Are You Running or Starting a Medical Practice? SMA’s Southern Regional Assembly, ‘The BUSINESS of Medicine’ track gives you access to the leaders in the medical industry, a look at how leaders in the healthcare industry meet demands and capitalize on opportunities.
The BUSINESS of Medicine Topics
Leading and Motivating Change
Stanley (Stan) Harris, PhD
As healthcare leaders and practitioners, you are expected to change to meet demands or capitalize on opportunities. Sometimes you get to guide the change from the beginning and other times you are expected to implement a change determined by someone else. Regardless of the impetus, how do you help change efforts succeed particularly given the historical odds of success? Only about a third of change efforts accomplish their designed purposes, another third fall woefully short, and a third fail. In this presentation, and drawing from over 25 years of research on the “Building Readiness for Change” model by Achilles Armenakis and Stan Harris, you will explore the five key concerns that underlie individuals’ decisions to resist, comply with, or support changes and examine them in your own context. You will also gain insight into the six leadership behaviors that can shape these concerns to build change support and enthusiasm. This presentation will help you become a more competent and confident change manager and leader.
- Understand the five key concerns that underlie individual decisions to resist, comply with, or support change efforts.
- Classify change efforts by their scope and rationale and understand that classification on the level of change challenge.
- Understand how to use six “strategic change activities” to build support for changes.
Jeff Gorke, MBA
A medical practice, like any business, requires operational and organizational structure to ensure profitability and functionality. Proper policies, procedures, and management deployment are paramount to the efficient operation of a business.
Sound business operations within the medical office setting (both in hospitals and private practices) provide a crucial structural framework to empower physicians to deliver high quality medical care.
Medical practices have different operational variables that must comingle to enhance the delivery of care. Yet many practices suffer avoidable issues due to problems with operational factors.
- Identify the variables that contribute to the efficient operation of a medical practice (whether an employed practice or private practice).
- Examine operational variables to identify shortcomings and/or deficiencies in the efficient operation of a medical practice.
Jeff Gorke, MBA
A medical practice is no different than other business. It generates revenue, pays bills, and must do so profitably. But the differentiator is the fact that a medical practice must manage its financial obligations while delivering high quality care. Sometimes the business side is at odds with the care side.
Yet the business finance aspect of health care is arguably more nuanced than that in a “normal” business. The generation of revenue in a medical practice is complicated and can be difficult to understand, the “cost” to deliver care is often a moving target, and the business of medicine is a business model where you cannot simply pass increased costs on to consumers via increased rates. Medical business finance is a whirling dervish of varying inputs requiring constant management and diligence.
- Comprehend the revenue side of healthcare
- Recognize the cost drivers
- Understand WHY increased costs cannot be passed on to consumers
- Assess overhead rates and calculations
Insurance and Risk Management
Jeff Gorke, MBA
Many medical practices overlook the necessity and potential exposure a lack of proper insurance offers. Though not wanton, many practices simply underinvest in risk mitigation. For purposes of this presentation we’ll contemplate “risk” as a variety of exposures for physicians and their practices.
For instance, medical practices require “normal” business insurance coverages such as business liability, directors and officers, assorted coverages for furniture, fixtures, and equipment, etc. However, there is considerable risk in improper coding of office visits and submission of claims based on that coding, fair market value (FMV) exposure of a joint venture, Stark related issues, and medical malpractice.
This presentation will review and address obvious risks, and those that are less obvious, and how risks can be addressed, managed, and mitigated.
- Distinguish a variety of exposures in a medical practice
- Interpret the pitfalls and risks inherent in the practice of medicine
- Address and mitigate risks
- Identify simple steps to mitigate medical/malpractice risk
Contracting and Reimbursement
Jeff Gorke, MBA
Proper contracting and timely collection of reimbursements are financial underpinnings for a medical practice. Negotiated contracts and accurate reimbursements drive the revenue component of the medical practice’s profit and loss statement.
Contracting occurs when the practice negotiates a reimbursement rate for a given procedure with an insurance carrier. Reimbursement is driven from performance of the contracted services.
While interrelated, contracting and reimbursements have different components. However, as a result of the harried nature of medical practices, many practices either don’t have a sound contracting process and/or have not negotiated adequate reimbursements. Often busy practices let contracting slide into an “evergreen” situation where contracts automatically renew. This can negatively impact physicians.
Also, reimbursements (and the revenue cycle) are often mismanaged and undervalued relative to their importance in a medical practice. The revenue cycle (billing/collecting) based on contracted reimbursement may lack policies, procedures, and checks/balances to ensure full and proper reimbursement for services provided. This can lead to financial strain for the medical practice.
- Recognize key components in contracting, what to look for, leverage, and how the process can work
- Discuss revenue cycle management, its components, and key metrics and measures
- Distinguish key components to examine in order to remedy the situation when a revenue cycle is in distress
Jeff Gorke, MBA
During the early 2000s a new era of physician employment sprang to the fore as reimbursements for many in-office procedures were reduced and the cost to practice medicine continued to increase. Many physicians began selling their medical practices to health systems and private equity firms. The American Medical Association (AMA) recently noted that more physicians are employed by health systems (or in other atypical employment situations) than are in private practice.
This presentation will contemplate a short history of provider acquisitions and employment, review the outlook of future employment scenarios, and consider different options for physicians.
The presentation will also review the differences between private practice management, hospital employment, and the tradeoffs of employment versus private practice considering pay, reimbursement, contracting, and basic accounting.
- Distinguish the pros and cons of hospital employment
- Describe the differences between private practice and employment
- Apply a more informed decision regarding employment status
Health Information Technology (HIT), Bridging the Gap
Reza Sadeghian MD, MBA, MSc, FAAP
Technology in every industry in business has been able to make things more efficient, automate processes, and reduce costs. However, in health care thus far, things have been the absolute opposite or extremely stagnant. Technology has yet to gain the same the traction and in some ways has taken a few steps backward. It has not done what we have all expected would occur; improve the quality of care for patients and improve the quality of life for providers, reduce healthcare costs, improve throughput, and make things so much easier. Why?
In this presentation, we will take a bird’s eye view into informatics, which includes the different variations of informatics and how it impacts health care today. Additionally, we we will briefly discuss what is the future of technology in health care, where it’s heading, and what we expect to see down the road. Are we heading into even tougher roads ahead or are things going to take a turn for the better? Are we still in the infancy of the technology age in health care?
- Describe the definition of HIT and related topics discussed
- Recognize the impact of HIT adoption
- Recognize various Informatics fields
- Utilize the learning objective to further their informatics knowledge
Hot Topics Panel Discussion
Join Southern Regional Assembly faculty Mr. Jeff Gorke and Dr. Reza Sadeghian as they conclude SMA's Business of Medicine program with a "Hot Topics" panel discussion. This 1-hour Q&A session will take place on Friday, November 1 from 3:15 pm - 4:15 pm and will allow attendees to revisit and ask questions related to the topics addressed throughout the day, including healthcare informatics, contracting and reimbursement, practice employment, and insurance and risk management.
To learn more about the Business of Medicine Simplified program and to register for SMA's Southern Regional Assembly, visit https://sma.org/assembly.