5 truths about physician practice management

Wow. There is no other word for my newfound perspective on what practice managers actually do. Just wow. Last week, I spent about three hours behind the scenes at a mid-sized independent primary care practice. In the grand scheme of things, that's a mere snapshot, but it was immeasurably telling.

I learned more about your jobs (as well as mine) in one morning than I know how to condense artfully, so I'll attempt to list some of my most powerful takeaways from this experience:

Running a practice is intense. The practice-management challenges are far more numerous, relentless and profound than I ever conceived. I felt more like I was watching a scene from Pushing Tin than an episode of Private Practice. While my host, the practice manager, wasn't "landing planes," she shared with me candid insights about numerous topics, from preauthorizations to credentialing to filing death certificates to e-prescribing and Meaningful Use to closing the loop on specialist referrals to adding revenue streams. In addition to the everyday work of ensuring patients get quality medical care and service, these issues are omnipresent and seemingly multiply like Gremlins exposed to water.

Cross-training is invaluable. I've passed along consultants' advice to cross-train medical office employees on numerous occasions, and these staffers confirmed its validity before I even had to ask. Almost all of the employees at this particular office were medical assistants (MA), which clearly helps with their versatility. The person who typically rooms patients also fills in at the front desk. Those in charge of billing are well-versed in asking patients about their preventive care. During my whirlwind tour I didn't quite sort out everyone's role or have time to take many notes, but I remember these exact quotes from employees: "We can run this office ourselves with just a skeleton crew--it's great." "We're all able to move around to where we're needed and we don't get bored. The days fly by." Many of the staffers have been with the practice for close to 15 years and have thus accrued about a month vacation each, making it even more valuable that they can cover for one another, the manager added.

Patient-centeredness is a culture. "I'm a nurse first," the practice manager told me. Not all managers are registered nurses, but that experience doesn't appear to hurt when it comes to promoting patient needs. She explained to me that she and the physicians expect all employees to be kind, warm and loving to patients at all times. "Not everyone can work here," she said. Those who do work there, I'm convinced, not only live up to those standards but believe in them intrinsically. I wasn't surprised to learn that the practice's patient satisfaction scores are outstanding, or that the team was outraged that a neighboring practice edged them out in one category by a single point. The practice is a certified patient-centered medical home but not wholly decided on going through the rigmarole of renewing the credential. It's eye-opening to me that even for a practice that pushes itself so hard, getting recognized for it truly is a constant struggle.

Communication is king. The importance of regular meetings is another idea this manager validated while we talked. She swore by the importance of meeting with her staff weekly. "There's always something new we need to work on or discuss," she said. She also showed me a sample agenda with hand-written notes filling most of the white space. With a tight-knit, social group, it's critical to keep the discussion on track before time runs out, she explained. The group also holds an after-hours meeting to go over business issues and financials quarterly. They've skipped it due to time constraints a couple of times and regretted it. At the most recent financial meeting, the group only covered about half of the material, so they'll have to reconvene. Not making the time to communicate is a mistake with too many repercussions to repeat.

Trust is everything. While it may be impressive that this practice's entire staff is so well-trained and competent, most of them with clinical credentials of at least an MA, "trust" is what their boss says she needs in them most. There is much work to be done, after all, and the stakes are high. "We're in a constant fight for independence," she said. "Everyone has to pull their weight."

So do these truths I observed match up to yours? If I could spend a day within your practice, what's the most important thing I could learn about using my role to help you succeed? - Deb (@PracticeMgt)