Archives : private practice

More physicians leave private practice

I was recently interviewed for an article which was published in the Carolina Journalism Network, titled “Physicians move out of private practice,” a story by Laura Montini.  The interview was prompted by an article I wrote for The Healthcare Entrepreneur Blog titled, “Time to throw in the towel on private practice…or is it?”

Click here to visit the article (excerpt below).

As an advocate of entrepreneurship, Quatre said that doctors should not lose hope on keeping their private practices afloat.

“When the owner of a practice has a vested interest in seeing the practice succeed, that’s an equation where incentives are alive in a way that has a real natural benefit to the community,” Quatre said.

There is still a place for more entrepreneurial practice owners in health care, he said.

“It’s not time to throw in the towel.”

Via: Physicians move out of private practice | Carolina Journalism Network.

Time to throw in the towel on private practice…or is it?

I don’t buy it.

An article in the New York Times today titled, “More Doctors Giving Up Private Practices,” told the story of an increasing number of physicians who are finding their “bliss” through employed, salaried positions, rather than at the helm of their own private practice.  The reason – increased costs, decreased pay, and ultimately unhappier doctors in the private practice environment.  Again, I don’t buy it.

The article spoke of the increasing financial burden on physicians who, in order to keep up with the demands of today’s healthcare arena, must invest heavily into expensive electronic medical record systems (EMR) and practice management softare (PMS), along with the staff required to collect payment from a growing number of patients who lack the financial wherewithal to pay their bills.  Sure, the challenges are real, but it’s still bullhonkey.

The silver lining in this shift toward larger, safer, and inevitably more monopolized healthcare practice – if there is one – the article goes on to say, is the continuum of care that is far facilitated by larger, more integrated systems which employ large numbers of physicians from a variety of specialties.  Not convinced.

The Medical Group Management Association (MGMA) reports - according to the article - that in 2005 more than 67% of medical practices were physician owned, however three short years later this number had dropped to below 50%.  With admitedly disturbing facts such as this, and the industry knowledge that is near and dear to my heart – that private practice owners are, in fact, struggling in pockets across the country – how could I possibly scoff at the fact that an article in the New York Times suggests that quite possibly it is time to throw in the towel by the physician masses?

Because it’s short sighted, cowardly, and undermines the creative and entrepreneurial fabric from which many of our country’s greatest practices are woven.

In a nutshell, it’s the wrong way to go.

I’ve been around healthcare my entire life, and my professional career has known nothing else.  I care deeply about people, and understand that passion, freedom, autonomy, and creativity are the inspiration behind the greatest care that our country can offer.  I also understand that in order to attain autonomy, passion, freedom, and creativity requires risk, hard work, and often times, failure.

I’ve worked salaried positions and have spent much of my life in a risk averse bubble, looking fondly at the status quo and fearing anything that risked upsetting it.

But I’ve also lived the other side.  The side that guarantees nothing, but promises everything.  The side that allows me to be exactly who I’ve been created to be, and to relish in failure as it is a means by which I will improve my service to others.  It is this side about which I am passionate, and about which I know I can change my life, the lives of others, and through my current mission with Vantage Clinical Solutions, change healthcare.

I don’t think the healthcare industry is going to benefit from bigger companies who can promise the world to its salaried professionals, while placing handcuffs on the passion and creativity that comes only with the ability to chart one’s own professional course.  I don’t think the continuity of care is going to suffer if small town doctors have to refer to one another rather than down the hall in order to provide the specialty care that is needed of their patients.  And I don’t think that failure is inevitable to those who try to make it work.

There are challenges, yes.  We, at Vantage Clinical Solutions help private practice owners deal with them everyday.  We feel the pressures of the economy just like the next guy.  The difference is that we see the challenges as an opportunity to look to entrepreneurship, creativity, and innovation as the tool from which our problems will be fixed.

We understand that the “corporate” way which benefits from huge economies of scale and infrastructural efficiencies does indeed have merit – but more importantly we know that it is not the only answer.  We work with numerous private practice owners every day who are delivering healthcare their way, doing it profitably, and changing their patients’ lives in the process.

At the risk of belaboring my diatribe of a post, I do want to make clear that I understand that entrepreneurship indeed is not for everyone, and the thousands upon thousands of professional, caring, and excellent healthcare providers who do thrive in the corporate, structured environment, need not change a thing.  Indeed, consolidation and centralization is a viable solution to many of the challenges we face in the healthcare industry.

My point, however, is to suggest that it is not the only solution, and to those who’s fuel does come from a burning passion to create, be different, and deliver care in their own way – bear down and get after it.

The system that the NY Times article speaks of is not for you.

Vantage Forums: Choosing the right entity for your practice

We get the question all the time: “What type of entity should I choose for my practice?”

It’s a loaded question, and depends on many factors including tax implications, legal ramifications, simplicity, liability protection, and more. Of the many great resources offered by the Small Business Administration (www.sba.gov), here is a nice and simple resource that outlines many of the factors that should be considered when choosing an entity for a practice.

http://bit.ly/ctCoko

via Vantage Forums: Choosing the right entity for your practice.

Vantage Forums: County Health Rankings Website

During a recent Market Analysis presentation at CSM 2010, I mentioned a website link that was referenced in a recent email by the APTA. The website is called “County Health Rankings” and the url is www.countyhealthrankings.org. This is an excellent resource for market health data at the county level and provides a number of data categories as well as an explanation of the data collection methodology and relevance for each. Really a great resource and I recommend you bookmark it…remember, data is EVERYWHERE!

via Vantage Forums: County Health Rankings Website.

Everybody is the best. What you need is to be different.

This is a bit hard to stomach, but it’s the cold, hard truth: I’m no better than the next guy.

At least that’s what I need to tell myself.  And you should consider the same.

The reason for this is pretty simple…everyone is the best.  Now, you might be able to argue the case that this isn’t possible (I mean, how can everyone really be the best, after all), but for all practical purposes – all purposes that matter to the owner of a business – it absolutely, vehemently, 100% is the case, and should be treated as such.

Think of it this way: You’re marketing your practice to your community, your referral sources, and maybe even a payer or two.  You need to give them a reason to use you, right?  So, what do you tell them…that you’re mediocre?  That you’re about half as good as the doctor’s office across the street?

If you’re still in practice you don’t.

You tell them that you’re the best, right?  Sure you do – but guess what – so does everyone else.

So, you might have established that you’re the best – right along with the other 100 practices in your market – but what you’ve probably failed to do is establish that you’re different.

In competitive markets (which health care is, and will continue to be), being different is better than being the best.  Being different in a way that people can remember, enjoy, and talk about will achieve a return on your marketing investment that far outpaces any returns you’ll achieve by letting everyone know how good you are.

You might be different because you own a piece of equipment that no one else has.  You might be different because your approach is a bit off the beaten path.  You might be different because your office is clean and plays nice music.  And yes, in some cases you might actually be different because you are the best (just don’t get too caught up on this one).

If you look hard enough, you’ll find that you are different…and that’s actually what really matters in marketing.  So, go ahead – be the best.  I will too.  Just do it behind closed doors and give people another reason to use you.

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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO.  Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.

Economic slowdown requires quick business

When working with practices, I often hear comments like this:

“It’s hard to compete with the hospitals, they have all the physicians locked in”
“It’s hard to compete with XYZ rehab corporation, they have so many locations”
“XYZ company has all the insurance contracts.”

However, in times of change, more is not always better.  Small businesses – specifically private practices – may not have every insurance contract, every referral source locked up, or every location covered; but they do have something their large competitors do not — the ability to implement change quickly.  

This is a big deal, especially in a slow economy, and it is often overlooked.  More referral sources, more locations, and more contracts also means more to manage.  Many organizations struggle to manage one or two referral sources, contracts or locations well, and adding more to the equation can sometimes simply compound inefficiencies, errors, or quality.

In response to the economic slowdown, having “more” requires greater efforts to change.  Small business, private practices have a greater ability to implement change and respond more quickly to the market.  Despite this, it is common for managers and owners to overlook this opportunity, and they often do not leverage this strength of their business to compete against the larger players in the market.  

In fact, managers and owners often make business decisions that limit this quality of their practice.  When making business decisions, consider how to sustain your practice’s agility and quickness to implement change.  With our economic slowdown, everyone is rethinking how they do business to thrive in this climate.  In response, implementing change could be like riding a jet ski for those in private practice, compared with navigating the Titanic for the behemoth hospital organizations or corporations.

To maintain quick and agile business practices during the economic slowdown, consider the following:

1. Flexibility is an invaluable, intangible characteristic.
2. Hire the person who offers to work a range of hours rather than the person who demands 40 hours per week from 9 am to 5pm.
3. Avoid accruing large fixed costs, these will limit your ability to sustain a profit with highly variable revenue.
4. Contracts with lengthy time commitments need hard consideration. Do you have a solid vision for where your practice will be in 12 months given our dynamic health care climate, let alone 3 or 5 years from now?

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Bridget Morehouse PT, MBA is a consultant with Steffes and Associates, a rehabilitation consulting firm based in Wisconsin.

Email marketing in private practice

I love email.  It’s efficient, versatile, and just about everyone uses it.  If done right, email can convey emotion, professionalism, and can strengthen (or quickly harm) one’s reputation.  I use email for a variety of purposes including personal communications, education and learning, professional communications, and even marketing.

Marketing with email is a slippery slope, and can as easily build a business as it can tear it down.  If not done correctly, email marketing can take the form of “spam,” or unsolicited mass distribution of a sales pitch or marketing message.

The good news is that email marketing done correctly can build one’s reputation and market appeal by offering genuine, unique information that is relevant to recipients, and in a manner that isn’t obnoxious or invasive.  This application is just the right fit for clinical practices, as by and large, we offer services to a fairly homogeneous group of customers (patients), all of which can benefit from scheduled updates, education, and information regarding their health.

Email as a marketing tool for private practices is efficient, cost-effective, and convenient for both the creator and the recipient of the marketing message.  Below are a few ideas for how to craft an email marketing campaign for any type of private practice, and here is a link to a great article about email marketing at the Small Business Branding blog.

1. Add “Email Address” to your patient intake form, and a check box to “opt-in” to your email newsletter.  This is a quick way to build your distribution list and is a good point of conversation to patients as they become familiar will all of the services offered by your practice.  The likelihood of patients opting-in is much higher in a personal setting such as a healthcare practice than it is on a website.
2. Use your email campaign to promote upcoming events at your practice.
3. Notify your distribution list of community events and sponsorships that your practice is involved with.  This can help to increase attendance at these events, but most importantly it communicates the message to your audience that you are active in the community, and on the local radar.
4. Provide links within your newsletter to resources outside of those offered only by your practice.  This builds credibility and adds value to the newsletter as it can be a means of educating your audience about information that can help them.
5. Include a link that allows recipients to “ask a question” or otherwise interact with practitioners in a way that is informative and approachable.
6. Include original content published by clinic practitioners so that your audience can begin to understand that your expertise is both broad and multi-dimensional.

There are hundreds of other ideas for your email campaign, and I know of no other industry where building a “community” around your business is as conducive as it is in healthcare.  Your patients most likely love what you have to offer, and by communicating with them on a regular basis through a simple and cost-effective email campaign, you are providing yourself with an easy way to strengthen your relationship with them, while providing them with value that your competitors may not.

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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a national healthcare consulting and management firm located in Bend, OR and Denver, CO.  Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website by clicking here.

Don’t chase the needle

Last Friday, I was fortunate enough to be invited by my friend, Tod, to go flying.  An aspiring pilot, I leapt at the opportunity, taking the morning off to view Central Oregon from above.

Now, I’ve been up in private aircraft a few times, but I have never experienced flying like this.  It was the perfect combination:  An enviable airplane, spectacular weather, and great company — all of which combined to make this experience one that I won’t soon forget.  I learned a bit about flying, and if you read on, a bit about private practice as well.

The airplane was a Vans RV series plane, completely teched out with electronic navigation, GPS, plush interior, and Sirius satellite radio — definitely as nice as my novice eyes have seen.  I was truly impressed. 

The weather was as clear as it gets in Central Oregon — not a breeze, bump, or cloud in the sky.  It was “smooth as silk” as they say, and I could see to the top of the Cascades, all the way to Silver Lake, and back to Smith Rocks, all without a squint.  And the company, as I said, was great.

This was my first time flying with Tod, and he was accompanying me on this flight as both a friend and mentor.  He’s been a pilot since 1979, and as much as he loves flying, I could tell that he derived equal, if not greater pleasure from turning others onto the sport.

It should have been no surprise then, when no more than 120 seconds after takeoff, just as I was beginning to control the awe with which I was viewing the landscape, that he said – “OK, take it, it’s yours.”

“Whoa.” 

This was a great opportunity, and mighty generous of Tod, but independent of all that, I really didn’t have much of a choice — I could look like a wimp who’s afraid of the stick, or take it confidently while submitting a silent prayer for both of our safety.  I did the latter, never letting on that I was the least bit nervous — I think.

So, I took the stick, and with palm sweaty, figured, “maybe if I don’t move, this thing will fly itself.”  Not a bad strategy until it was time for my first lesson. 

The first lesson went something like this, “Spin this thing around three hundred sixty degrees — go ahead and really bank it.”

“O…K…,” I said.   Not sure that I “really banked” it, but I did manage to do the 360…probably in no less than a 5 mile radius.

After that lesson though, it sort of clicked, and I became fairly comfortable up there.  I mean, after all, there was a long way down for him to take over and correct, and what the heck, why not just loosen up and enjoy the flight.

So, this is what we did for the next hour or so, when my lesson switched from “banking it” to “not chasing the needle.”

Chasing the needle happens when you’re striving for a certain altitude — in our case, 7,500 feet — and you make your adjustments just agressively enough that you shoot past your target and to the other side.  For us, it looked something like this:

“OK, doing good, just about 7,500 ft…oh, whoops, 7,600 ft — better correct — there we go, got it, ah, whoops 7,400 ft — darn it, let’s go back the other way, perfect — ah man, 7,700 ft,” and so on.

It’s really a struggle when you know you need to head a certain direction in order to correct, and by the time you’ve made what you think is the right adjustment, you’ve hung on just long enough to require a correction in the opposite direction.

The advice from Tod: “Don’t chase the needle.  Make small adjustments, lay off a bit, re-assess where you’re at, and adjust again.  Don’t continue making your adjustments until you actually see the needle hit the mark — if you do you’ll end up chasing the needle to the other side.”

Sound familiar? 

It should.  As you’re likely aware, there’s a lot more chasing of the needle than happens in airplanes.  While the gravity of the situation may appear greater at 7,500 feet, the principle applies to every mark we try to make, whether up in the air or in our own businesses.

In private practice, the mark that we’re shooting for might be patient volume, profitability, customer satisfaction, or anything in between.  The needle usually comes in the form of financial or productivity reports, outcomes and satisfaction surveys, or staff retention — basically anything that is measured within the practice.  The “stick” might be the marketing campaign, customer service training, clinical education, or anything else that is done to try to “meet the mark.”

At 7,500 feet, the altitude adjustment was pretty straightforward — push forward to go down, pull back to go up.  In a private practice, the adjustments are many, and the best method of tracking toward objectives are not always easy to do.  Increasing volume may require a combination of marketing plus customer service training; the financial profitability gauge may be more responsive to adjustments by way of expense reduction rather than revenue generation; and patient satisfaction may be tied more to clinical outcomes than to flexible appointment times.  No practice is the same, and it’s the job of the owner or administrator to understand which adjustments should be made, and how aggressively to make them.

The key is, regardless of which adjustments you are making, don’t throw everything at the gauge and expect not to chase the needle.  In private practice, it is critical to do just Tod said: “Make small adjustments, lay off a bit, re-assess where you’re at, and adjust again.”

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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a national healthcare consulting and management firm located in Bend, OR and Denver, CO.  Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website by clicking here.

Private practice – a flawed business model?

Here is an interesting take from an economist looking at the “business model” of small health care practices.

For most small business owners, the productivity of each employee increases revenue. Whether the product is a widget or a hot-dog or computer software, the general concept of employee productivity is that employees increase revenue and the more revenue per employee the better. Thus as sales escalate to the point of needing another employee, the revenue from that person’s productivity more than covers his cost. Thus scaleable businesses typically have desirable business models.

In private practice medicine, revenue is dependent on the productivity of one person – the doctor. Hiring more employees does not increase his productivity. The only thing that can increase revenue is for the doctor to work harder and faster to see more patients or do more procedures. He is the rate-limiting step in the business model. This is the reason why your trips to the doctor’s office get shorter and shorter.

Check out the rest of this article here.

Branding has a place in private practice

Developing a strong brand has a definite place within private practice healthcare.  A lot of practice owners don’t (or don’t want to) acknowledge this, thinking [erroneously] that simply hanging out their shingle and providing good care will keep the practice full. 

Guess what?  Everyone provides good care…at least we all say we do.

To develop a following requires a brand, and it doesn’t matter if you are a doctor, dentist, physical therapist, or an auto mechanic.  Like it or not, your “brand” is what comes to mind when your patients are deciding whether or not to come see you for the first, second, and 100th time. 

One thing about a brand is that one will find you whether or not you put in the time, money, and effort to craft it yourself.  And depending on who you are and what you create, this can be a good or bad thing.  You might be the doctor with bad breath, the dentist with the rude front office staff, or the physical therapist who is always late for appointments – believe it or not, these brands exist even though we would never choose them.

The process of branding can be likened to the development of our own personal attributes.  Our looks, clothes, personality, achievements, networks, experiences, and anything else that adds to (or detracts from) our appeal to others is basically what constitutes our own “personal brand.”  Now, branding as related to our personal development is only partially in our own control – we can’t control what we look like (well, thanks to the medical field I guess we can), our personalities are inherently difficult to change, and our achievements, networks, and experiences are in part built from the innate attributes that we are born with. 

When branding our private practices we have much more freedom to carefully craft a brand position that will appeal to our market, helping to make our practices more successful through broader (or in some cases, very specific) appeal.  It takes time, energy, and often entails a reasonable budget, but is there any doubt that development of the right brand is worth it?

This post from the Branding Strategy Insider talks about the seven concepts critical to positioning your brand in your market.

What seven concepts are critical to positioning?

   1. Perception (their’s, not your’s)
   2. Differentiation
   3. Competition
   4. Specialization
   5. Simplicity
   6. Leadership
   7. Reality

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