Balancing the Checkbook with Compassion

The business of caring, of balancing the checkbook with compassion, is one of the most important aspects of being a practice manager. There are several strategies that managers can employ to achieve and maintain this balance, which will ultimately increase the value of their practices and benefit their staff as well as their patients.

Clarify Standards and Accountability

As practice managers want their staff to be a part of positive change, they should invite feedback and help set the standards. The missions and goals of the practice should be reviewed on a regular basis, not just during orientation when a new employee comes on board.

Managers may also want to consider scheduling a staff retreat, which can provide the perfect opportunity to clarify standards and values that need to be established or improved upon. This type of activity is often enlightening and cathartic, and can help move the business to the next level. It can also very quickly identify who is likely to be there for the long haul. Staff members should be invited to share suggestions of what they would like to discuss at the retreat. An important item on the agenda should be the goals for the business, and how each member can contribute toward future success.

Engage Your Employees

To do the best job possible, I have to believe in what I am doing, as do my employees. At times, however, being the example for the practice can be very challenging. Managers must find effective ways to improve accountability, and need to consider how each employee ended up in his or her position in the practice. Were they hired for their skills and experience, for their initiative, or because the practice needed someone to sit in that seat for the moment?

I once interviewed a staff member who said, “I am not qualified to do my job. What am I going to do?” This person had been placed in a position that needed to be filled quickly, received minimal training, and was then expected to do a great job. It is vital that new employees have a clear understanding of why they were hired, and that they are provided with the tools and training they need to succeed.

Managers should routinely review the job descriptions associated with every position in the practice. If a description has not been updated in 2 years, advances in technology alone dictate that it needs to be revised. At the very least, it should include the level of education, experience, knowledge of systems or processes, and specific skill sets that you are looking for in a potential new hire.

I have noticed that hiring priorities tend to lean more toward culture, initiative, drive, and knowledge. If you can teach someone a task, that is one thing. An individual’s personality, however, cannot be changed. As I am sure you are aware, some people are just not meant to work at the front desk and ask people for money, whereas others are naturals at doing just that. It is the manager’s responsibility to assess whether individuals have the appropriate demeanor and skills needed for the job.

An effective strategy for learning about your staff’s challenges and accomplishments is to let them show you what they do on a daily basis. Managers should sit with their employees in their stations for 30 minutes and ask them what they like and do not like about their jobs, and what they would change if they could. Those who are interested in excelling in their position will likely suggest ways that they could do their job more effectively.

Spending 1-on-1 time with staff members also promotes bonding. This is not just a matter of emotion; if an employee likes their job and feels dedicated to the practice, they will work harder. You want your staff to believe in what they do and feel good about where they are. If you brainstorm with your staff about solutions that can save them time and effort, you will earn their respect, which is a win-win situation for everyone.

One of the best supervisors I ever had greeted me with, “My job is to make it so you can do your job as easily as possible.” Who would not want to do everything for this manager? As a community leader, we are the ones setting the standards for a new generation of care, and that is very important.

I believe that the best marketing tool for any practice is its staff. Patients notice what is going on when they enter your office. It is amazing to think that a few simple measures can make a massive difference, and indeed they do. One practice I work with raised the standards of accountability along with pay, which resulted in great success. When employees are accountable and engaged, patients will sense this.

Long-term employees equal long-term patients. Staff members and patients prefer predictability, especially in a setting that may produce some anxiety, because it offers a sense of security. This is what we want for our practices, and a high level of satisfaction is reflected in patient surveys to their insurance providers, which can in turn increase reimbursement as value-based indicators enter the formula.

As managers, we need to take the time to reflect on whether each staff member is pulling his or her weight. Which employees should we meet with regarding their performance and potential for excellence? Are high-performing employees leaving because we refuse to get rid of employees who are not meeting our expectations? Every single staff member impacts the value of the practice in a positive or negative way.

Prepare for the Future

All future insurance fee schedules are based on outcomes and risk. Whether you have an independent, clinic-based, or systems-based practice, you must be familiar with your numbers—this will help you realize the true value of your practice.

Although we pay a fortune for our systems, most of us tend to go only as deep as necessary to get the job done. My advice to practice managers is to call their vendors and ask whether there are any nuances or updates to the system that they may be unaware of. This can save a significant amount of time related to operations and workflow.

It is also important for practice managers to prepare for the next stage of their professional lives. They need to think about their future as a business. What choices can they make that will help them acquire more revenue? They should think in terms of short- and long-term goals. Considerations should include a quick pro forma to estimate the true financial value of their options.

With physician training taking up to 10 years to complete, practices are now facing the problem of a provider shortage, which experts estimate will begin in 2025.1 Other factors contributing to this trend include widespread adoption of new payment delivery models (eg, patient-centered medical homes and accountable care organizations), increased use of alternate settings and retail clinics, and delayed physician retirement. We are also seeing a rapid growth in the number of nonphysician clinicians, such as nurse practitioners and physician assistants, who are available to address patient needs. These healthcare professions now comprise a considerable segment of the medical community, and should be utilized as an additional resource.

Revenue Forecasting and Predictability

When it comes to medical practices and insurance companies, all we know is that we have discounted our fees to be on a list of providers that patients choose from according to their preferences.

For years, insurance carriers required global agreements for any product they would be offering at any given moment in time. Now there are narrow networks, usually associated with larger health systems, which may not include independent physicians. As a result, many long-time patients are learning that the practices they have been going to for years are suddenly out of network for their respective plans.

Now is the time to speak with payers and legislators regarding our concerns about these changes. We must consider the long-term impli­cations of the decisions we are making now.

Just as it is important to communicate frequently with your insurance carriers, it is always a good move to meet with your local and state representatives and strive to establish relationships that provide access to appealing efforts, especially with governmental programs. In North Carolina, we have an advocacy group that works with the state medical society, which gives us the opportunity to meet with local legislators.2

Let your local political representatives feel your pain. Ask them to spend time in your office so that they can observe your practice in action, and invite them to attend a local medical managers group.

The Increasing Role of Telemedicine

There is no doubt that telemedicine is growing by leaps and bounds within all specialties, and that it has the potential to increase access to quality care for many patients. However, this new method of providing health services must be used with caution. Practice managers will have to decide whether it is a viable option, based on their patient populations. Managers should contact their insurance representatives regarding coverage for telemedicine in their respective geographic areas, because use of this technology may result in better patient outcomes, which, of course, is our ultimate goal.

The Golden Door to Your Practice: Your Website and Portal

The majority of your patients will look at your website before selecting your practice or reviewing your services as a preselected physician on their insurance preferred provider list. What is the 1 thing the patients really want? The answer is accessibility. Therefore, it is important to make patients feel welcome while educating them on your standards and processes.

Your patients see your website as a doorway into your practice. It can also be a tool to address frequently asked business and insurance questions, and a useful source of information on topics such as postprocedure care. We all know that delayed care can be conceived as denied care. Therefore, it is critical to dedicate staff who will address any inquiries or issues that are communicated through the website in a timely manner.

An important goal is to encourage patients to opt for the patient portal instead of telephone or in-person conversations whenever appropriate. As it often happens with change, patients will put off making this switch until absolutely necessary. Because of the increase in the use of devices such as smartphones and tablets, and the fact that many people are already paying household bills online, hopefully it will not be a giant leap for them to include medical bills into that grouping as well.

An effective strategy for engaging patients in the online process is to ask them to enter their own information, such as their medical history and insurance information. Once they begin the actual process, they will probably become more involved in it.

Speeding Up Collection of Revenue

Revenue collection processes are faster than they used to be. Time of service collections are no longer an option, they are a must, and they send a clear message that payment is indeed expected in a timely manner.

Managers should always work with their front desk staff to establish monetary boundaries that would prompt the billing department to contact the patient directly. Any previous balances or bad debt should be addressed before the patient comes in for his or her next appointment, or receives additional services.

Many patients depend on their physician’s office to inform them of their benefits, and when payments are due. Managers should check with their vendors to see which forms, calculators, and estimators may be available to assist staff members in this process.

To revamp your revenue cycle process, consider using online billing options, such as electronic statements and remittance through your patient portal or via other vendors. The benefits of this strategy begin with the fact that there is no cost involved with the issuing of statements through many vendors. Of course, we all know that there is no such thing as a free lunch. Therefore, it is always important to ask, “Who gets the swipe?” Vendors receive a percentage of credit card processing; this fee should be clearly stated in their contracts, which should be reviewed as you enter into relationships with these companies.

Another advantage to using electronic billing is the fact that verification of receipt is very fast. It is also easier to locate patients, even if they have moved geographically, because their e-mail addresses usually remain the same. Keep in mind that it will be necessary to offer multiple payment options to patients, because some people will still prefer paper statements.

As with any new or updated procedure that includes patient interaction, it is important to test it thoroughly, either with a ghost patient or friend, for ease of use and accessibility to remittance and payment options.

Assess the True Costs of Providing Care

The traditional costs of running a practice include payroll, rent, maintenance repairs, and equipment. However, managers must also consider other expenses that affect the bottom line. What exactly is the cost to hire new employees or retrain existing staff? Ensuring that your employees are happy and well-trained is an important investment because patients will likely notice a disgruntled staff member, and, as a result, may choose to leave the practice with no explanation. I advise managers to keep track of patients who leave their practices. If the number begins to increase, they may want to consider calling patients to ask them why they left.

Practice managers should also consider the cost of signing on and remaining with a problematic insurance plan. It is possible that authorizations and other administrative work may not reimburse your staff enough to warrant maintaining such a plan.

Consider How Patients View Your Practice

Between the 2010 Affordable Care Act and employers being forced to reevaluate affordability of benefits on an annual basis, patients are experiencing “high-deductible sticker-shock” as they select physicians. Although narrow networks and other venues to control costs are popping up across the United States, some plans offer open access to any physician.

So, how does a patient go about finding the right physician? One of the most successful methods remains asking neighbors and friends. The personal testimonial still proves to be the most reliable resource for referrals.

Healthcare professionals should ask themselves, “What makes my practice so special that patients would choose to come here versus another provider?” Most physicians will say they spend more time with each patient and provide more preventive care than other providers. Beyond that, however, they need to identify what makes them different from other physicians within their specialty. From a patient’s point of view, 1 thing that is always noticed is the familial feel, or lack thereof, within the practice walls.


We must be confident that the most up-to-date care is being offered on a continual basis with each patient encounter—efficiently and with compassion. The practice manager is in the vital position of steering the practice every day and is accountable for every level and nuance of patient care. We have worked hard to establish a foundation of care that only strengthens our role as managers, physicians, and community leaders. We are indeed setting the new standards of healthcare. Let us do it right.


  1. IHS Inc. The complexities of physician supply and demand: projections from 2014 to 2025. Updated April 5, 2016. Accessed December 13, 2016.
  2. North Carolina Medical Society. Advocacy. 2016. Accessed December 13, 2016.

This article is based on a presentation by Ms Childs at the 2016 National Organization of Rheumatology Managers Conference.

Related Items

Subscribe to
Urology Practice Management

Stay up to date with urology news & updates by subscribing to recieve the free UPM print publications or weekly e‑Newsletter.

I'd like to recieve: