George Dickstein, MD, a gastroenterologist at Boston Endoscopy Center and chair of the Department of Medicine at MetroWest Medical Center in Natick, Mass., recently shared five ways to ensure success when managing a practice, from proper staffing levels to cost-cutting techniques to the case for working alongside — rather than against — hospitals.
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Question: What would you add to a practice management "cheat sheet?"
Dr. George Dickstein:
1) Staff appropriately now and for the future. The medical workforce changed seemingly overnight. Extended days and weekend shifts, even at time and a half, no longer appeal to many employees. Successful center HR management requires renewed attention to recruitment and retention of nurses and techs, understanding what keeps them happy at work (beyond competitive wages) and working collaboratively to achieve those goals. This may be one area where accepting a higher cost structure really pays dividends in the long term.
2) Assure fair facility fee compensation for the services provided. This will take a dynamic understanding by center leadership of the commercial and government payer base, including burgeoning Medicare Advantage plans. Getting accurate rate information to know what your competition is collecting can be challenging but will often be worth the investment. As dollars tighten and costs increase and insurers try to shift procedures to non-hospital licensed sights of care, there are inevitable conflicts and bumps in the road that will sometimes require difficult decisions to be made, including deciding what plans NOT to participate in. Resist the temptation to participate in poorly paying plans, especially when such participation will have little real impact on your success.
3) Secure sufficient anesthesia staffing. The anesthesia staffing shortages are not easily solved, particularly as reimbursement shrinks in many markets. Many ASCs are swallowing the bitter pill that they now have to supplement anesthesia pay with stipends or guaranteed day rates to keep sufficient staff. Discord between scope of practice among CRNAs and MDs does not help the matter. However, there are major staff shortages even in states where the working relationship between MDs and CRNAs is very good.
4) Be on the lookout for opportunities for volume growth. Sometimes this makes for strange bedfellows, like learning to work with, not against, your local hospital, or learning to work with your competition to be better aligned as a community of providers dedicated to keeping independent physician providers and the center financially secure.
5) Manage costs aggressively. Look for group purchasing organizations and do not be shy about pitting one against the other. Do not accept someone's claim that their prices are best without actually confirming it. Critically look at your inventory and concentrate on using lower-cost supplies, especially when they have little impact on patient care or outcomes, even when the providers might prefer one peripheral or device over another.