Published 10/1/2009
Jackie Ryan, MPA

Sailing through the economic storm

How to keep your practice afloat during uncertain times

Until recently, running your practice may have been smooth sailing. But then the recession struck like a gale-force wind. Now you, your partners, and your practice administrator are grappling with its repercussions on practice revenues, retirement plans, new equipment purchases, staffing levels, vacations, and more.

In sailing, a plan directs your course. But no matter how good the plan, when the gale blows, it’s time to shorten the sail and batten down the hatches. Charting your course becomes less about where you want to go, and more about knowing where the risks lie and steering clear of the rocks.

The same applies to business. Although you can’t heal the nation’s economy, you can take steps to keep your practice financially viable.

Take the helm
The new economic reality is one of unprecedented global socioeconomic and political challenges. It’s becoming a VUCA (volatile, uncertain, complex, and ambiguous) world. Leaders need to train their brain and build skills to offset VUCA. Volatility calls for vision, uncertainty calls for understanding, complexity calls for clarity, and ambiguity calls for action. Assess your readiness for the future and determine the type of leader you want to become.

Continuing medical education courses are, of course, one way to stay up on your field and ahead of the crowd, whether you take a course at the Orthopaedic Learning Center, participate in a Webinar, or attend the AAOS Annual Meeting. Education need not be expensive either, especially with the introduction of innovative course set-ups and online learning opportunities.

Avoid burnout
Emotional exhaustion and burnout are widespread in the medical profession, regardless of the practice setting. Factors such as the slumping economy, long working hours, stress associated with patient care, increasing overhead, decreasing reimbursements, and increasing government regulations can all contribute to burnout.

Stress is an unavoidable consequence of life. There are no magic bullets or quick fixes—the key to reducing stress is prevention. Getting enough sleep, eating a proper diet, avoiding excess caffeine and other stimulants, and taking time to relax can be effective stress reducers. Step back and examine your own burnout risk. Most often the solution involves a lifestyle change and the determination to break away from dysfunctional work habits.

Realize that the body needs time to cool down and recover after high-intensity work. Take regular rest breaks to recharge. Get to know yourself and train your brain to be aware of common stressors. Pay attention to how you talk to and treat yourself; thoughts can affect behavior.

Maximize efficiency
Evaluate your staffing needs to maximize productivity, but be cautious about reducing staff. Replacing trained and reliable staff once the economic tide turns will be costly. Try furloughs, pay cuts, or staggered schedules instead. Maintaining good communication and clear expectations with staff is essential. Show your employees that you trust and respect their need to know about issues that affect the practice, and in turn, their livelihoods.

Combine staff training with an inventory count: Devote one staff training session per quarter to performing a complete inventory count. Calculating the “right amount” of supplies prevents running out without overflowing your shelves.

Know your bottom line
It’s important to start with an accurate picture of your practice’s financial health. As a surgeon, you can’t manage a patient’s osteoporosis without first knowing the bone density level and associated risk factors. Similarly, knowing your cash flow, patient volumes, accounts receivable, and accounts payables helps you successfully manage your practice. Evaluate all of your contracts, renegotiate, and/or change vendors to reduce costs.

Improve your “billing and collections consciousness.” Compare month-by-month performance from this year to last year, and make the appropriate changes. Recognize that the financial health of the practice depends on a team approach. Producing clean, comprehensive claims is everybody’s responsibility—from the receptionist who verifies insurance coverage to the doctor who selects CPT and diagnostic codes.

Go green—scan documents to reduce paper and shredding costs. You’ll not only help your practice, but the environment as well.

Rethink your approach
Traditionally, additional revenue streams in orthopaedic practices come from expanding your offerings, by adding physical therapy, osteoporosis screening, or other imaging services. Practical changes that do not require significant capital investment, however, may also boost revenue.

Evaluate using physician extenders and cross training staff to maximize talent. Ask yourself the following questions:

  • Who are the patients of tomorrow?
  • How will they choose their medical care?
  • What are my desired patient types?
  • Is there a niche in the market that is not currently being filled?

Build a practice brand that focuses on your strengths and likes, pays well, and meets your market’s needs.

Re-examining your schedule can also lead to maximized time and income. Are certain days of the week less busy? Take time off during your slowest days and rework others to take advantage of a heavier patient load. Consider whether an evening clinic (staffed by physicians and/or physician extenders) would help expand your patient base.

Market your practice
Concern about the economy shouldn’t stop you from investing in the future of your practice. You may choose to cut down on your advertising, but don’t abandon your marketing efforts. One zero-cost initiative would be to give a talk to a community group using the free resources available as part of the
Community Orthopaedic Awareness Program. A Web site is a great way to market your practice and services to the public and other physicians, and the AAOS offers free templates.

As part of your strategic plan, marketing should have a clear purpose and goals. Market to your target patient population, as well as to payors and referring physicians.

Your staff, however, can be your best marketing tool. When staff delivers quality, patient-centered care and timely service, your practice reaps the benefits in patient retention and referrals.

The more efficient you are today, the more likely you are to weather the current storm. Plus, you’ll also be in a better position when the economic tide does turn.

For more “how-to tips,” leadership self-assessment, marketing assessment, and links to other articles, visit the AAOS online Practice Management Center.

Jackie Ryan, MPA, is a practice management program coordinator in the AAOS practice management group. She can be reached at ryan@aaos.org

Special thanks to the following members of the American Association of Orthopaedic Executives for their contributions to this article: Amanda Maselli, William R. Pupkis, John S. Nosek, Kimberly Anderson, Rick E. Weymier, Linda Miller, Susann Crowder, Christy Chalmers, and Bob Kahn.