Best Practice Management
Disputing Some “Alternative Facts” of Everyday Management

Alternative Fact #1: “I don’t really need to review my practice finances. I’ve hired an office manager to do that.”

Actual Fact: The practice owner should ALWAYS have their finger on the pulse of the practice finances – for their own good! There is no excuse for not knowing certain data; at the very least, Account Receivables and monthly internal trending. It is critical to monitor your cash flow and collection effectiveness on a regular basis, including detailed write-offs, who exactly is authorized to write them off, and reasons for claim denials. Financial policies for patients and standardized protocols for billing office must also be in place. Protocols that should specifically address strategies in handling insurance and patient payment responsibilities, copays, deductibles, collection agency accounts, embezzlement safeguards and, if applicable, fees associated with missed appointments. While it’s certainly valuable to have an office or billing manager to monitor these activities, routine meetings between manager/doctor are essential to analyze monthly reports and quickly address irregularities.

Alternative Fact #2: “I don’t conduct staff performance evaluations because it only opens the door to staff expectations of a salary increase…and the practice cannot afford it.”

Actual Fact: Conducting performance reviews are the lifeblood of a productive, happy staff. Employers/managers need to take a genuine interest in their employee’s development; it’s part of their leadership responsibilities. Now, if these are avoided because staff have “expectations” that reviews will automatically result in pay raises, that misconception needs to be laid to rest. Where did they get the notion that performance reviews=pay raise anyway? Was it precedent that led to that conclusion? Truth is, enhanced performance deserves to be rewarded by a wage increase, a bonus, or some other benefit. If the practice is currently experiencing a revenue crunch, and your super powers don’t include extracting water from stone, not to despair. There are still things you can do.

  • Have an honest discussion with your entire staff and share with them the current financial state of the practice. Tell them that until the revenue/profits increase by ___% (don’t be vague; give them a goal), and the financial strain on the practice is lifted, there will have to be a temporary hold on all raises. Thank them for their patience and understanding. Recognize that this communication will backfire if they feel deceived. In other words, if only staff (and not the doctors) appear to be taking the financial hit OR if some employees in the practice get raises and others don’t even though everyone seems to be contributing equally, brace for rebellion or mutiny and very likely, the loss of good staff.
  • What is apparent most often is there is a disconnect between an employee’s total compensation and what they receive in their paycheck. For this reason, it is worthwhile to educate them via a compensation worksheet. (Happy to send a copy of this form to interested readers – email This tool breaks down the costs involved with keeping them on as an employee (ie, taxes, bonuses, vacation time, uniforms, profit sharing or IRA plans, etc) It is not something to hold over their heads or leverage their employment in any way; rather it is meant to give them a clearer understanding of how much they are valued as an employee! And, BTW, that is how it should be presented.
  • Finally, take a step back and tackle the bigger question. WHY? Why the revenue shortcoming? Look at your numbers and ask yourself…what has changed? Is cash flow tied up in Account Receivables? Are claims not being submitted in a timely manner? Are front desk staff soft on patient collections? Is there a dip in patient load or new patients? What must change to turn things around? Knowledge is power.

Alternative Fact #3: “Staying on schedule is IMPOSSIBLE!”

Actual Fact: All offices occasionally run behind; however, if it becomes a routine occurrence, address it by assessing where the current system is broken. Then work to fix it. Some things to examine:

  • Start on time – If doctors or staff arrive late or the first patients on the schedule are not taken to their treatment room at least five minutes before their appointment time, expect an adverse ripple effect. Early morning late-starts turn into mid and late morning delays, which inevitably roll over into lunchtime (what’s that?) and you’re already behind the eight ball with afternoon patients. Starting late is the single biggest cause for running behind. There is an easy remedy for this: “If you can’t be on time, be early!”
  • Create distinctive “how to schedule” protocols (and train staff to use them consistently) – 1) Your schedule should be filled according to reasonable prior evidence (data) – not guesswork. Newsflash! Not every patient encounter fits into a 10 or 15-minute slot. Take your five or ten most common procedures and assign a realistic time, based on the average time you spend with each one. Then schedule accordingly. It isn’t always exact; however, it will absolutely be an improvement over the random “just fill in the empty slots” type scheduling. 2) Never schedule “complicated” visits (new patients, procedures, surgical consults, etc) back-to-back. It’s best if they are restricted to the top of the hour so they are adequately time-spaced. 3) Leave at least one interval in each day for emergencies. If not needed, use this freed-up space to accommodate last minute callers or necessary catch up. These are just a couple of scheduling actions you can take to start.
  • Streamline your check-in process – Insist that your new patients present with their patient registration paperwork completed to avoid waiting the 15+ minutes it takes for them to complete it onsite. Ideally, having new patient forms downloadable on your website offers not only convenience for most patients – yes, even the elderly; it also yields a more comprehensive patient history.
  • Enforce scheduling policies – Policies that describe how to handle patients arriving early or late, no shows, cancellations, emergencies, etc will all help to keep a structured and timely schedule. Of course, if a policy exists, it’s worth little more than the paper it is written on if not enforced. Consistently. By all. You can educate your patients on the importance of keeping their appointments by utilizing reminder calls/texts/emails and by employing consequences for repeated no-shows. If patients feel you don’t care about or respect their schedule (by running late), why should they care about or respect yours?
  • Treating multiple (unscheduled) conditions – Let’s face it, true emergencies almost always throw us off schedule, and fitting them in is not an option. On the other hand, fitting in those patients who expect on-the-spot treatment for (unscheduled) secondary complaints (perhaps to avoid a co-pay or the inconvenience of returning), IS an option. So unless there is a surprise block of free time to comprehensively address their additional concerns, it is always better to reschedule them. Rescheduling allows you; 1) the proper amount of time to thoroughly address additional conditions and follow your preferred/consistent treatment protocol vs a limited, rushed version; 2) to maintain an on-time schedule; and 3) to show consideration to compliant patients who arrive in a timely manner. Patients must be made to understand the boundaries of their appointment time, while the practice is responsible to enforce a policy that is fair to all patients.
  • Reduce the chit-chat – While a certain amount of small talk is important to socially building patient relationships, engaging in lengthy conversations when you are needed elsewhere leads to a disruptive, uncontrollable schedule. If you feel obligated to chat more than is necessary or have difficulty leaving a treatment room with an overly chatty patient, enlist the help of your staff by establishing an internal “SOS” exit code. For example, have staff proactively enter the room (at an agreed-upon appropriate moment) to complete patient care or help with their shoes and socks. This sets the stage for you to wind down conversation and is your cue to make a professionally artful exit. Works every time!

I conclude with a basis in fact: An alternative fact is an effort to promote what might be someone's belief or opinion as fact. An actual fact is a verifiable reality that is based on objective evidence and validated precisely because the alternatives have been disproven. Throughout my professional career in podiatry and conducting years of in-office consultations, I’ve been witness to many practices whose philosophies are steeped in management beliefs contrasted by thriving practices grounded in proven success strategies. My goal is to share those “Secrets of Success” with you. And as always, I welcome your feedback!