Posts Tagged plan

Plan While You Still Can

Plan While You Still Can

In our work with hundreds of medical practices, and in our Firm’s medical practice manager roundtable meetings, a common issue among medical practitioners is the uncertainty about the economic future of their medical practices.

Reimbursement levels may drop, many patients may choose medical coverage offered by a state-sponsored exchange, and the burden of changing technology is felt in many areas of practice. Since so many aspects of a medical practice are beyond the control of physicians, it is essential that doctors, in a private practice, exercise intentional control over the areas where they still can. This strategic planning is less daunting than many think, and can produce a more dynamic practice than you have experienced in years.

The process of strategic planning begins with an honest assessment of your practice’s current situation. Each physician’s candid opinions must be sought and considered in the development of an agenda for the group meeting. Since candor, among even the most collegial doctors in a given practice may be difficult to elicit, consider having an outside facilitator conduct these interviews. Based on the content of each doctor’s concerns, build an agenda for the planning meeting. It is recommended that these meetings be held at a neutral site outside the office but can be held in the practice conference room as long as no physician is permitted to exert his or her authority by sitting in their “power” chair or heavy‐handedly controlling the agenda.

Prior to the actual retreat, the administrator and facilitator must assemble background information and construct schedules necessary to answer as many fact‐based questions as possible. The goal of these schedules is to lessen the likelihood that a decision is postponed for want of additional data or a projection of the impact of the decision. Physicians are among the worst at group decision making. Some are so accommodating of their partners that they permit everyone to have “veto power” over any issue. Others let one member of the group require that the matter be tabled until every conceivable question can be addressed. Some groups apply their appropriately cautious medical decision-making processes to business decisions, which are not nearly as lethal or consequential. Whatever the reason, these result in what we refer to as Decision Deficit Disorder in medical practices. This too is a reason to have an outside facilitator.

With an agenda built on the issues of concern to all members of the group and background material developed for each point, the meeting is a time to make strategic decisions and assign tactical responsibilities. Select one of the easier matters for first on the agenda to establish a quick tempo, gain a positive perspective and promote participation by the entire group. If painful issues must be addressed, these should be handled privately unless that avenue has been tried and failed.

A sufficient content would be five to seven decisions, depending on the magnitude of the topics. We have been involved in planning processes where more than ten issues were resolved but a recent strategic process resolved five matters. In that instance, the group decided where to open a satellite office, determined to recruit two new physicians, renewed their commitment to reach out to referring physicians, decided to hire a marketing director for the practice and affirmed a plan to make their clinic days more accessible to patients. This proves that major things can happen when doctors focus on their own business needs.


Article contributed by Sae Evans, Maddox Casey and Jim Stroud, Members, Warren Averett Healthcare Consulting Group. Warren Averett is an official partner with the Medical Association.

Posted in: Leadership

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Pres. Trump’s Executive Order Creates Confusion

Pres. Trump’s Executive Order Creates Confusion

Earlier this week, President Trump signed an executive order that could be a first step in dismantling the Affordable Care Act. About 20 health organizations have so far spoken out against the executive order arguing the action could weaken patient protections and destabilize the individual market.

President Trump’s executive order signed on Thursday, Oct. 12, does not implement any policies, but it does request federal agencies such as the Department of Health and Human Services and the Department of Labor to develop regulations to expand the use of association health plans, which allow small businesses to join forces to purchase health coverage together, as well as to expand the definition of short-term insurance, which typically offers less coverage and comes with higher out-of-pocket costs.

The order issues three primary directives to federal agencies:

  • Consider ways to expand access to association health plans, potentially allowing employers to purchase insurance across state lines.
  • Consider expanding coverage through short-term health insurance plans, which are not subject to the Affordable Care Act’s regulations such as minimum coverage requirements.
  • Consider changes to health reimbursement arrangements (HRAs) — employer-funded accounts that reimburse workers for healthcare expenses — to allow employers to make better use of them.

During a press conference, President Trump said expanding use of association health plans would increase competition and allow more small businesses to have the same purchasing options as larger employers. He said he also plans to eliminate the three-month limit on short-term health insurance plans.

“The Medical Association is in the process of reviewing the President’s Executive Order and is consulting with industry experts to get a full understanding of the downstream effects the order will have on patient care. There is some concern that the order could erode important patient protections, which would be a serious issue however the true impact is unclear at this point,” Executive Director Mark Jackson said.

The executive order does not make policy changes itself, any new rules will go through a notice and comment period that could take months.

In a decision that coincided with the executive order, the White House has confirmed that it will stop federal payments for cost-sharing reductions to health insurers. These payments help insurers pay out-of-pocket costs for low-income individuals purchasing coverage through the exchanges. If stopped, premiums could dramatically rise and cause insurance companies to leave the exchanges and challenge the decision in court. There’s confusion as to when the payments, which could total about $9 billion this year, would end.

Posted in: Advocacy

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