Cover Story Fall 2012 Adding a New Name to the Shingle Paula Tarnapol Whitacre 48 AE Fall 2012
When a new physician comes into the practice, the administrator has a big role to play. Investing in equipment and office space requires analyzing options and making decisions, then trying to make a smooth transition from old to new. But a far bigger investment is when an ophthalmic practice adds a new physician. Get it right and it s pleasant and profitable. Get it wrong and the consequences are unfortunate for the practice, the new physician, and ultimately the patients. Although not a scientific sample, a recent ASOA Friday Focus survey (see p. 57) shows that about one-third of practices added a new physician in the past year. While the partners make the final decision, the administrator plays an important role throughout the process. The doctors want me to be their objective eyes and ears, said Corinne Wohl, COE, administrator of Delaware Ophthalmology Consultants, where two physicians joined the practice in the last year or so. An administrator has a role at every step. You re bringing together data, involved in recruitment, interviewing candidates, helping prepare a contract with an attorney, negotiating on behalf of the practice, and preparing for the arrival. Go or no-go? Mark Kropiewnicki, JD, LLM, The Health Care Group Inc., and Health Care Law Associates, P.C., Plymouth Meeting, Pa., said many large group practices have a process in place to decide whether to hire a new physician, but solo practices or those that have not added a new physician in a while have a lot of new information to consider. The big issue is whether you [the practice] can afford it, he said, noting that not only a base salary but also a potential bonus, benefits, malpractice insurance, any additional equipment or staff, and other expenses must be brought into the analysis. While financial specifics are beyond the scope of this article, the take-home point is that the administrator must provide information for the partner(s) to decide a course of action. Internally, the most important factor is patient volume do they have enough excess volume to justify adding a doctor? said Brad Ruden, MedPro Consulting & Marketing Services, Scottsdale, Ariz. They also need to examine their physical plant to ascertain if they have the space and equipment necessary for an additional doctor. Externally, they should be aware of the population growth of their marketplace and what may be happening with any competitors. Ruden suggested some valuable ways that an administrator can be involved in the decision-making, including the following: Analyze the current doctors schedules to make sure they are maximizing their efforts in the office before adding another doctor. Analyze the patient base to ascertain if a particular subspecialty would be beneficial. Analyze how far in advance patients must schedule an appointment or if a lot of them come from the same geographic area far away. Run projections about the costs of bringing on board an additional doctor (for the doctor, as well as any new equipment or staff) and the effects on the practice s bottom line. Determine how long the new doctor will need to be subsidized by the current doctors. This last point is often a surprise, especially to the doctors. They have to realize in the beginning that there is cannibalization, where the new doctor takes some of the existing doctors patients, said Ruden. Sometimes practices do not give this enough thought. Making the right match The administrator continues to play a central role if the partners decide to bring on a new physician, particularly someone who will eventually become a partner. It s very expensive to bring in a new person, market him, and then he leaves, warned Robert Dienethal, CEO of Eye Center South. It means there s a lot of homework to be done on the front end. Some practices recruit new physicians themselves, particularly if they are not under any time pressure. Others prefer to use recruiters, who usually have a wider network of contacts. Amelia Rogoff and Lauren Simon, ophthalmic recruitment specialists who 25 years ago began The Eye Group, which is based in Boca Raton, Fla., said they are seeing more openings than can- Get it right and it s pleasant and profitable. Get it wrong and the consequences are unfortunate for the practice, the new physician, and ultimately the patients. continued on page 50 AE Fall 2012 49
Cover Story Fall 2012 continued from page 49 Checklist for a New MD didates in all specialties. What that means is you are competing not just regionally, but nationally, according to Simon. A doctor says he wants to stay in Philadelphia, but ends up in Portland because of an opportunity. In most cases, a practice invites one or a few candidates to the office for an interview. The physicians (and, in many cases, staff) can size up the candidate, and vice versa. An administrator is a most important and valuable asset, said Rogoff. The doctors don t have the time, but the administrator can make the visit as productive as possible. Make it an ideal visit. Be prepared. That includes either having a contract to present to the candidate to review, as Rogoff suggested or, as Kropiewnicki often advises, having it ready to send within a day or two. As administrator, Morgan Taylor III, COE, was very involved when the sole doctor at Atlantic Eye Brad Ruden, MedPro Consulting & Marketing Services, shared a checklist he puts together for ophthalmic practices that are adding a new physician. 1. Contact the state medical licensing board regarding licensing requirements. 2. Obtain a narcotics license. 3. Obtain malpractice coverage. 4. Submit the physician s name to the necessary insurance groups and managed care plans. 5. Formally introduce your new associate (and family) to the practice staff. 6. Send letters to all referring physicians detailing your new associate s training and areas of expertise. 7. Send postcards to your patients announcing your new associate and when s/he will start. 8. List the associate s name with the telephone company, answering service, paging service, and the referral lists of local/regional hospitals. 9. Include the associate s name in all advertisements, promotional material, and letterhead. 10. Order business cards. 11. Obtain memberships in all pertinent local, regional, and state medical societies and associations. Center in Palm Beach County, Fla., decided to add a second partner. The doctor and I met together with a candidate to discuss terms. Any emails we sent, we would make them group emails and cc everyone, so nothing could be misconstrued, he said. A critical feature that Taylor and other administrators said they are looking for is fit how the new physician will mesh with the partners and the rest of the practice. They don t have to be a carbon copy, but they have to share core values, and the values differ depending on the practice. Taylor said, The person can be a good physician but not a good partner. You need to know your senior MD. If he is a workaholic and entrepreneurial, it would not work to bring in a doctor who wants more freedom and family time. Eye Center South s Dienethal agreed. Fit is most important. For us, it s a group mentality whether the person will go along with what s best for the group, even if it benefits another area [other] than yours. Because bringing on a new physician is such a huge investment, he added, the biggest mistake is to be impressed by credentials and ignore the fit part. Dienethal involves the staff when candidates visit. In a bigger practice like ours, don t make it a big secret. Involve your practice, he recommended. Department heads have a role in interviewing and providing input. Whether it s a good or bad feeling, we take what they say seriously. Practices generally retain an attorney to review the contract and suggest that the candidate retain his or her own attorney, especially if the physician has not had previous practice experience. 50 AE Fall 2012
A Physician s Perspective Kristiana Neff, MD, joined Carolina Cataract & Laser Center in August 2011. She shared her thoughts about how an administrator can help a physician coming into the practice in an email interview. AE: What were some concerns or questions that you had coming into a new practice that the administrator could help you with? Dr. Neff: There are always many questions that come up when joining a new practice. Often the practice administrator is one of the best resources to inform a new practitioner about basic employment benefits, credentialing, and, most importantly, to help provide a big picture as to how the practice runs on a day-to-day basis as a whole. It is important to have insight into how the entire practice works and interrelates in order to best integrate yourself into the existing system. Once you start seeing patients, it is so easy to become entrenched in your pre-existing practice patterns, which might or might not work well in your new practice setting. There is much to gain from understanding how the new practice operates and flows... The practice administrator often has the best grasp on each employee s strengths and weaknesses, which helps to utilize your staff appropriately. AE: Based on your experience and perhaps the experience of colleagues you know in other practices, what can administrators do to help ease the transition? Dr. Neff: The practice administrator can help in many ways. First off, each facility that you plan to work in will have its own set of requirements. The practice administrator can be critical in getting all of the paperwork and credentialing completed in a timely and organized fashion. Practicing medicine takes more and more paperwork each year, and having a liaison to keep you on track in a new setting is very important because they know the lay of the land at the new practice. Becoming adept in communicating with the practice administrator is also very important. The administrator plays a key role in development and management of your practice. Your old templates for the OR and clinic might not work in the new setting, and the practice administrator can often help troubleshoot the development of your new templates. S/he can also help you define your place in the community in order to allow you to attract the appropriate type of patients to your door (either with advertising or by getting to know appropriate referral sources). You will need to work together to optimize the flow of your new practice. AE: Is there anything else you would like to add about MDs entering a new practice? Dr. Neff: Truly successful matches between new practitioners and practices can be difficult to create. I think it is so important for the MD to be realistic about what is needed in order to be happy in a new practice setting. It is also key for all parties to be honest when discussing their needs/desires in a new partner or practice. Learning more about the practice and its personality PRIOR to signing on the dotted line can save you from making an unsuccessful move. Too often, people are caught up in the details of the contract (not to minimize its importance) and neglect really getting to know the culture of the practice and the people who run it. Fitting into the philosophy of the practice is key to long-term retention. The practice administrator is a great person to get to know well prior to the move because s/he often has the pulse of the practice and can give you insight into how you will be incorporated. The more knowledge you have before you start your job, the better. Be prepared, said Taylor. Most recruits want to know at what point a buy-in is offered and how it will be calculated. Even though it won t happen for a while, if you are not able to give an answer, it shows you are not prepared. A practice has to know what it can handle and not get into a bidding war, said Kropiewnicki. You still have to look at the numbers and figure out your maximum. Another risk in offering too large of a package to an associate is that the offer could be better than what would be offered to become a partner, thus removing the incentive to buy in. Bringing in the new MD The administrator also deals with many aspects of integrating the new physician into the practice, such as continued on page 52 AE Fall 2012 51
Cover Story Fall 2012 continued from page 51 ensuring that all legal and financial issues are handled correctly and that the staff, patients, and community welcome the new physician. Remember there are delays in licensing and credentialing, Taylor said, including the paperwork involved to get the physician approved with respect to Medicare, private insurance companies, and specific state requirements. These steps typically take about six months. If the physician is brought in before he or she can treat (and charge to treat) patients, the practice will be carrying an increased financial burden. Bottom line: You need to look at cash reserves, he said. Eye Center South is acutely aware of this reality because it has locations in Alabama, Florida, and Georgia. The paperwork is unavoidable, and for us, it s tripled, Dienethal said. You want them [the new doctors] to hit the ground running, so you want as much lead time as possible. A lot goes on behind the scenes in adding a new provider, said Ashlie Barefoot, administrator at Carolina Cataract & Laser Center near Charleston, S.C., which added a new physician in 2011 (see sidebar, A Physician s Perspective ). Credentialing, staff training, creating an accepting environment you need to learn how to meet the physician s needs to help [the physician] be most efficient. It s an ongoing process. When the physician is on board, Ruden suggested setting up introductory lunches or dinners with referring physicians and ensuring new patients are directed to the new doctor. Staff is important, he said. They can help create a level of comfort with patients and referring new physicians by talking up the new physician. When they come, there needs to be a lot of communication about the practice culture, said Wohl, noting it goes both ways. Prepare the staff for change. Integrate the new doctor as quickly as possible for a long-term and positive relationship for the team and for the patients. AE Paula Tarnapol Whitacre (703-212-0349, ptw@fullcircle.org) is principal of Full Circle Communications in Alexandria, Va., and writes on health, business, and environmental topics. ASOA Friday Focus Surveys: Focusing on the BUSINESS of Ophthalmology January 2012 Respondents: 426 1. Have you added a new doctor to your practice in the last year? Yes 35.3% No 64.7% 2. What influenced your decision to add a new doctor? (Select all that apply) Increased patient volume Desire to increase revenue by increasing capacity MD retiring or leaving the practice Implementing auxiliary services (e.g. audiology, optical shop, cosmetic) 54.7% 50.8% 36.7% 10.9% 3. When the question of whether to add a new doctor to your practice comes up, does your practice ever consider reducing patient volume instead? Yes 4.7% No 95.3% 52 AE Fall 2012