Archive for October, 2006

A practice with discrepancies between patient and physician perceptions

October 26, 2006

Recently I interviewed the physicians, office staff, and a sample of patients from a specialty medical practice. The results were remarkable in the discrepancy presented between how physicians viewed their strengths and quality of service, and how office staff and patients did.

Specifically, the six physicians in the practice unanimously saw themselves as a community fixture, caring for two to three generations of people in the local area. They believed that they excelled based on their quality of care, communication, and personal attention to patients.

Patients had some different views. While pleased with the overall quality of care they received, they noted that:

– At least two physician are notoriously late for appointments, often causing patients to miss a few hours of work and have to reschedule. In this blue-collar community, missing work for a no-show appointment is costly and frustrating.

– Another physician almost never communicates to patients about test results in a timely manner. This keeps patients in a worried state while they wait to hear good or bad news.

– Patients and office staff complained about how hard it can be to reach their own physician for specific and important questions about procedures and medications.

– Patients complained about certain office procedures that caused them undue hassle and concern. These issues — like having to bring a complete medication list to each appointment — could easily have been avoided with a pamphlet answering common questions and concerns.

There are a few conclusions to draw from this case study:

1. There is often a gap between your “intent” and your “impact.” You may intend to provide exceptional service, but how you do depends on the impact you have on your patients. It is a good idea to survey patients from time to time to see how you are really doing.

2. Every multi-physician practice should set clear performance standards about communicating test results, timeliness, and other factors — and be sure that all physicians are providing consistent service.

3. Communication comes up again and again in our work as an issue. Patients expect timely communication about both the big and the little things, from test results and their treatment plan to what they need to bring to office visits.

4. Be open to feedback without getting defensive. In today’s environment, it is probably impossible to make everyone happy. But good management demands understanding patient perceptions and continuously improving the consistency and quality of their experience. “Getting better” is of course the ultimate standard from the patient’s point of view, but patients still expect to be treated with respect, dignity, and professionalism throughout their episode. In our experience, some physicians refuse to acknowledge that they can do better — and this does not help their standing in the community.


A simple framework for practice management and marketing

October 19, 2006

On my first day at Harvard Business School our class watched a film about business management that summarized the entire MBA program.

The film showed a cartoon of some sort of business, and broke the business into two parts: cash coming into the business, and cash going out of the business.

The goal in any business, including healthcare practices (and our Healthcare Practice Management & Marketing Systems), is to maximize cash coming in and minimize cash going out.

The rest of the MBA program provided 500 case studies focused on exactly how to do that. We kept slicing and dicing the basic premise of maximizing cash in while minimizing cash out into finer and finer elements.

In a healthcare practice, someone should always be asking whether the practice is optimizing cash flow.

For instance, every medical practice should be reviewing its aging of receivables to uncover opportunities to accelerate cash flow, become better at coding, and understand their most profitable services and insurers.

However, in practice optimizing cash flow is not always easy. For instance, the standard way for a medical practice to increase cash coming in is by broadening one’s patient base. However, we work with many medical practices that could increase profits more by DECREASING their patient base and instead focusing on a more profitable patient mix.

Also, it can be challenging to determine the right perspective between short-term cash management and longer term returns. For instance, investment in new equipment can require a substantial cash outlay, with returns to come over time. In this case, it can take a savvy analysis to determine whether a new investment will really increase cash flow over time, above and beyond the cost of the investment and other opportunities.

Many medical professionals resist using a cold, seemingly impersonal business framework because it ignores the human aspect of patient care. But applying this framework actually presents an opportunity to improve care. Practices that provide outstanding quality and an excellent patient experience will generate rave reviews in the community and increase referrals (which ultimately will increase business results). They also tend to optimize both quality and efficiency of care, which makes everyone better off.

Maximize cash in. Minimize cash out. Easy to say, but not always easy to put into practice.

The little things some healthcare practices do that make a big difference

October 6, 2006

There is a local medical practice in my town that does an excellent job with the “little things” — and these personal touches ensure that I am always thinking about this practice and telling others about it.

Here are some examples:

1. After my first visit, they sent me a nice letter thanking me for placing my trust in them.

2. When I referred my father-in-law to see them, they sent me a very nice letter thanking me for the referral.

3. They send some updates about their practice and about trends in my specific health issue to me by mail. These updates are useful and educational to me, and I enjoy reading about them.

4. When I call their office, the office staff is not only extremely professional and friendly (an attribute that is not as common as it should be), but they also seem quite proud to work for this practice. When I asked if a particular physician was known for a certain procedure, they enthusiastically told me about this physician’s reputation and some of his credentials and achievements.

5. One of the physicians in the practice is very visible in the community. He serves on some non-profit boards, and is featured in the local paper frequently — whether about his community service or his advice on certain health issues.

Of course, it helps that this practice has fantastic credentials and a record of excellent quality. But those little, personal touches go a long way, too.

A strategic planning self-assessment for healthcare professionals

October 3, 2006

One of the products we offer with our Healthcare Marketing & Practice Management Systems is a series of concise but effective self-assessments for healthcare professionals to audit their management and marketing practices.

For instance, we challenge professionals to assess their strategic planning process. Following is an example of our strategic planning self-assessment. This is one of twenty-two self-assessments that come with the Business Audit portion of the program.

The purpose of these self-assessments is to give you a concise checklist of best practices in a clinical practice. This checklist follows the Pareto Principle of focusing on the 20% of business practices that get you 80% of the results. Therefore, we don’t claim that it covers EVERYTHING. But it does cover a good percentage of the most important things.

Let us know your thoughts, and whether you do adequate strategic planning in your practice.

Strategic Planning

  • We do a strategic planning process at least annually.
  • This process gathers input from key stakeholders and data about our marketplace.
  • We review our mission and vision for the practice.
  • We assess the size and growth of the market for our services.
  • We compare our own “penetration” to the size of the market.
  • We assess trends in managed care and payments.
  • We evaluate competitors’ strengths and weaknesses, and how we can gain an edge.
  • We assess the strengths and weaknesses of our referral network.
  • We evaluate the depth and breadth of our overall service offerings.
  • We assess the strengths and weaknesses of our marketing.
  • We assess our payers, including our payer mix.
  • We evaluate our clinical utilization rates and quality or care outcomes.
  • We evaluate our cost controls.
  • We evaluate our cost structure and financial ratios.
  • We review our technology.
  • We take a hard look at the patient’s experience, and how to improve it.
  • We assess the capabilities of our clinicians and staff and identify any gaps to fill.
  • We review physician and staff compensation.
  • We assess our risks, compliance, and malpractice insurance.
  • We evaluate our relationship with local hospital(s).
  • We analyze our financial strength, including capacity for debt, days receivables, trends in aging of receivables, payer and patient mix, and profitability by services.
  • We assess our facility and location, including whether we are located in the optimal zip code/area to serve our desired patient base.
  • We do an overall “Strength, Weaknesses, Opportunities, and Threats” or SWOT analysis about our practice.
  • We determine which services and programs to expand, which to defend, and which to exit.
  • We identify the top issues we need to address, and then identify key priorities to address these issues, achieve our vision, and be more competitive and profitable.
  • We set annual performance/financial goals for our practice and develop a plan to achieve those goals.
  • We assign specific accountability to achieve these initiatives, and a communication plan to follow up on them.