Manage My Practice

From today’s US News & World Report:

This is the fourth year that U.S. News and the National Committee for Quality Assurance, managed care’s major accrediting and standards-setting body, have teamed up to rank healthcare plans. We release the rankings during open-enrollment season, when millions of Americans prepare to select their healthcare coverage for the next year.

How were plans rated?

The rankings … show how well plans do at preventing and treating illness and providing consumer services to members.

How is consumer service defined?

(Measures) …included members’ opinions about the ease of making appointments and getting care, doctors’ ability to communicate effectively, and satisfaction with claims handling.

I find these measures particularly interesting as only “satisfaction with claims handling” is a measure of the plan. “Making appointments” and “doctors’ ability to communicate effectively” are services provided by the participating physician, unless the physicians are employed by the plan. I would like to see measurements of plans be more along the lines of:

• clarity of plan details communicated to subscribers and physicians;
• ability of plan agents to communicate with consumers and physician offices about routine issues and priority issues;
• ability of the plan to provide the physician office (preferably electronically) with pre-authorizations and pre-notifications for services, procedures, surgeries, and implants in a timely and efficient manner. These functions, which are very critical to getting patients needed services in a timely and efficient manner, are not usually considered to be a part of the claims handling process.
• ability of the physician offices to obtain (electronic) information on individual plan benefits by subscriber or beneficiary OR electronic adjudication of the patient’s visit that day;
• ability of the payer to provide the physician office with info for giving patients real quotes on tests, therapies, procedures and surgeries so that patients can make informed decisions about the cost of their care prior to having a service.

I know that to measure this, the plans would have to collect data from the physician offices (and some do), and publish this (none do that I know of.) Kudos to any plans doing this (and write to me and tell me if they/you are) because it acknowledges that the physicians are stakeholders and are a critical part in satisfying consumers.

Medical Group Management Association (MGMA) recently sponsored a survey ..” to assess group practice professionals’ attitudes concerning payers in all 50 states.” Members who participated will receive a copy of the survey for responses from their state.

More on NCQA:

I just participated in my first webinar and really enjoyed discussing the 2008 MGMA Annual Conference with colleague Marshall Maglothin and FierceHealthcare.com Editor-in-Chief Anne Zieger. Click here to register with FierceHealthcare and launch the webinar. My part starts at about 16 minutes.

Let me know what you thought about the conference.

Most people who ask what I do have never heard of managing medical practices. Many people say “I didn’t know there was a job like that.” Medical Group Management Association’s (MGMA) definition of medical group practice and medical practice management is helpful:

Medical group practice is defined as three or more physicians engaged in the practice of medicine as a legal entity sharing business management, facilities, records and personnel. This includes single- and multispecialty physician offices, ambulatory surgery and diagnostic imaging centers, hospital-based practices and academic practices. (Medical Practice Managers) … are part of a large and growing field that requires broad knowledge, skills and experience for long-term success. And the decisions they make directly affect nearly every aspect of a practices operations, from financial performance to patient care.

The next question many people ask is “How do you learn to do that?” People who do what I do come from lots of different professional backgrounds.

It has been a fairly recent development that there are undergraduate and graduate programs for this field. Many physicians who are business-minded have pursued degrees that allow them to manage their own practices while practicing medicine, or enter the healthcare management field and leave active clinical practice. According to a recent Times article, there are 49 schools that currently offer a dual MD/MBA degree.

Here a few ways other than formal healthcare management training that medical managers enter the field.

Nursing/Clinical: I have known some excellent medical practice managers who have four-year nursing degrees, but I don’t know a lot of them. It seems that most nurses want to be nursing, not managing, and that they became nurses to care for patients in a hands-on way. I have observed that some managers with nursing backgrounds are instant fixers, and have trouble taking the contemplative route to problem-solving.

Management Experience: There is no question that private practices are coming late to the business party and that experienced managers bring a lot to the field. It can be hard, however, to jump into managing a practice with no former healthcare experience because so much is so different. The owners of the business (the docs) are also the ones producing the revenue. As my husband says, the job is very much like being the Commissioner of Baseball.

MBAs: Having a MBA brings a lot of tools and resources to the table, but is not the be-all and end-all, especially when it comes to people-management. The best managers in any field truly like and value people, have time for people, are collaborative with people, and care about people. Can this be learned? I don’t know. Probably not genuinely.

Technology: Managers who understand and embrace technology will have the advantage over every other manager. Healthcare and technology are becoming more and more wedded. Every priority technology function that healthcare managers have to outsource is an aspect of the practice that is somewhat out of their control. Think practice management systems, EMR, phones, PACS, email, knowledge management, lab interface, hospital interface, patient communication, etc.

Up through the ranks: Managers who have come up through the ranks have a big plus in their favor and a big minus. The plus is that they understand healthcare, the nitty-gritty functions of the practice, have experience relating to administrative and clinical staff, and know how to network. The minus is that they are usually undervalued due to the lack of formal education, and may also undervalue themselves for the same reason.

In the end, it’s not where a person comes from that makes the biggest difference, it’s who they are and what they’ve made of their career. Anyone can enter the field of healthcare management, but I do suggest these three prerequisites:

1. Compassion for patients (compassion for all people)
2. A desire to continuously learn; if you stand still you’ll get moldy
3. A sense of humor.

For information on organizations that award credentials click here.

Here’s an interesting history of the field of medical practice management.

Photo credit: Mary Pat Whaley

My husband and I are away this weekend attending blogging camp. No, we’re not at a logging camp, we’re at blogging camp. If you remember, hubby and I both launched blogs in July (you’re reading mine right now,) so we’re newbies trying to learn more and meet others who are blogging. My passion is taking interesting ideas from other worlds and applying them to mine. Here are a few things I’m taking away:

• I just joined Twitter. This means I can communicate with others and they know what I’m doing and I can find out what they are doing via text messages. As I explore this more I’ll write about it. I’d like to use Twitter at MGMA in San Diego in October. If anyone out there is going to MGMA and using Twitter, please get in touch with me by leaving a comment, or emailing me at marypatwhaley@gmail.com.

• Some who know me will say I am obsessed with toilet paper dispensers and hand towel dispensers and they would be correct. My theory is: If you’re not paying attention to the tissue and hand towel dispensers (the little things) in your practice, you probably aren’t paying attention to the big things. More on this topic later as I am building out a new site for my practice and will write about making design and fixture choices in the future. Anyway, the conference we’re attending is being held at CubeSpace which is a very cool place where folks can come and use workstations and technology. The bathroom here has a very cool hand towel dispenser (picture above) that you work with your forearm! I will be checking it out for my new office.

• Backchannels are the new intranets. I am working on a knowledge management tool for my practice to help document important information that tends to be lost when staff leave the practice. I got some different ideas about accomplishing this goal from camp.

• The camp presentations were also streamed live and I learned a little about vlogging (video blogging.) The last time I thought about making an orientation video I was told it would probably cost $10,000! With some practice, I think my staff and I can make “videos” for just about any topic. We can do video tours of our facilities for our website, we can film our meetings for absent staff, we can do narrated PowerPoint presentations.

Whew. So much technology, so much fun!