Every new change in the health industry radically alters how doctors practice medicine. Patients see it one way — in the treatment they receive, the manner in which it’s delivered and even how it’s paid for. Doctors see it another way — from the administrative side.
For those who want to compete in the quickly consolidating medical community, the choices can be boiled down to a scant two — learn how to become a business person or hire someone who is.
“Physicians could get along quite well with a lot of waste,” says Kathi Jankura, management consultant for Advanced Concepts in Practice Management. “And there was a lot of waste in terms of not really watching on the expense side. You never heard of a physician practice going bankrupt.
“Now that happens. With managed care contracts that are out there, they absolutely have to run a tight ship.”
And not just in the obvious sense, Jankura says.
“Yes, they have to do the billing appropriately and make sure that they’re billing people and recovering the insurance checks and that the patients are paying their balances. It goes way beyond that.”
Plastic surgeon Brian H. Windle, president of Advanced Concepts in Management, learned early on the importance of running a tight ship.
“I think it’s generally a complacency — things have run this way for a long time, they’ve been running OK,” Windle says. “They don’t have the knowledge or they don’t have the system to create the knowledge to know where the problems are. We see practices all the time that just don’t understand whether they’re losing money or not making money.
That’s a drastic change from the cash windfall days of the past.
“(In) medicine today, you’re just not getting the reimbursements you want,” he says. “The golden age is gone. There’s no room for errors on the profit and loss statements anymore. You’ve got to be looking for ways to increase your revenue stream and make sure that you are not missing revenue.”
That includes keeping costs in check.
“You’ve got to be looking for ways to minimize your expenses,” Windle says.. “You can be doing procedures today and actually be losing money. You’ve got to know that. But there are people out there that don’t.”
Windle and Jankura created Advanced Concepts in 1996 to offer their services to practices that just can’t figure out why they’re not as profitable as they should be.
Often, a physician will ask Jankura to come in and “fix the billing.”
“I encourage them to get a full assessment,” she says, “because that’s a symptom. Probably, the problem is happening farther up. It could be the (billing) system. It could be the people that are at the front not following procedure. (It) could be that there are no procedures in place to collect money in the front. It all needs to be looked at. You don’t want to just treat the symptom.”
That full assessment is similar to a check-up for a doctor’s practices instead of the patients. It includes observation, employee interviews, systems assessments (phone, computers, software), a review of the marketing program and patient surveys. Jankura creates reports detailing her findings, which she reviews with each client, and makes recommendations.
Windle says his experience helps him see things from different viewpoints.
“I provide insights from the physicians’ standpoint,” he says. “I think they take it a lot easier. They listen a little bit better. One of my philosophies when we started this — because I’ve had a lot of other consultants come in, I’ve hired consultants myself — it’s a hit and run kind of thing. They come in tell you what you ought to do and run and not see it.”
Windle’s approach is to stick with the client and see things through.
“My attitude was well, I don’t want to become the baby sitter for other practices, but I don’t want to be known as a hit (and) run consultant either. We want to take a look at what you need done and come back on a regular basis and check back with you and make sure things are being implemented.
“(We want to) give you a hand where you need a hand to implement changes, get things tidied up and running more smoothly.”
With the continued changes in health care, Windle expects the need for the services Advanced Concepts provides to grow. They are training doctors in the art of medicine, but they aren’t teaching them the basics of practice management, he says.
“There’s becoming more and more demand,” he says. “There was a day when doctors made their money and paid their bills and they went home and they didn’t spend a lot of time looking at where they can improve. There was a lot of money coming in in the old days.
Windle says running a medical practice is like running any other business.
“It’s like anything else in business today,” says Windle. “I think what happens is you’re always looking for ways to increase your revenue stream, which is one the things we advise docs when we’re going into a practice and looking at them. What way can you increase your practice’s revenue stream?