A Quarterly Publication of Florida Medical Group Management Association

Florida MGMA NewsFlorida MGMA News

Vol. XIII Issue I

Winter 2015

Florida MGMA Annual Conference PicturesApril 22-24, 2015 - Omni Orlando Resort at Championsgate

It’s not too late to to join us at the Florida MGMA AnnualConference, April 22­24 at the Omni Orlando Resort atChampionsgate.  Our conference is packed with fabulousspeakers on timely topics. Don’t miss this opportunity to hearnationallly known speakers and interact with other medicalexecutives right in our home state. You can register on ourwebsite at www.flmgma.com under the Education Tab,then go to the 2015 Annual Conference Page.

Natinally recognized speakers in the healthcare field including:Frank Cohen, Rosemarie Nelson, Will Latham, Ann Bittingerand Tracey Spears will be in attendance as well as other greatspeakers to round out our highly informative conference. Theconference is being held at the beautiful Omni Orlando Resortat Championsgate which is surrounded by 36 holes of champi­onship golf. This Four Diamond resort is one of the nation’spremier golf, meeting and leisure retreats. Omni OrlandoResort features Mokara spa, fabulous dining at seven restau­rants and 15 acres of pools and recreation activities includingan 850­foot lazy river.

Don’t miss this opportunity to network with other administratorsfrom across the state of Florida and hear from national speak­ers on the most up to date information in medical practice man­agement.

2014 ­ 2015 BOARD OF DIRECTORS

President

Marynell Lubinski, FACMPEMiami Jewish Health Systems

President Elect, Conference Chair

Sherry Mills North Florida Surgeons

Treasurer

Ilene Gilbert­Droge, FACMPESMH Physician Services, Inc.

Past President

Michael A. Franks, MPA, CMPE Premier Dermatology

Florida Collaborative Chair

Kevin LockettMayo Clinic

ACMPE Representative North

Tom Menichino, FACMPEThe Villages Health

ACMPE Representative South

Lori­Ann Martell, LPN, CMPE

Advanced Medical Center, Inc.

Vice President ­ North East

Thomas BalestrieriNoPark Avenue Dermatology

Vice President ­ North West

Chip Geitz, CPA, CMPEMedical Center Clinic

Vice President ­ Central

Gerry Bessette

Medical Associates of Brevard

Vice President ­ Central West

Tracey MitchellUSF Physicians Group

Vice President ­ South East

Mario SalcedaMemorial Healthcare System

Past President at Large

Henry Del Riego

FIU HealthCare Network ­ FIU Health

Member At Large

Kevin Pizzuti, CMPEOcala Kidney Group

Executive Director

Lisa Beard(561) 452­6702 ~ flmgma@yahoo.com

Dear Colleagues,

This spring newsletter finds us lookingforward to our annual conferenceplanned for April 22nd – 24th at theOmni Orlando Championsgate. Theconference committee has prepared atop line­up of speakers includingRosemarie Nelson and Frank Cohen.In addition to the educational ses­sions, there is ample time to networkwith colleagues, one of my favoritefeatures of the conference. Whetheryou’re a new administrator in a smallpractice or a seasoned executive in alarge group, this conference will pro­vide practical tools and information tohelp you “drive the course” to manageyour practice.

The current healthcare environment ischanging faster than ever before.Reimbursement is quickly evolving topay for performance, and the impor­tance of gathering and analyzing yourpractice data cannot be understated.Florida MGMA continues to offer sev­eral webinars throughout the year toprovide you tools to tackle these chal­lenges. Our webinars are presentedby nationally known speakers on avariety of current topics. They are freeto FMGMA members and the value ofone of these webinars alone out­weighs the cost of your annualFMGMA membership. I encourageyou to take advantage of as many ofthese webinars as possible. If youappreciate the value they offer,encourage your colleagues to joinFMGMA as well to take advantage ofthe free programs. As an addedbonus, these live webinars qualify forACMPE credits for those members inthe certification and fellowship pro­grams.

Remember to participate with a localchapter in your area to complementyour FMGMA membership. Most localchapters offer monthly meetings, pro­viding both the opportunity for educa­tion, and for valuable networking.Florida is a large state with distincthealthcare markets. These localchapter can help you connect with col­leagues dealing with similar chal­lenges. Specific information on thelocal chapters can be found in theFMGMA website at www.flmgma.com

I look forward to seeing each of you inOrlando in April!

Sincerely,

Marynell Lubinski, FACMPE

Florida MGMA President

A Message from the President

Marynell Lubinski, FACMPEFlorida MGMA President

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What is the future of the small medical practice?

With the enactment of President Obama's healthcare reform, the Patient Protection and AffordableCare Act (ACA), there is much speculation that smallmedical groups or sole practitioners will go the way ofthe buggy whip. Dr. Ezekiel Emmanuel, one of theWashington architects of reform, contends that inorder for American health care to fulfill its promise,larger groups will be imperative in order to reducecosts and increase positive outcomes for patients.The large 100+ physician groups will ensure continu­ity of care and increase communication among theprimary care physician, specialist, and hospital.Empirical studies demonstrate that an integrateddelivery model perhaps can achieve these desiredresults.

What this does not contemplate, however, is asignificant reduction in competition

In normal functioning markets, competition leads toimprovements in quality and cost. Therefore, is it cor­rect to presuppose that competition increases theefficacy of health care? Nicholas Bloom of Stanfordbelieves so. In The Impact of Competition onManagement Practices in Public Hospitals, Bloomposits that hospitals with higher numbers of localcompeting hospitals have better management prac­tices. Martin Gaynor of Carnegie Mellon Universitydiscovers in What Do We Know About Competitionand Quality in Health Care Markets? that Medicarepatients show a positive impact of competition onquality. In his recent economic research, Gaynor andCarol Propper review approximately 13 millionadmissions at the National Health Service in theUnited Kingdom. The authors find that hospitalslocated in areas where patients were provided morechoice received higher clinical quality as measuredby duration of hospital stay and lower death rates fol­lowing admissions.

McKinsey & Co. recently published a paper, Whenand How Provider Competition Can Improve HealthCare Delivery. The authors theorize that thestrongest argument in favor of competition is that itcan be designed and deployed to create potentincentives that encourage providers to innovate sothat they can deliver higher quality at lower cost.

What is the correlation between competition anda fragmented physician base?

One theory suggests that if there are fewer practices,competition will decrease, thus raising prices. Many

experts believe, however, thathealth care demand is fairlyinelastic meaning that one con­sumes a good or serviceregardless of an increase inprice. For example, if you aresick, you will not be very pricesensitive.

There are exceptions, ofcourse, to this rule e.g. electivesurgery and the purchase ofeyeglasses. Yet, Amanda Kowalski of Yale Universityargues that health care may, in fact, be elastic. Dr.Kowalski uses the most recent wave of cost controlinitiatives in the medical community to demonstrateconsumer responsiveness to price. As an example,the Medicare Modernization Act of 2003 establishedtax­advantaged health savings accounts as an incen­tive to encourage price responsiveness for individu­als who enroll in high deductible health insuranceplans. Kowalski concludes that the price elasticity ofexpenditure on medical care is much larger than lit­erature would suggest. If, indeed, Kowalski is correctin her hypothesis that price does play a role in healthcare, then a material decrease in competition, whichwould perhaps increase prices would have a nega­tive effect on health care utilization.

The caveat in drawing conclusions about healthcare policy is that its a process rife with room forerror

But if one looks at historical reform there is markedcyclicality. Managed cares rise and fall suggests thatafter a period of increased regulation, policy is ulti­mately manipulated and stringent guidelines arerelaxed. The financial industry provides some salientclues. After the Enron bankruptcy and collapse ofWorldCom, the Sarbanes­Oxley Act was enacted in2002 in order to initiate new or enhanced standardsfor publicly­held companies, their managementteams and boards, and public accounting firms.Millions of dollars were poured into increasedaccountability and reporting by publicly­traded com­panies. Law firms and accounting firms prospered;after a few years, policies were relaxed and businessresumed.

This is not to suggest that health care reform is good

4

or bad; reasonable people will agree that Americacan do a much better job. And this is not to argue thatthe reforms will not be permanent, which would helpthirty­million Americans access care that perhapsthey should have had for years. What this does meanin a milieu of sweeping change is that physiciansshould take a measured approach to the future oftheir practice.

Before contemplating rash mergers or consolida­tion, reflect on those practices around you whorushed into electronic health records

Today, many of those physicians who attempted toget ahead of the technological curve before the reg­ulations were finalized and the respective softwarewas refined now have a significant investment sittingin their office that must be written off. This is not tosuggest that consolidation or mergers is an inappro­priate strategy for the long­term success of practices.The benefits of mergers are extensive, but there issignificant peril and irreparable consequences if theyare not executed thoughtfully without the assistanceof a trusted advisor. For example, what type of entitywill be formed? How are profits shared? Is there realproperty involved? How will physicians allocate over­head? What happens if a physician leaves? Are theredifferent tranches of stock? Are there buyback provi­sions?

Before Washington writes off the small practice,one should analyze California

According to the California Medical Association,almost two­thirds of patients within the state receivetheir primary care from a small practice. And with anincreasing number of insured Californians, demandfor care should increase. Persons with health insur­ance use more health care services than personswho are uninsured, writes Thomas Buchmueller, ahealth economist from the University of Michigan.Accordingly, demand should increase for physicianvisits, preventive services, disease managementservices, and prescription drugs. Janet Coffman ofthe University of California, San Francisco agrees. InThe Impact of National Health Care Reform onCalifornias Health Workforce Needs, she projectsthat there will be an increase in demand for healthprofessionals.

With this increase in demand and the historical trendof Californians receiving care from small practices, itshard to fathom the demise of the independent physi­cian. Today, these practices are the backbone of ourhealth care system. California may be the birthplaceof HMOs and home to many of the largest medicalgroups in the country, but ironically, most of the statesresidents receive their care from physician officeswith only one or two practicing doctors. For manycounties in the state, these practices are the onlysource of care for residents.

­ Reed Tinsley, CPA

What is the future of the small medical practice?

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Active Members

Lisa AtkinsonUniversity of Florida, Ped­I­CareGainesville

Cynthia BillupsAnesthesia ServicesFort Myers

Mark Bloom­Goldberg Memorial Healthcare SystemHollywood

Loretta Burbridge Memorial Healthcare SystemHollywood

Larry CohenClearlyDermBoynton Beach

Shawma CooleyUniversity of Florida, Ped­I­CareOrlando

Katherine DadismanWomen’s Care of Florida, LLCTampa

Melanie DelkUniversity of Florida, Ped­I­CareJacksonville

Barbara DiamantisFirst Physician’s GroupNorth Port

Maribel Diaz Memorial Healthcare SystemMiramar

Vielka EnriquezUniversity of Mami Miami

Lori FischerInfants and Children, P.A.West Palm Beach

Florida MGMA Welcomes New Members

Michelle FosterUS Anesthesia Partners/JLRMedical GroupMaitland

Misty GladdenUniversity of Florida, Ped­I­CareGainesville

Milen Gonzalez Memorial Healthcare System Hollywood

Joan Griffiths Memorial Healthcare SystemHollywood

Vedner Guerrier Memorial Healthcare SystemHollywood

Patricia Helsdon Memorial Healthcare SystemHollywood

Kim Herron Memorial Healthcare SystemHollywood

Catalina Hinestroza Memorial Healthcare SystemHollywood

Ashley HulseyTallahassee Neurological ClinicTallahassee

Chem JacksonUniversity of Florida Orlando

Kelsey JacobsJohn T. Littell M.D.Oviedo

Martha JohnsonUniversity of Florida, Ped­I­CarePanama City

Kathy LieffortThe Villages HealthThe Villages

Roslyn LindsayMemorial Healthcare System Hollywood

Linda Magrone Memorial Healthcare SystemHollywood

Michelle McClellanMemorial Healthcare SystemHollywood

Yvette MontveliskyMemorial Healthcare SystemHollywood

Roslynn O’RourkeOrlando Family PhysiciansOrlando

Stephanie PolandUniversity of Florida, Ped­I­CarePensacola

Elizabeth QueletVascular Associates LLCPanama City

Jorge QuinteroMartin Health SystemStuart

Marcia Ramirez

Memorial Healthcare SystemHollywood

Mischelle RegisterNorth Florida OB/GYN Baptist Jacksonville

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7

Florida MGMA Welcomes New Members, continued

Sheri RobinsonFirst Physicians Group of SarasotaMemorial Healthcare SystemVenice

Ronald RomearInfants and Children, P.A.West Palm Beach

Jessica Romero Memorial Healthcare SystemHollywood

Kam Rouhani Memorial Healthcare SystemHollywood

Heidi SalibaUniversity of Florida, Ped­I­CareGainesville

Simone Santana Memorial Healthcare SystemHollywood

Jennifer SavageOrlando Health Physician Assoc.Altamonte Springs

Denise SchneiderUniversity Urologists, a division of UGFLake Worth

Yana Shustin Memorial Healthcare SystemHollywood

Terri Sorrels Memorial Healthcare SystemHollywood

Nina Soto­Liebman Memorial Healthcare SystemHollywood

Holly Strickland, MAAdvanced Women’s CarePensacola

Amy SylviaHenghold Skin Health & SurgeryGroupPensacola

Brian ThornFaben Obstetrics & Gynecology, LLC Jacksonville

Joanna Torres Memorial Healthcare SystemHollywood

Christopher TurnerUniversity of Florida, Ped­I­CareTampa

Marie Whitcomb, BS, MBAFirst Physicians GroupSarasota

Joanna Williams Memorial Healthcare SystemHollywood

Lynne Wrubleski Memorial Healthcare SystemHollywood

Lisa YelinBorland Groover ClinicBoynton Beach

Arlene Zepeda Memorial Healthcare SystemHollywood

Tori ZoreOorthopaedic Associates of WestFlorida, PAClearwater

Corporate Member

Carol Crews, CMPE, CPMAccrews@thelbagroup.com

Bill Shelton, CPAbshelton@thelbagroup.com

Jim White, CPAjwhite@thelbagroup.com

Affiliate Members

Lawrence AchlerEMworkPort Orange

James AlexanderJITA Medical Billing & ConsultingSanford

Katie ClaxtonHealthPortAlpharetta, GA

Gianni GonzalezHealthCare ManagementSolutions, LLCJacksonville

Rhonda HoodUnitedHealthcare Maitland

Sally HuzyakProAct Health Solutions, Inc.Celebration

Deanna LessardPalm Beach County MedicalSocietyWest Palm Beach

Rebecca LynnEMworkPort Orange

Paulette PilcherProAct Health Solutions, Inc.Celebration

Marcial WongBlue Ridge X­ray Company, Inc.Arden, NC

Student Member

Dale HardawayUniversity of Central FloridaOrlando

Managing Your Practice’s Revenue Cycle in 2015

It's 2009 and you are looking at your key perform­ance indicators (KPIs) from 2008. It was a difficultyear due to the recession, but your practice made itthrough OK. Your payment mix was positive — thepercentage of major insurance carriers was consis­tent with the previous year.

It's now 2015: You are again looking at your KPIs andrealize the payment environment has changed radi­cally. Patients are now responsible for a much largerportion of their medical bill, and there has been a sig­nificant increase in the size of outstanding patientbalances. This is in spite of the increase in insurancecoverage due to the healthcare exchanges.

Several questions come to your mind: What is hap­pening when patients check in at the front desk? Arestaff letting patients know what their outstanding bal­ance is? What is happening on the back end withpatient collection efforts after the visit is concluded?

So you look and ask:

1. Does your practice's financial policy (that state­ment given to patients and posted on the website)state that payments are due prior to seeing theprovider?

2. What does your daily collections report show? Thissimply states, based on today's schedule of patients,how much was collected in terms of dollars, howmany patients were collected from, and if there wasno collection posted, why that occurred.

3. Does the front desk get accurate information onthe copay, deductible, and past due balances for allpatients? Are there inaccuracies, preventing themfrom asking for or collecting the amount due? Is thatinformation provided in a timely manner?

4. Do automated/staff generated appointment­reminder phone calls suggest that there will be a pay­ment required prior to seeing the provider?

5. Do you have adequate guidelines for staff con­cerning patients who don't pay prior to seeing theprovider? Does your staff have the authority toreschedule a patient if payment is not made? Whenis this clinically acceptable?

6. Does your malprac­tice carrier provideguidance in terms ofnot seeing a sched­uled patient due tolack of payment?

7. Is there adequatetraining for front­deskstaff in how to ask forpayment at the time ofvisit?

8. Have staff members have been assigned to identi­fy and collect outstanding patient balances?

9. Are there options through the patient portal to col­lect outstanding patient balances?

10. What is the practice position on collecting from anew patient with a high deductible plan? Do youmake sure you see the patient after the visit to ensurethat the level of services and all services provided aredocumented and can be collected at check out? Isthere an estimate of cost provided to the new patientat intake — on the initial call, as well as at check in?

11. Is there guidance for staff on the occasionalpatient who is private pay and requests a discount —e.g., offer a 25 percent discount (or even 50 percentif you have a fee schedule strategy of 200 percent ofMedicare, which means that the patient paymentwould be equal to that of Medicare)?

There is no time like the present to review yourpatient payment strategy.

One more thing — there was a slight adjustment inthe Medicare conversion factor from $35.80 to$35.75 as of Jan. 1 (which was a technical changeand not an SGR revision); but remember too, thatMedicare allowances will change as of April 1, 2015.There could be a significant hit, but more likely therewill be a small change in the allowable amount at thattime. Just be aware of it.

­ Owen Dahl, FACHE, LSSMBBodahl@owendahlconsulting.com

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Join your colleagues—become a member of The Doctors Company.

CALL OUR JACKSONVILLE OFFICE AT 800.741.3742 OR VISIT WWW.THEDOCTORS.COM

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9

Florida MGMA Free Member Webinar

April 14, 2015 at 1:00pm EDT

Game­changer: How do HDHPs affect medical groups?James C. Larson, FACMPE

About this webinar: High deductible health plans, or HDHPs, are revolutionizing how physicians are paid. Some striking information wasrevealed about HDHPs by a survey of MGMA members: 92% of respondents to the survey have seen an increasein the number of patients with HDHP insurance in their practice. These plans shift more of the financial burden forcare to patients, but at the same time, many patients don’t understand their benefits and some cannot afford thedeductible. 61% of respondents reported a decrease in patients’ understanding of their benefits, and 71% reported adecrease in patients’ ability/willingness to pay in full. This is causing many physician practices to feel pain in their rev­enue cycle more self­pay accounts receivable, and more bad debt. 71% reported an increase in self­pay A/R; 66%reported increasing bad debt. Forward thinking practices are responding to the HDHP challenge. This webinar will explore how HDHPs are impact­ing MGMA members and how they are changing their game to improve patient responsibility collections.

About the presenter: James C. Larson, FACMPE is a board­certified medical practice executive and a Fellow in the American College ofMedical Practice Executives with a proven track record of success in physician practice settings. Mr. Larson hasowned a successful medical billing company and has held executive positions with Charter Medical Corporation,Columbia/HCA, and the Health Alliance of Greater Cincinnati. He has managed several physician practices, from asolo practitioner to large multi­specialty groups. In addition to operating free­standing diagnostic centers, Mr. Larsonhas directed three Management Services Organizations, the largest serving over 800 providers.

Florida MGMA offers Free Member webinars

To sign up for our monthly webinars, go to our website at www.flmgma.com and Login to the Members Only Area with your User Name and Password.

Once you are logged in, go to the Education Tab and go to the Webinars Page to sign up. Past webinars are also archived on this page and are available on­demand for three months

after the original webinar date.

Membership Dues must be current to view this page.

Space is limited, sign up early!

If you have trouble logging in to our website please email us at lisa@flmgma.com.

Future Webinar Dates:June 9thJuly 14th

August 11thOctober 6th

November 10thDecember 8th

Check your email and our website for webinar topics and sign up information.

10

Membership DriveJanuary 1, 2015 ­ April 15, 2015

Recruit a colleague to join Florida MGMA and be rewarded with a

$25 Gift Card of your Choice.

$25.00 gift card$25.00 gift card awarded to any Active Member who refers/recruits a new Active Member.

(Target, Best Buy, Starbucks, or WalMart Card)

Upcoming Florida MGMA Member Benefits

Free Member Webinars Free Member Webinars April 14, 2015 at 1:00pm EDT

Webinar Title: Game­changer: How do HDHPs affect medical groups? ­ James C. Larson, FACMPE

Florida MGMA Annual ConferenceApril 24­26, 2015

Omni Orlando Resort, Championsgate

Quarterly Newsletters, Email Blasts

Membership Brochures can be downloaded from the website www.flmgma.comor by request brochures will be mailed.

Be sure your name is filled in under Referring Member! Please contact our office atlisa@flmgma.com or (561) 452­6702 if you have any questions.

HAPPY RECRUITING!HAPPY RECRUITING!

All Active Members recruiting 5 or more newActive Members will be eligible for theGrand Prize Drawing to be held at the

Annual Conference for a GoPro Camera!

12

As changes continue to occur in the healthcare indus­try, physicians are taking a hard look at the numbers ofa medical practice and gauging whether the year athand will be economically successful. To analyze theproductivity of the practice, physicians depend onaccurate and timely information. However, with thefocus of every practice on delivering quality healthcare, the financial side often becomes neglected orignored.

Frequent signs that a practice may not be payingenough attention to its financial side include: a lack ofdocumented billing procedures; lack of internal con­trols involving accounting and cash; lack of timeliness;no accountability for staff; missing or outdated records;and the lack of targeted benchmarks.

In order to run a practice profitably, a physician shouldreview weekly financial and cash flow updates to cal­culate overhead and determine how much to collectand how many patients are needed to cover thosecosts. These updates also allow physicians to deter­mine the level of patient visits, frequency of proce­dures, trends in expenses and changes in activities.

Develop a simple accounting system. Creating adependable and user­friendly accounting system isthe key to successful financial reporting. By engagingan accounting professional, practices can create asystem that works for them. The system needs to beable to generate weekly and monthly reports on thestatus of the office and must be kept up­to­date.

Buying easy­to­use accounting software is the firststep. Staff also must also be properly trained so datainput is timely and correct.

It’s also important that a professional accountant fre­quently review the activity in a practice’s accountingrecords, especially if the practice is growing, addingdoctors, expanding or is new. This review will allow apractice to properly report financial conditions andtimely tax planning. The last thing a physician wants tofind after months of recording the books are surprisesin regards to gains, losses or tax liability.

Implementing and documenting medical billing proce­dures is critical in today’s environment. Accurate med­ical billing (especially CPT coding) is extremely impor­tant to the success of any practice. Creating process­es that ensure data is captured properly and timelyshould become a top priority. Staff should be aware of

what is expected of them and how to get it done effec­tively.

The best way to establish these procedures is to placeproductive but reasonable practice goals with eachstaff member. Goals could include daily charges input,daily payments input, acceptable lag time days, num­ber of claims that have received follow­up, number ofpatient calls to make, zero lag time on correctingclaims transmitted, compliance with credit balancesand compliance with coding and documentation.

Several areas that should be closely monitored in thebilling process include regular follow­up on claims andappropriate attention to denials, zero EOBs and trans­mission rejections.

Next, make sure to create a continuous communica­tion cycle. Because of the pace of a physician’s office,formal communication between doctors, managementand staff often is fragmented, neglected or postponed.Animosity can develop between management andstaff because of inaccurate assumptions.

Management must take ownership of this responsibili­ty and strive to communicate with staff. Key issuessuch as turnover of personnel, additional hiring of per­sonnel to support practice functions and new process­es needing implementation should be communicatedtimely. Staff meetings with specific agenda items andformal memos documenting new policies and deci­sions seem to work well for physician offices.

Finally, establish your benchmarks – this I havepreached to you in the past. Benchmark all practicestatistics and most importantly, see how you are doingthis year compared to last year. If the year is flat ordeclining, investigate immediately and develop anassociated action plan of attack.

Through planned and integrated accounting, medicalbilling, communication and benchmarking, a physi­cian’s office can run smoothly and continue to care forpatients while being up­to­date on the economics ofthe practice.

­Reed Tinsley, CPA

Reed Tinsley, CPA is a Houston­based CPA, Certified ValuationAnalyst, and healthcare consultant. He works closely with physi­cians, medical groups, and other healthcare entities with man­aged care contracting issues, operational and financial manage­ment, strategic planning, and growth strategies. His entire prac­tice is concentrated in the health care industry. Please visitwww.rtacpa.com

The ABCs of Building a Financially Healthy Medical Practice

Overcoming the “Dirty Little Secret”

Effective group governance is now a survival skill formedical groups. Unfortunately, many medical groups,both large and small, suffer from something I call the“Dirty Little Secret.”

Here’s how it works:An individual physician thinks: “If I don’t like a groupdecision, or I didn’t vote for the decision, I don’t haveto abide by it or support it.”

Of course, no one really comes right out and saysthis, but that is often the way individual physicians act.This type of thinking can kill a group. If you have littleexpectation that the group members will implementgroup decisions, why spend time making decisions?

What can your group do about this? I believe thatevery group needs to ask and answer three funda­mental questions:

1. How will our group make decisions?

2. What is expected of each physician once a decisionhas been made?

3. What are a physician’s options if he or she doesn’tlike the decision?

Let’s consider each of these questions in turn.

QUESTION #1: HOW WILL OUR GROUP MAKE DECISIONS?

The group members need to agree on a fair and rea­sonable process to discuss issues and make deci­sions.

It is reasonable that there be some discussion on theissue, and then voting on the issue. It may be that thegroup will agree to empower a subset (such as aBoard) to make certain decisions for the entire group.

However, as I will discuss in later postings, I think it isunreasonable to require unanimity on decisions, andyou must be very careful in pursuing consensus(which most people take to mean unanimity). Intoday’s environment, the group needs to be able tomove forward with a majority (or depending on theissue, super­majority) vote.

QUESTION #2: WHAT IS EXPECTED OF EACHPHYSICIAN ONCE A DECISION HAS BEEN MADE?

What you want to hear includes:• Do it.• Abide by it.• Implement it.• Support it.• Not sabotage it.• Not complain about it to outsiders.

If you don’t hear the group members stating theseexpectations, or hedging on these items, you will suf­fer from the “Dirty Little Secret.”

QUESTION #3: WHAT ARE A PHYSICIAN’SOPTIONS IF HE OR SHE DOESN’T LIKE THE DECI­SION

There are three:1. Do it anyway: That’s group practice. If you want tobe in group practice, there will be times when youmust support something you may not fully agree with.2. Try to get the decision changed: But in the rightforum (i.e., the Shareholder or Board meeting), andcontinue to abide by the decision until it is changed.3. Self­select yourself out of the practice. I know thisis a tough one, but each physician should commit toeither supporting group decisions or leaving thegroup. The expectation should be set that a physicianwill not and should not stay with the group if they won’tabide by group decisions.

IN REAL LIFEA number of years ago I began a strategic planningretreat by asking a group these three fundamentalquestions. After the group agreed on how they wouldmake decisions, what was expected after a groupdecision was made, and what were a physician’soptions if they did not like the decision, one of thephysician said to me: “So, let me get this straight – intoday’s meeting, we are going to make some deci­sions?” “Yes,” I replied. He then said “And we arereally going to implement the decisions we make?”“You just agreed to do so,” I replied. And then he said“well, I guess I am going to have to pay a lot moreattention today than I have at any other planningretreat I’ve attended!”

A very telling comment. Prior to agreeing on thesequestions, he knew that there was no real commit­ment or expectation that individuals would adhere toand implement group decisions, because the group

continued on page 14

13

group decisions.

3. Avoids wasting time “making pasta:” How do youknow when pasta is ready to eat? Throw it against thewall and see if it sticks. Unfortunately that’s how manymedical groups operate – let’s make a decision andbe hopeful that people adhere to it (that it sticks). Inmy view, why waste a lot of time struggling with deci­sions if adherence is optional?4. Many issues/little time: Group governance andmeetings can consume a substantial amount of time.It is exhausting, frustrating and excessively time con­suming to have to guess whether or not people willsupport each and every decision. Groups whosemembers pre­commit to support group decisions func­tion much more effectively than those that suffer fromthe “dirty little secret.”

It is true that not everyone will live up to their commit­ments in regard to group decisions. As JamesMadison said, “if men were angels, no governancewould be necessary.” In later articles we will discusshow to deal with those who do not follow group poli­cies. But, as an important first step, ask people to pre­commit to adhering to group decisions.

­ Will Latham, CPA, MBALatham Consulting Group

www.lathamconsulting.comwlatham@lathamconsulting.com

For more than 25 years, Will Latham has worked with medicalgroups to help them make decisions, resolve conflict and moveforward. Will has an MBA from the University of North Carolinain Charlotte and is a Certified Public Accountant. He is a frequentspeaker at local, state and national, and specialty­specific health­

care conferences.

Overcoming the “Dirty Little Secret” continued

had never agreed that it would. The answers to thesequestion form the basis of developing any effectivesystem of group governance.

There are four additional important reasons thatgroups should ask and answer these questions:

1. Leads to real discussions: In our experience physi­cians tend to be conflict avoiders, when it comes tophysician­to­physician conflict. In many groups, anindividual physician “knows” that he or she will not beheld accountable in regards to adherence to groupdecisions. If this is the case, the physician may avoidtalking about an issue in a group meeting, counting onthe fact that no one will challenge their non­adherenceto group decisions at a later time. Their thoughtprocess seems to be: “I can avoid conflict now by notspeaking up, and I can probably avoid it later as noone will challenge me – because they are all conflictavoiders also.”

However, if each group member pre­commits toadhering to group decisions it is much more likely thatthey will raise dissenting opinions as part of the dis­cussion. This means that the group will have a morecomplete and richer discussion about the issue.

2. Eliminates the fiction of unanimity: Many groupsspend hours and hours trying to get everyone to votefor an issue, thinking that if everyone votes for thedecision then it will be much easier to implement thedecision. But it’s likely that everyone doesn’t agree –in the end they just vote for the issue to avoid conflictin the meeting They then turn right around and ignorethe decision. Stop wasting time with pursuing falseunanimity. Get people to pre­commit to supporting

14

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Visit our Job Board at www.flmgma.com under the Jobs tab for information on these and additional job post­ings. Members can post their jobs online at no cost.

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