The Future of the Physician Business Practice

Today, All Business.com is launching a major expansion of the information and services for the business of physician practices. We are an industry that is in flux, where the foundation of the industry is shifting, and we will emerge as a very different place. In his book, former Intel CEO Andy Grove called the time of such change an "inflection point." Ladies and gentlemen: we are going through an inflection point.

Here are the Top 10 Key Factors that are coming at us:

1. Flat and declining reimbursement


2. Pressure to improve and measure quality


3. Patient demand for more time with physicians


4. More data about patients — more things that can be measured, more data to be assessed in making clinical decisions.


5. Risk of being sued for malpractice


6. Revenue cycle that is inefficient and uncertain


7. Unraveling of traditional physician patient relationship


8. Loss of status, prestige — and income


9. Widespread dissatisfaction with the work of physicians


10. High and increasing overhead load

These issues are somewhat unique to physician practices. Then there are the run of the mill business issues impacting all small to medium sized businesses, including: increasing competition, competition for talent, health care costs, regulatory compliance, competition from traditional and untraditional industry players, access to capital, and even consolidation at all levels.

So what's a physician practice to do? How do we sort through these issues and develop a business strategy to continue our practice and even grow?

Let's distill this down to four principal goals:

1. Provide high quality care consistent with best evidence and practices


2. The patient visit will lead to satisfactory outcomes for both patient and physician


3. Back office and support operations will be efficient.


4. Stabilize and grow revenue and profitability

Now comes the hard part: how do we achieve these goals? This is where a business plan comes in. I am the author of "Medical Practice Business Plan Workbook — 2nd Edition", so I have a bias towards a business plan as a management tool. A plan is just that — the plan for the actions you will take to achieve the goals you have set for your business.

Faced with a complex environment, achieving these goals may take 2-3 years. By starting now, you can get out ahead of your competition, ahead of regulatory actions, ahead of where large employers and payers will push (or drag) health care providers.

Ten Actions Before 2010

1. Install an EHR system


2. Develop improved and more efficient back office and support systems. Review and revise processes and procedures — patient flow, forms, job descriptions and so on.


3. Adopt technology: establish a website, online patient registration, email communication and such.


4. Assess your clinical care to insure that it is current with accepted and best practice. Audit and monitor what is done.


5. Promote wellness and prevention.


6. Bring nurse practitioners and physician assistants' into the practice.


7. Implement year round training for all staff. The more the clinical support staff knows, the more they can enhance the value and effectiveness of the patient visit.


8. Improve patient interview techniques to be efficient and effective in information gathering, to give patients an impression of listening and to offer instructions that are understood and will be followed by the patient.


9. Add related services that increase revenue


10. Build relationships with other practices, employers, government and payers. Position your practice as a leader in quality and effective medical care.

I'll be writing more on these themes in the coming months, and welcome your thoughts, observations and experiences.