Time to tidy up how your practice is run

Spring is in the air with the arrival of the Spring Bank Holiday – and it is time many private doctors gave their practice a spring clean for financial health. Garry Chapman suggests suitable areas for treatment

Busy doctors involved in private practice are often so focused on providing a high standard of medical care for their patients that they lose sight of the most fundamental aspects of running their practice and forget the fact that it is a business.
Many independent practitioners still do not like to think of their practice as a business, but, in reality, for anyone employing people and running a practice with a reasonable-sized turnover, that is exactly what it is.
It is normal for any business to regularly review the processes and procedures used to operate the business to ensure that it incorporates best working practices.
If you take into account all of the changes that have taken place in the market in the last three years, it would make sense to review how your private practice is operating to decide if you need to make any changes.
And if, on top of the changes, your practice has also grown over the last few years, it is absolutely vital to take the time to review how it is functioning.
Of course, every consultant is an individual who operates their practice based on their own preferences.
But I have identified below the key areas that most practices should look at in any review.

Secretarial support
If this key area is not resourced correctly and kept in line with the growth of the practice, it will undoubtedly cost the consultant money in lost opportunities.
I visit many different practices in my working life and while I have stressed this point before (see Independent Practitioner Today, February 2013), I still come across many consultants’ practices where the secretary is struggling to cope.
This is particularly true where the secretary has more than one consultant to look after or where the consultant’s practice has grown so fast over the last few years that it has outstripped the capacity of the secretarial support.
The main areas of concern is communication, such as:

Phone calls
A practice has a plethora of calls from many sources. On top of all the calls it receives from private medical insurers in relation to finance queries, the largest increase is typically due to the amount of phone calls coming in during the day from either existing patients or new patients wishing to book appointments.
Combined with this is the amount of outgoing calls the secretary has to make to the insurers, including calls to obtain authorisations for the treatment. These have increased as these calls have become more complex.

Another huge change over the last few years has been the increase in emails that a practice receives on a daily basis.
This puts pressure on the secretary, because when people send emails, they expect a rapid response.
If they do not get one, they might perceive that as poor service and send another email chasing a response, which just adds to the amount of emails received.
If you look behind the reasons for the increase in phone calls and emails, it is not surprising that it has become a problem.
There are approximately 82 million mobile subscriptions in the UK with 92% of the adult UK population owning a mobile. The increase in smartphones means that more than 32 million people access the internet from these phones on a daily basis.
In 2011, for the first time ever, the volume of calls made from UK mobiles exceeded the number of calls from UK landlines. These statistics keep growing, so the problem is only likely to increase, as we live in a world where people want instant access to answers and information.
This could mean the practice is missing out on lost opportunities, with potential patients going elsewhere due to poor communication via missed phone calls or slow responses to emails, so unless these issues are addressed, the problem will only intensify.

Bupa’s ‘open referral’
Another major change that has taken place since January 2012 is the ‘open referral’ system that Bupa has introduced. Bupa has the lion’s share of the market, so until this has been in operation for some time, it is difficult to know what affect it will have on the number of patients that each practice gets referred from Bupa or what impact it will have on the wider sector.
This is obviously going to be specific to each practice, so an analysis needs to be done to identify if there is any action that the consultant needs to take to mitigate any downturn.

Internet presence/self-pay
Due to all of the changes in the market I have written about previously (see Independent Practitioner Today, April 2013), it is not unusual for a practice to have a substantial element of the billing to go to the patient.
Again, this is something that is going to be specific to each practice, so an analysis needs to be done to identify if there is any action that needs to be taken to make sure the practice is getting its fair share of this market.
The focus must be on:

  • Making sure that invoices are raised in a timely manner;
  • Ensuring that every procedure is billed correctly;
  • Invoicing with correct coding rules for each private health insurer;
  • Collecting the money in a timely fashion to avoid bad debts.

We are constantly surprised how rare it is to find these fundamental business principles being carried out within a medical practice.
The reason we know this is because the majority of our clients come to us in various states of financial distress.
Some have huge backlogs of outstanding debts, which quite often go back years. Some have clinics that have not been billed for many months and some are years out of date with their fee levels. And the worst have all of these issues.
Over the years, many consultants may have managed to exist without paying too much attention to the finance side of the practice and, as they have grown their businesses, this may have masked any inefficiency that existed.
It is down to each individual consultant to carry out their own practice health check and to decide in what priority to tackle these areas.
One thing to consider is outsourcing the billing and collection to a professional billing agency which can assist across many areas in multiple ways (see our June 2012 edition).
Whatever the consultant chooses to do, they should not delay, as any issues that they have will only get bigger the longer it goes unchecked.
Garry Chapman (right) is managing director at Medical Billing and Collection

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