Introspection: The First Step in Answering a Challenge

January 2008. A new year filled with promise and a fresh start for new ideas and new directions. But promises not acted upon become empty and can result in no substantive and perhaps much needed and desired changes. What areas of your business of practice are in need of review and reorganization? What challenges do you face? How confident are you in your business’s ability to meet those challenges? How talented and experienced are the personnel upon whom you rely and entrust your business to? Are they able to advise you as to the myriad of business and legal challenges you and your business face? How many businesses have they run? How visionary are they? Do they have the entrepreneurial, organizational and network skills needed? Would you be ready to invest and risk your money on their success as a startup in their own business? Would an institutional lender? If not, what makes you believe that they could handle your business with the level of success you want? After all the effect is the same on the money that you make and the way you work.

When I hear many of my colleagues complaining, they do not complain for the most part about what it takes to care for patients, rather the complaints center around the business of the caring for patients. Shrinking regulated reimbursements accompanied by escalating unregulated business costs, constant fights with carriers over needed studies; worry about the changing legal environment and managing risk, whether employee liability or OSHA and HIPAA fines; fighting carrier claims of fraudulent coding and billing if the chart doesn’t appear to support the bill or a clerical error occurred, are regularly expounded upon and alone are justifiable complaints. Add to this the realization that business options and expansions opened to other professions, are closed to healthcare, along with insurance participation with its restrictive fee structure not utilized to any significant degree by others such as attorneys, dentists, vets etc and it is obvious to see the reasons for discontent.

To survive and maintain its autonomy to best extent possible it is essential the practice, now treated as a business, must react as a business. One must look for entrepreneurial solutions and institute them, review and maximize organizational efficiency, while putting in place methods that assure compliance with legal and regulatory issues are on autopilot. Sadly this is not a common occurrence. Not many of my colleagues are referred to as “good businessmen” by either themselves or by businesspeople in general. Why is that? I believe it is because the vast majority desired to become a professional, trained to be a professional and never trained to be or focused on being a business. Additionally, the professional component requires maintaining skills and a level of time consuming one on one interaction with patients and other professionals which leaves little time for the activities of business involvement. What do many do? What is their answer? Trapped by inertia and a lack of business acumen they do nothing. Rather than investing in themselves and their business by bringing in a coach as is a common business practice, they chose to leave these vital matters to employees who for the most part are (in matters of business) untrained, inexperienced in business management and not equipped to fully handle a business. As an owner, they convince themselves that as long as the checkbook appears positive and they can pay their bills all is OK. Whether money is being lost by wastage or lack of efficiencies (which if realized would increase profit and therefore checkbook balance), or by not searching for cost effective additional revenue streams to increase profits, never enters into the equation. Further, they choose to maintain a blind eye to personal legal risk from improper (or lack of) compliance on multiple fronts. All these issues remain unsatisfactorily addressed: They could be viewed as sort of a business equivalent of the armed forces “don’t ask…don’t tell” policy. The end result is the same: being left with problems festering below the surface, which remain OK until they hit the fan, and then unfortunately you’re the fan.

How do you avoid the entrapment? What should you do? Admit to yourself that issues exist and become an active participant in examining your business. First: try to allot some time to becoming better at understanding the different roles that employees and advisors play in the flow of a business. Second: honestly assess your business and see if it is performing as you desire it should. Is it growing and are the signs of growth healthy? Are my employees performing optimally? Knowing what I know now would I rehire the same people? Third: Do you know how to best utilize advisors? If not, talk with an advisor. Ask them how they can best be of service. Investigate if they have networks and can help add revenue streams. Tell them what you want to accomplish, but be open to ideas they may present to you based on the conversation. Also, do you know how to read and understand financial statements? (If the answer is no, then allow me to suggest you read a good book called “The McGraw-Hill 36-Hour Accounting Course” 3rd Edition by Dixon and Arnett) Knowing how to interpret accounting statements and understanding the language of accounting will prove invaluable.

Have you, like many successful enterprises, engaged a business advisor who has the skills, knowledge, business experience and network organization to maximize your potential and help you meet the financial and legal challenges that exist today in the business of practice? Have you thought of availing yourself of this advantage? If not, then place your ego on the back burner and look to maximize your situation and retain one. Notice I suggested retain, not hire. Unlike an office manager who needs to be working full time to handle personnel, patient problems, staffing and workflow issues most practices only need a business advisor to analyze the business, handle specific issues, offer revenue enhancement and other suggestions that will improve efficiency, empower your personnel as well as to be available to brainstorm on any ideas or problems you feel a need to discuss. Like any good coach a practice advisor is a team player, sitting on the sideline ready to jump in where needed, whose only desire is to utilize all at their disposal to increase your success and the success of your team.