The Two Key Drivers Of A Physician’s Practice

It’s an oversimplification to suggest that a physician’s practice could come down to two key drivers, and yet without focusing on these key drivers all of them would struggle to keep their doors open. The key drivers are work-flow and cash-flow. They impact everything, and just about every physician is aware of them to some degree.  Despite this, many physicians rarely take the time to work on improving either one.  Why is that?  They’re too busy taking care of patients.  Forgive me if it seems that I am suggesting that patients aren’t important to a physician’s practice.  They are extremely important.  I am specifically referring to those aspects of a physician’s practice that support, and therefore drive, their ability to care for patients.

Physicians do what they have been trained to do, and that is to take care of patients.  We typically are not trained in optimizing work-flow management or in improving the financial foundation of our practice.  There is a tendency to think, “that’s what office managers and accountants do”.  That may be true, but there is no better person than a physician to understand the nuances of a physician’s work-flow than a physician.  They just need to see their work-flow mapped out in order to understand how to improve it.  As it turns out, work-flow affects cash-flow and vice versa.

A few years ago I was involved in developing a clinical practice for our healthcare system.  I sat down with a process engineer who mapped out one of our clinical practices.  After reviewing the Visio work-flow diagram of the clinical practice, I pointed out where he made, what I thought were, several notable errors in the work-flow.  He carefully read the clinical practice statement out loud to me and sure enough, he didn’t make any errors.  The errors were in the practice statement.  What we thought was a clearly written statement, was not.  It left room for interpretation, and depending on how it was being interpreted, it could lead to increased work and costs for the physicians and healthcare system.  Our good intentions were being sabotaged by a clinical practice which was not very effective in its current form.  This not only increases non value added work for all of us, but can also impact our earnings.  That was another lesson that hit me hard early in my career.

Reimbursements were down and at one point our practice was collecting only 32 cents on the dollar.  My manager’s solution was that we needed to work harder.  I was already working 80 hours/week and thought there must be a better way.  There is.  Work smarter, not harder.  I went into solo private practice.  In a few short months I was collecting 64 cents on the dollar and working 50 hours/week.  (This was an urban trauma surgery practice and I was billing 200% of Medicare at the time.)  That is a 38% improvement in productivity, and a 100% improvement in collections.  That difference is a direct result of learning how to focus on these two key drivers.  Needless to say, the 30 extra hours a week did wonders for my work/life balance.  The days of the solo private practice are over (at least for me), but the basic idea of taking the time to improve work-flow and cash-flow is not.


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