Instructions:
For a medical practice where you are a patient(include the name and lcoation of the practice)…..if you were hired as the practice manager, what are three changes you would implement.These could be personnel changes, overall flow of the office, web site, any needed updates, .
Part 3
Watch the video, and summarize the four legs of medical practice success. It starts at 5:15.
Emerge Stronger Healthcare Bootcamp – Zoom
HAP 410, George Mason University
The Group Medical Practice and the Role of the Practice Administrator
Module 2
The Healthcare System….
First, what is health? The World Health Organization defines this as
a state of complete, physical, mental, and social well-being, and not
merely the absence of disease and infirmity.
The healthcare profession deals with life and death matters,
maintaining the dignity of all patients and family in decision making.
There is a special bond of trust between healthcare professionals and
the patient, including the healthcare administrator as part of the
healthcare team. You are currently training for this key and vital
role……. why have you chosen the profession of healthcare
administration for your studies?
The term medical care encompasses the care the patient receives
from physicians, technicians, dentists, nurses, and other professionals,
with oversight by a professional healthcare administrator (you!)
Historical Perspective
Historically, medical group practices were very simple. Up until the
early 1970’s, most physicians were in solo, or in two physician practices.
Health Insurance was non-existent, and out of pocket payments were
used to reimburse the physicians.
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In the late 1970’‘s, things became more complex. The advent of
Medicare and private health insurance plans came on the scene. The
managed care companies began to have more bargaining power in
obtaining discounts in payments from the physicians.
Starting in the early 1980’s, physicians began forming corporations
called group practices. Doctors in the same specialty, and sometimes
multispecialty, would practice as a group. They would have more
negotiating power with the health plans and could reduce costs through
economies of scale.
Healthcare is becoming more complex, and here are some of the
challenges of the healthcare system……
• Rising cost of care
• A growing population, including more elderly and immigrants.
• Disease burdens and rise of chronic disease.
• Unlimited demands from the patients for the best medical care.
• Limited financial resources by the government and insurance
companies to pay for this care.
• Changing technologies and treatment
• Affordable Care Act of 2010
• Non-traditional providers
• Value based reimbursement
The challenge will be reducing costs, while increasing quality and
access.
2.
There are alternate organizational forms which will be discussed
later in the course:
-Hospital based medical practices
-Accountable care organizations
-Physician hospital organizations
-Integrated delivery systems
-Independent practice associations
-Faculty practice plans
-Physician management companies
-Management service organizations
The term profession can be defined as:
• An act of declaring a belief, faith, or opinion
• A calling requiring special knowledge of a “defined body of
knowledge”, and often long and intensive academic preparation.
• A principle calling, vocation or employment.
Medical practice management is considered a profession. Our
professional association is Medical Group Management Association
MGMA.com. They also create and update the professional body of
knowledge that this course is based upon. 3.
Who are the physicians we will be working with/for as a medical
practice administrator?
A physician is an individual who studies and is licensed to be able to
practice medicine in the evaluation and treatment of patients.
There are two types….
M.D…medical doctor
D.O…doctor of osteopathy (extra study in musculoskeletal system)
– Four years of undergraduate study
– Four years of medical school (MCAT exam)
– Three-to-four-year residency in chosen medical specialty.
– Two-to-six-year fellowship for more specialized study in their
specialization
It is safe to say they are highly motivated and highly educated in
clinical medicine…but not necessarily in business!
What makes a successful physician?
Clinical and bedside manner…. does the physician produce quality
outcomes (health status of the patient is improved) AND is the patient
treated in a respectful, friendly, and concerning demeanor?
The physician/ patient relationship ………once the doctor has accepted
the patient to provide medical care, the patient has the right to
expect continued care, unless the doctors give suitable notice that this
care relationship will end. Trust and confidentiality serve as the basis
of this relationship.
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Types of Physicians
Primary Care…. Family Practice/Internal
Medicine/Pediatrics/Obstetrics and Gynecology
Specialties…… (provide some examples of doctors you have seen)
Others” …………………. who are licensed to provide medical care:
Nurse practitioners (NP)
Physician assistant (PA)
Chiropractors
(DC)………title of “doctor”
Podiatrists
(DPM)……title of doctors
.
Types of Medical Practices
1. Solo…a doctor who practices alone or with others but does not
pool earnings or expenses.
2. Independent Group practice….
3. Hospital employed Physician Groups…. a growing trend, also
called the “physician enterprise.”
What is a Group Practice?
According to The Medical Group Management Association, a group
practice is any relationship between three or more physicians who
share facilities, expenses, profits and other resources like support
staff and equipment.
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Group practices tend to fall into two categories: those that organize
around a particular medical specialty and those that encompass several
specialties.
a. Single specialty…. limited to one specialty as general
surgery.
b. Multi-specialty…. Physicians in different specialties
practice together, as oncology, cardiology, and
gastroenterology as an example.
Benefits of Group Practice:
•
•
•
Access to doctors from various disciplines for referrals and
advice
Better coverage on weekends and off-hours
One-stop clinics for comprehensive care and testing
The role of the practice administrator…What is a medical
practice administrator responsible for? Let’s look at a the job
Description in the readings
Characteristics of Physician Groups vs. Other Professional
Corporations (as CPA Firms, Law Firms, Engineering, Consulting) ….
All have highly educated, highly motivated, highly intelligent
professionals.
6.
Shared:
– Members generate revenue
– Group and Individual Costs Identified
– Development of a “Client Base” by Members
– Join Competing Group? ……. Restrictive Covenant Enforceability
Unique:
-In the groups listed above, the individual work is subject to review by
“higher ups” before presented to clients on a prospective basis
– Doctors are trained to be the “Captain of the Ship” …with the
autonomy to make immediate life and death decisions for their
patients……clinical outcomes may be reviewed on a retrospective
basis by the physicians in the group.
Implications in Working with a Group of “Captains of the Ship”
– Doctors are highly intelligent and highly motivated. Respect what
they know and do.
– Taking the time to get to know them…. meeting one on one formally
and informally whenever there is opportunity.
–
Because they are independent, they don’t do well in structured
organizations, where there are certain rules and policies which must
be followed.
– Sometime difficult to standard operational procedures
– Their support staff must (practice employees) must balance
practice polices and rules, with being self directed when working
with the individual physician on a day-to-day basis.
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– Building and maintaining your credibility with the doctors /earning
their trust is vital.
– Knowing how and when to use the outside “experts”, i.e., CPA, Atty.,
when to retain management consultants for needed expertise
– Hiring a well trained and competent staff to “make the doctor’s job
easier.”
Conflict Management
Today’s medical practice is home to an increasingly diverse set of
interests among shareholders. To address disagreement, conflict
management becomes useful.
There are different conflict resolution strategies which allow the
individual and group to access their preferred resolution
strategies. They include:
-Competing
-Compromising
-Collaborating
-Accommodating
-Avoiding
8.
Self assessment leading to self awareness is critical to conflict
management. There are several commercial assessments which
validate measurement of temperament, personalities, and
behavior.
These include:
-Myer-Briggs
-DiSc
-Pre-active Index
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