How a CA Privacy Law Could Affect Your Marketing Plans

ep. 20

Improve Organizational Management

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In this episode of the Growing a Successful Orthopedic Practice Podcast, Chris Samulowitz, Senior Organizational Development and Business Executive at MRC Corp., and Debbie Howard, Founder of STAT Healthcare Revenue, join Keith Landry, to offer orthopedic physicians and practice managers strategies they can use this week to run their practices more efficiently.

Samulowitz says physicians and practice managers have to analyze the efficiency of their revenue streams, systems and operations, and keep employees engaged to keep those processes on track. Howard adds managers should hone in on how they use technology to improve profit margins.

Tune in to discover:

  • How a team meeting using sticky notes can begin the efficiency effort
  • Adapt your processes when online reviews are showing a troubling trend
  • Train team members to adjust to necessary changes to improve productivity
  • Analyze accounts receivable to collect payments more quickly

About Chris Samulowitz

Chris Samulowitz is Senior Organizational Development and Business Executive at MRC Corporation. He offers 30 years of experience helping management teams put organizational development plans in place. Samulowitz helps leaders identify critical success factors to improve individual and business outcomes. He works to identify gaps in business operations and to develop core competencies for companies and workers to optimize performance.

About Debbie Howard

Debbie Howard is Founder of STAT Healthcare Revenue. She offers 30 years of experience helping practice administrators improve their systems and profitability. Howard has worked with a wide variety of medical groups. She helps physicians and managers improve employee performance, accounts receivable operations, third party contracting and helps them improve their use of information technology.

How a CA Privacy Law Could Affect Your Marketing Plans

About Keith Landry

Keith Landry is Director of Public Relations at Insight Marketing Group. Keith has been a public relations consultant since 2010. He has more than 26 years of experience as a news anchor, news reporter and public affairs show host, which he uses to implement innovative public relations strategies for medical practice clients.

Sponsored by OrthoLive

Episode Transcription

Chris Samulowit…:        Is it running smoothly? Are they gaining the right kind of revenue return based upon the work that they’re putting into it? So it’s a goals-oriented, but process and systems oriented review.

Speaker 2:                    Welcome to the Growing a Successful Orthopedic Practice Podcast. Join us every episode to hear from fellow medical practice administrators, staff, and physicians, as we break down current issues affecting the industry and share real stories from guests on their way to growing a successful orthopedic practice. Let’s get started.

Keith Landry:                Hello Everyone. And welcome to another episode of the Growing a Successful Orthopedic Practice Podcast. I’m your host, Keith Landry. And I will tell you, this episode is brought to you by OrthoLive. We want to thank everybody for being with us. We love our orthopedic physicians and practice managers and everyone else tagging along for the ride today as well. Today, we’re going to focus on improving organizational management because you can have an operation and have people who are working hard, meaning well, but there’s always a way to be more efficient. And I have two operational efficiency gurus on the other side of the microphone today. We have Chris Samulowitz and Debbie Howard. Thanks to both of you for carving a little time out of your efficient schedules to be with me today on the podcast, how are you both doing?

Chris Samulowit…:        Good to be with you, Keith, doing well.

Debbie Howard:            Doing great. Thanks for having us.

Keith Landry:                Awesome. And I’m going to give our listeners just a little brief bio on each of you so they know why you’re on the other side of the mic today. Chris Samulowitz is a senior organizational development and business executive with MRC corporation, a strategic senior HR executive for organizational development and plan implementation. Functions as the strategic leader and senior consultant human resource executive for companies. The bio’s very long, but in a nutshell, he knows how to run companies very well and efficiently. So thanks for being here. And Debbie-

Chris Samulowit…:        I have the scars to prove it.

Keith Landry:                And Debbie’s got 30 years of practice administration. She’s the founder of STAT Healthcare Revenue. And she’s a self motivated, goal-oriented medical professional with successful experience in managing multi-site, multi-discipline group medical practices. So, great insights ahead today from both of you. And thanks for being here. How are you both doing, as we move into spring?

Chris Samulowit…:        Good, Keith. Doing well, especially now it’s warming up a bit after that cold spell. Nice.

Debbie Howard:            Ready for warm weather.

Keith Landry:                All right. So, when I throw out the topic of improving organizational management, let’s go to the 30,000 foot level. Chris, what does that even cover? What are we talking about on this podcast?

Chris Samulowit…:        Well, for us, we’ve been at this for about 30 years as a practice in all types of industrial verticals. And the medical practice world is something we worked with as people would come to us with questions, but we never really focused on it specifically. And we’ve begun to do that in this past year. And that’s when Debbie and I came together. For us, organizational development is understanding what the goals of the practice are. The goals of the people who own the practice, the doctors, and then translating that into processes that can help them achieve that goal.

So, we’re very committed to the planning and the systems side of the business, as opposed to wishful thinking, which a lot of people say, “I want to be this. I want to have this type of a practice.” That’s great. How do you do that, exactly? Who will be responsible for it? What are the timelines? So I think that’s where we weigh in on this. And we see it with the tremendous growth of practices in Florida, which is almost the epicenter for healthcare in the world now, with people coming in from Brazil and from Africa and Europe and in Canada for their health care. So we see it as a very important need. And the independent physician practice is one that’s under a lot of pressure nowadays. So, planning and being organized, we think is essential for their success.

Keith Landry:                Debbie, when we talk about improving organizational management, what’s it mean to you? What’s your focus on that?

Debbie Howard:            It’s interesting, because Chris and I have really joined together. And I think of Chris as the architect of the roadmap, if you will. Once he gets an opportunity to work with the physicians, and get into the nuts and bolts and develop the plan, that’s where the rubber meets the road. And we implement the necessary operational steps that we need to ensure the plan’s success basically. So, I look at it as sitting down on the beginning, at the front end, with the doctors. What are their end goals? What are they trying to accomplish? And then Chris developing that roadmap, which, once we’ve gotten that accomplished, then it’s easy to start putting the necessary action steps in place to actually have it come to fruition.

Keith Landry:                So Chris, at MRC corporation, you focus on strategic planning as the primary focus of what you do to help folks out. Give us an overall idea of what that is. What is this strategic planning that you help administrators with?

Chris Samulowit…:        We interview the practice managers. We interview the doctors that own and run the practice, if that’s the case. And we try to establish just specifically, what is their near term goals and challenges? Where do they want to be in 10 to 15 years from now? Do they want to expand the practice? Are they thinking about retirement? All of these different issues. And once that’s understood, then we try to gain their sense of what they think they’re able to accomplish. So it’s a review of the business model. It’s a review of their marketing plan. It’s a review of their staff and personnel. And then the major role that Debbie and her team plays in coming in and assessing how efficient that is. Is it running smoothly? Are they gaining the right kind of revenue return based upon the work that they’re putting into it? So it’s a goals-oriented, but process and systems oriented review.

Keith Landry:                Hmm. So many different areas of operations to analyze and improve the efficiencies within. So tell me, how does MRCs medical practice consulting group fit into the medical sector? And how does it approach to an independent medical practice trying to work more cost-effectively? Tell us a little bit about that.

Chris Samulowit…:        So what we essentially do is, we’ll sit down and talk about the objectives. We’ve been at this for 30 years. And as I mentioned before, in the past, it had always been a bit of a hobby. What we’ve done now is created a team of people, including Debbie’s team, to look at the whole picture, not just the visionary side of it, but the actual implementation side of it. We also spend a lot of time looking at, and drawing upon, our experience with working with people. Is there a good team chemistry? How are goals set? How are people advised as what to do? What does success look like for an organization?

So we try to define that so that everyone is on the same page. So that’s our approach, and it’s the same in any industry. In the medical practice industry, it’s no different. Though everyone thinks they’re different from someone else, but in fact, there are many similarities. So, it’s about the goal. It’s about the processes. Do the systems support the work of the people or is that a problem? And do you have good team chemistry? Do the people get along? Do they have the right background to deliver for their colleagues? So, that’s our approach.

Keith Landry:                Sounds like a very comprehensive approach. Debbie, what do you want to add to that?

Debbie Howard:            Well, I think that Chris has probably hit most of the nails there on the head, because I think everything that he’s developed through any industry that he’s worked in has had great success. And I think a lot of that just naturally marries over into the healthcare sector. I think a lot of what he’s seeing and recognizing as well are ensuring that you’ve got the right people in the right places to do the job that needs to be done. And I think, by going back to the very beginning of that and recognizing what we need to do to ensure that the needs of the physicians are being met, that’s really where Chris comes in and talks with them and develops, as I mentioned earlier, that roadmap.

Keith Landry:                Good deal. So now we’re going to give the big nuggets of this podcast, the big payoff and five bullet points so somebody can go on to lunch and remember the main points here. Chris, if I’m a practice physician or a practice manager, and I’m trying to improve business operations, what are the big five areas? The main areas of focus I should look at in order to improve how my office and my team operates?

Chris Samulowit…:        So, I mentioned earlier about the importance of having a marketing program. And we have a marketing group that we use that will come in and work with the physician to align his goals with what’s actually being delivered. So that’s really checked off against by reviews that you might get online from patients, and then converting those reviews and concerns, if any, to action, to either change the way you approach a project, to change how things are communicated, how they’re set up in the office. And then you’re building training programs and other types of activities that are going to reinforce what it is the patient, the customer, if you will, is seeing every day. So you may have one vision and be living it in the back office, but for the patient coming in the front door, they may be seeing something quite different. So, that’s where we talk about the systems alignment. And Debbie can talk in detail about that. But we think that’s really, really key.

Keith Landry:                That’s a great point, Chris. You think you’re doing everything right, and then you get the feedback from a chain of patients who said all something similar that wasn’t what you thought, right, Debbie?

Debbie Howard:            Absolutely. A hundred percent. It’s interesting, when I was considering what are the five areas when you just mentioned that. Obviously, coming from a revenue cycle background, the first thing that comes to my mind is obviously the revenue. It’s the financial aspects. What are the key performance indicators that we’re looking at, such as, how long is the days in AR? How long is our money sitting out there that we’re not collecting it? What’s our total revenue per full-time provider? Those are all metrics that I think are vitally important to monitor when you start looking at that. So the first thing that comes to mind, for me, is obviously looking at the financial side of it.

But then in addition to that, just to allude a little more to even what Chris said is, patient satisfaction. How are we doing on our wait times? How are we doing on timely response to phone calls? So there’s a lot of things that go into the marketing arena that, when you think about it, that provides what we want and that’s patient satisfaction. I think today’s consumer of healthcare is really more interested in an experience. They want to feel like they’re getting something more than just a transaction. I mean, I think the healthcare industry is trying to catch up to that. I don’t think we’ve done a very good job of that, honestly.

But I think the other thing to consider is employee satisfaction, because employees are also a consumer of a product. They’re also looking at, what am I getting for the money and the time, what am I getting out of it besides just an income? There are internal processes that I think are important. Looking at the way we process what we do in our office. And then, the last thing that I would just mention is just utilizing technology. I don’t think healthcare, in general, has done a good job of embracing technology, but I think there’s some amazing things out there that can help practices that they just either don’t know about, or they’re not aware of, or they’re not willing to invest in. But I think utilizing technology is probably one of the five areas that I think practice managers really should consider and start looking at.

Keith Landry:                That is a great list of priorities. And let me bounce it back over to Chris to finish his main points. I think I pulled the discussion away from him a little.

Chris Samulowit…:        It’s fine. Debbie’s great.

Keith Landry:                All right. Good deal. So then we’ll move forward then. So how do you work with medical practice to improve their processes? Debbie, what are you looking at when you’re going to improve their processes? It’s like a little jigsaw puzzle. What am I working with here?

Debbie Howard:            Yeah, absolutely. I think the first thing that we have to look at is obviously determine what the problem is. And I think that’s solved by asking lots of questions. That becomes part of the initial intake that Chris referred to earlier when he starts looking at the plan. But I think, at least the things that I’ve been really successful with in changing processes is, I want to review the current step-by-step process. I suggest things as easy as getting everybody in a room without cell phones, without their phones, with a whole bunch of sticky pads and you just create whatever the problem is, you get everyone that’s involved in the process in there. And you just start labeling and creating steps or action items. You start putting everything that we do on every single process up there until you have all 45 or however many process steps there are in that, on the wall where everybody can literally look at.

Then it’s a whole lot easier to start saying, “Okay, we’re duplicating this. You’re doing it. Now, they’re doing it.” So we start removing and reallocating job duties. And does it make sense that we do this first and then that. So it’s that type of analysis that makes it so black and white to look at a process from beginning to end, see where the bottlenecks are, see where the problems are. And then it’s easy to start adding and putting in solutions to quantify the result, so we get the result that we’re looking for.

Keith Landry:                Chris, if I’m trying to improve my organizational management, why, in your opinion, is it so important to analyze probably almost all of the different processes?

Chris Samulowit…:        Well, because you’re going to be matching those up against the people that you’ve got, and you’re going to see what the gaps are. You’re going to be getting the reviews from your marketing organization in terms of how you’re being perceived. So if you have those systems and then you’re looking at your personnel, you’re looking at areas where, okay, well, what kind of training do we need to do? So as Deb talked about, we’ve gone through the assessment, we see the gaps, we’re looking at realigning things. But just like any team, you’ve got to have the right players for the play that you’re going to run. Not everyone is right for the same program. So, we think looking at the personnel, looking at their interest and their background ability, trying to enhance that by training, giving them the right tools, the systems that are efficient, they operate intuitively, is everything.

And then if your practice is going to grow, or if your practice is going to merge with another practice as a part of an expansion, or even in a contraction where you’re going to go from, we have one group that’s going from seven offices down to five for different reasons. So now you’re bringing new people together and they’re going to work with each other in ways that maybe they hadn’t in the past. You may even have compensation systems, how you’re going to pay people. So, having that understood, as Debbie had gone through that, then puts you in a position to say, “Okay, do we have the right players? How can we develop their skills so they can play this game that has to be played to enhance the best patient experience?” And then when you’re out to recruit people, then that’s a whole different story in the sense that now you can start fresh. How you find those people and how you qualify them is very, very important.

Keith Landry:                So let me ask you this. Chris, when you and Debbie go in and analyze all these processes and you come back with your report, and the practice manager or the team of physicians says, “Yeah, you guys are right. We need to change some of these processes.” How do you coach the team to stay disciplined and adopt and stick with the new processes? Do you have to coach them sometimes on that?

Chris Samulowit…:        Yeah. You’ve got to be sensitive too because people have invested a long time into their practice, they view it as themselves. So it’s like, you’re walking into a room, you see someone dressed in a certain way, you go, “You look horrible in that outfit.” Well, that’s not the way you want to start the morning out, right? So you have to get their buy-in. You have to be smart. You have to be gentle about it. And the way that we typically do it is that there is an opportunity to achieve this particular level of success, whatever that might be, if we can consider doing certain things differently and implementing a new system of some kind. And that is received much better than if you go into tell someone, “Hey, what you’re doing is really wrong. It really has to change.”

So we believe in a very soft approach, and we tie it back to the numbers. If we take the following steps, implement the following software solution, perhaps, or adjust our marketing plan, we could increase revenue by X percent. We could increase the amount of revenue that we recover by 10%. And that translates into a hundred thousand dollars a quarter, then you get people’s attention. So we focus on the opportunity, Keith, as opposed to, you’re the problem, your office is the problem, your people are the problem. They might be, to some level, but we try to look at a positive way to present it, and a way to consider it an opportunity versus something that’s gone wrong that has to change.

Keith Landry:                That’s awesome. So helping them see the payoff helps get the buy-in from the team. Debbie, when you’re coaching a medical practice manager and their team to improve their workflows and their efficiencies, what do you do? How do you approach these topics of workflows and efficiencies?

Debbie Howard:            Well, I think that part of it is, I think, most employees really want to do a good job. I don’t think managers are any different. And I think that going in, like Chris mentioned with a soft approach that, “I’m not here to get you fired. I’m here to really let the doctor know what a rock star manager he has, what leadership he really has.” A lot of times, I think it’s an issue of not having people to do the work. I think a lot of it is working on a shoestring budget, if you will. And, strategically, if you look at what’s going on and you look at some of the information from MGMA, the better performing practices don’t have fewer employees, they have more. So the doctors that look at it like, well I can’t afford it. You have to look at the cost of the investment because return on investment with staffing can be huge. If they’re doing something that’s a revenue generating service for you.

So, I think a lot of it is just letting the staff know that we’re not in here to get anybody fired. We’re really here to support them, help them to be a better employee for the office, help them become more valuable because the more training they have, the better they are, the less likely it is for them to get terminated. But I think, for the most part, it’s helping staff to feel comfortable that bringing problems to management will allow it to be solved, not get them in trouble. And that’s what I think part of the problem is where staff are just too hesitant to bring problems because they don’t want to show their cards, if you will, to management, because they’re concerned about losing their job.

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Keith Landry:                I think that’s a huge point. What is the culture in the organization? Is everyone running scared? Is there an openness? Is the manager’s door open or is it closed with the blinds down? Chris, what would you add to that?

Chris Samulowit…:        No, I think just letting people know that we’re there for them. One of the things that I typically do, Debbie does the same thing. We directly engage with the staff and talk to them. And when I say talk to them, we actually don’t talk. We listen. How are things going? And through the decades, I’ve had my firm with some major challenges in a turnaround, almost never have we had people depart. The goal is to work with people as their support mechanism, as a solution provider. But most importantly, we’ve said it a few times, to hear them and to hear what their issues are, and then translate that to a positive outcome, through an investment, through training, whatever the case may be or realignment of personnel and their system.

Keith Landry:                Hmm. Debbie, this may all come down to one word and that’s empowerment. We’re trying to empower the staff to buy into the vision of the people above them. What are your thoughts on the best way to empower the staff? And what does it look like and feel like in the office when 95% of the people that work there are actually empowered and buying in?

Debbie Howard:            Well, I think that if everybody knows what the vision is, and what the company chooses, whatever, the leadership management team chooses, what’s our end goal? When you come to work every day and you have no idea why you’re there, it makes it a little more challenging to be focused on the end game. But if the management team, including the physicians, are all focused on, this is where we’re going and they’ve let the staff in on that, then they become part of the solution, not part of the problem. Because, as I mentioned earlier, I think most people really want to do a good job when they come in.

I think that spending most of the time with the staff actually ‘in the trenches’, they’re the ones that are actually doing the work. They’re the ones that can probably give us more information than the manager can. Because, generally, what you find when you start talking and interviewing with the staff is there’s a consistent theme. They all have the same ideas of this really is the issue. And then it’s a whole lot easier to fix that. And when they get an opportunity to have a voice and recognize that they’re not going to get in trouble for it, you get a different culture because now they want to help.

Keith Landry:                Chris, what do you think? How important is it when you go to work and you walk into a practice office for the first time, is that one of the things in your mind, how am I going to attempt to empower the people in the trenches?

Chris Samulowit…:        Yeah. So one of the things, through my career, that I see is consistently vital to a successful organization is team chemistry. Do the people get along? So you hear about the underdogs at the basketball tournament going on now, right? The underdogs that come back and beat the teams with the greatest athletes and all of that, from a small group. And it’s really about team chemistry and leadership that takes these individuals and gives them the systems that make their jobs easier.

And I talked about the turnarounds we’ve done for decades with companies. And those turnarounds were really the ideas and the efforts of the people in the organization, who are then empowered to speak, felt safe to speak. And typically it’s trusting Debbie, or trusting myself, or one of our staff people, so when we get that feedback, that things could change how we deliver that. Sometimes it’s not traceable and we talk. Sometimes we’ll interview any number of people, more than we need to, because we want to be able to bury who was the one person that had the great thought that is now challenging the legacy manager or physician or whatever, that whose idea it was 25 years ago to do something in a certain way.

So it’s the little tricks you play that you’ll learn in time, how to protect people, how to draw out their ideas. And you have to be patient. It just takes time for people to gain that trust. And in some organizations, longer than others, because of the history or the leadership style of the manager. But most people want to be successful. And most people are willing to change, particularly if they have the tools to implement that change.

Keith Landry:                Great points, great insights. And with the empowerment, has to come accountability as well for the staff, and the managers, I might add. So Chris, what is a fair way to assess the performance of the staff members? And how do you wade into that mud?

Chris Samulowit…:        You have to be there. So it starts off again with having a plan that has the details. What are the different things we’re going to do, what systems are we going to bring to this organization that’s going to help them perform at a different level? And so, in every plan, there’s certain critical success factors, things that must go right and things that can’t go wrong. So you identify those and you do a gap analysis. So where are we today? And where do we need to be? And those activities that close that gap become the responsibilities of the people who are going to have to implement the changes or the system.

So, once you have the plan and you can articulate, this is your role, this is what you have to do, and you can quantify that, then it becomes a very easy conversation to come down and say, “Mary, you’ve done a terrific job.” Or, “Mary, one of the things we identified back three months ago, and we were going to launch this new HR system was that you were going to be responsible for doing these following things. And here’s the dates that they were going to be done by. And those things were not accomplished. They were not accomplished on time.”

And what it does, it depersonalizes the criticism or coaching that you’re giving that person, because it’s all about a process. We agreed to it. We knew what the defined outcome was going to be, and that didn’t happen, or it didn’t happen to the extent. So it makes it an easier conversation. So it’s not about, I don’t like you, or I’m picking on you, or I’m smarter than you. It’s, we agreed. There was the plan. This was your role. This was going to happen by the 25th of March. It’s now the 1st of April. And for example, that has not yet been done.

So, and in fact, when we’re out recruiting and looking at talent, we talk about how do they plan their work in their current office, because that’s what they’ll know. And what is their perspective on how work is planned and then assignments are given out or responsibilities divided. And once you get that out there, it makes it so easy to have those conversations. And again, to Debbie’s point, people want to be successful. And happy teams are successful teams. So they say, how do you get a company’s morale turned around? Make them successful. Everybody loves to be a part of a great team. And you’re not going to have great happiness and a sense of satisfaction if you’re constantly fighting problems and reading terrible reviews about your practice. And your employees aren’t oblivious to that, they see that, and it makes them concerned about their leadership. So it’s almost a performance appraisal, but in reverse. So, looking up at the doctor, they’re looking at the practice manager and saying, “You are not positioning me to succeed.”

Keith Landry:                Debbie, assessment and accountability. Your thoughts?

Debbie Howard:            I agree with everything that he just went through. That is vitally important. And I think that when I look at even my history in healthcare, I look at other managers that I recognize that they are the problem. And it’s not being willing to change, and recognizing that exactly what Chris said, you’re not setting up your employees to be successful, which a hundred percent falls on the management. And as difficult as that is, sometimes managers need to do a self-reflection as well and recognize that maybe they’re not necessarily the solution, but they’ve become part of the problem. And recognizing that we all should be learning. We all need to be willing to take a step back and take a look in the mirror and say, am I part of the solution or part of the problem? And be willing to accept outside help to recognize that maybe my processes, as Chris mentioned, from 25 years ago, are not working.

Keith Landry:                Great point. A lot has changed in 25 years. Let’s switch gears, talk a little bit about market research, what it is, what it means to a practice manager, and how practices can use it effectively. Chris, how do we even define this market research?

Chris Samulowit…:        So you’re looking at the different practices that you’re competing for patients with, and you’re looking at your location, you’re looking at how your office and all of that is set up. So I think market research, what does the heat map look like? How many competitors do I have who do similar things? How are they positioned? What insurances do they offer, and programs? How are they credentialed in the hospitals and elsewhere?

So, I think, knowing where you stand competitively is everything, because that also rationalizes and makes the reason why maybe your staff has to do things differently. Maybe why you have to invest in new software to be able to drive scheduling or confirmations of schedules, things of that nature. And a lot of times that’s a tough discussion to tell a physician you’re going to go from a system where it’s $650 a month to a thousand dollars a month for an improved scheduling and AR processing, and all of that, approvals process. But you have to make the case. Again, you can make the case easier if you have the market research to support it. You can talk about why you’re going to change, why it’s worth the investment. And then you can also measure how far you’ve gone towards being a different organization, a more effective organization.

Keith Landry:                Awesome. Debbie, anything you want to add on that one?

Debbie Howard:            Just as he was saying, that it makes me think of ensuring that the physicians have, you have to have buy-in at the very beginning of this process because the physicians have to recognize that they take a part in it as well. And they don’t get the opportunity to step back and say, “Okay, everybody else needs to change for the practice to be successful.” But that they take a very, very vital role in being the leadership. And if they’re willing to change, as Chris mentioned, just something as simple as changing a software. If the physician is going to dig their heels in on everything that we recommend or suggest, then it’s never going to be successful. It has to have buy-in from the upper management, and from the physicians, in order for it to be successful. And they have to be willing to change just like they’re asking the staff to change.

Keith Landry:                Hmm. Great point. It leads to my next question about recruiting management candidates. Because when you’re going to make a change, you’re going to put an important person either at the top of the totem pole or near it, the influence of that candidate that will be in place for a while will be huge. How do we effectively recruit management candidates?

Debbie Howard:            Well, I think that it depends. I think a little bit of that goes back to the culture of the practice. I think Chris mentioned it, and certainly hit the nail on the head when he talked about ensuring that the person that we look at bringing in actually fits into the culture of the practice because that’s so vitally important. I think it’s important. At least when I look at recruiting a management candidate, I’m not so much, obviously I need somebody that has the skillset that we need to do the job, but I’m not as concerned about experience, personally, as I am about how they manage, because I personally manage in a very specific manner. And I’m always willing to train and retrain. If I have a situation where somebody’s had to be terminated, I self-reflect to determine, is that something that I did? Did I not give them everything they needed to be successful?

So, I’m a little more concerned about ensuring that somebody, as a manager, especially, has confidence in themselves, in their ability to recognize that they take ownership and they take a part in good and bad. And it’s difficult when you start recruiting. I personally would rather have somebody new because I’d rather train them the way I think that it would be the most successful for the practice versus trying to ‘teach the old dog new tricks’ because sometimes that doesn’t always work out so well. But Chris probably has a better thought on recruiting the management candidates because of what he’s looking for.

Chris Samulowit…:        Yeah. What we try to do early on, Keith, is seed the organization at its basic levels, the entry levels with talent that we think can be promotable. Because if you see a person grow within an organization, they understand the personalities, they get the systems, we’ve had a chance to view them and coach them, run them through our processes. And they’re going to have a much better chance of being successful than if every time you’re recruiting a practice manager or some other type of the leadership position, you’re going to the outside. And I think, when you do have to recruit from the outside, too few people invest the time to really understand that candidate. So the methodology and the questions you ask. Similar to how you’re running the podcast today, how those questions are framed, how they’re delivered. And that’ll make all the difference in the world.

And so we think seeding from within is absolutely the way to go, particularly if the practices want to be poised to grow. And that should be the goal, I think, most times. And then being able to assess those people and coach them once they’re inside. And then if you’re going to hire from the outside, really investing the time to understand not only what they did, what type of practice they may have worked in, or system they worked with. But how did they work within that system? Did they recommend changes? Did they actually see things that weren’t happening? And did they bring it to the manager’s attention or to the physician’s attention? And how did that go? So, how do they think? How do they respond? And how do they act? If you have to go to the outside. It’s a time-consuming process, but if you make a hiring mistake, it’s huge.

Keith Landry:                You got to be careful and make sure you make the right decision. All right, let’s switch gears just a little bit, Debbie. I want to talk about revenue cycle management. I know this is your 30 years of expertise right here. Give us some nuggets that we can take away on this. What can we do better in most offices?

Debbie Howard:            Well, I think it’s interesting because when you look at even everything that we’ve talked about thus far, I think what you hear are looking at workflows, looking at efficiencies. And I think that revenue cycle management is probably the easiest thing to manage. That’s the way I look at it, anyway, because it really goes back to comparing the practice to industry standard benchmarks. There’s tons of data out there, and benchmarks that are available through MGMA, that physician offices need to be looking at on a daily basis. And it’s things, where’s the clinic on days in AR? How long is my money sitting out there? Denial percentages. Are all my claims getting submitted, but they’re all getting denied? Lag time from data service to charge entry, from the data service to when I put the money in to send it to the insurance company.

Those are just a few of the measurements that are easily tracked. They’re quantifiable. And they ensure that the management system and the function of our AR is actually functioning on all cylinders. If you see an area below benchmark, it’s vitally important that the managers start doing a deep dive into that. What’s going on? Why is our days in AR all of a sudden going up? That’s information that really needs to be provided to the physicians daily. They should be seeing that information so they start knowing the information. And when things start changing, there’s a feeling of, wait a minute. Something’s not quite right. We need to do a little more change and look into that.

In addition, I think ensuring that the office staff is staying current. There’s ever changing coding rules and regulations. They change daily. It’s making sure that somebody is on top of all of it. Somebody’s in the list serves, somebody’s getting that data on a daily basis. I’m a professional coder. I encourage practice to make sure that you hire the right person. They need to be a qualified candidate to handle your revenue. Don’t go to all of the time and effort to go to med schools, start your practice, hang your shingle, and then hire somebody for minimum wage to run your checkbook. It makes no sense. I know it’s a big investment, but getting somebody that’s qualified will pay for themselves time and time again, because the revenue cycle process is very complicated and it’s not as easy as just, I saw a patient and I got paid.

It doesn’t work that way. There’s so many steps in between that the physician needs to understand. And it’s things as simple as just denials. I know. I go into practices. I look at, they’re good as long as it gets processed, it gets paid the first time. But there’s usually always a drawer that nobody looks in. And that’s where all the denials are sitting, that nobody’s working. And it’s just money that is going to, it’s basically going to age out of the system. And at the end of the year, the CPA is going to say, “Okay, all of that’s now getting adjusted off for timely filing limits.” And it’s just money. The doctor should be able to get everything that he’s done. He should get paid for that. But unfortunately, if you don’t have somebody qualified to do it, it gets passed over.

Chris Samulowit…:        They talk about, you hear the line, the rich get richer and the poor get poorer, and there are reasons for that. So, if you’re measuring all of your financial performance, and you can get that into the top 5%, then you should be able to compensate your staff at a higher level. So, that’s a way of measuring it. And what happens is, getting better people by virtue of more aggressive compensation yields better results. And you’re that rich getting richer.

Keith Landry:                Awesome. Chris Samulowitz and Debbie Howard, brilliant insights for our listeners today. How can folks follow up with you if they want to connect with both of you? Chris first and then Debbie.

Chris Samulowit…:        Well, so you can go to And you can then scroll down to our medical practice group, and there’s contact information there. That would be probably the easiest way to get to us,

Keith Landry:                And Debbie?

Debbie Howard:            Mine is just as easy. It’s just STAT Healthcare Revenue, or simply make a phone call to me on my cell phone. The number is listed there, but it’s (407) 451-8593, if anybody needs it. But Chris and I work hand in hand. So if there’s a little confusion on who does what, if they call me and it’s on the strategic part, I’m kicking that over to Chris. If it’s a billing issue or a concern, he’s going to kick that over to me. So either one of us can really answer any questions that anybody may have or direct them to the other one, if necessary. So I think we’re comfortable working with either one of us.

Keith Landry:                Perfect. All right. Thanks to both of you for your insights today. That’s a wrap on this episode of the Growing a Successful Orthopedic Practice Podcast. I’m your host Keith Landry. And let’s do it again soon. Thanks for being here.

Speaker 2:                    Thanks for listening to the Growing a Successful Orthopedic Practice Podcast. Please consider pressing subscribe on your podcast player so you never miss a future episode. And if you haven’t given us a rating or review on Apple podcasts already, we ask that you take a spare minute to help us reach and share our medical practice growth stories with peers.

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