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Practice Management Consultants — Who Needs Them?
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You’ve made great accomplishments within the practice, whether by implementing electronic health records, opening up a new office or redesigning an existing one, increasing practice revenues, motivating staff, reducing A/R and improving patient flow.

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Yet, I would venture to guess that you are probably not completely content just to get the job done. There is a continuous drive to exceed the expectations of your patients, staff and physicians. In your never-ceasing plan for improvement, you probably rely on a combination of resources, such as monitoring and contributing to AAOE’s three listserves (E-Talk, E-Expert and/or E-Retina), attending courses and reading educational guides and practice management newsletter articles like this one. While all these resources are invaluable, there are times you need a little individual attention. That’s where a practice management consultant can become a great resource for your practice.

Why should you consider hiring a practice management consultant?
Most practice management consultants have worked with hundreds of practices throughout the country. A good consultant can objectively diagnose a problem. Sometimes it is easy to overlook one or more problem areas when you’re too close to the situation. Because most practice managers do not spend much time in other practices, an outsider’s perspective can be extremely helpful. After all, it is much more detrimental to take on an unfamiliar project and make costly mistakes.

What services do practice management consultants offer?
Many practice management consultants offer a full range of services, so you’re sure to find several that can consult with you on your issue, from legal to space planning, billing, optical or strategic, and/or daily management issues.

John Pinto, practice management consultant and member of the Academy’s Consultant Directory, has been working with the Medical Eye Center in Medford, Ore., since 1991. As the practice has evolved, so has the area of consulting concentration. Initially, Pinto helped the practice develop a comprehensive marketing program for refractive surgery for this three-office practice (with one location that is exclusively refractive). Currently, strategic planning and recruiting are the areas of concentration.

Just as you and your staff establish an ongoing relationship with your patients, so too should you seek to establish an ongoing relationship with your consultant, as long as the relationship continues to work. Your consultant will understand your history, office culture, what’s worked well and not so well. You should consider a consultant an extension of your practice.

How often should you interact with your consultant?
Consultants may be engaged for a one-time practice assessment to examine the potential or existing problems in a practice, or a consultant may provide ongoing services. This assessment might take place in person, over the phone or a combination of both.

Pinto says, “You should treat your relationship with your consultant as you do your relationships with your accountant, attorney or other professional advisors. For a small practice, you might need to contact your consultant just once a year, for a large practice it could be once a month.”

He visits the Medical Eye Center twice a year, in addition to monthly conference calls as needed.

Would you welcome a consultant into your practice?
Before a consultant is hired, especially when the goal is more closely related to daily operations, Keith Casebolt, CEO for the Medical Eye Center, recommends that a practice manager “be very clear about the goal. You must be open to change and feedback. You need to let go of being perfect. You may feel defensive and irritated with the consultant’s recommendations, but ultimately the goal is improved performance. Owners will greatly appreciate improvements in effectiveness, and their respect for you will increase as a result.”

Recently, Pinto helped the Medical Eye Center implement a recall system that has significantly increased volume for the practice. He also recommended some extensive changes to the organizational structure that were ultimately successful as well.

A consultant will probably suggest many ideas for improvement. Casebolt says, “I don’t take all the advice. Sometimes recommendations are too far ahead of us or more than we can implement at once. Other times we just don’t agree. You are not ceding management decision-making; you still have to be accountable for running the practice. However, what I notice is that even when I disagree, the process still often leads to some new direction I had not considered before.”

Pinto does not expect a practice to take action on all the provided suggestions, which could number from a dozen into the hundreds. A practice manager must judge what suggestions are the best fit for the goals and structure of the practice at that time.

Setting the Right Tone
The practice needs to establish a “no blame” culture from the start. Ideally, this pronouncement will come from the physician–owner(s), who will clearly state that the purpose of the consultant’s visit is not to point fingers, but to improve quality and effectiveness.

What qualifications should I look for?
This will vary depending on the project. A consultant usually has an educational background in health care, accounting, business, law or architectural design. Many also have an MBA (master of business administration), CPA (certified public account), CFP (certified financial planner) or CHBC (certified health care business consultant) credential.

A consultant should be an expert in medical administration, experienced in the field of ophthalmology and well versed in political and economic influences on the practice of medicine. For example, let’s say you are interested in engaging a consultant to find a buyer for your practice. Most, but not all, states require real estate brokers and attorneys to perform consultations involving a practice sale, associate buy-in or merger.

That being said, as Brad Ruden, practice consultant and member of the Academy’s Consultants Directory, says, “General business brokers simply don’t understand the nuances of appraising a medical practice or the restrictions in selling a medical practice. There are many factors that contribute to a practice’s value, such as doctor reputation, staff, location, procedures performed and so forth. To further complicate matters, some states have restrictions on non-physician owners. Practices need to hire someone who understands their specialty.”

How do I find a consultant?

  • Use the Academy’s Consultants Directory to search for consultants: While there are competent consultants who do not belong to the network, each consultant member is required to have a minimum of three years professional ophthalmology-specific experience, to submit two endorsements (one from an Academy member in good standing), and to offer areas of expertise in the seven key competencies that the Academy deems relevant in today's health care environment. Several offer a discount to Academy members.
  • Make use of your network: If you’re a member of the American Academy of Ophthalmic Executives (AAOE), use the E-talk listserve to solicit recommendations from your peers. You could also get recommendations through the Academy Online Community, either by posing the question in a relevant group or by posting something on your community persona.
  • Schedule time with consultants during the Annual Meeting: Several consultants present courses, moderate roundtable discussions and/or provide free consultations in the Conversations with the Experts practice management booth. This interaction will enhance your ability to select the right consultant for your needs.

What questions should I ask before I hire a consultant?

  • Fees: Ask about fee structure, and make sure the contract details a breakdown of charges. In most cases, consultants charge by the hour, day or project. Hourly rates typically start at $125 and go up from there. Other consultants use alternate methods. For example, a financial consultant might charge based on the total value of your portfolio; other consultants may be held on retainer to assist in third-party billing issues or managed care compliance administration.
  • Goals: The contract should also specify goals for your practice. If the goals are time-sensitive, for example moving the office, you might consider specifying some recourse if goals aren’t met according to the schedule outlined.
Here are some sample questions you should ask prospective consultants. In most cases, an interview with a consultant can be conducted adequately over the phone. If you and your partners feel more comfortable meeting the consultant in person before hiring, then you should expect travel expenses will be assessed.
  1. How long have you been a consultant? (Note: If you call a consulting firm that employs multiple consultants, make sure you understand who you will be working with.)
  2. What is your background?
  3. What size practices do you work with most often? A consultant should specialize, at least to some extent, in working with small, medium or large practices. If your practice has a subspecialist focus, the consultant should understand your unique needs.
  4. Have you consulted with other practices on a similar issue? Depending on the nature of your issue, it might be difficult to find a consultant who has experience with the exact type of problem in your region with a similar-sized practice, but the consultant should understand your needs and be able to recommend a solution.
  5. In which states are services provided? This question is especially important when it comes to legal issues. While most consultants are willing to accept assignments in various states, do not overlook the cost of travel expenses.
  6. Is there a minimum charge or a minimum number of hours?
  7. Is a post-evaluation report included in the price and what information will be included?
  8. What references can you provide me? (Two or three is generally sufficient.)

What will the consultant expect from you?

  • Data: The consultant may let you know what information will be required in advance of the visit. If not, you should pull together reports and monitor activities in advance of the visit that you deem will be helpful.
  • Advanced preparation: Remember, consultants are often paid by the hour, so don’t let the consultant sit around while you generate reports, brief your staff and so forth. Make the best use of your time. Casebolt of Medical Eye Center sends a one- to two-page e-mail in advance of the visit stating his top concerns in order to focus the visit.
  • Honesty: Make sure you are perfectly upfront with the consultant, otherwise you probably will not be pleased with the outcome. Like you, consultants have seen it all, so you should not feel embarrassed to reveal information and you should not try to conceal information to obtain a lower quote. If you have retained an attorney or another consultant to work on the same project, let the consultant know.
  • Open mindedness: Avoid the “we’ve always done it this way” syndrome.
  • Follow through: After the consultant leaves your practice, the real work begins. It’s now up to you to put the plan into action. If it’s not working or your encountering resistance from one or more staff member, you should contact the consultant to come up with some alternate solutions.

What should you expect during an onsite visit?
The onsite visit will vary from consultant to consultant, and it will also vary with the nature of the issue, but here’s what you might expect:

  • Briefing meeting: All stakeholders should be encouraged to attend this meeting, and everyone should openly state any concerns or questions. This meeting will help to alleviate any resistance to change after the onsite evaluation.
  • Observation time in the practice: A practice management consultant needs to understand how things currently work in the office before making any recommended changes. You should schedule as you normally would so the consultant can make a realistic assessment.
  • Interviews: This will vary depending on the assignment but, in most cases, it would be important for the consultant to speak to as many employees in the practice as possible. You should encourage staff to communicate candidly with the consultant.
  • Exit meeting: Most consultants will meet with you and other staff upon completion of the assessment. Again, all stakeholders are encouraged to participate in this meeting. A good consultant should also suggest strategies for prolonged success.
  • Reports: Consultants will usually generate reports approximately two weeks after the visit. Inquire as to which reports will be generated and in what format.
  • Schedule: The length of an onsite visit will typically span anywhere from two days to a week. The days can be long, starting at 7 a.m. and run into a meeting with physicians late into the evening. An onsite consultant’s visit can be intensive, so make sure you’re prepared and well-rested. “Some clients compare it to a therapy session,” Pinto says, “since it forces a practice to take a 360 degree look at itself.”

Final Thoughts
Consultants value long-term relationships with clients — and referrals — so it is in their best interest to make sure you perceive the service as valuable. If a consultant is not meeting your needs, you should verbalize your concerns and seek out another consultant if the situation doesn’t improve. Remember, everyone benefits from a successful practice.

Search the Consultants Directory to find consultants that meet your needs. Also, if you’re a AAOE member, sign up for the eExperts listserv. E-Expert provides AAOE members free online access to scheduled discussion topics led by consultants, administrators and physicians in the field of practice management. Not an AAOE member? Learn more about the benefits of membership today!

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About the author: This article was adapted from a version originally published in the April 2005 issue of Executive Update. It was written by Donna Lock, AAOE Executive Director.

 
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