Physician / Administrator TEAMS
How to make them work to benefit everyone.
BY MARK M. PRUSSIAN, MBA, FACHE, COE

In my experience, few ophthalmologists think of a medical practice as a business. But ophthalmology practices are businesses -- and most of them aren't "mom and pop" operations, either. Any organization bringing in more than a million dollars a year certainly qualifies as a business, and according to Medical Group Management Association, the median level of receipts per ophthalmologist is about $750,000. That means if you have a two-doctor practice, you probably have at least a million-and-a-half dollars in receipts. Why is it so important to acknowledge this? Because in order to survive, a business has to have revenue that exceeds expenditures.

To make sure this happens in a medical practice, someone has to be paying attention to the business side of the practice. That's why having an administrator -- and an effective physician-administrator team -- is so important.

Many doctors expect to manage the financial side of their practices with little or no business experience. To make matters worse, many doctors get what they perceive to be their best business advice from other physicians -- not from somebody who's done real homework on methods and results. Needless to say, this is not the most effective way to conduct business.

Here are a few good reasons to have an administrator -- and an effective physician-administrator team:

► A two-person team leading the practice allows division of duties in an increasingly complex environment.

► Not all decisions need phy-sician involvement. Leaving those decisions to a competent administrator whom you trust allows for far better use of your time.

► Having someone to keep track of coding can save your practice a bundle. I strongly encourage you to read the Medicare Fraud and Abuse Penalties. You can be charged $10,000 per CPT code for violations, which pales in comparison to the upcoming HIPAA compliance rules for privacy. (I've heard numbers as high as one-quarter million dollars per incidence of violation. I don't know about you, but if I did that a few times, I'd start to run out of money.)

► An administrator can minimize uncollected monies. A company called Medical Claim Relief, which examines practices to see how complete their claims are, found that the average practice only files 60% of the CPT codes. That means these practices are leaving money sitting on the table.

Making a Physician/Administrator Team Work

It's not enough simply to hire an administrator. A number of key factors will determine whether your physician/
administrator team is going to provide your practice with the advantages described above. The most important factors are:

The administrator must have authority -- not just responsibility. When Medical Claim Relief investigated how thoroughly practices filed for reimbursement (see above), they found that the more authority the administrator had, the more complete the reimbursement filings were.

That's why, when physicians and administrators work together, it's crucial for the physician to recognize that the administrator should not be a "yes-man" or a "yes-woman." The administrator needs to be an independent, thinking person who brings value to the party, not just someone who follows the directions of the senior physician or the executive committee. Think of your administrator as a chief executive officer, with both responsibility and authority.

The physician must be willing to work with the administrator. As the physician, you should be willing to:

► share authority

► treat the administrator as an equal in most situations -- especially when staff try to bypass the administrator and get what they want from you. In these circumstances, you need to say, "If Sue said that our policy is going to be 'X,' that's what it's going to be."

► let things work out via a different route or methodology than you would have chosen yourself

► share business information -- financial statements, income figures, procedural volume, etc. You can't expect your administrator to function effectively without this information.

The administrator must have certain qualities. The person you hire or promote to this position should:

► have a good eye for detail, and be strong-willed, willing to speak up, respectful and exceptionally articulate

► understand the personalities of the physicians in the practice, and respect the sacrifices the doctors made to get where they are, as well as their skills and education

► always display maturity

► know how to choose battles wisely; some things are worth disagreeing about and fighting for -- and some aren't

► be willing to bear the burden of proving his or her point in case of a disagreement

► be trustworthy at all times (including at home; someone who admits cheating on his income tax is a poor choice)

► have a "presidential" presence -- look professional, and be easy for others to respect and work with.

Developing Your Team

To make your physician/administrator team work:

Make sure you really want it to work. If not, you'll undermine the arrangement and minimize the benefits.

Make sure the administrator has a job description. If you don't want to create one yourself, ask a consultant for help, or ask the administrator to create a very detailed list of what he or she plans to do and hopes to accomplish.

Communicate. Failure to keep open communication causes businesses -- and practices -- to fail. (It's always a bad idea to hide information from your staff if it's pertinent to them. They'll eventually find out, and trouble will ensue.)

Get to know each other. Do something outside the office together. You'll work together much more effectively.

Make sure the administrator knows what's happening in the office. If the administrator has little previous ophthalmology experience, have him or her shadow you around the office to see what's really going on.

If you have a multi-physician practice, have off-site retreats. These will give you a chance to discuss office issues and share opinions and reasons for them.

Be willing to share the credit for practice success. If you never praise your administrator publicly when success happens, bad feelings will eventually creep in and erode the relationship.

Reaping the Benefits

An effective physician/administrator team will pay off in numerous ways. Most -- maybe all -- of the physicians in your practice will be happy with the way the practice is being run. Patient and staff satisfaction will be high. And you may personally gain in any number of ways, depending on your individual goals: more profit from better business management, higher comfort level, more time with patients, and/or more free time. In addition, your administrator will remain loyal and stay with the practice for many years.

If you don't have an effective physician/administrator team in your practice, I encourage you to create one. After all, if you run a business -- and that's exactly what you're doing -- you might as well make it as successful as possible.

Mark Prussian has served as administrator of two large ophthalmology practices since 1989, and is principal consultant of Medical Group Advisors, LLC, an ophthalmic practice management consulting firm. Mark is a Certified Ophthalmic Executive, a 1999 graduate of ASOA's Wharton Executive Management Program and a Fellow of the American College of Healthcare Executives. He can be reached at (502) 599-4148 or solutions@medicalgroupadvisors.com.