simplifying pediatric practice

If you are spending more than 5 hours a week managing your Pediatric Practice as a physician owner/partner, then you should evaluate simplification techniques. How do processes move from simple to complicated? Usually it is a function of a process that has added features and needs with minimal looks at re-design. Redesign changes to a process shift a practice toward simplification and do not happen with a one-time change (there needs to be multiple small changes). An owner and/or operations lead of a Pediatric practice need to make incremental changes each week. Some suggestions on how to move your Pediatric Practice to optimal simplification include:
• Once a year, make a list of all the items that you spend time managing outside of Patient interactions (recommend spend 30-40 minutes to gain some depth without moving too granular). Identify how much time per month you spend on each item.
• Place each of the items in the list into different categories (Employee, physicians, marketing, Managed Care, finance, supplies, facilities, etc.).
• Rank the categories and the priorities that ‘matter’ most to the practice (e.g. which items increase revenue and reduce work load).
• Highlight the items that consume more than two hours per month and do not significantly increase revenue (a good question: would I pay someone $100/hour to manage this activity? If the answer is no, look to move off or eliminate from your work stream).
• Allow a week to pass then spend an hour (uninterrupted), to ask some basic questions: Do I need to service my processes (e.g. do you need to use your time to manage billers, IT personnel, back-ups)? What is the level of training and expertise of my practice personal? How do they benchmark in skills and performance versus the industry standards as billers and practice admin personnel? Do I have the skills/training to educate and assess them in the admin areas?
• Wait another week and evaluate 2-3 Pediatric Specialty Billing Companies – ask what is there collection rate? What is the range in increase revenue for Pediatric Practices that switch to their system? What support personnel will you as a Pediatric Office need if you leverage their resources?

A word of caution, this is a task that cannot be delegated to another staff member due to conflict of interest (e.g. billing team concern that the new process will show more productive to the practice – this was not ‘their issue’ probably just a system/process and/or training issue). Simplification, if done correctly, will provide the Pediatric partners with more income, less work and less stress.

There are many vendors and sales people that want to sell you extra ‘stuff’ for your Pediatric office. Does the product you are being sold simplify your operations, management time and increase revenue or increase your overall burden and cost? This is a basic question that every decision maker of a Pediatric Practice needs to make. The goal should be able to see 30-40 patients per day without hours of work on charts, processes, computer systems, servers, and people. Keeping this simple approach can be done with a few basic questions: what is the time I spend on charting? What is the collection rate of my practice? Does my billing team obtain continuous training on Pediatric Medical Billing? What is my audit system? Is my electronic Health Record system only designed for Pediatrics? Are we collecting above the Medical Group Management Association(MGMA) Benchmarks? Does my system require me to be the manager of Servers, IT Protocols, data back-ups as well as management of vendors whom manage these items?

Your Pediatric Billing Vendor (or internal team) should be able to provide a simple monthly report that answers the billing and claim follow-up. This report should also provide trends of billing and collections by provider in the group as well as a list of summary of claims by Insurance Company.
A practice management and E.H.R. system should be designed to first optimize your Pediatric Office as well as for the clinical workflow of Pediatrics. Our clinical system is designed and developed by Pediatricians only for Pediatrics by first optimizing the payment systems so that the offices we manage achieve >99% collection rate (significantly above the MGMA benchmarks). Not all vendors are meeting these standards. Many products are very difficult to use that requires so much training and change in workflow design. The system should not ‘feel like working in Microsoft Excel’. If so, maybe the vendor is out of date.

Some vendors hold their clients ‘hostage ‘ to their own data. All vendors should provide the practice data in a usable format if they decide to switch. There are many vendors, both large and small, that make it very difficult for practices to pull their data out of the system (this includes Client-Server software vendors that lock the data into their application….all because the server is in your office does not mean that you are protected for a hostile tactic of a vendor). If a system is simple, increases revenue, decreases hassle then a vendor does not need to move to these tactics.

Continuous improvement should be the norm in the industry. Pediatricians work very hard. If the existing system in your office is complicated and/or date, look at other options. If your collection rate is below 99%, look for a vendor whom specializes in Pediatric Medical Billing.