Fundamentals of Practice Management

In this podcast, The Fundamentals of Practice Management we will cover the following:

• Introduction to Practice Management Challenges: Shaun Kirk addresses the common administrative challenges faced by practice managers in busy healthcare settings, using a Texas practice as a case study.
• Staffing and Time Management: Discusses issues with staff shortages and the critical need for effective time management among clinic directors who are overwhelmed with daily tasks.
• Strategic Planning: Emphasizes the importance of planning ahead to prevent management by crisis, encouraging proactive rather than reactive management styles.
• Delegation and Staff Empowerment: Highlights the necessity of delegating tasks and empowering staff to handle problems independently to enhance operational efficiency.
• Management Routines: Shaun suggests establishing consistent management routines that drive the practice forward, reducing dependency on the practice owner for problem-solving.
• Utilizing Administrative Windows: Offers strategies for maximizing limited admin times, such as planning sessions and short-term goal setting to improve practice outcomes.
• Building a Self-Sustaining Team: Advocates for training and development that enable staff to manage their own areas effectively, thereby reducing the burden on practice owners.
• Tools for Success: Provides practical tips on creating management dashboards and using key performance indicators (KPIs) to track and improve practice performance.

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Transcript

0:09

Hello, everyone, uh, welcome to this webinar on the fundamentals of practice management. Uh, today, I just want to go over a variety of different things that I think may help you in that little bit of admin time that you have available. On Friday, I was talking with one of my clients, super busy practice in Texas, love the guy. Um, he's got a great team, super hard working folks, and unfortunately, just like other people, uh, they are looking desperately for physical therapists, and the ones they've got are super busy. Now he's got two clinic directors who are super willing guys, want to kind of wrap their arms around the practice better, but they have very, very little time. And so when they actually have what looks like a window of admin time, they're not really sure how to maximize that time to get the most out of their management of their particular clinics. And I don't think everybody's alone in that. Uh, for most practice owners that I talk to, unless you've gotten to some reasonable size, say above 300 visits or more, um, you'll, you have a situation where you're kind of a, uh, owner operator. Right. You're treating patients mostly and you're managing around the edges and a lot of the management is by fire What blows up today what blows up today what blows up today? So every day you you get out of bed you go to work and you know one thing's going to happen Someone's going to ask you to solve a problem So what we always want to do is get people in a better position to be able to solve their own problems. So Um, you can have very deep level of management with Um all kinds of complexity. The bigger you are, the more management skill you need. But I would, I would argue that if you have great management skill in the very beginning and you get your discipline in place on your management actions, not your patient care actions, you will become the larger practice, more successful practice, something that you can look back on and go, I'm really glad I did this. Right. So, Uh, the School of Hard Knocks has a fairly high tuition and sometimes it's not what you learn. It's what you apply. It's not what you're doing. It's what you get done. Okay, so that applies to you as a manager owner and applies to all of your staff as well. Okay, so with that said, you know, I want to kind of tap through some slides here. So we want to talk about, like, what is kind of the situation that might be going on? in most practices. So this is kind of how I'm positioning this particular talk is that we have this kind of a situation. So one is you wear a ton of hats. You have Every hat you can think of, right? You might do, you may be in your own marketing. Um, you possibly are in patient care most of the time. Um, you're handling questions. You're hiring people. Um, you're making policy. You're doing everything. You're wearing a lot of hats. You're very involved, again, in patient care. And you have staff who drop problems at your doorstep to handle. It doesn't mean you have bad staff. It's just you made them that way. Own it. You created it. If a guy goes, I'm so sick and tired of staff coming to me, present, giving me problems to solve that they should be figuring out on their own. You did it. You created it and you can undo it, but you created it. You made it easy and you solve their problems. So one thing's very important is you, once you train somebody, is you never, never, never, never, never solve their problems. Okay. You get them to present a solution. It's not so hard, but if you, if you're very quick on the trigger to solve problems, then you might think that's your job. So, what we have is very little time to manage the practice. So, 1 thing that's important is we have to go with that assumption that these things. So, what's important here is that we set up, um, like, what are our 4 points of management? Like, I talk about this a lot, maybe it's into an echo chamber at times, but there are 4 key aspects of. good management. And sometimes we do them well, sometimes we do portions of them well. So very simply to break them down, one is planning. What are the planning actions that you take? And this means planning is something into the future, right? So we have the neurosis of the practice, which is a firefighting method of management, where you're just going, put out that fire, put out that fire, put out the fire, call that guy, do that thing, right? That's not planning. That's reactionary. So planning is what you're doing right now that builds a better future down the road. Now that down the road could be as early as an hour from now, or it could be a year or two down the road. So it's planning. It doesn't have to be deep, it just has to be planned. Even if your plan is to beat last week, that's a damn good plan, right? So you'd write that down. What is the plan? Then what you do, once you've actually put together the plan, you want to be able to assign portions of your plan to individuals on your staff to execute, to get done, to accomplish. So you want to be able to assign them to people. So if you write it all down and you do it all yourself, it's like, what's the rest of the team for? Okay, so sometimes it might be, they're so busy putting out fires and all day long because that's our management style that. You know, they're not really thinking about the future at all. Well, even as a clinician, you have to kind of think with the future of, you know, managing your caseload, what I've got an opening in my schedule. I can get on the horn. It can recover. Somebody can ask for a referral. I could plan those things out and put them on my list of things to do. So remember we have very limited time. So, um, and I'm from a management hat, right? So what I want you to do is like, look at it from setting the stage. It might be something you take a weekend on and really create a plan And maybe set a short term goal, not a big long goal. Maybe it's like you look over your statistics for the week and you go, okay, I would like to, you know, get, I don't know, 15 more new patient, patient visits. Make it simple. In this week. Okay. Put a plan together. Figure out who's going to do what with the plan. That doesn't mean you're not doing anything, but who's going to be doing portions of that plan. Then once we've assigned it to individuals, then we need to coordinate with them. So. It's really simple. It's like as simple as having a meeting or is as simple as just wandering around through the clinic in between patients. If you have very little time go. Hey, where are you on that plan? And again, it could be the plan to beat last week or the plan to take over the world. Right? But where are you on the plan? And it's heat and pressure makes a diamond. Okay. And it's like, you need to apply a right amount of management pressure. You want to create a certain amount of tension on being productive, not being buried, not being swamped. You know, I don't want anybody to get the idea that I, I, I'm a whip, whip and chain kind of guy when it comes to management. It's just that you keep a little pressure on it because life is filled with distractions. And if you're having trouble yourself, just imagine how everybody else is feeling. So we're all filled with distractions. So we have to have a little bit of applied pressure. pressure throughout the week to make sure people are not just neurotically doing their job, but also doing one or two things from the plan that will bring about a better week for them or the organization, right? So we coordinate. And that could be just a, a daily walk around depending on the size of your practice and like, Hey, but you're doing it regularly, at least once a week on bigger plans. And if it's just daily for the week, it's like, okay, what has to get done to get 15 more patient visits into this practice? Right. And then you're checking on it. Has that been done? Did we get ahold of Joe and get him back on the schedule? No, we haven't. Have you called Joe? No, I haven't called him now. But like, Heat and pressure makes a diamond, right? Coordination. And then what we ultimately want to be able to do with any kind of plan that we ever put together when we come to managing something is we want to do it with maximum efficiency, with minimum effort. And efficiency could be time, money, effort. Personnel costs, et cetera, right? And minimum effort. So, sometimes people will have plans and I've done it myself. Well, put together a plan. That's actually so, um, complex. Right that, um, it never gets done. It's just, it's just too much. It's like, it, it might actually achieve the purpose, but it's. Takes a lot of effort to get through it. So, plan, something simple. Don't plan something big. If you're going to put on a planning hat this weekend, um. Plan something simple. Maybe beat last month, beat last quarter, um, but not how to get to five clinics when you have one. So what we want to be able to do with these four points is we want to work out your management routines, right? So it says you management routines. Work out you management routines, right? Work out your management routines, okay? So when we look at a management routine, we're looking at what are your regular actions that you follow daily or weekly to drive the practice forward. Okay, now, let that one sit there for just a moment and, um, make a note to do this. What are your regular actions that you follow daily and weekly to drive your practice forward? And I mean regular. Every single day, I do X, Y, and Z. Every single week, we do X, Y, and Z. For many, this is where the coping takes place versus the really planned production, is there's no regular action. The regular action is staff know that they can come to me and that I will solve their problems. I am the walking, talking, policy, and procedure manual, right? So your regular actions, what do they consist of? When do you do them? Right. Um, how do you do that? And it could be as simple as, um, when the, at the end of the week comes, I get my, my statistics. Maybe I'll look at them over the weekend, um, at it, you know, in the morning, it'd be as loose as that in the morning on the weekend. And then I analyze the trend on a 3 and 6 week basis. And then I put together the following plan for the new week, and I, and I list out the individuals that I want to sign portions of the plan. For the new week and on Monday morning, first thing I go over the plan for the new week with my key people and I assign them tasks and duties and I check up on it every day to make sure it gets done right. That's could be a management routine. It could be I check my emails all the time. That's not a good routine. You know, maybe I check my emails twice a day. That's a better routine. So you're not trapped in it. You know, um, I, I, I post content during this time. I, I, whatever our staff meeting is during this time, but figure out what your regular management routines are that you follow on a regular basis, um, for your practice. Right. So from there. What we want to do is, so we have that, these are plans and programs, but they have to translate to statistics, they have to translate to something that betters the practice, otherwise we won't Why do it? I mean, there's nothing wrong with making things comfortable, smoother and stuff like that, but, you know, a good exec is always thinking with, how do I actually grow this organization without overburdening anybody? Of course. Right. But I'm not planning to. for the sake of planning. I'm not organizing to be organized. I'm organizing to be more productive. And you'll find areas that are well organized are very productive. And you find personnel who are very organized are very productive. Now we have to measure that productivity. We need to be able to take a look at and or assess what's working, what's not working, etc. And so we do that with KPIs, right? So we look at what are your steering KPIs. Like, in other words, if you're looking just at a dashboard, not going deep, you know, what would be on there, right? Well, we probably have new patients that would be on there, patient visits, production, which is, I call it charges, the dollar amount charged, right? And then collections. We just look at these four stats. We could look at more. There's no, I also look at, well, think of a dashboard. Like, if you were on vacation and you were calling the office and you're like, how are we doing? Receptionist says, good. You don't know. Okay. Well, how, how good? Well, pretty good. Are you busy? Oh, we're busy. You still don't know anything, right? You go, what do the new patients look like? Oh, we're at 43. Good. Is that up over last week? Um, I don't know, but you should know, right? The fact that they don't know, right? Tells you they're not focusing on target attainment. Um, yes, it's over last week. Excellent, right? What's the PVs look like? It's this. Is it up over last week? Is it up over three weeks? Yeah, you can hang up and get back on the beach, right? So, you know, what do you definitely need to get a picture of what's going on? And it might be It won't be more than about six statistics But I just put the basic four up here right new patients patient business production and collections You could break it down by clinic if you have a bunch of clinics But if you think of what you want to be able to do is you're steering kpis and you drill down You New patients, we got five clinics, new patients total, new patients by clinic, right? PVs total, PVs by clinic. Now, your, your EMR tracks this stuff. It's all in there, but if you don't pull it out and put it into some kind of, um, Scorecard dashboard or whatever in some in some way that you can quickly analyze statistics. It'll be too burdensome burdensome. That's a word. Yeah, burdensome to actually, um, implement into. Into the practice, right? So, excuse me. So, here's. What we want to do is we want to create a dashboard. If you don't have a dashboard or you don't have a way to look at this data quickly, and if you do have a way that you can look at it, like, I look at this report, I look at that report, I look at this report, I look at that report, write it down. Step 1, look at this report, note these things. Step 2, look at these reports, note these things, right? Create yourself in your just planning is like, how do I analyze statistics, right? So I, having a dashboard, if you need a simple, you know, kind of like a Google sheet kind of dashboard or whatever, reach out to me. I can get you one, not a problem. Um, just send me an email, okay? So, what we also want to do when we have the KPIs that are the steering KPIs, is that you want to look at what adds up to the steering KPI. And this is an area where we tend not to pay attention to um, unless it's really bad. If it's bad, in other words, your PVs are in the toilet, you look at these things. When your collections is in the toilet, you'll want to look at these things, but you should know what they are on the, uh, on the back of your hand, like, I guess, and any staff that works in those areas should be able to rattle off what adds up to the KPI that you're looking at. So for instance, we look at production, dollar amount billed, things that influence the dollar amount billed, patient visits, average charge per visit, average patient frequency, how often they come in during the week, you know, units per visit. Right. Possibly visits the discharge, right? There could be a couple of more, right? Maybe we're looking at, you know, what percentage of your caseload is T. E. and manual, right? It's probably not so much for production, but it definitely is for collections because T. E. and manual tend to be lower, uh, reimbursed codes. Versus therapeutic activities and neuromuscular education, right? So, you know, looking at your, um, coding structure, it won't affect your production dollar amount bill, but it will affect your collection. So this would probably be a wrong thing that adds up to total amount billed. Everybody makes a mistake once in a while, right? So, um, TE and manual. So you, you look at what adds up to. So we have very little time, but go back to that. One plan. You're going to have to take that time. If you don't have it during the work week, you know, you, you sit down and you really analyze things on the weekend or an evening, whatever works for you, but enough time to really know on Monday morning, how to hit the ground running. Okay. And do it for you, but you're going to have to do it. If you don't have a dashboard or a way to go, what statistics add up to my KPIs, my key KPIs, then, you know, you really need to, um, figure that out. So, then, what we want to be able to do is now that we actually have these KPIs, we want to be able to assign, uh, these KPIs, these, actions, your plan steps to individuals, and we want them to actually be able to keep statistics of their production, right? So we want to set targets. Now, I have another thing here, set quotas. So what in the world? They're both are the same. They're both not the same. So target Might be, like, for instance, let's say we have a new patient target for next week, 20. Yay! Let's say 20 is better than the 18 of the prior week. That's our target. You say in a staff meeting, the target for new patients is 20, and everybody goes, yeah! But what you do is you set quotas that if all those quotas are hit, you should hit 20. 20 new patients. So if your target is 20 new patients, your quotas could be, um, X number of visits to doctor's offices, right? Um, you know, so many calls to past patients to check up on them. Um, you know, um, so many emails sent out, so many pieces of mail sent out. Um, you know, And you, you set quotas numbers, actual numbers, and those get assigned to individuals so that they are pushing towards the actions that get you statistics. If you have a staff meeting, and you set, uh, you set a target without any quotas of what it takes to get it done, you will often. Miss the mark. Okay. So if you're in it, you're in, you're, you're looking at production dollar amount built and you go, our production was. 44, 000 this week, and we want to, we are our target for the next week is 48, 000. I was like, yeah, good. How are we going to do it? So then you go, okay, well, we need this many patient visits. That means we have to schedule this many people. Our 5 day forecast much must look like such and such. Um, you know, um. Our average patient frequency. I want every one of our new patients to be scheduled for three times a week for the first two weeks Before we even consider winding them down, you know, you set quotas for that and then you check that that's part of the data that you'll check Okay, so even with limited time if you do that planning on You know I don't know, weekend or whatever. You do that planning and you actually are assigning it to individuals and then you're assigning statistics to individuals where they're responsible for it and you're setting quotas for those actions who that belong to those people and you check up on it every single day in a very light but never forgetting manner. You'll start moving the needle in the right direction. So then what you want to have Is a morning huddle. I guess it doesn't have to be in the morning. Um, I had a client that did it. It was really good. I mean, uh, had many clients that do it, but I originally got it from one of my clients in Oklahoma and they just had this really quick morning huddle where put everybody together and they lined up like, are you on target? Okay. Are you on target for the week? We set targets that we want. Like, for instance, if it's, um, if it's a therapist, there would be a targeted number of maybe a patient visits for the week. Is that guy on target? If he's not on target, then there should be a list of things that add up to his patient visits. Okay? That could be, certainly, his new patient volume, but it could be, um, you know, any missing in action. They haven't come back in. It could be, uh, any, anybody cutting back on their frequency and have to have a little bit of a chat, right, um, who are like starting a self discharge. Um, it could be, you know, they have opportunities to follow up on some past patients and they didn't take it. They just took that extra time to be doing their notes, right? If you don't fill opportunities on a person's schedule of what they need to be doing when their stats are down, clinicians will just do notes. And they'll never get very efficient with their notes unless you give them these other things and then they'll get more efficient not not like I'm a Mean person, but I've my wife's a PT and I love her with all my heart and she's still out there Practicing and she's digging it, but she's a very low caseload. He's kind of a She's, uh, she, she's, um, amazing. How's that. And, but yet she'll still stick around an hour or so at the end of the day doing her notes, but she likes that. She, she, she doesn't mind that because she, she's okay with that. Um, so just think with that. It's like someone's long takes a long time on their notes. That's only a problem. It's if they're having a problem, okay, if they end up staying an hour late doing their notes. They stay an hourly doing their notes, right? But we want to have a morning huddle so that when their volumes are on on the money, everybody's high fiving. If it's missing the mark in some ways, you go, um, are you on the target for the week? Oh, I'm actually down. Okay. So what are you working on? Well, I've got two patients that I'm calling to make sure that they show up because they've been missing, uh, their appointments. And I also have, um, I also have this one guy that just kind of disappeared last week and the front desk hasn't got him in. So I'm going to get him on the phone. You see that? So it's like the person is actually rattling out things that they could be doing to keep themselves fully productive. And, you know, one line I always say is that you, you, The only way to make money is to make money. Um, the only way to make more money as a staff member is to make more money as a staff member. I, it, it's, I know it sounds really silly and it seems very basic, but it's really the only way. If you hire a receptionist who wants to make more money, she's going to do that by her statistical production. If she's got a very high arrival rate, she shepherds all the flock of patients into the schedule and keeps them coming in and regularly attending. Um, she's earning something. Okay, you know, she, by her production, she's generating revenue. If I've got a therapist who sees the, uh, whatever you call your basic expectated, expectated. It's another word I just made up here on the, on the spot. And, um, the expect expectancy level of production, but one guy gets you 30, um, patient referrals a year and another guy gives you three, which one is more valuable? Okay. We know that answer, right? So by having, um, kind of the substats or what adds up to every staff member's statistic and for them to know that when their status down, they're like, I don't know, man, just the bottom fell out of the week, right? Versus it could still happen, but versus my number is down. I'm tracking it through the week and I'm doing my list of quoted type actions that I would do to raise that higher. Okay, so to cap up, we have a limited amount of time. Most of the time we're in patient care. We have very little time to manage. If we're like that, it's probably we have other staff who are like that too. Nobody should be sitting around with 20 minutes, 20 hours of admin time available to be filled with some items to do. So, how you set your stage is important. So, you want to have, you want to manage by statistics. You want to have a plan that you put together. Maybe it's every week. I would really recommend every week you put together a plan, and the plan is simply beat last week. If what you're doing is working out really well, keep doing what you're doing. Okay, but really dissect what it is that you're doing. So you 1 is you're going to have to take some time and you're going to have to do some planning. So you do the planning. Next thing is that you're going to need to be able to assign steps on that plans to individuals. who at first might be completely bewildered because you've always done it yourself. So you're going to get them that information for them to be responsible for. Then you want to check up on it. It takes two minutes to walk through your practice. You're walking through it all the time. Like you walk by and you go, Hey, are you on target? Are you not on target? In the absence of that, you don't have time for that. Have a morning huddle or do both. Right. But it's like you are keeping their attention on target attainment. And if. Everyone's doing that. It's quite a win. I had two clients that I talked to this week, that last week, who, um, you know, our motto is little changes lead to massive success. Okay. We have a program called the practice blueprint, which goes into, you know, several different key areas of fundamentals to establish in your practice that creates a base from which to expand. And so what's always surprising for some guys that I work with is that when you put these foundation things together and these real management routines in a variety of different areas of your practice, and it's just like clockwork, you're hitting those targets of actions that you take, the practice starts to grow, right? So I had two clients. One, one had a, uh, was surprised to see that they They, they, they're year over year, uh, last year to this year. It was like, I don't know. Let's see. Um, it was like 65, 000 dollars more, um. Rapid collections that they brought in that quarter and another client, it was like 67, 000 in collections that they brought in a quarter of recorder and. Their practice is like steadily grown, steadily grown, steadily changed, steadily improved. And then they look back and go, well, not only make more money, I'm also leaner and meaner and more profitable. And the morale of the staff is super hot. And when they want more money, I, you know what, they are earning it. Like you said, if you want to make more money, you just have to make more money. And I think the staff got it too. So if you'd like to know more about that reach out to me, send me an email. You know how to reach me. Pretty much knocking on your door every other day. You know how to reach me, we can set up call. Love to talk to you. If you want a writeup of, of everything that I just went over here send me an email, a message if it's in Facebook and I'll see about getting it over to you. Okay. All right. Well, thank you very much for your time. Um, love you. Take care. We'll see you. Bye.