It’s not rare to have a cancellation policy that requires (err…requests) a $25 payment for missed doctor, dentist, or physical therapy appointments.  It’s pretty standard and I see it all the time.  I haven’t heard too many complaints about this type of policy from patients, and I believe that for the most part it’s a widely accepted practice.  In fact, I don’t mind the policy myself.

I think the reason there isn’t too much ruckus over this policy is that there is really no obligation to pay it if you miss the appointment.  Sure, the provider might not allow you to reschedule if you don’t pay, but how often is that really going to happen?  Physicians and dentists have reputations to protect, and I don’t know many that are going to risk it over a $25 no-show charge.

So, if a no-show charge doesn’t incentivize patients to show for appointments then how do you keep your no-show rate down (as if good healthcare isn’t enough by itself)?  In this post from the Musings of a Dinosaur blog, we learn about a specialist that charges $75 IN ADVANCE to hold an appointment. 

Show up ready for your appointment?  Get your check back.

No show? No refund.

Not sure if I like it or not, but I bet it works.

The specialist’s first available appointment was April 22 (six weeks out.) That’s par for the course around here, but what floored me was the demand to send a $75 check along with the required pre-visit paperwork, along with a deadline after which the appointment would be canceled if not received. The check would be returned to the patient at the time of the visit, and would only be cashed if she failed to keep the appointment.

I’m a runner.  I’ve had plenty of periods where I don’t run for a while, but I always come back to it, and it’s always for the same reasons. 

Nothing makes me feel quite the same as I do after putting in a 5 miler.  I breathe deeper, get good time alone with my thoughts, feel better during the day, and on and on.  At the same time, nothing is quite as difficult to stay consistent with as running 5 days a week. 

As I was running the other morning, I began thinking about some of my private practice clients, and how in many ways they face a similar challenge.  Just as I always feels good when I’m done running, I’ve found that many private practice owners have the same feeling when they’re “done” with a big project, “done” with the startup phase of their practice and finally have the doors open, and “done” with getting a big bank loan finalized. 

Being “done” always feels good, whether running the streets, or running a practice, but the process of reaching that end goal isn’t always a whole lot of fun.  As much as I love running, it’s not really the feeling of being out of breath, the constant pounding that I feel with each step, or the burning in my legs that makes it worthwhile.  It’s the feeling of accomplishment that is achieved when I put each of those tiny steps, deep breaths, and aches and pains together over a period of months and years to achieve personal accomplishments that can be obtained in no other way.

When I work with a client, I spend a lot of time discussing vision, personality, lifestyle, values, and a lot of other stuff that doesn’t have an immediate tie to the bottom line.  The reason for this is that running a private practice, like a 5am running routine, is only going to be successful if it lasts for a really long time, and the only way to achieve this by tapping in to motivation, experience, and vision.  To do this, I use the same techniques to keep myself running that I do with my private practice clients: Stay focused on the end objective, always be prepared for bad weather, break each session (project) up into bite-sized milestones, enjoy the journey, and don’t go it alone.

I’ve found that when these elements are taken into account along the way, the bottom line usually falls right into place.

In any aspect of healthcare, clinical excellence is necessary in order to provide patients with the information and intervention necessary to keep them healthy and return them from illness.  Clinical excellence by itself though, still requires intelligent administrative and organizational delivery in order for patients to receive good care.  In this article from Net News, this point is made as relates to the dental profession.  Schools focus on the education of clinical skill, but still lack in terms of the business education required to keep the doors open to dental practices.

“Dental schools might be great, but they’re notoriously bad at addressing business issues,” said Jim Du Molin, dental management consultant and founder of The Wealthy Dentist. “Students learn lots of science and very little about practice management. But how can graduates expect to practice dentistry if they can’t run a dental practice?”

We all realize that our medical practices should have risk-management programs in place, however, taking the time to develop a solid program is often put aside due to other operational components of our business.  Without proper procedures in place that are documented and abided by, we place our businesses in potentially precarious positions.  Here are a few tips from MGMA when reviewing your risk-management program.

Everyone in a medical group practice benefits from an effective risk-management program. A strong program helps identify problem areas and enables clinicians to reduce patient errors and poor outcomes. To accomplish this, leaders — including the practice administrator — must constantly gather pertinent information. This allows you to develop policies and procedures that promote quality health care and a safe environment.

The basic components of a risk management program are a source document to report incidents, staff education and a quality-improvement team.

Collecting on aging accounts is vital to the health of our business.  The collection process needs to be thorough and efficient in order to maximize cash flow.  But, having a methodical system does not mean that customer service is thrown out the window.  Peter Lucash offers some insight into maintaining great customer service while working these accounts.

Collecting fees, from co-payments to non-covered expenses, requires a degree of tact and compassion. Our goal is always to develop long relationships with our patients – they should never be viewed as one time transactions.

Understanding the overall costs associated with running a private practice is critical to staying afloat in today’s healthcare environment.  In this 20 minute podcast, Owen Dahl speaks about the importance and tactics behind understanding these important costs.

In this 20 minute podcast,  Owen Dahl, MBA, FACHE, CHBC, author of Think Business! Medical Practice Quality, Efficiency, Profits, discusses how much it really costs a doctor (or a practice) to see a patient. No, the answer isn’t what you charge for an office visit. A physician needs wise management of costs and an understanding of revenue enhancement to assure long term success for the practice. But how do you analyze costs in a practice? Mr. Dahl addresses fixed, variable, direct and indirect costs with practical examples of what costs you can control. You may think it is your office supplies – but analysis of your payroll may yield larger savings. Also hear his expert comments about patient satisfaction, your no-show rate, overtime costs, and what it means to the practice to see just one additional patient per day.

This isn’t going to work for every practice, but the science behind overbooking warrants at least a second look.  This article from American Medical News goes into detail about when, where, and how overbooking might be appropriate in healthcare.

“I think everyone’s first reaction to overbooking in heath care is, ‘That’s got to be awful,’ and we thought that, too,” said Dr. Lawrence, an associate professor of operations management at the University of Colorado at Boulder Leeds School of Business. He is an adviser to Dr. LaGanga, who conducted the research for her dissertation as a PhD candidate and is now an instructor at Leeds. “But we knew it happened, so we wanted to see when benefits exceed the costs.”

Dr. Lawrence agreed that “the real cost is if you do overbooking, there will be patient waits and overtime to be sure.” But he argues that overbooking could still be beneficial for some practices. The dilemma is determining when it might work or when the stakes are too high.

When I was leading a team of physical therapists in a healthcare organization I remember how much my team hated when we would discuss the “P” word (productivity). We all knew it was important, but the nuts and bolts of calculating and monitoring productivity was a turnoff, as we were all just interested in making our patients better, not in the bottom line of the organization.

I would spend a lot of my time preparing for meetings that would discuss productivity planning out the correct language around the topic, every effort put forward toward ensuring that the team could understand how it was measured, and why it was important.

Now, as a healthcare consultant to private practices, I work mostly with practice owners and managers. Productivity is well understood, and the importance is known. We will often discuss that the challenge in healthcare is striking the balance between a productive work environment that supports a healthy bottom line for a practice, and one in which quality experience is achieved by all patients who enter the door.

The following article from Medical Economics approaches the subject of productivity in healthcare practices, how productivity is calculated, and which formula may be best based on your individual practice.

When you judge a baseball hitter’s output, what numbers do you study? Hits? Runs? Runs batted in? Batting average? Slugging percentage?

Likewise, you have your choice of stats for defining physician output.

For soloists, productivity is easy to describe—see enough patients and render enough services to meet overhead and provide you with a desirable income. In a group, however, splitting revenue is often complicated and contentious, because somebody’s bound to think that the yardstick for productivity is unfair.

If you’re sizing up a job offer or you’re a partner in a group that’s fighting over income, you need to understand how various productivity measures affect compensation. We’ve developed this primer to bring you up to speed and help you negotiate the best possible terms.

You’ve probably heard the adage, “no margin, no mission.”  This applies to many facets of business, and this article from Dental Economics explains how it applies to the dental profession.  If dental practices don’t manage their operations well enough to provide a healthy bottom line, there won’t be any way to help patients in the first place.

I see so many dentists spend an incredible amount of time and money improving their clinical skills, which is always important and necessary, but these highly trained dentists come back to their offices with the same practice management problems they left with. They’re now able to offer incredible dentistry to patients, but there are no takers. Patients don’t respond only to clinical skills. In fact, most patients cannot differentiate between a dentist who has taken 1,000 hours of continuing education in the past year and a dentist who has taken only 20. If you don’t equally advance your practice management skills along with your clinical training, your dental practice will not grow.

Here’s a great summary by Peter Lucash at the Medical Practice Business Blog about the importance of understanding that like businesses, employees also have a life cycle, and getting the most out of them requires an understanding of the stage at which they exist.

In medical practices, your employees are as important as physicians in building a successful practice, Patients spend more time with your staff than you, and a good staff makes your life better.