The business of private practice medicine. Business personal statement?

[kuma1212]

I have been in a well established, single specialty private practice for 12 years now.  As I learn more about finances and establish more a business sense, I have come to realize, my practice is not the most business savvy.  Don't get me wrong, we do fairly well and usually continue to have an improving financial picture annually (although not last year).  A lot of private practices around us (and nationwide) are being bought up by the larger entities such as hospitals, and we would like to remain independent as long as possible.  We do not have a managing partner.  We just all meet and discuss and vote (with equal weight) on any directions and decisions for the practice.  And we each have varying degrees of business experience and interest.  Some of the docs just want to come in, see their patients, do their work and go home, without much care for the practice itself.

I think our group should create a mission and "personal statement" to help us with the future.  It makes so much sense to create a personal investing statement on an individual level, so probably makes sense for the practice too.

My initial thoughts would be to include a specific mission, 1 year goal, 5 year goal, 10 year goal, and succession plan.  Some of the ideas that may be included would be:  adding a midlevel provider (we don't have one), adding an office, adding an MD, building an office building.

Has anyone done this?  Or have any thoughts or experiences of your own private practice business model?

[Zaphod]

kuma1212 wrote:

I have been in a well established, single specialty private practice for 12 years now.  As I learn more about finances and establish more a business sense, I have come to realize, my practice is not the most business savvy.  Don’t get me wrong, we do fairly well and usually continue to have an improving financial picture annually (although not last year).  A lot of private practices around us (and nationwide) are being bought up by the larger entities such as hospitals, and we would like to remain independent as long as possible.  We do not have a managing partner.  We just all meet and discuss and vote (with equal weight) on any directions and decisions for the practice.  And we each have varying degrees of business experience and interest.  Some of the docs just want to come in, see their patients, do their work and go home, without much care for the practice itself.

I think our group should create a mission and “personal statement” to help us with the future.  It makes so much sense to create a personal investing statement on an individual level, so probably makes sense for the practice too.

My initial thoughts would be to include a specific mission, 1 year goal, 5 year goal, 10 year goal, and succession plan.  Some of the ideas that may be included would be:  adding a midlevel provider (we don’t have one), adding an office, adding an MD, building an office building.

Has anyone done this?  Or have any thoughts or experiences of your own private practice business model?

Click to expand...

I dont know what a mission/vision statement will do other than look corporatey. This along with name/logo changes are probably some of the more over done and worthless things one can do. What would it say...more money?

A practice statement with your goals and such sounds like a good idea with actionable bullet points. If a mission statement was worth much you wouldnt need this separate bit.

You dont necessarily need any of those biz ideas at any one time. Succession plan always makes sense. Maybe make a list of that kind of thing that can potential increase revenue or efficiency for a practice. At your meetings you can look at where bottlenecks or demand is coming from, and look at growth ops and see if any of these ideas fit into your practices needs.

[Rando]

I've been solo FP for about 15 years, but have also been in a small 3 person group and a partner in a large multi-specialty group.  It's a challenge to get everybody on the same page and on board with a plan, especially if the group has been doing OK without mission statements and goals.  It would help to know how many docs are in your group.

Many mission statements I've seen aren't really business-oriented and are focused on quality of care.  That's obviously important, but it sounds like you are looking for more of an overall business plan.  Some of the partners may not feel expansion is desirable, so you may have to present data that tells them why it would be.  I know the group I was in was focused on growth to the point we were having a lot of "bad years" due to increased spending.  I do think bringing in mid-levels is a fairly obvious thing to do assuming there is adequate patient demand.

[kuma1212]

Zaphod wrote:

kuma1212 wrote:

I have been in a well established, single specialty private practice for 12 years now.  As I learn more about finances and establish more a business sense, I have come to realize, my practice is not the most business savvy.  Don’t get me wrong, we do fairly well and usually continue to have an improving financial picture annually (although not last year).  A lot of private practices around us (and nationwide) are being bought up by the larger entities such as hospitals, and we would like to remain independent as long as possible.  We do not have a managing partner.  We just all meet and discuss and vote (with equal weight) on any directions and decisions for the practice.  And we each have varying degrees of business experience and interest.  Some of the docs just want to come in, see their patients, do their work and go home, without much care for the practice itself.

I think our group should create a mission and “personal statement” to help us with the future.  It makes so much sense to create a personal investing statement on an individual level, so probably makes sense for the practice too.

My initial thoughts would be to include a specific mission, 1 year goal, 5 year goal, 10 year goal, and succession plan.  Some of the ideas that may be included would be:  adding a midlevel provider (we don’t have one), adding an office, adding an MD, building an office building.

Has anyone done this?  Or have any thoughts or experiences of your own private practice business model?

Click to expand…

I dont know what a mission/vision statement will do other than look corporatey. This along with name/logo changes are probably some of the more over done and worthless things one can do. What would it say…more money?

A practice statement with your goals and such sounds like a good idea with actionable bullet points. If a mission statement was worth much you wouldnt need this separate bit.

You dont necessarily need any of those biz ideas at any one time. Succession plan always makes sense. Maybe make a list of that kind of thing that can potential increase revenue or efficiency for a practice. At your meetings you can look at where bottlenecks or demand is coming from, and look at growth ops and see if any of these ideas fit into your practices needs.

Click to expand...

Thanks for your reply,

For me it would help make overall business decisions involving spending and investment.  If our group of 7 MDs all agreed on a plan toward geographic expansion and having 10-20 providers, we would obviously need a totally different strategy than we have now (which is treat patients as best as possible, try to stay on top of MACRA, MIPS, rising IT costs, and decreasing reimbursement.)

[kuma1212]

Rando wrote:

I’ve been solo FP for about 15 years, but have also been in a small 3 person group and a partner in a large multi-specialty group.  It’s a challenge to get everybody on the same page and on board with a plan, especially if the group has been doing OK without mission statements and goals.  It would help to know how many docs are in your group.

Many mission statements I’ve seen aren’t really business-oriented and are focused on quality of care.  That’s obviously important, but it sounds like you are looking for more of an overall business plan.  Some of the partners may not feel expansion is desirable, so you may have to present data that tells them why it would be.  I know the group I was in was focused on growth to the point we were having a lot of “bad years” due to increased spending.  I do think bringing in mid-levels is a fairly obvious thing to do assuming there is adequate patient demand.

Click to expand...

That's interesting that you mentioned this, because as I was trying to come up with a plan, it separated out into a medical/quality of care side and a business/financial side.

And I agree, mid level is pretty clear for us, and a much less expensive option than adding another MD.

[Zaphod]

kuma1212 wrote:

Zaphod wrote:

kuma1212 wrote:

I have been in a well established, single specialty private practice for 12 years now.  As I learn more about finances and establish more a business sense, I have come to realize, my practice is not the most business savvy.  Don’t get me wrong, we do fairly well and usually continue to have an improving financial picture annually (although not last year).  A lot of private practices around us (and nationwide) are being bought up by the larger entities such as hospitals, and we would like to remain independent as long as possible.  We do not have a managing partner.  We just all meet and discuss and vote (with equal weight) on any directions and decisions for the practice.  And we each have varying degrees of business experience and interest.  Some of the docs just want to come in, see their patients, do their work and go home, without much care for the practice itself.

I think our group should create a mission and “personal statement” to help us with the future.  It makes so much sense to create a personal investing statement on an individual level, so probably makes sense for the practice too.

My initial thoughts would be to include a specific mission, 1 year goal, 5 year goal, 10 year goal, and succession plan.  Some of the ideas that may be included would be:  adding a midlevel provider (we don’t have one), adding an office, adding an MD, building an office building.

Has anyone done this?  Or have any thoughts or experiences of your own private practice business model?

Click to expand…

I dont know what a mission/vision statement will do other than look corporatey. This along with name/logo changes are probably some of the more over done and worthless things one can do. What would it say…more money?

A practice statement with your goals and such sounds like a good idea with actionable bullet points. If a mission statement was worth much you wouldnt need this separate bit.

You dont necessarily need any of those biz ideas at any one time. Succession plan always makes sense. Maybe make a list of that kind of thing that can potential increase revenue or efficiency for a practice. At your meetings you can look at where bottlenecks or demand is coming from, and look at growth ops and see if any of these ideas fit into your practices needs.

Click to expand…

Thanks for your reply,

For me it would help make overall business decisions involving spending and investment.  If our group of 7 MDs all agreed on a plan toward geographic expansion and having 10-20 providers, we would obviously need a totally different strategy than we have now (which is treat patients as best as possible, try to stay on top of MACRA, MIPS, rising IT costs, and decreasing reimbursement.)

Click to expand...

Just make goals like you specified. Actions follow. The mission should be obvious from that. Mission/vision stuff is usually the opiate for the masses for cultural buy in, not for actual use.

Current strategy is basically treading water and trying not to drown, you're trying to grow which sounds good as long as everyone is on board.

[WealthyDoc]

You may benefit from a better office manager? or better goals, accountability, or budgeting?  Maybe better payer negotiations or a better allocation of expenses?

Not a mission statement.  We had one in my private practice.  It was a big thing in business 20 years ago.  Most of us have since realized it is just something to frame and hang on the wall.

 

[Kamban]

Have a logo. Have a mission statement that sounds very patient oriented that you can craft after getting ideas from the web and put it up. Both really don't add any value other than to say the hospital groups have one and so do we.

You need to bring in the physicians who just come in and practice and go home on board with the ideas of growth, expansion and increased revenue. Take baby steps. Analyze tour patient loads, waiting times and see if there is need for adding another provider. If so, add a mid-level. Then see if there is need for another location. Analyze the possible growth in that area and competitors. See if you can have mid-levels and physicians willing to serve that location.

Don't try to do it all at once. That is a recipe for partners to get disgruntled and the practice breaking up.

[pulmdoc]

I don't think a mission statement per se is helpful. Having candid conversations with business partners about their goals and ability and desire to handle a certain workload, whether additional staff would leveraged into additional profit etc is essential.

[kuma1212]

Rex wrote:

You havent listed anything that would “confirm” that the other partners arent business savy and that your ideas are going to fly.  I also didnt see where you provided any data that adding whatever including a midlevel is going to work out well.  You actually mentioned that last year the financial picture didnt improve so im guessing that you havent “done the math” on your ideas.  I agree that you could easily disgruntle your partners if you arent careful.

Click to expand...

I'm not sure how I can confirm this to you.  Here's an example though.  We have unused office space and a relatively long wait to get in for an appointment.  I get notes at least on a weekly basis (and sometimes daily) that a patient went elsewhere because they could get in sooner.

No one in our office knows how to "do the math" on these ideas.  We don't know of a specific formula to help determine whether to add another provider.  Any suggestions would be appreciated.

I'm not concerned with disgruntling my partners because we (usually) communicate well and are fairly open minded.

[kuma1212]

WealthyDoc wrote:

You may benefit from a better office manager? or better goals, accountability, or budgeting?  Maybe better payer negotiations or a better allocation of expenses?

Not a mission statement.  We had one in my private practice.  It was a big thing in business 20 years ago.  Most of us have since realized it is just something to frame and hang on the wall.

 

Click to expand...

We have considered a different office manager.  Perhaps someone with an MBA?  But that idea has generally been shot down.

[Zaphod]

kuma1212 wrote:

Rex wrote:

You havent listed anything that would “confirm” that the other partners arent business savy and that your ideas are going to fly.  I also didnt see where you provided any data that adding whatever including a midlevel is going to work out well.  You actually mentioned that last year the financial picture didnt improve so im guessing that you havent “done the math” on your ideas.  I agree that you could easily disgruntle your partners if you arent careful.

Click to expand…

I’m not sure how I can confirm this to you.  Here’s an example though.  We have unused office space and a relatively long wait to get in for an appointment.  I get notes at least on a weekly basis (and sometimes daily) that a patient went elsewhere because they could get in sooner.

No one in our office knows how to “do the math” on these ideas.  We don’t know of a specific formula to help determine whether to add another provider.  Any suggestions would be appreciated.

I’m not concerned with disgruntling my partners because we (usually) communicate well and are fairly open minded.

Click to expand...

You will want to run some actual numbers on this. Get a spread sheet and input number of pt inquiries (calls, emails, site hits, etc..), appointments, wait times, why they go elsewhere etc...Fwiw we run a 100% cash cosmetic practice so obvious differences but we follow every pt on every metric. From inquiry to d/c, where/why they came, etc...

I hear similar complaints or issues all the time. You will be surprised how quickly the slack can be taken up and all the sudden this tsunami of complaining pts is taken care of. Often staff will over estimate and over dramatize the complaints of this nature and docs over estimate how deep this pool of pts is. I am for example fairly routinely asked by staff to open 'late hours' or a 'saturday' clinic because 'so many ppl' are asking. I always tell them their full of it and I dont believe them (office mangagers love to make a big deal about 1 incremental inquiry). What typically happens is these days end up being canceled as the 3 ppl who had to have it cancel or dont show. Happened this week too for black friday, was pressed to open for consults, etc...I told them no way it fills enough to justify being open so go ahead and do it. Was closed by thursday this week due to such little interest it wasnt justifiable.

Idk, most people have little intuition to people, let alone business. They make huge deals of situations that are one off or marginal. Those are not worth expanding or hiring for. Seasonality makes it awful too if you have that. You end up understaffed during the busy season to make up for the over staffing when its slow.

I've seen this a lot with surgery centers. Tons of single surgeons (aesthetic/cash) have multiple ORs at their centers, and somehow end up surprised they dont utilize it to their fullest and try to bring on a partner to help with overhead. We have 2 ORs and ours is still over built. Even when we had 4 surgeons, 2 doing 2 d/wk and the other 2 doing 1.5d/wk we only ever needed to run the second room 4-5d/month in the absolute busiest time of the year only.

Basically, make sure you run the math and there are so many people leaving disgusted every day that you will in fact lose money by not getting help of some nature. Yours sounds like a logistical issue which could first be addressed by finding the bottleneck. Dont assume its lack of providers, thats the absolute last and most expensive barrier. You could have non optimized intake, screening, rooming, etc....and there could be simple ways (additional MAs, cutting fluff, process improvements, etc...) that could make the day much faster. Follow the pts experience (or better yet have staff treat you as the pt) from the phone call to post visit survey and see where time/resources are wasted.

[kuma1212]

Zaphod wrote:

kuma1212 wrote:

Rex wrote:

You havent listed anything that would “confirm” that the other partners arent business savy and that your ideas are going to fly.  I also didnt see where you provided any data that adding whatever including a midlevel is going to work out well.  You actually mentioned that last year the financial picture didnt improve so im guessing that you havent “done the math” on your ideas.  I agree that you could easily disgruntle your partners if you arent careful.

Click to expand…

I’m not sure how I can confirm this to you.  Here’s an example though.  We have unused office space and a relatively long wait to get in for an appointment.  I get notes at least on a weekly basis (and sometimes daily) that a patient went elsewhere because they could get in sooner.

No one in our office knows how to “do the math” on these ideas.  We don’t know of a specific formula to help determine whether to add another provider.  Any suggestions would be appreciated.

I’m not concerned with disgruntling my partners because we (usually) communicate well and are fairly open minded.

Click to expand…

You will want to run some actual numbers on this. Get a spread sheet and input number of pt inquiries (calls, emails, site hits, etc..), appointments, wait times, why they go elsewhere etc…Fwiw we run a 100% cash cosmetic practice so obvious differences but we follow every pt on every metric. From inquiry to d/c, where/why they came, etc…

 

 

Click to expand...

It's very impressive, and an excellent idea to have data on every patient on every metric!  I will try to implement a similar idea although this may be tough since we are a high volume practice.  I think I would have to train the phone staff and maybe the MAs to collect more data.  Website data is easier since we get that quarterly from our IT guys.

Thanks for the input!

[Rando]

kuma1212 wrote:

Rex wrote:

Click to expand…

 

No one in our office knows how to “do the math” on these ideas.  We don’t know of a specific formula to help determine whether to add another provider.  Any suggestions would be appreciated.

 

Click to expand...

I would think just knowing your group's waiting time until next routine appt for new patients would be helpful.  That should be easy to find, just ask your front desk.  Then combine that with the notes you're getting on pts. going elsewhere because of the wait.

[Zaphod]

kuma1212 wrote:

Zaphod wrote:

kuma1212 wrote:

Rex wrote:

You havent listed anything that would “confirm” that the other partners arent business savy and that your ideas are going to fly.  I also didnt see where you provided any data that adding whatever including a midlevel is going to work out well.  You actually mentioned that last year the financial picture didnt improve so im guessing that you havent “done the math” on your ideas.  I agree that you could easily disgruntle your partners if you arent careful.

Click to expand…

I’m not sure how I can confirm this to you.  Here’s an example though.  We have unused office space and a relatively long wait to get in for an appointment.  I get notes at least on a weekly basis (and sometimes daily) that a patient went elsewhere because they could get in sooner.

No one in our office knows how to “do the math” on these ideas.  We don’t know of a specific formula to help determine whether to add another provider.  Any suggestions would be appreciated.

I’m not concerned with disgruntling my partners because we (usually) communicate well and are fairly open minded.

Click to expand…

You will want to run some actual numbers on this. Get a spread sheet and input number of pt inquiries (calls, emails, site hits, etc..), appointments, wait times, why they go elsewhere etc…Fwiw we run a 100% cash cosmetic practice so obvious differences but we follow every pt on every metric. From inquiry to d/c, where/why they came, etc…

 

 

Click to expand…

It’s very impressive, and an excellent idea to have data on every patient on every metric!  I will try to implement a similar idea although this may be tough since we are a high volume practice.  I think I would have to train the phone staff and maybe the MAs to collect more data.  Website data is easier since we get that quarterly from our IT guys.

Thanks for the input!

Click to expand...

For cash pay type practices it helps so that you can follow whether a marketing source is doing a good/bad job or where to focus efforts. Utility may be entirely different for different practices of course. Our 'emr' tracks all of this with ease, generates reports and we have several additional spreadsheets where we follow calls, clicks, appntmnts, conversions, no quotes, etc...

Rando wrote:

I would think just knowing your group’s waiting time until next routine appt for new patients would be helpful. That should be easy to find, just ask your front desk. Then combine that with the notes you’re getting on pts. going elsewhere because of the wait.

Click to expand...

This assumes the bottleneck or constraint is already correctly identified and not simply assumed or a by product of a separate constraint. If you go to any department/division in a business each one will tell you how they are held back by some other one not doing things timely/correctly/etc....the blamed party will have similar fingers to point. Somewhere, there is usually an underlying cause that has rippled through to manifest as these other things in several areas. Its hard to find them by just treating the symptoms. We've always been impressed by how a whole slew of issues can come up from a single person doing/interpreting something wrong, etc...and of course mission drift. People start off doing things correctly and as trained, but slowly revert to some kind of slimmed version until theyre eventually doing it in a counterproductive way and need to be polished again.