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Not the right question
That can be answered in 3 minutes
The real question is complex and is really
asking "How to run an Efficient Medical
Practice where staff learn, perform, and grow
to create a dynamic environment for patient
satisfaction, employee satisfaction, and
physician satisfaction, while growing revenue."
I altered the topic
(Opening the Door to
Revenue)
 Building
a Practice and a Life
(The Efficient Practice)
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Student, Intern, Resident, Fellow
Learning by Immersion ("Drowning")
Focus on understanding the facts, processes,
data, understanding science, your role in it all
Minds are fresh, open, curious, exploring, and
protected. (Academic Setting)
"I don't care about making any money, I just
want to treat and help my patients"
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Employed
What does my contract say?
What do I have to do?
How do I get paid?
Am I satisfied? Am I happy?
What can I control?
Are there any other options?
Am I enjoying my life outside of my job?
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Private Practice- small, medium, large
Are my patients satisfied?
Are my employees satisfied?
Am I satisfied? Am I happy?
Am I in control?
How do I control my destiny?
Insurance Companies, Government plans and
regulations
Can I survive out here?
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Never stop learning after "official training"
Be open to ideas outside of the medical field
Keep medicine as a big part of your life, but not
your LIFE !
Discover your purpose and your dream and go
after it with all that you have.
Always work on yourself more than you work
on your job
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Our current financial challenge in medical practice
Overview of my practice - Oliver Family Healthcare,P.C.
New Paradigm - “Think Twice” (White Coat / Dark Suit)
White Coat Thinking
Dark Suit Thinking
EHR – The Centerpiece of Profit Growth
Putting technologies together - Laddering technologies
Results – The profitable practice
Future enhancements and efficiencies for additional profit
See the possibilities for growth in my own practice.
Can I really still be in charge of my destiny?
"If you don't work for your own dreams,
You'll work for someone else's"
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Sharing my journey as an illustration
Your path will be much different
It will be of your choosing, or of your not
choosing
If you gain one bit of information today that
helps you in your future, then my purpose will
have been served.
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Attitude
Quality Care
Right Staff
Servant Service
Systematized Business
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Physician First
Office will reflect Dr’s attitude
If Dr. treats staff coldly, staff treats patients
coldly
Work to develop functional team
Avoid Hierarchy in the office
Direct physician communication with staff
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Patients don’t care how much you know, until
they know how much you care !
Always put patient care first
My mentor: Dr. Steve Young, Cardiology
“If you take great care of the patient, you’ll
never have to worry about the money”
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I choose attitude and personality over skill
Must have good skills, but skills can be
taught… attitude and personality cannot
Attitude: Team, caring, ambitious, industrious,
fast paced, teachable
Interview, screen, ½ day workview
I get input from current staff
If you make mistake, admit it, fire fast
Hire slow, fire fast
Eliminate “Deadwood”, Trim the plant
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Entire office should be servant trained
Patients don’t want to feel like objects
We smile, use patients names often
Ask how we can help
Ask if everything was handled today
Dr. asks patient if any problems with office or
staff to let him/her know personally
No automated attendants!!!
Call patients with every lab, test, procedure f/u
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Have systems in place for everything
System for how to greet patient, phones, scheduling,
check-in, collections, insurance, settlement protocols,
financial task redundancy, deposits, time off, every
aspect of business.
Every team member must understand
Takes time, education, positive reinforcement
Morning Huddles
Monthly executive review
Annual strategic planning
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Declining Reimbursements from 3rd party
Escalating Costs- rent, supplies, equip
Govt / Insur oversight / decision mgmt.
Performance initiatives – Pay 4 Perform
Consumer demands – patient pays more
Pressure to be clinically / tech up to date
"Healthcare Reform" is changing landscape
I believe we are moving toward "cookbook
mediocrity"
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Family Medicine for 28 years
ER Physician during first 7 years
Started with 2 other Dr’s
Developed a 4 location, 15 Dr. Group
Developed and operated 5 urgent cares
Sold entire group to Hospital
Was Medical Director of the hospital group
After contract up, bought back current practice
Last 9 years focused on small, efficient,
profitable practice
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1Dr., 1FNP, 2 PA-C
20 total staff
Family Medicine with modified open access model
Use Allscripts Professional EHR and PM system
Wireless tablets for providers, laptops for nursing, desktops for
administrative and reception staff
Onsite x-ray, dispensary, ancillary services
No hospital, nursing home care, I use hospitalists
On staff at two local community hospitals
75,000 charts on system
Average 2300 patient visits per month
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Medical practice has two independent mindsets operating
My clinical practice and my medical business
Decisions require “Think Twice” evaluations
White Coat Thinking – What’s best for the patient
Dark Suit Thinking – What’s best for my practice
Strategic Planning – Plan, Do, Review
Physician ownership mentality is required
Physician buy-in is imperative for greater profits
Learning the power of the EHR and partner technologies will
create greater rewards for practice and Dr.
A resource ! Michael Gerber’s The E-Myth Revisited, and The EMyth Physician
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Patient Care Enhancement
Diagnosis and Treatment
Quality of Care Issues
Safety for patients
Risk reduction
Continuing Education
Preventive Care implementation
Follow-up Care obligations
Results reporting to patients
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The business of our practices
Focusing on revenue expansion
New services
Greater efficiency in managing
patient care
Controlling costs – transcription,
employees, supplies
Schedule management
Intra office communication
Office – patient communication
Bringing it all to the bottom line - Greater profits
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Schedule management and visit expansion
Enhanced intra – office communication
Correct coding – E/M calculator
Test results reporting efficiency
Preventive care and visit outreach
In House service expansion - In House Dispensary
E-script efficiency
Patient follow-up reminders and tracking
Vendor interfaces – Lab, Hospital, Ancillary Equipment
Patient feels that Dr. is better, technology = quality
Vendor Interfaces
Lab, Hospital
Patient Follow-Up
Reminders & Tracking
E-script
Efficiency
Schedule Management
Visit # Expansion
EHR
Service Expansion
First Fill
(EKG, PFT, Holter)
Enhanced Intra-office
Communication
Correct Coding
E & M Calculator
Preventive Care & Disease
Management Outreach
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Establish independent parameters for each Dr. / Provider
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Establish appointment times for ancillaries in office
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Track No-shows
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Keep lists to fill appointment cancellations
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Set up appointments for disease states or insurance types
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Color coded patient appointment management
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Messaging between phone intake and nursing staff
Messaging between Dr. and nursing staff
Messaging among nursing staff
Consult passing between Dr.s and midlevels
Sending charts for work to appropriate staff member
Sending dated reminders to staff regarding patient care
Create shared message boxes for general work
In exam room contact between Dr. and Nursing , EHR
communication and voice command contact
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Most physicians undercode E & M codes
A review of our coding practiced showed following
 $61,000 undercoding loss in 2005
 Captured this revenue following year with E&M calc.
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$39,000 undercoding on New Patient Visits in 2006
Captured this revenue in 2007 with E&M calculator and have
continued to improve annually
Continue to enhance coding at point of care
Physician must take control of practice financial destiny
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Lab tests come overnight into patient chart
Single test review site in EHR.
Physician reports all tests by voicemail to each patient
Patients feel that “personal call” came from Dr.
Nursing staff use voicemail to notify patients also
EHR allows rapid movement to multiple patient charts
Medvoice is the technology we use, others available
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Automatic search of EHR for preventive protocol
Automatic search of EHR for disease management protocol
Automated phone calls and confirmation of appointments
Patients can cancel appointments electronically
Open appointments can be filled immediately
First month revenue increase $ 13,500, continues to grow
Patients think service is incredible – they don’t have to think
2008 start of program - Revenue increase of $300,000
2011 consistent revenue enhancement of $400,000
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A-S Dispensing program
On premises medication dispensary
½ of sales are cash, ½ of sales through insurance
Can order prescription in exam room – Checks inventory
Verifies patients medication insurance coverage level
Patient picks up RX at front office on check out
First 4 weeks profit = $2,600, continues to grow
Expansion of in office formulary easy
Inventory control easy
Automated reorder of medications
2008 Dispensary revenues of $35,000
2011 Dispensary revenues of $51,000
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Scripts sent to any State Pharmacy from
exam room
Patient satisfaction high. No wait at pharmacy
Rapid refills from E-Script requests from pharmacies
Enormous time savings = more time for revenue production
All of prescriptions are legible
Can send prescriptions electronically, by fax, to printer
Script management by nursing staff via grants
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Send future reminders to staff for patient care
Track referrals as reports return
Send future action plans for patient tests or procedures
Automatic reminders about specific patient needs or desires
Eg: 32 y/o patient with breast lump, tender, freely moveable.
Recommended 1 month of conservative care and observation.
Patient advised to follow up in 4 weeks. Left a 6 week dated
reminder to notify patient if she hadn’t returned. Patient had not
returned, we called, she came in, got mammogram after reevaluation. Lump was malignant and was removed early.
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Bi-directional interface with Lab, overnight lab results to chart
Pull electronic data and put in chart from local hospital network,
Docs for Docs
Incoming fax reports directed to patient charts for review
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We’ve had hundreds of patients enter our practice after
friends, family members, and co-workers have
experienced some of our technologic services.
In a time where patients will pay more out of pocket for
primary care services, the office that provides the best
service and care will have the most “good” patients.
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Immediate results when we went “live” on EHR
1. $39,000 reduction in transcription costs
 Our transcription bill from year prior
2. $60,000 reduction in employee costs
 Two employees left, didn’t want to learn
“computers”
 Did not need to replace them due to less paper
handling
3. Loss of expenses related to charts, filing, space
requirements for files
4. Employee satisfaction and lower turnover
5. Our EHR was paid for with this immediate cost
savings
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9 years
50 patients a day to over 115 patients a day
250 new patients a month
Patient satisfaction surveys average 95% in all categories
Increased Employee benefits every year – Dental , vision,
80% of health insurance cost, 100% matching 401K, profit
sharing plan for all employees, monthly bonus plan for
all employees, extremely low employee turnover, only
1 person has left in 6 years.
25% + profit growth annually
Quadrupled revenues in 9 years –measured from year
prior to renewed private practice implementation
2008 with 27% increase revenue over previous year
2009 provider time off expanded with same profitability
2010, 2011 increased revenue with preventive business
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EHR and Mgmt. software integrated
Point of care Charges input by provider
Clean claims submission within 24 hours
Navicure real time claims interaction
Automated payment posting from insurers
Active in house collection management
Patient training for up front payment,
discounts and deposits up front.
Accounts Receivable > 90 = 2.75%
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Use fully integrated EHR / PM
Chart connect Labs, Hosp., Pharms
Chart connect in-house ancillaries
Data mining software
Point of service E/M coding
Intra-office and patient communication
Point of service quality care protocols
In-house profitable ancillaries patients want
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Increased Employee Benefits
Dental, vision, 80% of healthcare costs
100% matching 401K
Profit sharing plan for all employees
15-25% profit growth annually for 9 yrs
Increased provider time off
Able to add new ancillaries / update equipment
Employee Monthly Bonus Plan
Adequate profit to fund outside investment
opportunities
2009 – Added Preventive company –Cash Business
2012 - Recruiting second physician actively
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2002,
2003,
2004,
2005,
2006,
2007,
2008,
2009,
2010,
2011,
employed Dr. + NP
Private Practice Dr. + NP
Private Practice Dr.+NP+PA
Private Practice Dr.+NP+PA
Private Practice Dr.+NP+PA
Private Practice Dr.+NP+2PA
Private Practice Dr.+NP+2PA
Private Practice Dr.+NP+2PA
Private Practice Dr.+NP+2PA
Private Practice Dr.+NP+2PA
$ 625,000
$ 875,000
$ 1,250,000
$ 1,635,000
$ 1,975,000
$ 2,300,000
$ 2,715,000
$ 3,060,000
$ 3,390,000
$ 3,705,000
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Morning huddles to future-face any problems of the day
Train staff to high level to off-load work of Dr./NP/PA
Always explore new technologies for possible benefits as time
savers or revenue enhancers.
Get started now – review current status and write plan for
improvement. Always “Think Twice”
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Implement and understand your EHR
Mine and act on data acquired
Use automated systems for non complex
actions
Train your patients to understand systems
Add profitable, necessary ancillaries
Make every staff member a patient advocate
and revenue producer
Establish monthly and annual plan, do, review
Spend time working on your practice, not just
in your practice
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Strategically plan implementation of laddering technologies
Stay up to date with upgrades, new technologies
Take advantage of training modules
Always think twice / “White Coat and Dark Suit” paradigm
Be a high quality, high profit practice
Focus on your patients and practice, not outside influences
Attitude is EVERYTHING, Take charge of it !
Discover or remember your purpose in life.
Write down and take action on your dreams, goals, plans
Work on self-improvement
Understand it's OK to make a profit
Make every year Your Best Year Yet !!
Opportunity:
Searching for a D.O. to join me in my
practice in 2012. Entrepreneurial minded
physician who would enjoy working in a small
fast-growing private practice . To be part of a
team that values working hard, playing hard,
and deciding and taking actions on ideas that
make our patients healthier, our employees
satisfied, and our personal lives rich and
rewarding.
Email: ofhc.oliver@gmail.com 317-331-6160
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