Sunday, January 19, 2014

Can a Physician Run a Business???

Physicians have run small businesses for years with varying degrees of success.  Success can be identified multiple ways: 1. Financial; 2. Personal Satisfaction- being a good doctor; 3. Psychologically Rewarding- ego gratification; 4. Etc.; 5. Etc.

Physicians are excellent at providing good medical care and excellent at thinking that this automatically translates into productivity, process improvement, patient satisfaction, financial reward, and efficiency.  They mold their practices, so that everything works reasonably well, according to their personal vision of how it ought to function.

With the continual addition of more rules, the Affordable Care Act, meaningful use, and higher costs of keeping practices open, many offices are closing.  Whereas, the application of some sophisticated guidance from outside consultants could help.

Physicians may consider hiring such consultants, and often their first recommendation is to create a "Business Plan" representative of the physician's, or practice's goals. Such a plan is corporate-speak for an organizational strategy to achieve those goals, and is customarily laid out on paper.  However, many doctors, if they have a structured overall plan, often maintain it solely within in their own minds, if maintained at all.

Decisions always have to be made for that plan, and therefore always evolving to keep up with the ever-changing practice environment.

Examples include:

  1. What Electronic Health Record works for this practice?
  2. Is the meaningful use incentive funds worth it?
  3. What computers to purchase?
  4. How many providers are necessary- physicians, NP, PA, medical assistants, voice activated technology?
  5. Do we staff to demand- right number of people at the right time of day?
  6. What malpractice to choose- my bias is the least expensive with the lowest limits of coverage acceptable-?
  7. Should we perform labs and x-rays in-house or partner?
  8. Should we do our own billing?
  9. What about ICD 10?
  10. Do we accept Medicare and/or Medicaid?
  11. How do we get credentialed with payers?
  12. How much do we market or advertise?
  13. Do we rent, lease or purchase space?
  14. Should we sell out to the hospital to eliminate 1-8- what happens after the 2- year honeymoon period?
These are complex questions with no easy answers.  Best decisions in this regard are always made when time is taken to get sufficient data and advice before making adjustments.  But even if decisions are made to change practices, changing behaviors is not so easy, no matter what the facts, or realities of the particular care setting say.

Wisdom is not always easily acquired, and one should carefully listen to those both within and outside of the particular workplace in question.  Optimizing one's practice through small incremental steps with limited investments can be richly rewarding.

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