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A Quarterly Publication of Florida Medical Group Management Association
Florida MGMA NewsFlorida MGMA News
Vol. XIII Issue I
Winter 2015
Florida MGMA Annual Conference PicturesApril 22-24, 2015 - Omni Orlando Resort at Championsgate
It’s not too late to to join us at the Florida MGMA AnnualConference, April 2224 at the Omni Orlando Resort atChampionsgate. Our conference is packed with fabulousspeakers on timely topics. Don’t miss this opportunity to hearnationallly known speakers and interact with other medicalexecutives right in our home state. You can register on ourwebsite at www.flmgma.com under the Education Tab,then go to the 2015 Annual Conference Page.
Natinally recognized speakers in the healthcare field including:Frank Cohen, Rosemarie Nelson, Will Latham, Ann Bittingerand Tracey Spears will be in attendance as well as other greatspeakers to round out our highly informative conference. Theconference is being held at the beautiful Omni Orlando Resortat Championsgate which is surrounded by 36 holes of championship golf. This Four Diamond resort is one of the nation’spremier golf, meeting and leisure retreats. Omni OrlandoResort features Mokara spa, fabulous dining at seven restaurants and 15 acres of pools and recreation activities includingan 850foot lazy river.
Don’t miss this opportunity to network with other administratorsfrom across the state of Florida and hear from national speakers on the most up to date information in medical practice management.
2014 2015 BOARD OF DIRECTORS
President
Marynell Lubinski, FACMPEMiami Jewish Health Systems
President Elect, Conference Chair
Sherry Mills North Florida Surgeons
Treasurer
Ilene GilbertDroge, FACMPESMH Physician Services, Inc.
Past President
Michael A. Franks, MPA, CMPE Premier Dermatology
Florida Collaborative Chair
Kevin LockettMayo Clinic
ACMPE Representative North
Tom Menichino, FACMPEThe Villages Health
ACMPE Representative South
LoriAnn Martell, LPN, CMPE
Advanced Medical Center, Inc.
Vice President North East
Thomas BalestrieriNoPark Avenue Dermatology
Vice President North West
Chip Geitz, CPA, CMPEMedical Center Clinic
Vice President Central
Gerry Bessette
Medical Associates of Brevard
Vice President Central West
Tracey MitchellUSF Physicians Group
Vice President South East
Mario SalcedaMemorial Healthcare System
Past President at Large
Henry Del Riego
FIU HealthCare Network FIU Health
Member At Large
Kevin Pizzuti, CMPEOcala Kidney Group
Executive Director
Lisa Beard(561) 4526702 ~ [email protected]
Dear Colleagues,
This spring newsletter finds us lookingforward to our annual conferenceplanned for April 22nd – 24th at theOmni Orlando Championsgate. Theconference committee has prepared atop lineup of speakers includingRosemarie Nelson and Frank Cohen.In addition to the educational sessions, there is ample time to networkwith colleagues, one of my favoritefeatures of the conference. Whetheryou’re a new administrator in a smallpractice or a seasoned executive in alarge group, this conference will provide practical tools and information tohelp you “drive the course” to manageyour practice.
The current healthcare environment ischanging faster than ever before.Reimbursement is quickly evolving topay for performance, and the importance of gathering and analyzing yourpractice data cannot be understated.Florida MGMA continues to offer several webinars throughout the year toprovide you tools to tackle these challenges. Our webinars are presentedby nationally known speakers on avariety of current topics. They are freeto FMGMA members and the value ofone of these webinars alone outweighs the cost of your annualFMGMA membership. I encourageyou to take advantage of as many ofthese webinars as possible. If youappreciate the value they offer,encourage your colleagues to joinFMGMA as well to take advantage ofthe free programs. As an addedbonus, these live webinars qualify forACMPE credits for those members inthe certification and fellowship programs.
Remember to participate with a localchapter in your area to complementyour FMGMA membership. Most localchapters offer monthly meetings, providing both the opportunity for education, and for valuable networking.Florida is a large state with distincthealthcare markets. These localchapter can help you connect with colleagues dealing with similar challenges. Specific information on thelocal chapters can be found in theFMGMA website at www.flmgma.com
I look forward to seeing each of you inOrlando in April!
Sincerely,
Marynell Lubinski, FACMPE
Florida MGMA President
A Message from the President
Marynell Lubinski, FACMPEFlorida MGMA President
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What is the future of the small medical practice?
With the enactment of President Obama's healthcare reform, the Patient Protection and AffordableCare Act (ACA), there is much speculation that smallmedical groups or sole practitioners will go the way ofthe buggy whip. Dr. Ezekiel Emmanuel, one of theWashington architects of reform, contends that inorder for American health care to fulfill its promise,larger groups will be imperative in order to reducecosts and increase positive outcomes for patients.The large 100+ physician groups will ensure continuity of care and increase communication among theprimary care physician, specialist, and hospital.Empirical studies demonstrate that an integrateddelivery model perhaps can achieve these desiredresults.
What this does not contemplate, however, is asignificant reduction in competition
In normal functioning markets, competition leads toimprovements in quality and cost. Therefore, is it correct to presuppose that competition increases theefficacy of health care? Nicholas Bloom of Stanfordbelieves so. In The Impact of Competition onManagement Practices in Public Hospitals, Bloomposits that hospitals with higher numbers of localcompeting hospitals have better management practices. Martin Gaynor of Carnegie Mellon Universitydiscovers in What Do We Know About Competitionand Quality in Health Care Markets? that Medicarepatients show a positive impact of competition onquality. In his recent economic research, Gaynor andCarol Propper review approximately 13 millionadmissions at the National Health Service in theUnited Kingdom. The authors find that hospitalslocated in areas where patients were provided morechoice received higher clinical quality as measuredby duration of hospital stay and lower death rates following admissions.
McKinsey & Co. recently published a paper, Whenand How Provider Competition Can Improve HealthCare Delivery. The authors theorize that thestrongest argument in favor of competition is that itcan be designed and deployed to create potentincentives that encourage providers to innovate sothat they can deliver higher quality at lower cost.
What is the correlation between competition anda fragmented physician base?
One theory suggests that if there are fewer practices,competition will decrease, thus raising prices. Many
experts believe, however, thathealth care demand is fairlyinelastic meaning that one consumes a good or serviceregardless of an increase inprice. For example, if you aresick, you will not be very pricesensitive.
There are exceptions, ofcourse, to this rule e.g. electivesurgery and the purchase ofeyeglasses. Yet, Amanda Kowalski of Yale Universityargues that health care may, in fact, be elastic. Dr.Kowalski uses the most recent wave of cost controlinitiatives in the medical community to demonstrateconsumer responsiveness to price. As an example,the Medicare Modernization Act of 2003 establishedtaxadvantaged health savings accounts as an incentive to encourage price responsiveness for individuals who enroll in high deductible health insuranceplans. Kowalski concludes that the price elasticity ofexpenditure on medical care is much larger than literature would suggest. If, indeed, Kowalski is correctin her hypothesis that price does play a role in healthcare, then a material decrease in competition, whichwould perhaps increase prices would have a negative effect on health care utilization.
The caveat in drawing conclusions about healthcare policy is that its a process rife with room forerror
But if one looks at historical reform there is markedcyclicality. Managed cares rise and fall suggests thatafter a period of increased regulation, policy is ultimately manipulated and stringent guidelines arerelaxed. The financial industry provides some salientclues. After the Enron bankruptcy and collapse ofWorldCom, the SarbanesOxley Act was enacted in2002 in order to initiate new or enhanced standardsfor publiclyheld companies, their managementteams and boards, and public accounting firms.Millions of dollars were poured into increasedaccountability and reporting by publiclytraded companies. Law firms and accounting firms prospered;after a few years, policies were relaxed and businessresumed.
This is not to suggest that health care reform is good
4
or bad; reasonable people will agree that Americacan do a much better job. And this is not to argue thatthe reforms will not be permanent, which would helpthirtymillion Americans access care that perhapsthey should have had for years. What this does meanin a milieu of sweeping change is that physiciansshould take a measured approach to the future oftheir practice.
Before contemplating rash mergers or consolidation, reflect on those practices around you whorushed into electronic health records
Today, many of those physicians who attempted toget ahead of the technological curve before the regulations were finalized and the respective softwarewas refined now have a significant investment sittingin their office that must be written off. This is not tosuggest that consolidation or mergers is an inappropriate strategy for the longterm success of practices.The benefits of mergers are extensive, but there issignificant peril and irreparable consequences if theyare not executed thoughtfully without the assistanceof a trusted advisor. For example, what type of entitywill be formed? How are profits shared? Is there realproperty involved? How will physicians allocate overhead? What happens if a physician leaves? Are theredifferent tranches of stock? Are there buyback provisions?
Before Washington writes off the small practice,one should analyze California
According to the California Medical Association,almost twothirds of patients within the state receivetheir primary care from a small practice. And with anincreasing number of insured Californians, demandfor care should increase. Persons with health insurance use more health care services than personswho are uninsured, writes Thomas Buchmueller, ahealth economist from the University of Michigan.Accordingly, demand should increase for physicianvisits, preventive services, disease managementservices, and prescription drugs. Janet Coffman ofthe University of California, San Francisco agrees. InThe Impact of National Health Care Reform onCalifornias Health Workforce Needs, she projectsthat there will be an increase in demand for healthprofessionals.
With this increase in demand and the historical trendof Californians receiving care from small practices, itshard to fathom the demise of the independent physician. Today, these practices are the backbone of ourhealth care system. California may be the birthplaceof HMOs and home to many of the largest medicalgroups in the country, but ironically, most of the statesresidents receive their care from physician officeswith only one or two practicing doctors. For manycounties in the state, these practices are the onlysource of care for residents.
Reed Tinsley, CPA
What is the future of the small medical practice?
6
Active Members
Lisa AtkinsonUniversity of Florida, PedICareGainesville
Cynthia BillupsAnesthesia ServicesFort Myers
Mark BloomGoldberg Memorial Healthcare SystemHollywood
Loretta Burbridge Memorial Healthcare SystemHollywood
Larry CohenClearlyDermBoynton Beach
Shawma CooleyUniversity of Florida, PedICareOrlando
Katherine DadismanWomen’s Care of Florida, LLCTampa
Melanie DelkUniversity of Florida, PedICareJacksonville
Barbara DiamantisFirst Physician’s GroupNorth Port
Maribel Diaz Memorial Healthcare SystemMiramar
Vielka EnriquezUniversity of Mami Miami
Lori FischerInfants and Children, P.A.West Palm Beach
Florida MGMA Welcomes New Members
Michelle FosterUS Anesthesia Partners/JLRMedical GroupMaitland
Misty GladdenUniversity of Florida, PedICareGainesville
Milen Gonzalez Memorial Healthcare System Hollywood
Joan Griffiths Memorial Healthcare SystemHollywood
Vedner Guerrier Memorial Healthcare SystemHollywood
Patricia Helsdon Memorial Healthcare SystemHollywood
Kim Herron Memorial Healthcare SystemHollywood
Catalina Hinestroza Memorial Healthcare SystemHollywood
Ashley HulseyTallahassee Neurological ClinicTallahassee
Chem JacksonUniversity of Florida Orlando
Kelsey JacobsJohn T. Littell M.D.Oviedo
Martha JohnsonUniversity of Florida, PedICarePanama City
Kathy LieffortThe Villages HealthThe Villages
Roslyn LindsayMemorial Healthcare System Hollywood
Linda Magrone Memorial Healthcare SystemHollywood
Michelle McClellanMemorial Healthcare SystemHollywood
Yvette MontveliskyMemorial Healthcare SystemHollywood
Roslynn O’RourkeOrlando Family PhysiciansOrlando
Stephanie PolandUniversity of Florida, PedICarePensacola
Elizabeth QueletVascular Associates LLCPanama City
Jorge QuinteroMartin Health SystemStuart
Marcia Ramirez
Memorial Healthcare SystemHollywood
Mischelle RegisterNorth Florida OB/GYN Baptist Jacksonville
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Florida MGMA Welcomes New Members, continued
Sheri RobinsonFirst Physicians Group of SarasotaMemorial Healthcare SystemVenice
Ronald RomearInfants and Children, P.A.West Palm Beach
Jessica Romero Memorial Healthcare SystemHollywood
Kam Rouhani Memorial Healthcare SystemHollywood
Heidi SalibaUniversity of Florida, PedICareGainesville
Simone Santana Memorial Healthcare SystemHollywood
Jennifer SavageOrlando Health Physician Assoc.Altamonte Springs
Denise SchneiderUniversity Urologists, a division of UGFLake Worth
Yana Shustin Memorial Healthcare SystemHollywood
Terri Sorrels Memorial Healthcare SystemHollywood
Nina SotoLiebman Memorial Healthcare SystemHollywood
Holly Strickland, MAAdvanced Women’s CarePensacola
Amy SylviaHenghold Skin Health & SurgeryGroupPensacola
Brian ThornFaben Obstetrics & Gynecology, LLC Jacksonville
Joanna Torres Memorial Healthcare SystemHollywood
Christopher TurnerUniversity of Florida, PedICareTampa
Marie Whitcomb, BS, MBAFirst Physicians GroupSarasota
Joanna Williams Memorial Healthcare SystemHollywood
Lynne Wrubleski Memorial Healthcare SystemHollywood
Lisa YelinBorland Groover ClinicBoynton Beach
Arlene Zepeda Memorial Healthcare SystemHollywood
Tori ZoreOorthopaedic Associates of WestFlorida, PAClearwater
Corporate Member
Carol Crews, CMPE, [email protected]
Bill Shelton, [email protected]
Jim White, [email protected]
Affiliate Members
Lawrence AchlerEMworkPort Orange
James AlexanderJITA Medical Billing & ConsultingSanford
Katie ClaxtonHealthPortAlpharetta, GA
Gianni GonzalezHealthCare ManagementSolutions, LLCJacksonville
Rhonda HoodUnitedHealthcare Maitland
Sally HuzyakProAct Health Solutions, Inc.Celebration
Deanna LessardPalm Beach County MedicalSocietyWest Palm Beach
Rebecca LynnEMworkPort Orange
Paulette PilcherProAct Health Solutions, Inc.Celebration
Marcial WongBlue Ridge Xray Company, Inc.Arden, NC
Student Member
Dale HardawayUniversity of Central FloridaOrlando
Managing Your Practice’s Revenue Cycle in 2015
It's 2009 and you are looking at your key performance indicators (KPIs) from 2008. It was a difficultyear due to the recession, but your practice made itthrough OK. Your payment mix was positive — thepercentage of major insurance carriers was consistent with the previous year.
It's now 2015: You are again looking at your KPIs andrealize the payment environment has changed radically. Patients are now responsible for a much largerportion of their medical bill, and there has been a significant increase in the size of outstanding patientbalances. This is in spite of the increase in insurancecoverage due to the healthcare exchanges.
Several questions come to your mind: What is happening when patients check in at the front desk? Arestaff letting patients know what their outstanding balance is? What is happening on the back end withpatient collection efforts after the visit is concluded?
So you look and ask:
1. Does your practice's financial policy (that statement given to patients and posted on the website)state that payments are due prior to seeing theprovider?
2. What does your daily collections report show? Thissimply states, based on today's schedule of patients,how much was collected in terms of dollars, howmany patients were collected from, and if there wasno collection posted, why that occurred.
3. Does the front desk get accurate information onthe copay, deductible, and past due balances for allpatients? Are there inaccuracies, preventing themfrom asking for or collecting the amount due? Is thatinformation provided in a timely manner?
4. Do automated/staff generated appointmentreminder phone calls suggest that there will be a payment required prior to seeing the provider?
5. Do you have adequate guidelines for staff concerning patients who don't pay prior to seeing theprovider? Does your staff have the authority toreschedule a patient if payment is not made? Whenis this clinically acceptable?
6. Does your malpractice carrier provideguidance in terms ofnot seeing a scheduled patient due tolack of payment?
7. Is there adequatetraining for frontdeskstaff in how to ask forpayment at the time ofvisit?
8. Have staff members have been assigned to identify and collect outstanding patient balances?
9. Are there options through the patient portal to collect outstanding patient balances?
10. What is the practice position on collecting from anew patient with a high deductible plan? Do youmake sure you see the patient after the visit to ensurethat the level of services and all services provided aredocumented and can be collected at check out? Isthere an estimate of cost provided to the new patientat intake — on the initial call, as well as at check in?
11. Is there guidance for staff on the occasionalpatient who is private pay and requests a discount —e.g., offer a 25 percent discount (or even 50 percentif you have a fee schedule strategy of 200 percent ofMedicare, which means that the patient paymentwould be equal to that of Medicare)?
There is no time like the present to review yourpatient payment strategy.
One more thing — there was a slight adjustment inthe Medicare conversion factor from $35.80 to$35.75 as of Jan. 1 (which was a technical changeand not an SGR revision); but remember too, thatMedicare allowances will change as of April 1, 2015.There could be a significant hit, but more likely therewill be a small change in the allowable amount at thattime. Just be aware of it.
Owen Dahl, FACHE, [email protected]
8
PROTECTION
UNCOMPROMISING
As the nation’s largest physician-owned medical malpractice insurer, with
75,000 members, we constantly monitor emerging trends and quickly respond
with innovative solutions. And our long-standing relationships with the state’s
leading attorneys and expert witnesses provide unsurpassed protection to our
over 15,000 Florida members. When these members face claims, they get
unmatched litigation training tailored to Florida’s legal environment, so they
enter the courtroom ready to fight—and win.
Join your colleagues—become a member of The Doctors Company.
CALL OUR JACKSONVILLE OFFICE AT 800.741.3742 OR VISIT WWW.THEDOCTORS.COM
IN FLORIDA, WE PROTECT OUR MEMBERS WITH THE BEST
OF BOTH WORLDS: NATIONAL RESOURCES AND LOCAL CLOUT
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9
Florida MGMA Free Member Webinar
April 14, 2015 at 1:00pm EDT
Gamechanger: How do HDHPs affect medical groups?James C. Larson, FACMPE
About this webinar: High deductible health plans, or HDHPs, are revolutionizing how physicians are paid. Some striking information wasrevealed about HDHPs by a survey of MGMA members: 92% of respondents to the survey have seen an increasein the number of patients with HDHP insurance in their practice. These plans shift more of the financial burden forcare to patients, but at the same time, many patients don’t understand their benefits and some cannot afford thedeductible. 61% of respondents reported a decrease in patients’ understanding of their benefits, and 71% reported adecrease in patients’ ability/willingness to pay in full. This is causing many physician practices to feel pain in their revenue cycle more selfpay accounts receivable, and more bad debt. 71% reported an increase in selfpay A/R; 66%reported increasing bad debt. Forward thinking practices are responding to the HDHP challenge. This webinar will explore how HDHPs are impacting MGMA members and how they are changing their game to improve patient responsibility collections.
About the presenter: James C. Larson, FACMPE is a boardcertified medical practice executive and a Fellow in the American College ofMedical Practice Executives with a proven track record of success in physician practice settings. Mr. Larson hasowned a successful medical billing company and has held executive positions with Charter Medical Corporation,Columbia/HCA, and the Health Alliance of Greater Cincinnati. He has managed several physician practices, from asolo practitioner to large multispecialty groups. In addition to operating freestanding diagnostic centers, Mr. Larsonhas directed three Management Services Organizations, the largest serving over 800 providers.
Florida MGMA offers Free Member webinars
To sign up for our monthly webinars, go to our website at www.flmgma.com and Login to the Members Only Area with your User Name and Password.
Once you are logged in, go to the Education Tab and go to the Webinars Page to sign up. Past webinars are also archived on this page and are available ondemand for three months
after the original webinar date.
Membership Dues must be current to view this page.
Space is limited, sign up early!
If you have trouble logging in to our website please email us at [email protected].
Future Webinar Dates:June 9thJuly 14th
August 11thOctober 6th
November 10thDecember 8th
Check your email and our website for webinar topics and sign up information.
10
Membership DriveJanuary 1, 2015 April 15, 2015
Recruit a colleague to join Florida MGMA and be rewarded with a
$25 Gift Card of your Choice.
$25.00 gift card$25.00 gift card awarded to any Active Member who refers/recruits a new Active Member.
(Target, Best Buy, Starbucks, or WalMart Card)
Upcoming Florida MGMA Member Benefits
Free Member Webinars Free Member Webinars April 14, 2015 at 1:00pm EDT
Webinar Title: Gamechanger: How do HDHPs affect medical groups? James C. Larson, FACMPE
Florida MGMA Annual ConferenceApril 2426, 2015
Omni Orlando Resort, Championsgate
Quarterly Newsletters, Email Blasts
Membership Brochures can be downloaded from the website www.flmgma.comor by request brochures will be mailed.
Be sure your name is filled in under Referring Member! Please contact our office [email protected] or (561) 4526702 if you have any questions.
HAPPY RECRUITING!HAPPY RECRUITING!
All Active Members recruiting 5 or more newActive Members will be eligible for theGrand Prize Drawing to be held at the
Annual Conference for a GoPro Camera!
12
As changes continue to occur in the healthcare industry, physicians are taking a hard look at the numbers ofa medical practice and gauging whether the year athand will be economically successful. To analyze theproductivity of the practice, physicians depend onaccurate and timely information. However, with thefocus of every practice on delivering quality healthcare, the financial side often becomes neglected orignored.
Frequent signs that a practice may not be payingenough attention to its financial side include: a lack ofdocumented billing procedures; lack of internal controls involving accounting and cash; lack of timeliness;no accountability for staff; missing or outdated records;and the lack of targeted benchmarks.
In order to run a practice profitably, a physician shouldreview weekly financial and cash flow updates to calculate overhead and determine how much to collectand how many patients are needed to cover thosecosts. These updates also allow physicians to determine the level of patient visits, frequency of procedures, trends in expenses and changes in activities.
Develop a simple accounting system. Creating adependable and userfriendly accounting system isthe key to successful financial reporting. By engagingan accounting professional, practices can create asystem that works for them. The system needs to beable to generate weekly and monthly reports on thestatus of the office and must be kept uptodate.
Buying easytouse accounting software is the firststep. Staff also must also be properly trained so datainput is timely and correct.
It’s also important that a professional accountant frequently review the activity in a practice’s accountingrecords, especially if the practice is growing, addingdoctors, expanding or is new. This review will allow apractice to properly report financial conditions andtimely tax planning. The last thing a physician wants tofind after months of recording the books are surprisesin regards to gains, losses or tax liability.
Implementing and documenting medical billing procedures is critical in today’s environment. Accurate medical billing (especially CPT coding) is extremely important to the success of any practice. Creating processes that ensure data is captured properly and timelyshould become a top priority. Staff should be aware of
what is expected of them and how to get it done effectively.
The best way to establish these procedures is to placeproductive but reasonable practice goals with eachstaff member. Goals could include daily charges input,daily payments input, acceptable lag time days, number of claims that have received followup, number ofpatient calls to make, zero lag time on correctingclaims transmitted, compliance with credit balancesand compliance with coding and documentation.
Several areas that should be closely monitored in thebilling process include regular followup on claims andappropriate attention to denials, zero EOBs and transmission rejections.
Next, make sure to create a continuous communication cycle. Because of the pace of a physician’s office,formal communication between doctors, managementand staff often is fragmented, neglected or postponed.Animosity can develop between management andstaff because of inaccurate assumptions.
Management must take ownership of this responsibility and strive to communicate with staff. Key issuessuch as turnover of personnel, additional hiring of personnel to support practice functions and new processes needing implementation should be communicatedtimely. Staff meetings with specific agenda items andformal memos documenting new policies and decisions seem to work well for physician offices.
Finally, establish your benchmarks – this I havepreached to you in the past. Benchmark all practicestatistics and most importantly, see how you are doingthis year compared to last year. If the year is flat ordeclining, investigate immediately and develop anassociated action plan of attack.
Through planned and integrated accounting, medicalbilling, communication and benchmarking, a physician’s office can run smoothly and continue to care forpatients while being uptodate on the economics ofthe practice.
Reed Tinsley, CPA
Reed Tinsley, CPA is a Houstonbased CPA, Certified ValuationAnalyst, and healthcare consultant. He works closely with physicians, medical groups, and other healthcare entities with managed care contracting issues, operational and financial management, strategic planning, and growth strategies. His entire practice is concentrated in the health care industry. Please visitwww.rtacpa.com
The ABCs of Building a Financially Healthy Medical Practice
Overcoming the “Dirty Little Secret”
Effective group governance is now a survival skill formedical groups. Unfortunately, many medical groups,both large and small, suffer from something I call the“Dirty Little Secret.”
Here’s how it works:An individual physician thinks: “If I don’t like a groupdecision, or I didn’t vote for the decision, I don’t haveto abide by it or support it.”
Of course, no one really comes right out and saysthis, but that is often the way individual physicians act.This type of thinking can kill a group. If you have littleexpectation that the group members will implementgroup decisions, why spend time making decisions?
What can your group do about this? I believe thatevery group needs to ask and answer three fundamental questions:
1. How will our group make decisions?
2. What is expected of each physician once a decisionhas been made?
3. What are a physician’s options if he or she doesn’tlike the decision?
Let’s consider each of these questions in turn.
QUESTION #1: HOW WILL OUR GROUP MAKE DECISIONS?
The group members need to agree on a fair and reasonable process to discuss issues and make decisions.
It is reasonable that there be some discussion on theissue, and then voting on the issue. It may be that thegroup will agree to empower a subset (such as aBoard) to make certain decisions for the entire group.
However, as I will discuss in later postings, I think it isunreasonable to require unanimity on decisions, andyou must be very careful in pursuing consensus(which most people take to mean unanimity). Intoday’s environment, the group needs to be able tomove forward with a majority (or depending on theissue, supermajority) vote.
QUESTION #2: WHAT IS EXPECTED OF EACHPHYSICIAN ONCE A DECISION HAS BEEN MADE?
What you want to hear includes:• Do it.• Abide by it.• Implement it.• Support it.• Not sabotage it.• Not complain about it to outsiders.
If you don’t hear the group members stating theseexpectations, or hedging on these items, you will suffer from the “Dirty Little Secret.”
QUESTION #3: WHAT ARE A PHYSICIAN’SOPTIONS IF HE OR SHE DOESN’T LIKE THE DECISION
There are three:1. Do it anyway: That’s group practice. If you want tobe in group practice, there will be times when youmust support something you may not fully agree with.2. Try to get the decision changed: But in the rightforum (i.e., the Shareholder or Board meeting), andcontinue to abide by the decision until it is changed.3. Selfselect yourself out of the practice. I know thisis a tough one, but each physician should commit toeither supporting group decisions or leaving thegroup. The expectation should be set that a physicianwill not and should not stay with the group if they won’tabide by group decisions.
IN REAL LIFEA number of years ago I began a strategic planningretreat by asking a group these three fundamentalquestions. After the group agreed on how they wouldmake decisions, what was expected after a groupdecision was made, and what were a physician’soptions if they did not like the decision, one of thephysician said to me: “So, let me get this straight – intoday’s meeting, we are going to make some decisions?” “Yes,” I replied. He then said “And we arereally going to implement the decisions we make?”“You just agreed to do so,” I replied. And then he said“well, I guess I am going to have to pay a lot moreattention today than I have at any other planningretreat I’ve attended!”
A very telling comment. Prior to agreeing on thesequestions, he knew that there was no real commitment or expectation that individuals would adhere toand implement group decisions, because the group
continued on page 14
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group decisions.
3. Avoids wasting time “making pasta:” How do youknow when pasta is ready to eat? Throw it against thewall and see if it sticks. Unfortunately that’s how manymedical groups operate – let’s make a decision andbe hopeful that people adhere to it (that it sticks). Inmy view, why waste a lot of time struggling with decisions if adherence is optional?4. Many issues/little time: Group governance andmeetings can consume a substantial amount of time.It is exhausting, frustrating and excessively time consuming to have to guess whether or not people willsupport each and every decision. Groups whosemembers precommit to support group decisions function much more effectively than those that suffer fromthe “dirty little secret.”
It is true that not everyone will live up to their commitments in regard to group decisions. As JamesMadison said, “if men were angels, no governancewould be necessary.” In later articles we will discusshow to deal with those who do not follow group policies. But, as an important first step, ask people to precommit to adhering to group decisions.
Will Latham, CPA, MBALatham Consulting Group
For more than 25 years, Will Latham has worked with medicalgroups to help them make decisions, resolve conflict and moveforward. Will has an MBA from the University of North Carolinain Charlotte and is a Certified Public Accountant. He is a frequentspeaker at local, state and national, and specialtyspecific health
care conferences.
Overcoming the “Dirty Little Secret” continued
had never agreed that it would. The answers to thesequestion form the basis of developing any effectivesystem of group governance.
There are four additional important reasons thatgroups should ask and answer these questions:
1. Leads to real discussions: In our experience physicians tend to be conflict avoiders, when it comes tophysiciantophysician conflict. In many groups, anindividual physician “knows” that he or she will not beheld accountable in regards to adherence to groupdecisions. If this is the case, the physician may avoidtalking about an issue in a group meeting, counting onthe fact that no one will challenge their nonadherenceto group decisions at a later time. Their thoughtprocess seems to be: “I can avoid conflict now by notspeaking up, and I can probably avoid it later as noone will challenge me – because they are all conflictavoiders also.”
However, if each group member precommits toadhering to group decisions it is much more likely thatthey will raise dissenting opinions as part of the discussion. This means that the group will have a morecomplete and richer discussion about the issue.
2. Eliminates the fiction of unanimity: Many groupsspend hours and hours trying to get everyone to votefor an issue, thinking that if everyone votes for thedecision then it will be much easier to implement thedecision. But it’s likely that everyone doesn’t agree –in the end they just vote for the issue to avoid conflictin the meeting They then turn right around and ignorethe decision. Stop wasting time with pursuing falseunanimity. Get people to precommit to supporting
14
Florida MGMA Job Board
Executive Director Lifeskills of South Florida Deerfield BeachManager of Operations Gastroenterology Consultants, PA HollywoodBusiness Office Manager Women's Health Specialists Jensen BeachPractice Manager Family Practice MiamiBilling and Coding Manager Family Physicians OrlandoDirector, Clinical Services Sarasota Memorial Health Care System Sarasota
Visit our Job Board at www.flmgma.com under the Jobs tab for information on these and additional job postings. Members can post their jobs online at no cost.
It’s time to get recognized for your skills, knowledge and experience as a medical practice professional; become a Certified Medical Practice Executive (CMPE) today!
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Visit us on the web at www.flmgma.com
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