that sometimes trouble can follow us. With that in mind a
136 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

doctor and staff need not accept every patient. Some patients appear
more rigid than others and appear to be more problematic. When prob-
lem patients come along simply state the doctor is overbooked but you
can refer them to another physician.
To a certain extent many physicians have been poor at accepting the
inherent risks in practice. Many believe that since treatment is noninva-
sive that there is lower risk—this is not true. Knowing, understanding,
and applying protocols of managing risks will help prepare for ques-
tions, issues, and quite possibly litigation. Risk management is similar
to an automobile accident; you believe it won’t occur until it does,
therefore prevention is the key. To that extent, risk management is about
being aware, being proactive, acknowledging, and accepting change.
Reading voraciously, counseling with others, remaining current, and
planning are the keys to success. Those who do will thrive, those who
decide differently will not be so lucky.
CHAPTER 9

PRACTICE MANAGEMENT
TECHNOLOGY

No doctor in today’s environment can operate without the use of tech-


nology. From the need to have devices such as telephones and copy
machines there is an inherent requirement to have computer equipment,
software, and even cellular technology so that patients can connect with
you wherever, however, and whenever they can. For the doctor, technol-
ogy can make operating the practice more efficient. This includes, but is
not limited to, systems that will help with appointments and cancella-
tions as well as the ever present billing and coding. This chapter is
nothing more than a brief overview of some of those systems. It is
always recommended to get specialists in the field so that you can have
a better understanding of what technology will fit your budget, , or
office space and remain congruent with both your staff as well as your
patients.
One of the first things that any doctor is going to require is a tele-
phone. The telephone will be most important for your business because
it’s how are you going to communicate with your patient. The systems
themselves don’t have to be overly complicated or expensive and many
of them come with bells and whistles you will probably never need.
However, if I offer any piece of advice it’s going to have to do with
developing an office system that will allow you to grow with your prac-
tice and upgrade as the technologies change.
There are a myriad of mixed use telephones in the markets today.
These include, but are not limited to, voice over IP systems as well as
the hardwired old-fashioned AT&T and Verizon lines. My advice is to
settle for a system that is relevant to your budget and makes it easier to
answer calls and make them. Therefore the best telephone system you
can have is the one that offers multiple lines: and you will probably
need no more than four or five lines and the ability to forward those
lines to emergency services or even voicemail should your front desk
138 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

receptionist be unavailable. All phone systems today must have a voice-


mail attached to them so that you can record a personal message and
retrieve the calls before and after hours.
Highly recommended are some of the new technologically available
calls that can send voicemail messages or a text message to an answer-
ing service before and after hours. This simplifies the process of having
to dial in to obtain your calls especially during weekends, holidays or
during times of illness. In addition, some of these new fangled tele-
phone systems also allow you to send messages to existing patients.
These systems would be very helpful in times of emergencies or even
in times of a disaster. Examples would include flooding, snowstorms,
earthquakes, hurricanes, tornadoes, or any other issues that mother
nature might decide to throw our way. Having the ability to communi-
cate on all scheduled appointments in one message is an exceptionally
useful methodology in managing your office.

9.1 PRACTICE MANAGEMENT

Once you have your telephone system in place, the next and probably
most important piece of your medical practice will be to obtain an auto-
mated practice management system that helps to support patient sched-
uling, demographic data, benefit verification, point of service
collections, and quite possibly the ability to send messages. There are
so many systems on the market that it would be hard to recommend
one; however, in medical practice, the doctor should look for systems
that help to support account receivables including billing and coding,
insurance billing, patient statements, and collection activities. If you’re
going to spend any money and invest in the future of your practice and
the health and wellness of your patients, it is vitally important to obtain
a robust system. Mind you I’m not suggesting that you get the most
expensive system available but one that is able to provide you with as
much efficiency and risk management as possible. A good practice man-
agement system will help you with your marketing because it will allow
you to understand patient referral tracking, it will also help you with
your accounting because it will understand payer mixes, productivity
statistics, and even your account receivables. These are two vital areas
of the practice that you do not want to be economise on.
There is no reason why you cannot simply invest in a small system
to start and then upgrade once your practice starts to grow. For exam-
ple, you might have a practice management system that schedules
PRACTICE MANAGEMENT TECHNOLOGY . 139

appointments and at least allows you to place charges in for billing.


However, your billing and coding will need to be done by either an
employee who will perform this function manually or you might decide
to outsource. Regardless of what you decide you really need to plan for
long-term use in the selection of the software. As I mentioned earlier,
you might not need all of the bells and whistles but as your practice
grows, as the industry evolves and the regulations change, you’re going
to really need a system that can grow with you!

9.2 SCHEDULING AND PATIENT MANAGEMENT

Should you decide to do so, there are a number of software packages


available for mobile technology that allows you to communicate fre-
quently with your current and prospective patients. Many of these sys-
tems provide services beyond the reach of your voicemail. For example,
you might decide to acquire a system that helps to confirm appointment
with patients days, weeks, or even months in advance. I even know of
services that not only remind patients a week prior to the appointment
but actually even text message and call on the day of the appointment!
Remember that your time is valuable and so keeping busy and filling
the blocks of an eight hour day is where your revenue comes from.
Patients forget, and no one is damaged, so you want to ensure that you
help them along the journey to keep their appointments while keeping
you wealthy!
If you have a multidisciplinary practice, there are also services that
can text or voice mail patients should you happen to have an opening
in your schedule. This is exceedingly helpful if you have a busy prac-
tice and someone with an emergency or a dire need to follow up on
some type of test such as blood or urine can come and visit with you.
These types of services are exceedingly helpful with the overall patient
experience. Moreover, with the increase of younger generations in the
workplace and over 94 percent of individuals carrying mobile phones,
the increasing use of text messaging to confirm, schedule, and cancel
appointments is on the rise. If you choose not to use voicemail, there
are a number of companies that will also provide methods so that you
can convey information instantly to your patient base.
140 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

9.3 WEBSITE

Given the current state of technology and the Internet, it has become
increasingly important for any doctor to be more in tune with the Inter-
net today than ever before. If this had been written 10 to 15 years ago,
it could be said that the Internet is nothing more than a static electronic
brochure. However, today, it is a credible source for prospective patients
to discover more about you and actually engage with you. Periodically,
I obtain emails and blog comments from people who are interested in
the services that I provide and so can you. So what can you do to make
your site more interactive?
In order to justify the purpose of creating a site it is best to create a
strategy similar in design to your overall marketing strategy. There must
be a purpose for the website, and proper messages must be created to
appeal to the demographics that you are attempting to attract the atten-
tion of. With over 300 million websites there are simply too many today
that are competing for similar space, audiences, and attention. Therefore
you want to think as critically as possible to appeal to those who would
be interested in your services.
The first operation for your site would be to choose the type of
pages that you want to have and the messages for each of the pages.
For medical doctors just beginning this process I typically suggest the
following: Home Page, About Us, Services Offered, Case Studies, Prod-
ucts, and Contact Us. Frankly this is all you need. You should believe
in the KISS method. Keep it simple, keep it succinct, keep it scintillat-
ing so that it creates the actions you desire from prospects.
With this in mind there are some rules to developing a purposeful
website so that you gain the levels of success you desire.

1. Research the most popular keywords possible to understand the


words that will be used to view your site. For instance you might
have people searching for Orthopedist or Dentist. A great
resource for reviewing this data is available for free on the
Internet and it is called Google Keyword ToolÓ.
2. Every page must be not only short but should have a purpose.
Each page must have the following features in it; (a) your value
proposition, (b) lots of white space so that it is not cluttered, (c)
some pictures that are clear but nothing over the top, (d) good
fonts so that information is easy to read, (d) using the formula of
placing the most important information “above the fold” so that
PRACTICE MANAGEMENT TECHNOLOGY . 141

prospects do not have to scroll to find it, and (e) an action step.
Every page must not only have a purpose but must also tell your
reader what you want them to do and get them to do something.
Unfortunately most individuals remain on a page for less than
seven seconds, so you need enough information to keep them
there and get them to do something.
3. Create some type of free marketing magnet so that individuals
might leave you a name and email. This will allow you to create
a lead generation system without having to pay for lists and use
many of the other marketing activities mentioned above. By the
way a marketing magnet is a free gift such as a white paper,
audio, vitamin, analysis, massage, anything that you can provide
that has value that someone wants.
4. Know what the issues are and why people come to see your
page. Can you identify the struggles they face? When you
identify their issues you can speak more articulately to them so
that your page actually has a conversation with the person. It is
as if you are speaking with them electronically.
5. One idea to use in building your website concerns the entire
essence of this book and that is building a customer-centered
relationship. So when you design and develop this site you must
design it so that it can be read, has a professional tone and
verbiage, and will be able to prove how you can provide value to
the intended audience.
6. When building your home page, create something with the
following outline so that it focuses on output and returns to the
patient. For example:
(a) Problem: Tell them what is not working. Provide a paragraph
or two and let them know what is at issue right now.
(b) Solution: Tell them how it could be. Provide a paragraph or
two to let them know what utopia might look like when the
problem is resolved.
(c) How come? Provide a question as to why they have not
already resolved this. You might provide a paragraph or two
that provokes them, even agitates them, enough to question
why they haven’t taken care of the situation.
(d) What you need to do: Provide an approach that’s proven to
work. Now in a short paragraph give them a general solution
that’s proven to work without giving too much prescriptive
information. You might provide a deep understanding of
142 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

methodologies, even business practices, that allows


individuals to understand how you and your organization can
assist them in reversing the role.
(e) Call to action: Prove that you can help them. Write an
exceptionally strong statement that includes your core
marketing message or your unique selling proposition or
even your value proposition that explains to the prospective
client how you and your organization alone can help resolve
the issue that the client is currently experiencing.
7. Your About Uspage should be personal, conversational, and
similar to the way you speak. Provide some flair and some
pictures so that patients can find out why you got into medicine
and healing. Answer what you can do to help them and then tell
them about your family and your practice.
8. When you provide information about your services, stay away
from using technical, scientific, and medical information. Not
many understand or ask about terms such as subluxation, motion
points, and so on. And many will not ask. More important is that
every person who visits is concerned about one thing and that is
how you can help them. The best practice is to write in lay terms
with the patient in mind without sounding completely like a
doctor but more like a trusted individual.
9. Think in terms of conversion not in terms of website hits. While
hits are important the fact is that what really counts are the
number of individuals who actually convert into a prospect. That
said, there are reasons why people may not convert into a
prospect. These include (a) your niche is not clear, (b) your
results are not specific, and (c) there is a lack of clarity in your
systems and processes. When you create a link between the issue,
the solutions, and the demographic you more accurately convert
individuals more successfully.

Last but not least is that a website is a work in progress and need
not be perfect. What you need to think of is that the website is the
adjunct to the practice not the purpose of it. Therefore, take your time
to strategize well but once you are ready, implement. Do not sit on the
sidelines constantly judging and ridiculing, because you will paralyze
the analysis. Then as you begin to formulate analytics around your sys-
tems you can make any needed alterations.
PRACTICE MANAGEMENT TECHNOLOGY . 143

9.4 A QUICK WORD ABOUT THE SOCIAL MEDIA

Last year, 68% of Americans using social networks said that none of
those networks had an influence on their buying decisions. This
year, only 36% said that there was no influence. Now, 47% say
Facebook has the greatest impact on purchase behavior (up from
24% in 2011). Incidentally, Twitter dramatically underperforms in
this category at 5%. (Qualman 2012 )

The social media today has taken over many of the nuances of the
Internet allowing communication without barriers of any kind.
As the social media develops we see the growing fascination as
well as the preponderance of evidence of increased noise. While there is
merit in some use of the social media, much of it is personal and seems
to continually clutter important information on the Internet. Yet, for
medical doctors the influence and the reach of Social Media is not
something to be ignored. With over 900 million people on Facebook
and over 150 million on Linkedin and over 1 billion Tweets per day
there are too many individuals using the social media to ignore its use.
Yet like websites there are some things that have to be recognized.

1. The social media does assist in creating a community since it


allows an electronic flow of communication from one to many
individuals seeking services such as yours.
2. The social media does require some degree of focus. While there
may be limited control there is no reason to build pages on
Twitter, Facebook or any media where your patients are not
located. If you realize that marketing requires your use of
geography to lock into your target market, social media also
requires it. I know of many who have wasted time and energy
building pages and sites with very low interest and volume.
Make certain you efforts are well worth it.
3. Remember that the social media unlike websites contains very
limited control. That said, you may receive unsolicited feedback
on services, treatments, blog posts and so on. Ignore those that
make little impact on your life.
4. Finally, follow the trends. Determine what is interesting for your
readers and community and what isn’t. Do not get caught up in
too much social media that takes you away from the most
important focus of your practice—building it.
144 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Many years ago Albert Einstein stated, “Insanity: doing the same
thing over and over again and expecting different results.” If your prac-
tice is not growing and you continually do the same thing and do not
get results, why bother? Medical doctors invest a lot of time into their
craft and deserve better rewards. Those seeking to gain maximum bene-
fits and better results simply need to convert from the medical business
to the marketing and relationship business.

9.5 SOFTWARE THAT AIDS YOUR REPUTATION

If you are like me, as a child you must have grown up under the prem-
ise of “sticks and stones may break my bones, but names will never
hurt me.” The expression notes that no matter what you say you're not
going to harm me by name-calling. However, doctors are similar to any
product or service. Doctors, their staff, and their practices have a brand,
and like all products or services that brand must be protected.
The value of a brand is that patients invest in it for the brand’s own
sake and not with the usual amount of analysis, cynicism, or caution. A
brand creates a response among the public. Think of brands that you
use that create eponymous communication. Branding is more about a
perception of excellence than about the perception of a good deal. This
holds true for services like doctors’ services. A negative press can
instantly and immeasurably harm brands. Doctors must be involved
with a new process known as reputation management to aid in protect-
ing their brand.

9.6 WHAT IS REPUTATION MANAGEMENT?

The use of the Internet is outstanding with over 670 million webpages
and over 33 percent of the world’s population now engaged online. Pro-
spective patients are now utilizing search engines to find new doctors
while conducting a tremendous amount of research to determine if that
doctor’s brand matches with the patient’s value. In addition to the
myriad websites, there exist numerous places such as forums, Twitter,
and Facebook where comments about you reside. True, false or indiffer-
ent, these digital footprints will cast a blanket on your practice.
PRACTICE MANAGEMENT TECHNOLOGY . 145

9.7 IS REPUTATION MANAGEMENT WORTH IT?

A proactive approach requires doctors and staff to monitor the web on a


regular basis. With well over 2,000 patients seen per year and many of
those calling the front desk but not making appointments, there are sim-
ply too many entry points that can create a bad press. The World Wide
Web has also thrown up several individuals who can dispense negative
information online that would never be said to you personally. And
with over 1 billion searches per day these negative ratings, comments,
or even thoughts can harm your brand.
For example, I am certain that you have made use of Amazon to
some degree. Amazon as many know is a broker of goods and services.
Many products are sold on Amazon such as books, music, and even
movies. With each one there is a comment area so that readers or listen-
ers can allow others to understand what they’ve enjoyed or not about
the particular product or service. Herein lies the question, how many
products have you refrained from using because of another reviewer’s
comments whether they were truthful or not? This then is similar in
your world.

9.8 HOW DO I BEGIN?

The first step in any successful campaign is simply utilizing a search


engine such as Google or Yahoo and research your own name. Simply
enter your first and last name into the search bar and begin to review
the sites that allow comments. Determine for yourself what existing and
prospective patients are saying about you and staff. By the way, this is
a tremendous way to also mystery shop your practice.
Now all this seems practical, but there is also the fact that you’re
very busy seeing patients and don’t have the time. If this is true then it
is always helpful to hire a reputation management company, a social
media management company, or even an Internet virtual assistant who
continually monitors the web for such activity. While the prices
dependon the experience and level of sophistication, the fee invested
will be better than the lost opportunities.
What many doctors fail to realize is that their name and their prac-
tice is a brand. Based on services offered, patient service, and other
nuances, there is value placed in the patient’s mind. It is this positioning
146 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

that creates an emotional appeal whereby patients book appointments


for brand sake.
Reputation management when handled appropriately could poten-
tially increase pipeline flow, decrease obstacles to prospective patient
entry, and increase your revenue. Reputation management is analogous
to planting a tree and ensuring that it has a tremendous root structure. It
will aid your reputation and root your future revenue flow.
CHAPTER 10

TRENDS IN PHYSICIAN
PRACTICE MANAGEMENT

This book has been written as a primer in order to get physicians and
their practice staff understand the importance of practice management
and the practice experience. By that I mean it’s important that doctors
operate an efficient and effective practice so that they remain profitable
and achieve the highest levels of success possible. In addition, operating
the practice also means implementing consistent strategies that continu-
ally bring patients into the practice. This not only requires terrific mar-
keting procedures but, as has been mentioned throughout this book,
also requires a terrific staff.
Yet, with any business as with any practice there are a myriad issues
that can immediately create obstacles for any physician. These include,
but are not limited to, politics, economics, technology, competition, and
since this book is being written in 2015, Governmental changes affect-
ing the health care industry. While these obstacles always impact any
business the issue in healthcare is that it creates a pile of paperwork
and takes time away from what physicians really enjoy doing—treating
patients. If you’re a practice manager working with a doctor, you would
have seen that the passion for healing, for care, and for solving what
sometimes seems to be unsolvable, is what energizes a doctor on a daily
basis. Unfortunately though, these obstacles can create a burden that
automatically impacts the energy, the passion, and conviction for what
is their avocation. Therefore, it’s important to understand many of the
forthcoming obstacles so that physicians and their practices can be bet-
ter prepared. This preparation will allow the doctors to still maintain
their energy while also ensuring that the staff is focused on the exact
same thing—patient care!
The rest of this chapter discusses some of the issues that I particu-
larly see as coming up, and how doctors might be able to thwart some
of these obstacles in the months and years to come.
148 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

10.1 BURNOUT

Ask any doctor and he or she will tell you, as I mentioned earlier, that
the one particular item on their mind, when they wake up in the morn-
ing and retire at night, is to help the patient. However, new changes in
healthcare as well as new administrative details have created an increas-
ing amount of work making it more difficult for doctors to see patients.
For example, in 2013, the American Heart Association established new
criteria for statins making it more daunting for those in cardiology, and
even general medicine, to see more patients. My cardiologist currently
sees 2,500 patients and this new report on statins may require an addi-
tional 1,000 to 1,500 patients to be seen per year. As one can imagine
there is not enough time to see 4,000 patients at least with the quality
of care that everyone professes. Doctors and staff are, for the lack of a
better word, stressed.
Job stress and burnout are some of the most imperative issues in
today’s business environment. Both stress and burnout negatively
impact morale and satisfaction in the workplace. The increased need to
be productive while reaching higher levels of profitability without any
additional manpower simply produces negative effects in workplace
morale. More than half the workers say they work under a great deal of
stress, and 77 percent say they feel burned out on the job. Most impor-
tantly, health care costs across the United States are continually increas-
ing. According to research there are numerous instances where high
health care costs are attributable to stress and anxiety in the workplace.
It is proven that:

. Job stress and burnout produce more heart related issues because
of the increased demand on the body.
. There are more digestive issues such as nervous stomach, ulcers,
colitis, and many others.
. As burnout increases depression and fatigue get higher creating a
negative impact on productivity and morale.

Needless to say there are numerous other issues but these three
seem to be the most demanding in today’s workplace. However, the
worst experience for most individuals is simply the feeling of power-
lessness when it comes to job burnout stress. There is an overarching
feeling as they have no answers to questions and feel defenseless
against demands, people, and constant problems. Since job burnout is
TRENDS IN PHYSICIAN PRACTICE MANAGEMENT . 149

not an overnight occurrence, it's important to recognize its early signs


and to act before the problem becomes truly serious.
No one said that running a practice was easy. And, you would be
foolish to think that you as a doctor would not suffer from any signs of
stress or burn out. The rigors of attempting to acquire patients, while
keeping your existing ones, as well as hiring and retaining staff are
themselves daunting tasks. When coupled with maintaining a normal
personal life, this produces all types of daily challenges causing stress
to erupt.
So you might ask, at this point, what some of the signs of stress
are, other than just patients.

Prior authorizations are a major, and growing, source of physicians’


paperwork burden. More and more payers are requiring prior author-
izations for more drugs and procedures. Consider, for example, that
in 2013, 21% of the brand-name medications covered under Medi-
care Part D required prior authorization, and 35% were subject to
some form of utilization management. By contrast, in 2006 when
Medicare Part D began, those numbers were 8% and 18%, respec-
tively, according to a Kaiser Family Foundation study.
Another Kaiser study, from 2012, estimated that the nation’s physi-
cians spend more than 868 million hours annually on prior author-
ization activities. Payers say prior authorizations hold down costs,
improve treatment efficacy, and ensure patient safety. To physicians,
however, they are an obstacle to providing the best care for their
patients. (Terry et al. 2014 )

As you can imagine this gap in authorizations leads to less patient


care and increasing bureaucracy in an industry that has too much of it
already. For doctors and their staff, who are only interested in providing
the care that a patient needs, the increasing amount of paperwork cre-
ates an inordinate amount of stress because patients are constantly call-
ing to follow-up and move their payer forward, and most importantly,
doctors and their staff are increasingly barraged with paperwork that
continually piles up on their desks. Nothing seems to move forward as
all the paperwork seems to stall movement.
In addition, another source of stress and burnout that is continually
ravaging the industry are the changes within the entire ICD 10 structure.
This project was endorsed and despite several attempts to implement it
for a number of years, it has also been delayed several times.
150 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Unfortunately, there is a need not only to understand the required gov-


ernmental changes in training but these new coding changes also create
a tremendous amount of stress when learning to use the EHR,
EMR and the practice management software packages. Without sound-
ing cynical, the one thing a doctor does not have time for, is to attend
another training class which takes him or her away from patient care. It
is no wonder that many physicians sometimes tend to walk away from
the industry because the burden of administrative work is too great not
only on them personally but also on the family.
One of the best ways to mitigate all the stress is to take everything
in one’s stride to a certain extent. What is being suggested here is that
the industry is moving toward unprecedented times of change and as
human beings we don’t like change. Therefore, doctors and their staff
should implement some alterations in their work life balance to help
mitigate some of the stressors within their practices while creating
higher levels of communication channels among each other to under-
stand the reasons for change and to support each other through it. The
one thing that we do know is that, with insurance companies, the gov-
ernment, and the integration of global healthcare issues, change will be
chronic for centuries to come.

10.2 INDEPENDENCE VERSUS EMPLOYMENT

It is widely known that many physicians after their internships and resi-
dencies desire to remain within hospitals and clinics because of the
established support mechanisms. Hospitals have an incredible number
of operational and administrative staff to help take care of many of the
issues mentioned earlier. There are those who take care of technology,
those responsible for authorizations, others responsible for billing and
coding, and even technicians to help with the numerous tests and check
ends when a patient visits. Aside from paperwork, a physician in a hos-
pital or clinic has the ability to see more patients with less stress as
mentioned earlier.
At some point, a doctor will decide that being an employee of a
large bureaucratic organization is not in their best interests. Many strive
for independence and long to control their destiny, especially from a
revenue standpoint. And, as an employee of a large institution many
physicians do not enjoy the issues of someone “looking over their
shoulder” and being held accountable for the number of patient visits,
the number of surgeries, and any number of other accountabilities the
TRENDS IN PHYSICIAN PRACTICE MANAGEMENT . 151

hospital deems necessary. For example, many organizations such as


large hospitals are now turning toward a measurement called a relative
value unit (RVU), which compensates a doctor based on his or her pro-
ductivity and the type of worked being performed.
For example, a doctor who performs surgery in a hospital would
generate more RVUs than a doctor who sees a patient for a checkup in
an outpatient setting (Samantha 2014).
http://www.stltoday.com/business/local/new-pay-model-leads-some-
physicians-to-leave-mercy/article_288d0aec-3515-5d9d-8c24-
88188d154fcc.html
To a large extent, this accountability is causing many physicians to
turn toward an independent status. This however brings an increasing
set of challenges for someone who has never worked for himself and
does not have the support structures of a complex matrix organization.
To some degree that is the obvious reason for writing this book, so that
I can assist physicians understand the business portion of operating a
small to moderately sized practice. It is not easy as I have suggested
throughout this book simply because the physician needs to understand
operations, administration, staffing and development, patient retention
and acquisition, and, most importantly, caring for patients. The myriad
issues create a situation for doctors who begin to think returning to the
hospitals is a panacea because of the allocated resources.
Yet, for the amount of stress in operating a private practice, seminal
work in this area illustrates that in accordance with the American Medi-
cal Association over 60 percent of doctors operate in private practice.
Considering the current demographic of approximately 860,000 practic-
ing physicians, that is a significant number for individuals desirous of
making the jump from a bureaucracy to an individual effort. It is not an
easy task but sometimes the risks outweigh the opportunities or the
opportunities outweigh the risks. This is simply a matter of what is in
the best interest of the physician, the revenue flow, and the family val-
ues. The decision whether to remain with a hospital and undo the hospi-
tal’s accountability directives or choose independence is strictly up to
you. As with much of the advice offered in this book, it is best to seek
out legal and financial assistance so that you can make the best decision
for yourself and your family.
152 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

10.3 INSURANCE AND DICTATORSHIP

One must remember that when you decided to attend professional


school for medicine you gave up a lot. You may have delayed getting
married, having children, taking vacations, and even spending time
alone. Then as your desire increased so did the bills and the pressure to
succeed. You carried on with your path attempting to become the best-
darned physician that you physically can be… that is until you found
out what was needed to run a practice. Here you were thinking that you
have to make the calls, you did not answer to anyone until the DaVinci
Code of Medicine was revealed, and the standard business model is
accepting payment from a third party. http://chiroeco.com/chiro-blog/
patient-acceleration/2012/04/18/the-maintenance-free-practice/
In fact it is typically found in the medical field that:

. Third party practices determine how much your work is worth.


. Third party practices tend to control your fee structure.
. The third party can change what they pay you at any time.
. Third party practices constantly change rules, codes, billing and
so on creating more work, more paperwork, more stress, and less
outcome for you.
. Third party practices limit your exposure to your patients. They
can tell you how often to see them and when to end your
relationship.
. Third party practices await payment so much so that doctors are
constantly in arrears from the third party.
. Third party practices are risky because they create full risk and
exposure on one type of payment plan and limit methods of
passive, aggressive, and sometimes creative income.
. Third party practices are not solo operations but rather ball and
chain operations since there is constant attachment to one type of
payee.

Under this type of model, you will be tied down by constraints, and
there will be less likelihood of success. Therefore, it must be understood
that if you are working with insurance companies and even Medicare
and Medicaid there will be some level of imprisonment. There are some
specialty practices that have opted not to utilize insurance and where
possible strictly allow for only cash payments from patients. Some of
TRENDS IN PHYSICIAN PRACTICE MANAGEMENT . 153

these are spine centers, laser therapies, magnetic resonance imaging,


bariatric surgeries, and the list continues.
Fortunately and unfortunately we live in a society that allows us to
accept insurance payments so that payments can provide a small stipend
toward their personal care. This lessens the financial burdens that often
accompany healthcare symptoms. For example, hospital care especially
for extended stay is unaffordable to those with certain incomes. The ris-
ing cost of prescription medications also makes it increasingly unafford-
able for people of any income to pay for their health. Therefore,
insurance becomes the fait accompli for the practicing physician. It is a
dictatorship and there’s no other way around—unless you decide on a
different business model. Some have opted, as discussed earlier in this
book, for concierge medicine. This is also known in many instances as
retainer medicine. For example, there is a doctor in Arizona who
charges the patient $5,000 and only cares for 300 patients at a time so
that most of the consultative advice is paid up for front. Most impor-
tantly the fees are paid strictly in cash and the doctor need not worry
about insurance premiums, authorizations and so on. These services are
quite obviously based on the demographic that can afford these fees.
Therefore, you need to understand your demographic and what is
affordable and not, to determine whether or not you will be a victim of
insurance dictatorship. Suffice it to say though that the insurance world
is simply a part of the business and an obstacle that will not go away.

10.4 IPATIENT

In the age of technology everyone including patients is seeking faster


alternatives to communicate. With a wealth of social media, blogs, web-
sites, and videos there is a barrage of information. To that end, patients
seek easier means to communicate with physicians and their staff. It
appears, with doctors’ offices busier and visitation gaps longer, patients
desire easier ways to connect with doctors about their health, and enter
the patient portal.
For those not aware, a patient portal is an internal website that ena-
bles a patient and a physicians’ office to communicate with each other;
it is easier than using email or multiple forms of the social media. With
the use of a dedicated server and a third party software, patient portals
(depending on the options doctors desire to make available) enable
patients to schedule appointments online, email doctors about prescrip-
tions or issues in health, gain valuable information in the form of a
154 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

newsletter, make information available on patients’ vitals, have prescrip-


tion information available on the portal as well as many other options.
The notion behind a patient portal is simply patient engagement.
Many write about patient engagement without disclosing its impor-
tance and understanding the physician practice. There are a variety of
definitions; suffice it to say that it has become a buzz phrase, but patient
engagement is defined as the communication, collaboration, and coordi-
nation provided by healthcare providers to ensure a positive patient out-
come with limited obstacles. To a certain extent, one might align patient
engagement with customer service. To that end, all hospitals and health-
care providers ensure a successful engagement from the time a phone is
answered or a patient visits a waiting room until the time a patient con-
cludes conversations with office staff.
In addition, patient engagement is also aligned with providing the
patient a means of self-managed care. According to research from
Athena Health “35% of U. S. adults have gone online to figure out a
medical condition; of these, half followed up with a visit to a medical
professional.” The proliferation of the Internet has created a dearth of
searches in health care from disease and wound care to physician
reviews. The same report from Athena Health indicates “63% of adult
cell phone owners now use their phones to go online, a figure that has
doubled since 2009. In addition, 34% of these cell internet users say
that most of their online use is via cell phone. That means 21% of all
adult cell phone owners—about 1 in 5—now do the majority of their
online browsing via mobile phone, not another device such as a desktop
or laptop computer.” With this type of usage more patients will review
health statistics such as vitals, weight, medication, exercise or even
symptoms if available. These searches will then lead to some form of
communication with a physician’s office. This self-managed method cre-
ates more power to the user because they have more information avail-
able to them than in earlier years.
Coincidentally, not only are portals effective for the patient but they
are increasingly productive for physicians. For example, prior to email
and the Internet, lab results, appointment scheduling, and even prescrip-
tion follow up meant multiple calls due to failure of attempts or even
voice jail. The patient portal would place much of this complex data
online. Call volumes might also decrease with the plethora of data
instantly available on the portal. To that end, many patients can have
meaningful, secure, and private conversations with doctors and their
staff about symptoms. Yet, it is the availability to communicate with the
doctor wherever and however. Further, these new electronic means
TRENDS IN PHYSICIAN PRACTICE MANAGEMENT . 155

actually diminish workflow, paper, time lags, and patient communication


allowing both the doctor and staff to attend to other important work.
As conducive as portals are, there can be some limitations such as
patient participation, staff and doctor follow up, and supportive technol-
ogy. Change in an increasing technological world is about adaptation
and adoption; it is also about leadership communication. If the doctor
provides full support, explains the benefits, and uses the technology as
a means for better efficiency then everyone will quickly adopt—includ-
ing staff. The use of a portal includes efficiency, provides better com-
munication, easies workflow, and enables doctors to diagnose, diminish
symptoms, and return the patient to health.

10.5 STAFF RETENTION

Staff turnover can be a significant drain on both practice revenue and


resources. The Center for American Progress estimates that for workers
earning less than $50,000 annually, it will cost employers approximately
20% of that employee’s salary to find a replacement (Terry et al. 2014).
The largest issue for any practice that stumps growth is worker produc-
tivity. With economic volatility and healthcare reform issues currently
impacting profits, productivity issues can wreak havoc on practices
already on the brink of zero margins. In addition, when worker produc-
tivity falters, costs are higher.
When it comes to productivity, much research has been conducted
that suggests that recognition for a job well done is the top motivator
for employee performance. However, most chiropractors don’t under-
stand or use the potential power of recognition or reward. In fact, in
research conducted by our organization over 54 percent of chiropractic
office staff suggest that they would rather work in an environment
where they would receive better recognition.
It is important to understand that when it comes to recognition in
the workplace there is a direct relationship between the doctor or prac-
tice manager and office staff. The better the relationship between the
practice owner and employee the higher the profitability.
It is imperative to note that individuals do not leave bad practices—-
they leave poor chiropractic owners. It is also imperative to develop
feedback loops. Morale is lifted when individuals are recognized for
efforts. In addition, when recognition feedback commences, employees
desire to do better.
156 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

There are several reasons to engage in a relationship that also leads


to reward and recognition.

. Productivity: When individuals are recognized for a job well


done they are much more motivated and perform at higher levels.
. Profitability:The cost to the practice is less when morale and
productivity are high. Passionate employees achieve more work
with less labor.
. Patient Retention:The motivation is stronger if the form of
recognition creates a story that employees can tell others. So
when employees are happy with the boss they tell other potential
employees—even prospective patients.
. Operational Costs:Operational costs are lower when employees
are recognized for a job well done. Happy employees simply stay
on the job longer.

Do not misunderstand me. There are many reasons why recognition


helps with job satisfaction and productivity; however, it is important to
realize that recognizing employees is the right thing to do.
Even if you operate in a small office of 10 or less employees it is
still important to understand how recognition can assist practice morale.
Here are several tips and techniques that will create a high performing
practice for you.
First there is a myth that everyone wants to be paid what he or she
believes they are worth. However, it is also important to understand that
individuals work better when they are appreciated. It is more important
to produce a series of formal and informal recognition programs rather
than use salary to increase morale. If the culture of the practice does
not allow good relationships or even provide good treatment for others,
then paying people more does not change the culture. Employees do
not leave bad practices, just bad doctors.
Here are some other things to consider:

. Gratuity Cards:One of the sweetest things any doctor or practice


manager can do is simply remember a birthday, anniversary, or
an important emotional event. A hand written note or card that
conveys your admiration for the employee will go a long way to
creating passion in the workplace. When individuals know that
they are appreciated, they will have more commitment to your
practice.
TRENDS IN PHYSICIAN PRACTICE MANAGEMENT . 157

. Communication:Perhaps the largest issue concerning recognition


is communicating. Due to busyness it is easy to attend to
patients, pay bills, attend seminars, and forget about your most
important asset. Everyone needs a simple atta boy or girl every
now and again. In fact research from several sources indicates
that employees would rather receive constant recognition rather
than a raise.
. Awards:Provide a visible form of recognition to illustrate years of
service, exemplary effort, and so on. Awards illustrate not only
achievement toward goals but also the relationship between
doctor and staff.
. Training and Development:Self Mastery and skills development
are very helpful to office staff who desire to achieve more.
Knowledgeable employees are more passionate. When employees
feel they are appreciated they do more for the practice. This is
helpful in situations where employees have promotional
opportunities.
. Work Life Balance:We live in a crazy busy world providing
numerous personal and professional constraints. Trying to
balance work and family is very difficult creating most
workplace stress. Chiropractors sensitive to staff issues can
provide extra breaks, days off, personal time, and so on So that
individuals do not feel pulled by personal and professional
strains.
. Personal:Take the time to get to know your staff. Ask your
coworkers about their family, their hobby, their weekend, or a
special event they attended. From Dale Carnegie, “Become
genuinely interested in others.”
. Food:Take coworkers or staff to lunch for a birthday, or any
other special occasion. Have a staff meeting at a local restaurant
to show your gratitude for their joint efforts.
. Gifts and Gift Cards:The personalization of gifts and gift cards
will show your knowledge of someone’s personal interests,
something they will appreciate. This requires some research but
will pay huge rewards.
. Timely Performance:The one technique above and beyond all
mentioned above is the need to provide feedback when positive
performance occurs. Waiting too long diminishes the possibility
of recognizing the employee’s terrific efforts. Give them thanks
and praise immediately. It is not only preferred—it’s expected.
158 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Many practices might use a scattered approach, believing a bit here


and there might lead to some results. Or, they recognize so infrequently
that recognition becomes diminished. Recognition must be consistent
and constant. Integrate some form of recognition at least once per
month.
To help initiate a program create goals and action plans for
employee recognition. You want to recognize the actions, behaviors,
approaches, and accomplishments that you want manifest. Establish
short term and long-term goals for recognition programs. And do not
forget to ask your staff for the proper input. When they are part of the
process they will feel closer to the practice.
Ultimately your staff needs to see that each person is a contributor
to the organization. This requires that recognition is fair, balanced, and
equal. All are to be appreciated. More importantly all should know that
they are all entitled to recognition. It is important to recognize all the
people who contributed to the practice’s success.
No matter what is used, recognition must not be overlooked.
Rewarding recognition too often will make it a right; too little—dimin-
ishes impact. The greatest assets aside from patients are your employ-
ees. Take the time to provide thanks, praise, and admiration for their
efforts and watch the productivity of the practice soar.

10.6 RISK MANAGEMENT

Operating a practice is such a lucrative decision. It is wonderful to be


your own boss and, most importantly, treat individuals who you desire
to cure. Unfortunately, since you have decided to operate your own
practice, there will be myriad responsibilities. Apart from the general
implementation of policies and procedures as well as staff recruitment
and management, there is also a vital need for risk management. And,
in today’s litigious society it becomes increasingly important to manage
risk in every single practice.
It might be best to determine what exactly risk is. By and large risk
management is the set of processes and procedures enculturated within
the practice that ensure reasonably safe, secure, and confidential treat-
ment for the patient. Risk Management also identifies, analyzes, evalu-
ates, and monitors actual and potential areas of risk associated with
patients, always striving toward the prevention of any malpractice and
its associated legal actions. The overarching goal for every office is to
TRENDS IN PHYSICIAN PRACTICE MANAGEMENT . 159

promote the safe delivery of high quality patient care, without penaliza-
tion, injury, or accident.
In addition, not only is risk management important for the doctor
but also for every one of his staff.
I was recently brought into a medical office to review their risk
assessment needs. Within the first few moments I noticed there were
patient files on the front desk. It was very easy for me to reach inside
and obtain names and issues of current patients. This is a direct viola-
tion of HIPPA compliance and places the doctor in direct violation of
risk. Since the topic is so broad and there are so many issues to review,
I am choosing three of the most important for both new and experi-
enced physicians.

10.7 RECORDS

Ask any doctor about his or her worst fears and annoyances and they
will tell you that they relate to documentation. Documentation takes too
much time and too much focus away from their daily efforts. Yet, for
the doctor, documentation is vital to overall patient care. Whether you
operate cash or reimbursement practice, documentation is proof for your
modalities, protocols, and sequences for patient care as well as eradica-
tion of the patient’s symptoms. Without documentation it becomes
exceedingly difficult to gain reimbursement for services rendered.
It is well known in the medical profession that notes are a necessary
evil. And, ask many practice professionals and they will tell you that
they are behind with their notes. It is impossible to provide complete
and quality care to patients without good records. Without proper
records there is no way to record your diagnosis, your intended treat-
ments, and your modalities to cure the patient. More importantly, what
is the response to your care?
And when you lag behind in this critical foundation, you defer your
billing, coding, and reimbursement. Even if you do your own billing
and coding you are in critical violation of standard patient care. It
would be most difficult to appear before a judge or an insurance com-
pany inquiry and indicate that you have not documented information on
the relevant days .
In order to justify continuing care it is imperative that you record
the patient’s progress and your objective opinion. This is not an area
that can be delegated to staff. You must do it! However, I do not want
to raise a problem without providing a solution. Therefore, if you are
160 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

poor at documentation then utilize practice management software that is


readily available and requires you to document a patient’s diagnosis
prior to checking out. There are numerous tools that offer this and you
should review them today. If however, you are a student or your budget
does not allow you currently to acquire this type of software, then you
can utilize software and mobile applications such as Dragon Dictate or
even Apple and Windows based software tools that convert your voice
into text. The sooner you gain access to these tools the more compliant
you become.

10.8 CONFIDENTIALITY

All patient information must remain confidential. This is not only the
required ethical standard but also federal law. Most doctors today,
because of their small offices, have very little storage and file space.
However, when patient files are left available for others to see or even
appointment sheets have patient names displayed, all these become vio-
lation of confidentiality. It is then incumbent upon the doctor and his
staff to ensure that all patients’ details remain private.
First and foremost, all patient files should not be placed at the front
desk but rather behind the receptionist or doctor’s assistant so that
others cannot view them. All files along with their labels should also be
placed down so that only the backside is showing, not displaying
patient information. The staff should make this a routine practice in
their daily work. Furthermore, files that are no longer needed for billing
and coding should be immediately filed.
Second, there are times when employers, family members, and even
insurance companies desire to understand a patient’s diagnosis. Both the
staff and the doctor should always err on the side of caution. No
patients information should ever be released without the expressed writ-
ten authorization of the patient himself or herself. Further, only copies
of the required information should be sent. Never release originals to
anyone.
Third, at the beginning, middle, and end of the day we are all
human beings. We all enjoy chat and even some humor. What this
means to you and staff is that at no time are patient names, diagnosis,
and information to be spoken of amongst family and friends and peers.
This is ground for zero tolerance and immediate termination. Patients
visit with you to be cured of their symptoms and not to be the target of
conversation.
TRENDS IN PHYSICIAN PRACTICE MANAGEMENT . 161

10.9 OFFICE MANAGEMENT

Whether or not the doctor is a sole practitioner or has staff, it has no


significance when it comes to risk management. In other words, the
office must have a culture of confidentiality and adherence to ethical
standards. What this means to the doctor can include but is not limited
to: scheduling and rescheduling appointments and placing those
appointments in a confidential file, ensuring that every patient has a file
and all paperwork and administrative detail becomes part of that file,
that every file has a diagnosis and a modality of treatment as well as
the patient’s consent for such treatment. In addition, as it pertains to
some of the information above, the patient also understands his or her
obligation to pay, and if it is reimbursement, the insurance company’s
obligation to pay.
Secondly, when it comes to office management, some cultures and
their environments are formal and others less informal. Yet, there is a
gray area when it comes to riddles, jokes, current event information,
political issues as well as touching hugging, and so on. As soon as a
patient engages with the office as well as the doctor, there is a relation-
ship. That said this relationship requires complete ethical and professio-
nal conduct. There are many times when conversations, touching, and
even implications seem to get out of hand. Boundary issues could be
inadvertent but also tragic. Therefore, every single relationship a doctor
has, which includes the staff, must maintain professionalism. Anything
less and the doctor and the staff will be subject to criminal charges.
Some of the methods that can be used to ensure proper protocols
can include, but are not limited to, a clearly written office procedures
manual. This should also include a code of ethics that can also be dis-
played in the lobby or even in every treatment room. Secondly we all
understand that sometimes trouble can follow us. With that in mind a
doctor and staff need not accept every patient. Some patients appear
more rigid than others and appear to be more problematic.

10.10 TECHNOLOGY

Technology needless to say we are in one of those industries where


technology is very pervasive. From medical devices to prescription
medication, technology seems to be taking over to advance the best
interests of patient care and simplify obstacles in treating patients. There
162 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

is new technology coming out each and every day from telemedicine to
robotics to even new forms of medication that helps treat issues such as
diabetes, cancers, and even the new infectious diseases like Ebola. Doc-
tors are barraged by changes and challenges in technology.
There are far too many technological changes to list in a book such
as this and some of them, such as ICD 10, have already been men-
tioned. Yet, as we are all concerned about patient healing, there will
always be technology to help this cause. In fact, growing might even
suggest from the times when medicine was first founded an individual’s
performance different types of practices to heal patients; technology was
involved. The suggestion here is that if you want to understand technol-
ogy and utilize many of its improvements, then it will be necessary to
remain ahead of the curve. This will require you to remain in touch
with current events and news items whether you choose paper-based
periodicals or simply the Internet so that you understand the benefits of
new technology to you, your staff, and your practice. The only way to
meet change is to continually educate yourself on the process, commu-
nicate the issues to your staff, and understand its effects on your prac-
tice both now and in the future.

10.11 GOVERNMENT

For those of you reading this book outside of the United States whether
it’s from Europe or Asia you have to understand the practices of gov-
ernmental regulation as it pertains to healthcare. Even those in Canada
have regulations from the government of what doctors can or cannot do
and how to treat patients. Some believe this to be fair and many others
don’t. With that in mind the United States has controversially discussed
government getting involved in healthcare in contemporary times during
the Clinton administration and now currently in the Obama administra-
tion. As of the writing of this book, in 2012 the health care reform act
or as aptly named Obama care, was instituted so that individuals who
did not have access to healthcare can get it. The issue for many how-
ever, is the fact that it is a government regulation and penalties will be
instituted for those not signing up for healthcare.
While much of this chapter has dealt with changing trends to come
within the next decade, one of those trends that is being seen more
often is governmental intervention in healthcare. To some this is in the
best interests of the patient, for others it’s in the best interests of the
insurance companies and other bureaucracies that control the healthcare
TRENDS IN PHYSICIAN PRACTICE MANAGEMENT . 163

industry and for yet others, simply a conspiracy. In either case, the gov-
ernment of the United States, as in many other countries, is getting
increasingly involved in healthcare. We have known for years that the
FDA control some of the prescription medications and institutional
ways in which hospitals care for patients, while in other countries indi-
viduals pay taxes for universal healthcare. Since the world has become
a melting pot of ideology due in large measure to the availability infor-
mation on the Internet governments can quickly assess what might be
in the best interest for citizens. What we do know, as has been men-
tioned earlier, is that we are in an unadulterated sea of change and the
winds of that change are blowing in our direction. We can only hope
that with governmental interference there will be fewer restrictions and
better patient care. And we also know that we cannot fight every single
point, especially as it concerns the government. With that in mind we
can only hope that many of the regulations and ideologies soon to come
will be in the best interest of physicians so that they can have a healthy
and prosperous practice and that patients can be cared for wherever,
however, and whenever they need it.

REFERENCES

Samantha, L. July 26, 2014. "New Pay Model Leads Some Physicians to Leave
Mercy: Business." St. Louis Post Dispatch.. http://www.stltoday.com/
business/local/new-pay-model-leads-some-physicians-to-leave-mercy/
article_288d0aec-3515-5d9d-8c24-88188d154fcc.html (accessed March 12,
2015).
Terry, K., A. Ritchie, D. Marbury, L. Smith, and E. Pofeldt. December 01,
2014. “Top 6 Practice Management Challenges Facing Physicians in 2015.”
ModernMedicine Network. http://medicaleconomics.modernmedicine.com/
medical-economics/news/top-6-practice-management-challenges-facing-
physicians-2015?page = full
WEEK 4—FINANCES

If you want to own and operate a practice you must be financially liter-
ate. Being financially literate ensures that you can maintain a profitable
and effective practice. It is one thing to be frugal, another to be a
spendthrift, but very different if you are unfamiliar with the practice
finances. I have seen many practices fold up because of an inability to
invest back into the practice. Financial literacy allows for the independ-
ence to grow in both good times and in bad.
You might be asking yourself why is a conversation about finance
important? The answer is actually quite simple. A discussion on finan-
ces helps you to understand that (1) the more money your practice
makes the more you can potentially keep, (2) the more money you col-
lect quickly the more valuable it is, (3) the less risky the practice the
easier it is to borrow when you need cash and the more sound the prac-
tice, (4) the more money you collect the easier it is to pay bills such as
utilities and staff, (5) and, finally, the more money you collect the more
financial freedom for you. Doctors who are more astute about finances
make better decisions, have more patients, live with less stress, and
have more for retirement.
“A recent poll of the National Federation of Independent Businesses
(NFIB Foundation) found that almost two-thirds of small businesses
experience money problems. Businesses either do not collect enough
money, of they have money but cannot get to it when it is needed.
Nearly one fifth of small business managers reported that cash flow –
how much and when money will come into and found out of the busi-
ness is a continuing problem, one they face daily.” (Katz and Green
2011, 442)
The reasons for the issues mentioned in the quote are three-fold.
First there are many practices that operate like many large businesses—-
they work for shareholder return. Recall, the purpose of a practice is the
acquisition and retention of patients. When you operate under the guise
of a shareholder return you lose focus on your most prized asset making
it more of a liability. Second, a lack of good financial skills just does
not make practical economic sense. Too many practices, good business
people, and even celebrities over the years have entrusted others with
166 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

responsibility for their money. Unfortunately in these cases they have


awoken to a negative capital. Third, many doctors when they obtain
money spend it rather than reinvesting back into the practice. From
large trips to many material items the money is spent foolishly on items
that do not build the practice and, worse, do not invest in retirement.
As a doctor or practice manager you are all you have and when there is
no money there is no future.

CASH IS KING BUT...

The collection of money in your practice will come in several forms but
suffice it to say that cash should be your main attraction. Everyone
from suppliers to vendors to even your staff will require payment in
cash. If cash is not automatically accepted then you might obtain a
check or debit card, which our contemporary society uses (a form of
cash now knows as the debit card which authorize automatic with-
drawals from patient bank accounts). Finally, cash is obtained upon
reimbursement from insurance claims. However, much of this money is
not seen for 90 days or more due in large measure to repayments and
insurance settlements.
The reason for mentioning all this is that good practices engage in
the knowledge of cash flow. Cash flow is nothing more than the flow of
money in and the flow of money out. When there is understanding of
cash flow the practice can expand, keep more money, do more things
such as borrow more or acquire or simply keep more in the bank. What
is really being stated is your ability to engage in good financial
management.

FINANCIAL MANAGEMENT 101

Financial Management begins with the understanding of where the prac-


tice is and where it is going. There are excellent computer programs on
the market such as QuickBooksÓ that allow you and the practice man-
ager to understand the state of the practice. These computer programs
quickly illustrate income and debts while allowing you to automate
checkbook balances, bills to vendors, reimbursements to patients as well
as the ability to run financial reports to understand the state of the
practice.
WEEK 4—FINANCES . 167

One does not have to run many reports, but there are several worth
mentioning to help understand the healthiness of your practice. The first
is the balance sheet. The Balance Sheet represents a quick snapshot in
time of the practice. This provides the practitioner with a statement of
assets and liabilities. Assets are items such as cash on hand, furniture,
equipment owned, and other items and perhaps even long term items
that will convert to cash. For example, assets include cash and equiva-
lent, account receivables, and any inventory you paid for in supplies.
Liabilities are just those that you are liable to repay, something like
debt, leases, and so on. These include plant, property, and equipment
leases. The interesting thing about a balance sheet is that it helps you to
understand the financial health of the practice in both the long and the
short term. A Balance Sheet will help the doctor understand liquidity,
financial flexibility, and financial strength.
There is also the Income Statement, which is a source of under-
standing the practice’s profitability. There is a simple equation to under-
stand your profits, that is, revenue minus expenses equal your net
income. The result indicates your actual remaining cash after expenses
or what the doctor gets to keep, save, invest,and so on.
The Profit and Loss Statement quickly provides a summary of the
revenues, costs, and expenses incurred during a specific period of time
such as a quarter or an entire fiscal year. This will provide a good
assessment as to the value of the practice at any one point in time.
These are just some of many reports that a doctor and practice
manager can review. My advice however is to engage a good account-
ant and financial planner to better understand your financial position
as well as guide you into the best practices for your particular
practice.
Before you venture into building these reports, you might consider
four very useful resources. As I mentioned there are a number of com-
puter software packages that have pre-built templates to assist you with
understanding the strength and limitations of your practice. In addition,
and if you like being even closer to the numbers, you might consider
using a spreadsheet available from either MicrosoftÓ or any other ven-
dor that have templates for financial management. You also might con-
sider using the services of both an accountant and a financial advisor.
The former will conduct a monthly audit of your books and handle
your expenses and the latter will help you with frugal financial manage-
ment. No matter what you use it is highly recommended to not skimp
in this vital area of your practice. Your fees will range from a few
168 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

hundred dollars in software to several thousand in personal services, but


your savings in time, stress, and IRS payments will be well worth it!

PLAYING PSYCHIC WITH EARNINGS

Managing your finances is important, but another area of cash review is


attempting to play prognosticator for future earnings. For centuries,
sales managers have used a forecasting tool to better understand sales
productivity, which also assists corporations with future financial fore-
casting to Wall Street. Well, your practice is also a growing concern
similar to large organizations. With that in mind, one of the best tools is
a Sales Forecasting tool.
Forecasting is an essential ingredient for understanding the future of
the practice. Forecasting is more an art than a science and there is no
magic formula. Moreover, it is a catch-22 in that although forecasting
well can lead to proper focus and helpin reaching the practice’s financial
goals, bad forecasting will lead to missed goals,
and poor internal morale, and stress. Yet the positives outweigh the neg-
atives. Forecasting makes good sense because a forecast allows the doc-
tor and his practice manager to understand economic trends, creative
ideas for expansion where needed, and methods to meet the financial
goals of the practice. Good forecasting is critical to the well-being of
the practice.
Where can you begin? If you are a practicing physician with more
than five years of experience, you already have the data. Simply review
the sales during the last five years and use these numbers to determine
monthly trends. Then use a spreadsheet to divide the year into months
and then decide on a monthly basis (cash only) the total gross income
you believe the practice will make in the current economic year. For
example, let us assume you desire to make $1.2 MM in your practice.
Take a spreadsheet and list the columns from January through Decem-
ber. Then create two rows, first your fee for your services and then the
total patients you expect to see per month. Then multiply the number of
patients with your service fee and you list this in the third row. This
becomes your sales forecast for each month.
Should you sell ancillary products or services such as massage,
exercise classes, pillows, stimulation equipment, vitamins, juices and so
on then each of these products or services should be listed separately
using the formula above. Using this approach allows you to determine
WEEK 4—FINANCES . 169

where you stand with your competitors, how well you might do during
the year, and how the trends are.
Yet in the end, a sales forecast, healthy as it is, becomes nothing
more than an educated guess but it does allow you to get your head in
the game to see how profitable your practice will become. Your sales
plan along with your marketing, your strategy, and your business model
becomes the guiding force that decides whether your practice operates
in the red or in the black. A bit of qualitative research allows you to
justify your reasons for the forecast. And, you might want to have a
“good as gold” forecast and then a pessimistic forecast so that you miti-
gate through volatile periods. The important thing is that you should
not conduct this plan alone. Sit down with your significant other or
financial advisors you can trust and who will allow you to bounce ideas
to gain some insight and determine the best approaches to building the
plan. Do not worry about meeting projections to the actual decimal
point, but do aim to get within a certain range of the target numbers
posted.

SAGE FINANCIAL ADVICE

Some of the world’s best physicians are also the world’s worst money
managers. Get into the habit of saving every month, take a predeter-
mined amount of money from your investments and immediately place
them into savings where they will not be touched. Continue to build
that savings account until it can move to other financial vehicles such
as stocks, bonds, mutual funds, or other cash related instruments. Inves-
ting anywhere from 10 to 15 percent of income can help you eventually
amass a fortune. I also suggest to pay yourself first and then live on the
remains to pay expenses. This will allow you to do two things: (1) it
will force you to start building your fortune and (2) if you need more
money to fund the practice, it will allow you to save more for future
opportunities.
A good book for financial money mastery is Rich Dad Poor Dad by
Robert Kiyosaki. One of my favorite principles is the use of three enve-
lopes named Savings, Investments, and Tithing. Kiyosaki suggested tak-
ing your weekly income and placing it into three piles. Then place an
amount (not necessarily in thirds) in each of the three envelopes. This
exercise is to be done each week as income arrives and should be con-
tinued throughout the course of the practice. By continually forcing
yourself to save and invest, your practice becomes nutritionally sound.
170 •  PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

However, one thing is vital for the success of this exercise—never use
saved money unless there is a financial emergency. I know too many
­people living in $750,000 homes with lawn furniture in their living
room. Which is more important? Sending your children to university or
­flying a private plane to Peru for a holiday? Be smart, be frugal, and live
comfortably.

EXERCISING FINANCES

Financial literacy is similar to exercising for the very first time. You meet
your trainer; you perspire and grimace often, in aberration of every bicep
curl and sit-up. After a while you become more comfortable and endure
less pain. Once you begin saving your income and see your investments
grow, you become more comfortable. The important thing is to simply
come out of your comfort zone. Once you develop the habit of ­savings,
things become much easier. When Warren Buffett, a world famous
­billionaire today, began working he invested just pennies a day. Today
Mr.  Buffett is one of the world’s wealthiest individuals because of his
ability to save and invest.

Wealth is the amount of earnings without worrying


about expenses

CASH IS KING

One of the easiest ways to kill a practice is to spend money foolishly.


Spending too much keeps you in debt, prevents you from saving, and turns
your focus from accumulation to consumption. The recession of 2008 cer-
tainly illustrates the way Americans consume. We typically want more so
we spend more. One way to curb your spending habits is to pay cash for
everything. Cash is much more immediate. Cash allows you to remain
focused on what is in the account and what isn’t. Cash allows you to spend
less because you’ll be more frugal than if you use a credit card. Every
potential purchase is scrutinized more, and decisions are actually wiser.
Most importantly any good financial expert will tell you that you must live
within your means.
Some tips to stop you from spending foolishly:
WEEK 4—FINANCES . 171

. Only borrow money if you can repay within 30 days.


. Rather than spend, pay small debts first.
. Pay off all practice loans.
. Reduce the amount of mortgage payment and car loan.
. Make a wish list; sometimes what you wish for becomes
obsolete.

As you focus more on spending less and saving, there will be a new
focus for your practice and, most importantly, more freedom in your
lifestyle. As your myopic focus switches from spending to consumption,
you begin to enjoy more freedom. Coincidentally, you also notice that
this transformation allows you to spend more time with family and
friends. Your values and your priorities also begin to change. In addi-
tion, you begin to measure your savings against your debt. This allows
you to realize that you are not only building the practice but also your
future.

FINANCIAL MANAGEMENT SUCCESS TIPS

PAY LOCAL VENDORS PROMPTLY

There are a number of folks in my local community. They include


graphic artists, web designers, printers, and shippers. One of my favorite
vendors is the person who owns the local UPS franchise. Many of these
people I see in local restaurants, my church, and other local events. You
want to be the focus of attention for your practice not of your practice.
Therefore, it is imperative to pay for local vendor services immediately.
Your reputation is one of the most valuable assets that you own. In
short, it is good to pay vendors in a timely manner so that you are not
talked about at the local coffee station.

PAY BILLS AS SOON AS THEY ARRIVE

In the midst of the 2008 Great Recession, banks and other financial
institutions with credit cards decided to alter credit card payment plans.
Prior to the recession there was a 30-day cycle. During the volatile eco-
nomic period, financial institutions were worried about cash and so
terms were changed to 20 days. This created a panacea as many con-
sumers were making late payments and incurring high late fees.
172 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

Although Congress revised terms for these institutions, a practice will


be healthier if you pay bills as they arrive. The sooner they are off your
desk the less stress and the less risk of penalty.

PURCHASE EQUIPMENT RATHER THAN LEASE

My wife and I have contentious conversations about the importance of


purchasing versus leasing. There are occasions when leasing equipment
does make more financial sense. However, rather than incurring a
monthly annuity on equipment that increases liabilities and decreases
assets, sometimes purchasing is more prudent. And only lease when it
is absolutely necessary.

REVIEW INVOICES FOR MISAPPROPRIATED FEES

In the last several years and due to deregulation in the telephone indus-
try, there is a plethora of ways in which erroneous fees can hit your
statement. I have personally received thousands of dollars of erroneous
fees on long distance and local charges both on the cell and on regular
landline services. In addition, my cable operator and Internet provider
all have erroneously invoiced me at one time or another. Organizations
make mistakes and that's fine. However, you are the one who will pay
for the error of their ways. Review statements often, and ask to receive
immediate compensation.

SEEK UP FRONT PAYMENT

The one thing I learned many years ago, especially in the service prac-
tice, is to seek payment in advance. I provide inordinate value to my
patients and there is some initial work required before I begin. I simply
ask to get paid in advance so that I can begin the required work. Seek-
ing advanced payment requires fewer rigors and less worry for account
receivables. I have found this to be a healthy way to conduct practice in
the last several years.
WEEK 4—FINANCES . 173

BEWARE OF ADVANCED OR ANNUAL BILLING

During the last several years, I have noticed an increase in advanced


billing for subscription-based services. Whether periodical or Internet
subscriptions, there seems to be an increase in the advance payment
prior to subscription termination. Everyone likes to have their money in
advance but not to the tune of highway robbery. Check your invoices
frequently for malicious behavior. If necessary cancel subscriptions that
desire to invoice you three months.

SEND OUT PATIENT INVOICES IMMEDIATELY

I am always aghast at doctors who wait 30 days to bill patients. You


have a practice that requires income; why wait to obtain payables?
Once you complete service with the patient, immediately invoice them.
There is no reason to wait for services rendered.

SUBCONTRACT SERVICES WHEN POSSIBLE

The increase in the use of technology implies that work is easier. How-
ever, I know too many practice professionals who spend countless hours
attempting to save pennies on airfares and hotels. There are other cases
where many practice professionals spend hours on word-processing pro-
grams and behind printers in an attempt to develop collateral materials.
Why waste precious hours that can be spent in front of a patient rather
than in saving money? A wonderful exercise is to take your gross
income and calculate your hourly rate. Assuming it is more than $50
per hour do not spend time on mundane tasks. Outsource anything and
everything that is possible. Your time is better spent on acquisition and
retention of patients not administration.

STOP WORRYING ABOUT THE JONESES

The proliferation of the media allows you to see the successes of many.
Most certainly technology recognizes success and confers celebrity sta-
tus instantly. Your mission is to simply focus on your foundation and
yourself. Stop worrying about the Joneses. The only conclusion of this
is victimization. Remain focused on three simple things earning, saving,
174 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

and investing. There is little need to be sidetracked by the folly of


others; you are a success in your own right.

SEEK OUTSIDE COUNSEL WHEN NECESSARY

In 35 years of athletics, I find the one commonality in every athlete is


the use of the coach. Every athlete whether elite, academic, or weekend
warrior uses a coach to help influence strengths. There is nothing wrong
in gaining counsel from those who can assist you and provide myopic
focus. If you need help, seek it. There is nothing wrong in gaining
counsel from someone who can place you on solid ground.

WHAT GETS MEASURED

Thus far, we have reviewed some of the fundamental and foundational


components to operating a successful practice. There are other pieces of
information that will provide you some very good indicators of a profit-
able, successful practice. “What gets measured gets improved,” a quote
by Robin S. Sharma, author of The Greatness Guide says it best about
financial management. When you review and measure your success
monthly you improve yourself, the practice, the staff, the patient experi-
ence, pretty much everything.
When coaching, I use a Medical Practice return on investment
(ROI) calculator to help illustrate trends, anomalies, strengths, and limi-
tations of the practice. The Physician or the Office Assistant and I
review these statistics weekly to understand the weekly financial condi-
tion of the practice so that it meets its sales forecasts. The numbers
instantly tell us where changes are required and how well we are meet-
ing annual forecasts.
While all of this data is contained in a spreadsheet it is best to offer
qualitative information here to understand their significance before plug-
ging content into your spreadsheet.
First establish some columns. These include: description of the num-
ber to be analyzed such as patients per week; Dr. Drew’s Sweet Spot,
which is the monthly goal I seek for the practice; benchmark, which is
the monthly goal of the physician; and, finally, a column for each indi-
vidual month. Once complete then there will be an assigned row for
each of the following about to be described.
WEEK 4—FINANCES . 175

Patients per week This number is vital. This information


illustrates the number of patients treated
by a principal, independent contractor,
associate, or employee. In order for a
physician to operate a sustainable prof-
itable practice, a physician should be
seeing at least 85 patients per week.
These numbers not only foundationally
allow the doctor to survive but also
provide the necessary savings resources
to thrive with marketing and other
business development assistance.
Average visit rate The average visit rate is the amount of
money received for medical services.
The average physician is somewhere
between $45 and $75 a visit. Just
remember every physician practices dif-
ferently in both treatment as well as
demography and regional nuances.
Salary Ironically many physicians never pay
themselves for their work. In fact, one
of my clients recently paid his wife a
salary for the first time in 15 years!
Money needs to be allocated for salary
of some kind. Physicians should not live
pay check to pay check. Doing so
provides pathways to the poor-house
as well as a poverty mentality. Provide
some salary for the doctor, for the staff,
and anyone required to aid the practice
including billers and coders.
Practice% Some physicians just beginning their
careers will operate as independent
consultants (IC). Doing so allows the
doctor the freedom to build a practice
without leasing equipment, paying staff,
or a lease. However, the downside is
that depending on the tenure and
patients, the ICs do pay a percentage
of their income to the principal doctor.
These fees range from a flat fee of $500

(Continued)
176 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

for the first six months of service to 5%


of gross income from patients to as
much as 30% of gross income after a
year or after N number of patients. This
number is very important because if the
doctor is not producing enough patient
visits, he or she is operating at a loss
because the principal gets paid with 0 or
100 patient visits.
Case fees—PVA (Patient Your overall PVA accounts for the
Visit Average) average visits per active patient. An
active patient is someone who visits for
initial and continuing treatment of some
condition. To determine PVA, consider
your number of active patients over 12
months and divide that number by the
number of patient visits you had in the
same time frame. For example if you
had 1,000 patients over 12 months and
divided that number by 50 (the number
of active patients), then your PVA is 20.
Further, you can calculate PVA for
specific types of patients under the
categories of personal injury, initial
target, secondary market and so on.
As you know some cases such as
personal injury will have a higher PVA
than others and, after all, in some states
you are limited in the number of
treatments due in large measure to
insurance claims. However, that said,
the higher the PVA the better. I
typically recommend a PVA of 28 or
more. This number provides the doctor
with the important number of how
many patients are retained. In my work,
my typical initial client has a PVA of 10.
I have seen it as low as 5 and as high as
54 or more. Remember, this is an
average, so some patients will treat
faster, others have excuses, others do

(Continued)
WEEK 4—FINANCES . 177

not like treatment, and so on. However,


the more focused the number the more
profitable your practice.
Debtor days/$ Debtors days measures how quickly cash
is being collected from debtors. The
calculation is current date minus invoice
due date. Remember the longer it takes
to get paid the longer it takes for the
practice to receive money. The concept
here is to ensure aside from the insur-
ance reimbursements that 30 days
should be the maximum amount of time
to get paid.
Work in progress (WIP) WIP Days is a vital number to be in
days/$ control of. This calculation is the
number of days, on average, that jobs
are in progress prior to invoicing. One
way of calculating this measurement is
as follows: Days WIP = Total Current
WIP/Direct Costs  Time Period. For
example if you have Current WIP of
$500,000 and Direct Costs for the year
to date of $1,500,000. The calculation
then is
$500,000/1,500,000  365 = 121.667
This means that in this example, the
average WIP Days equals 122. That is
on average, those jobs are in progress
for 122 days prior to invoicing. As you
can see, the higher this number this
more severely it will impact cash flow.
This number needs to be as low as
possible to ensure you get paid on time.
Missed appointments avg It is necessary to always review the
number of both missed and rescheduled
appointments. Your time is money and
when patients miss an appointment, you
do not get paid. Worse if they cancel or
reschedule they actually deter someone
else who might have desired that time.
While many physicians will not invoice

(Continued)
178 . PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

for missed appointments, many still


have a policy of 24 hour notice. I
suggest the use of both policy and
after-a-time fee to ensure patients do
not abuse your time. If there are too
many missed appointments there is a
trend or the staff make it too easy to
cancel. And if there are too many missed
appointments your sales forecasting will
be completely incorrect.
Team count The amount of staff including contrac-
tors. You must account for this number
since this is a line item against expenses.
Revenue Revenue is the amount of money re-
ceived for all services provided. This
number will be counted as gross revenue
for all services provided.
Profit Similar to the line above, this is the
amount of gross revenue received minus
the expenses for the business. In normal
financial terms this is known as net
income. It is computed as the residual of
all revenues and gains over all expenses
and losses for a particular period
whether a month, quarter, or year.
Payment report all pay- This is a very simple report that defines
ment types in summary how the practice receives its
money in the form of cash, credit card,
debit card, check, and insurance reim-
bursements.
Transaction summary re- Evaluates all transactions paid either to
port the practice or directly
Top 15 procedural codes This report reviews the top codes used
monthly to determine if there is con-
sistency in the treatment mix.
Aged trial balance (payer, Alphabetically lists accounts receivable
specialty, provider) with outstanding balances. It displays
one balance for every account by age
and is typically produced only once on
demand to check receivable details
against other reports.

(Continued)
WEEK 4—FINANCES . 179

Days in A/R The number of days vendors and suppli-


ers owe the practice money for services
rendered.
Percentage of A/R This is a percentage of the total balance
of aged receivables.
Claim denial rate The denial rate is a provider metric. It
also often helps to report the top 5 or 10
denial reasons with the denial rate-
—which helps to answer the question
of what exactly is being denied for a
particular provider. This is typically
used in hospitals and medical practices
but a useful term for physicians with
accessibility in these markets.
Payer mix This area lists the breakdown of Medi-
caid, Medicare, indemnity insurance,
and managed care of monies received
by a practice. This allows the physician
to review how they are getting paid and
by whom.
Medicare
Medicaid
Commercial
HMOs
Worker compensation
Personal injury
Cash

The idea of the chapter is to not make doctors or physicians


accountants or financial managers but rather to make them more aware
of the practice. The practice depends largely on cash and cash inflows
to sustain its profitability and it is prudent for the physician to practice
financial prudence—for himself or herself and the staff. The more fis-
cally responsible the doctor, the more profitable the practice. The idea is
not to waste valuable resources, time, and money but rather acquire and
retain. The more astute the doctor in finances the more fiscal, sustain-
able, and long term the practice.
180 •  PRACTICE MANAGEMENT FOR HEALTHCARE PROFESSIONALS

SUMMARY

1. The most successful practice people know how to save and invest.
Live within your means.
2. Spend time on patient acquisition and retention; do not spend time
on menial tasks that take focus away from the practice.
3. Use cash whenever possible and avoid credit cards.
4. Seek financial literacy; those who are educated know the best ways
to invest.
5. Use bookkeepers and other financial experts to keep your books
solid.
6. Pay yourself first but pay bills in time.
7. Always remember to pay local vendors immediately.
8. Commit to save a minimum of 10 percent; deduct from your income
and invest in a planned portfolio.
9. If you’re concerned about assets then take action to develop an
action plan.

REFERENCES

Katz, J. A., and R. P. Green. 2011. Entrepreneurial Small Business. 3rd ed. 442.
New York: McGraw-Hill.Kiyosaki, R. T., and Sharon L. L. Rich Dad, Poor
Dad: What the Rich Teach Their Kids about Money– That the Poor and Mid-
dle Class Do Not! New York: Warner Business, 2000. Print.
INDEX

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Advertising, 67 JHRJUDSKLFSDUDPHWHUV
Aesthetics, 78–79 LQYHVWPHQWV
$I¿UPDWLYHDFWLRQSODQ landlords and leaseholders, 16
Affordable Care Act, 1 PRQWKO\LQFRPH
Alliances, 70 PRQWKO\OHDVHSD\PHQWVDQG
Annual sales forecast, 39 GRZQSD\PHQW
Attrition, 95 RI¿FHGHVLJQDQGOD\RXW±
Awards, 157 RSHQQHVV
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safety, 14
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Blogs, 68, 91 %XVLQHVVSODQQLQJ
Booklets, 69 annual sales forecast, 39
Branding EHQFKPDUNVDQGSODQV
differentiation, 44 FRVWSHUKRXU
H[SHUWLVH FRVWSHUSDWLHQW
ORQJWHUPHIIHFWV FXVWRPHUVHUYLFH
PDUNHWLQJP\WKV± delegation, 35
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SDWLHQWOR\DOW\ PDUNHWLQJDFWLYLWLHV
SURVSHFWLYHSDWLHQWV QHWZRUNLQJDQGPHHWLQJSDWLHQWV
WHVWLPRQLDOV 35
value, 41 SDWLHQWYLVLW
Businesses location SUDFWLFHDFFHOHUDWLRQEXVLQHVV
access, 16 PRGHO±
budget, 16 SUR¿WDQGORVVVWDWHPHQW
EXLOGLQJVSDFH UHODWLRQVKLS
FRPPHUFLDOOHDVHDJUHHPHQWV retention, 34
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182 • INDEX

staff dress, 34 D
WKLUGSDUW\SUDFWLFHV Denial rate, 179
WUHDWPHQWSODQV Delegation, 113
Dress code, 116
C
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Center for Medicare and Medicaid (FRQRPLFV
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&ODLPGHQLDOUDWH 115
Coding, 131 (PSRZHULQJ
&RPPHUFLDOOHDVHDJUHHPHQWV (QWUHSUHQHXUDQGVPDOOEXVLQHVV
accessibility, 19 3–4
additions and exclusions, 19 (TXDOHPSOR\PHQWRSSRUWXQLW\
IXOOVHUYLFHWULSOHQHW 116
OHDVHKROGHULPSURYHPHQWV Ethical issues and risk
security, 19 PDQDJHPHQW
tenants, 19
WHUPRI F
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Culture of concern, 104–106 revenue, 178
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ZRUNLQSURJUHVV ZRUNUXOHVDQGSHUIRUPDQFH
Forecasting, 168 standards, 117–119

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*RRJOH.H\ZRUG7RRO ,QGHSHQGHQFHvs.HPSOR\PHQW
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FRQ¿GHQWLDOLW\ULVNZLWK
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dress code, 116 /DZRI&RPPXQLW\
HPSOR\PHQWDWZLOOVWDWHPHQWV Law of Constant Contact, 47–48
115 /DZRI5HFRPPHQGHG5HVRXUFHV
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116 /DZRI6KRUW7HUP7UDQVDFWLRQV
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advertising, 67
alliances, 70 O
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FRPPXQLFDWLRQV 3DVVLYHLQFRPH
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newsletters, 70 Patient service
SDWLHQW¶VPDUNHWLQJPDJQHWLVP aesthetics, 78–79
65–66 FXVWRPHUVHUYLFHWUDLQLQJ
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referrals, 70 Internet, 77
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value, 45 SDWLHQWLQWHUDFWLRQ
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PHVVDJH± SHUVRQDOLW\VW\OH±
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trusted advisor, 80 stress, 149–150


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65–66 Practice acceleration business
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Internet and instant connectivity, 3UR¿WDQGORVVVWDWHPHQW
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job burnout, 148 Purchasing vs.OHDVLQJ
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PDUNHWLQJLVVXHV
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PXOWLGLVFLSOLQDU\SUDFWLFH 5HFUXLWPHQW
P\WKVRI± Referrals, 70
RI¿FHPDQDJHPHQW 5HSHWLWLRQ±
SDWLHQWHQJDJHPHQW 5HSXWDWLRQPDQDJHPHQW±
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186 • INDEX

Socio-cultural factors, 56–57 WUDLQLQJDQGGHYHORSPHQW


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accountability, 107
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hiring, 95 7HVWLPRQLDOV
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lower attrition, 95 7LPHO\SHUIRUPDQFH±
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Staff retention 7URXEOHVRPHFXVWRPHUV±
awards, 157
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gifts and gift cards, 157 9RLFHPDLO
gratuity cards, 156
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156 Website, 68, 140–143
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158 standards, 117–119
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THIS TITLE IS FROM OUR PRACTICE MANAGEMENT
COLLECTION
Drew Stevens, Logan College of Chiropractic; Maryville University, Editor

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EBOOKS Practice Management for Healthcare

STEVENS
FOR THE Professionals PRACTICE MANAGEMENT
ENGINEERING Drew Stevens COLLECTION
LIBRARY “Medical practices are very complex and different from general
Drew Stevens, Editor
Create your own businesses. As a doctor you not only have to be an expert in your
Customized Content field but also need to understand and deal with rapid changes in
Bundle  — the more healthcare, new governmental policies, insurance changes and
reimbursements, referring physicians and hospitals, and, most
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the higher your

Practice Management for Healthcare Professionals


developed an impressive, comprehensive step-by-step strategy
discount!
that leads to a successful healthcare practice. This is a must
read for anyone in the medical field concerned about increasing
THE CONTENT patient care, revenues, and their position in the market.”

Practice
• Manufacturing —Sudhir Jain, MD FACC MBA,
Engineering Associate Professor of Medicine, Washington
• Mechanical University School of Medicine St. Louis Missouri

Management
& Chemical
Engineering Healthcare is one field that remains a growing industry, ­according
• Materials Science to the U.S. Bureau of Labor. As the youngest baby ­boomers
& Engineering
• Civil &
Environmental
continue to ascend in age, the need to employ ­
­ qualified
health care personnel to both prevent and treat ­medical issues
­increases. BLS suggests that there will be substantial growth of
for Healthcare
Engineering
• Electrical
people in the healthcare field, from practitioners to operations
personnel in administration and technology. Yet, many in the
field struggle.
Professionals
Engineering
This book provides relevant, pertinent, and focused
THE TERMS i­nformation to aid a new or existing practice. The author, a
• Perpetual access for ­well-respected international practice management consultant
a one time fee and medical practice coach, offers insights to revive a ­struggling
• No subscriptions or practice. He provides frameworks, templates, and scripts that
access fees practices can immediately use.
• Unlimited
concurrent usage Drew Stevens, PhD, works with struggling physicians and
• Downloadable PDFs transforms them into wealthy professionals. He works with
­
• Free MARC records medical practitioners and their practices to build leaders,
­
­manifest brands, and orient the practice into a profitable and
For further information,
a free trial, or to order,
sustainable entity. Stevens is an international keynote and
­plenary speaker and in the last 25 years Dr. Stevens has made Drew Stevens
contact:  over 9000 presentations to audiences throughout the world.
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ISBN: 978-1-60650-697-4