April 28, 2025 • 29 mins
In this episode of the MGMA Podcast, Daniel Williams, Senior Editor, sits down with Dawn Plested, an MGMA consultant, and contributor to the MGMA book Advanced Strategy for Medical Practice Leaders: Operations Management Edition. In the discussion, Dawn talks about the importance and impact of administrative structures in medical practices. Dawn also discusses the significance of leadership styles, considerations for choosing organizational structures, and the need for regulatory compliance.
00:00 Introduction and Guest Welcome
00:52 Importance of Administrative Structures
03:12 Leadership's Role in Shaping Structures
05:55 Choosing the Right Organizational Structure
08:08 Strategic Staffing Considerations
13:59 Implementing Health Information Systems
18:34 Financial Management Strategies
21:49 Enhancing Patient Engagement and Satisfaction
24:47 Regulatory Compliance and Risk Management
27:19 Key Takeaways and Conclusion
Additional Resources:
- Connect with Dawn Plested on LinkedIn
- MGMA Books (Dawn is a contributor to the MGMA Advanced Strategy book series)
- MGMA Events
- MGMA Consulting
- MGMA DataDive
- MGMA Stat
- MGMA Podcasts
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Daniel Williams (00:07):
Hey, everyone. This is Daniel Williams, senior
editor at MGMA, host of the MGMApodcast network. I am here today
with Dawn Plustidge. She's anMGMA consultant, and she's
exploring the ideas of medicalpractice operations,
administrative structures inthose practices, and a lot of
(00:27):
other issues related to medicalpractice operations. Dawn,
welcome.
Good to see you again. Thank
Dawn Plested (00:34):
you so much. Thanks for having me. I'm very
excited to talk about thistopic. Very, very relevant, very
important to what we do. Sothanks again for having me.
Daniel Williams (00:43):
You got it. So we've got a lot of questions.
We're gonna try to get throughthese as in as thorough and as
complete a fashion as we can. Sothe first question I have for
you is what is the importance ofadministrative structures in a
medical practice, and how doesit relate to the advanced
strategy operations perspective?
Dawn Plested (01:05):
Yeah. So your administrative structures are
really the backbone of yourmedical practice. It's
foundational. And I will saythis, I think that so many
medical schools, and this is mylittle soapbox, don't do a lot
of training on the front endwith providers on how to run
(01:25):
their medical practice. And youhave physicians who are just
brilliant, excellent clinicianscoming out of school or mid
career looking to start theirmedical practice.
And there's a ton of enthusiasmaround taking ownership over
their care delivery model, butthere's maybe not the science
and attention that needs to bepaid to your administrative
(01:48):
structures. And laying those outwell and thoughtfully and
strategically on the front end,it's crucial for ensuring your
efficient operations, thatyou're compliant with
regulations, just generaldelivery of patient care to
ensure that your revenues areflowing and that your expenses
are managed. From an advancedstrategy and operations
(02:12):
perspective, effectiveadministrative structures really
plays a central role in aligningyour goals with your functions.
So it ensures that yourresources are used, they're used
effectively, that you're readyto adapt to change in the
healthcare environment, that youcan anticipate changing and
(02:34):
moving landscape around you.Again, I say again, because I
mention this every time we doone of these podcasts, but COVID
had such a profound impact onthe industry.
And you can really see thedifference between medical
practices that were ready toanticipate and pivot and move
with changing and unexpectedcircumstances and those who
(02:55):
weren't. And frankly, at thefoundation of that is really
effective administrativestructures, because those are
that that concept's predicatedon the idea that you're ready to
pivot as changes occur.
Daniel Williams (03:11):
Okay. So given the idea that you are gonna make
some changes there, develop thestructure you want, how does
leadership then contribute toshaping administrative
structures in a practice? Andthen what are the implications
of different leadership models?
Dawn Plested (03:27):
Yeah. So leadership is foundational.
There's a cliche that goesculture eats strategy for
breakfast, and it's a age oldbusiness cliche that everybody's
heard a thousand times. Whatthat means is the culture of
your organization really defineswhat you're going to accomplish,
(03:47):
and your best of intentions aredefined by your organizational
culture. Why do I talk aboutculture when you ask about
leadership?
Because leadership defines whatyour culture is going to look
like. And it it has an, aprofound impact on your
administrative structures. Youreally can't build out your
medical practice. That build outoccurs under leadership. And
(04:10):
there's a number of differentleadership models that people
have heard of.
You have servant leadership. Youhave the classic authoritative
leadership or hierarchicalleadership. You have
transformative leadership.There's rule by committee.
There's a number of differentleadership styles, and that
impacts your decision making,communication.
(04:33):
It can impact the patientengagement and experience,
employee engagement, patientsatisfaction. It will very much
have an impact on your abilityto pivot. Back to what we talked
about in the previous question,if you're not a nimble
organization, first of all, Iask, why are you an independent
(04:54):
practice who is not a nimbleorganization? You should be able
to move. You're not, in theory,bogged down by bureaucratic
layers that you can see in theselarger Byzantine systems.
And so one but but with thatsaid, you have to have your
administrative structurescorrectly in place, and that
will come to a leadership style.And I do wanna say within that
(05:17):
leadership style, there thereare a number of different styles
that I just listed out that canbe effective at different times
and in different circumstances.But I think throughout, you
really have to have the abilityto trust and delegate to your
employees and have thestructures in place from an
(05:38):
administrative perspective thatallow you to have the confidence
that there are guardrails up andthat you can release some some
of that control to the folks youwork with. Otherwise, you won't
have that ability to pivot andbe nimble.
Daniel Williams (05:54):
All right, Dawn. What factors then should
be considered when choosing theappropriate organizational
structure? I know you talkedabout some of the different
ones. What are those factorsthen that you're looking for?
Dawn Plested (06:06):
Yeah. So in terms of your org structure, first of
all, there are a number ofdifferent types, you know, that
you'll have varying degrees ofcontrol over. You're gonna have
everything from a solo practice,group practices, partnerships,
hospitals, ownership models,integrated health systems, for
(06:27):
profit structures, telehealthcompanies.
Daniel Williams (06:30):
And
Dawn Plested (06:33):
really, of course, now we're seeing, and I'm
getting a little far afield interms of org structure, but I
think it makes a difference. Yousee these kind of alternative
healthcare environments such asCVS or Rite Aid, some of the
pharmacies are getting into itfor a little while there. Amazon
was giving it their best shot.And those would of course change
(06:55):
your org structures. But yourtraditional ones are really your
solo practitioner, yourpartnerships, your group
practice, your hospital employedmodel, and your integrated
health system.
In terms of if the sky's thelimit, if you get to decide what
your practice looks like, whatyou really want to consider is a
(07:16):
number of different factors indetermining what that org
structure should be and whatmakes sense for you. You're
going to want to consider whatyour own goals are, what type of
medicine you want to practice,what amount of autonomy, and in
coupling with that autonomy,what amount of responsibility
you want to have over thebusiness functions of your
(07:38):
practice. You're going to wantto consider the size of practice
you want to have as well as thesize of the patient population
you want to serve. You're goingto think about your
specialization, any kind ofregulations, both locally at the
state level, at the federallevel. And so I think those are
(08:00):
your primary factors that reallyshould play into what that
organizational structure lookslike.
Daniel Williams (08:06):
Thanks for that, Dawn. So next issue I want
to talk about here in relationto organizational structures is
related to staffingconsiderations. So when you're
developing that structure, whatstrategic staffing
considerations should be takeninto account and base those on
(08:27):
patient volume, servicesoffered, and any other factors
as well?
Dawn Plested (08:33):
Yeah, so staffing, the million dollar question.
This is something that practicesreally need to pay close
attention to. I recently did asession, a podcast session, and
we touched on staffing and justthe challenges involved in that.
And I'll say this. There's acouple reasons, well, few
(08:53):
reasons why I would say thatthis is so important to your
strategy.
And number one is because stafftends to be one of the larger
costs to a medical practice,Ensuring that you have the staff
that you need doing the rolesthat they need to be doing is
critical. And you also need tomake sure that you have the
budget to cover that and thatyou're allowing and allocating
(09:17):
the resources needed to supportyour staff and to support the
size of the staff that you need.I think the other reason it's
such a large area of concern isbecause staff can be very highly
specialized depending on therole that they're going to fit
for your organization. So havinga handle on who you need and
(09:41):
what you need them to do is key.And then recruitment can take,
can be very all consuming.
So that's a very, that's a verybig consideration. And then of
course, the elephant in theroom, which is the staffing
shortage we've experienced,particularly since COVID. The
(10:02):
burnout levels in healthcare arejust extraordinary and have been
extraordinary in recent years.And that really just leads to a
vacuum of availability in yourlabor pool. And so you need to
be very strategic about this.
As you mentioned, looking at itthrough the lens of that patient
(10:22):
volume, the services that you'relooking to offer, you need to
think through strategies forrecruitment. That should play
into your strategic planningprocess. That should be part of
your long range work that you'redoing as you build out your
staffing model. And you need tobe thoughtful about both
(10:44):
recruitment, but also retention.You really want to make sure
your compensation packages arecompetitive.
You want to invest in yourstaff, help have them feel and
sense and understand the growthopportunities for their career.
And provide ways for staff todevelop within your own
(11:07):
organization. Nobody wants towork the same job indefinitely
and really with no hope ofcareer advancement or growth or
additional challenges. You wantto really think about your
training. I see training asbeing an area that a number of
practices skimp on.
And I can't tell you the numberof times that I have been called
(11:30):
in to do an operationalassessment for an organization.
I go to their varyingdepartments, and what I find is
you have some people who aredoing everything perfectly,
fantastically. They could writea textbook on it. But you have
other people just doing itridiculously. And it's a
completely nonstandard process,and it's because there's no
(11:52):
standardization in the training.
Start with documenting yourtraining processes, your
expectations, have a standardoperating procedure, and then
get serious about training. Justbecause you've got this person
over here who's doing everythingperfectly and can write a
textbook on it actually doesn'tmean that they can train. It's a
(12:14):
skill. Teaching otherindividuals how to do the work
is a skill. So really investingin that training goes hand in
hand with your staffdevelopment.
Then I would also say whenyou're thinking about your
staffing, culture is just a hugepart of that. We see with the
younger generation that theywant a purpose driven work. They
(12:39):
want purpose driven work. Theywant to feel that they are
making a difference with whatthey do. And that needs to just
here's the good news.
Healthcare is a fantastic placeto provide purpose driven work.
We are not pushing pencil saleshere. We are saving people's
lives, and we have a hugeopportunity to impact people's
(13:02):
health in such a positive way.There can be nothing more
meaningful. But we can losesight of that pretty darn quick
if we're not very thoughtfulabout the culture we're trying
to build.
So you really want to work onthat culture of patient care,
having that mission, thatvision, that clarity of your
values and your purposefuldriven work. And then foster,
(13:26):
build a positive workenvironment. So you're working
on patient driven work. Itdoesn't have to be grueling. It
can, we can have fun.
We can care about each other. Wespend more time with our
coworkers than we do with ourfamilies in a lot of cases. And
you should like the people youwork with. Build an environment
(13:48):
where it's enjoyable to bearound each other. It's
enjoyable to spend timetogether.
I think that's very criticalwhen you think through your
staffing structures.
Daniel Williams (13:58):
Okay. Another key aspect in any structure is
what the health informationsystem looks like. So talk about
that. Walk us through thatprocess. What are the key
considerations for implementingEHRs, practice management
systems, whatever else orwhatever other platforms you may
(14:19):
need in that practice?
Dawn Plested (14:21):
Yeah. So, you know, your tech tools have an
opportunity to be one of thebiggest time savers and cost
savers for your practice, andthey have the potential to be
one of the most costly soulsucking components of your
practice. It really is thatimportant. I really, so I will
(14:46):
say this. I think the toolsavailable to us today are just
extraordinary.
The list goes on and on in termsof what you can automate. The
question that you always need tostart with is, what do we need?
And then you really, at thefront end, need to employ so
(15:09):
much due diligence in a reviewof the technology tools that
you're considering. There is noend of vendors who will promise
you the moon. You really have todive deep to figure out can they
deliver?
And not everybody can. And I'mhere to tell you that can be
soul crushing, as a smallpractice or a practice startup.
(15:33):
But quite frankly, at any level,if your EHR is not effective,
not effectively aligned withyour other technology pieces,
not user friendly, it is justgoing to be such a resource and
time drain for your practice. Itjust there can be I can think of
(15:53):
few things that would have amore negative impact on your
practice than that. And so onething that I do want to say is a
potential risk area that I seefor a number of practices is
they either seem to focus reallyheavily on if the EHR is a
clinical fit for the physicians,or they're heavily focused on
(16:18):
does it do what needs to be doneon the revenue cycle side of the
ledger.
It is not an eitherorproposition. You really need to
make sure that you have an EHRand you have the tools and
technology, so a practicemanagement system, payment
management system, that canhandle both sides of the
(16:40):
practice, because one withoutthe other is not effective. And
there is a balance to be struck.I have never met yet a doctor
who wants more clicks in theirEHR. And I get it.
But some clicks are going to benecessary to ensure that your
billing is happening in a timelyand efficient and effective
manner. And so you need to findwhat's going to be the most
(17:03):
effective method to get both therevenue cycle flowing and the
clinical side flowing correctly.You need to think about all
sorts of things. You need tothink about your patient
management, data access, patientportals, of course, billing
processes, scheduling. And thenI strongly feel that
(17:26):
interoperability, particularlywith other tools and technology,
is such a key piece.
Your EHR really needs to workand work with a lot of different
tools. So while I'm not a shillfor the commonly used EHRs out
there, There is something to besaid for working with a known
(17:46):
vendor because theinteroperability is stronger
with new and incomingtechnologies. And again, I don't
want to spend too much time onartificial intelligence and some
of the additional technologiesthat are available. But the
tools that are being madeavailable to us are really
(18:07):
happening at the speed ofbusiness. It's just daily,
there's a new opportunity toinnovate, standardize, automate
different functions of themedical practice.
That is only as effective as howwell those tools can integrate
with your EHR.
Daniel Williams (18:25):
Okay. So let's go, Dawn, to the next key
aspect, one one of the buildingblocks of a medical practice.
That is the financial managementside of it. When you're building
out this structure, What are thekey decisions you need to make
in terms of whether it'sbudgeting, revenue cycle
management, any kind ofstrategies for cost
(18:48):
optimization, revenueenhancement? Anything else you
wanna share with us there?
Dawn Plested (18:53):
Yeah. Financial management is probably the key
part of a successful practice.And I would say maybe the most
challenging part. Again, I'veworked with so many amazing
clinicians and physicians, Butfinancial management isn't core
learning in med school, andthat's fair. And fabulous
(19:14):
practice managers out there.
And again, a lot of focus on thepatient safety and quality side
of the ledger, which isincredibly important. Financial
management needs to be thebackbone of your practice. So
let me say this. I think youneed to think about your
financial management in terms ofrevenue. So you need to start
(19:37):
with your foundation, which isyour budget.
No practice should be without abudget that's going to talk
about your assets, yourliabilities, your expenses, and
your revenue. But layered righton top of that is your revenue
cycle management. And I thinkthat there is some confusion in
practices that revenue cycle isyour billing. And really,
(20:01):
revenue cycle starts from themoment the patient makes contact
all the way until you've donefinal collection, bill fully
paid, services and clinicalservices completed. Every step
of the way impacts your revenuecycle.
And so you really need to have ahandle on that. And as mentioned
(20:26):
before, your EHR and yourpractice management system has a
huge impact on that revenuecycle system. Automate where you
can. Standardize where you can.Make sure your training is on
point and solid, consistent, andstandardized.
Very key. And then look at thereports. That it's shocking the
(20:49):
number of practices that don'thave a regular mechanism in
place for reviewing theirreports. Look at your AR, look
at your billing, look at yourdenials, look at your expenses,
look at your revenues. Try tounderstand what the flow is in
terms of patient volumes orservices, and adjust staffing
(21:11):
accordingly.
Make strategic decisions andmake it based on solid data,
which there is no data moresolid than how your finances are
running. Really think aboutstrategically, consistently
think about growth. Think aboutadding service lines. Think
about how you're going to growyour practice. At no point
(21:33):
should you grow your practicejust for the sake of growing.
But at all times, you need to beconsidering the financial health
of your practice, and growth isa very important part of that
overall picture of yourfinancial health.
Daniel Williams (21:49):
Okay. Another piece of that is how do you
improve patient engagement andsatisfaction? And by doing that,
how do you look at that, amedical practice design, so you
have a patient centricadministrative process that
builds these out? How do you dothat?
Dawn Plested (22:07):
I think with all human interactions, so human
centered design, that oldbuzzword, what's the core of it
is communication. You reallyneed to make sure, and
communication is not a one waystreet. It's you info dumping or
telling the patient what youthink they need to hear. It's a
two way street. And so patientsreally need to have a feedback
(22:31):
loop.
They need to have a mechanismwhere they feel heard. And you
really need to be thoughtfulthroughout the design of your
practice operations to ensurethat, listen, the patient is
actually driving this show andunderstanding what they have to
say, and this is a really keypart. And you can see that being
(22:52):
problematic in any number oflevels for practices, whether
there are a number of challengesin just scheduling an
appointment. I've worked withpractices where there will be
two to three phone calls to getinsurance information and
patient demographics and so onand so forth, just to get the
patient scheduled, to get a newpatient in the system and
(23:15):
schedule. How frustrating forthe patient.
How much that must make themfeel like they're not being
heard or listened to or caredabout. And then you see it all
the time when a patient goes into see the doctor. I understand
that there is a balance and youcan have patients talking to you
for two hours if you let them,but a patient needs to be heard
(23:35):
in that exam room. And there isnothing that makes them feel
less heard than a doctor whobustles in and sits down at
their computer and asks them afew questions and pokes a
stethoscope at them and bustlesout in five minutes. They want
to talk about why they're there.
And so I think just ensuringthat there is, again, an open
(23:56):
door communication process.Think about all the places where
there is a patient touchpoint,whether it is scheduling,
whether it is within the office,whether it is follow-up with
results. And think about, A, howyou can streamline that
information in terms of thetiming to get the patient to the
(24:16):
end result that they're lookingfor. And then are there multiple
ways you can offer thatinformation or that interaction
to occur? Some patients, forexample, on scheduling may
prefer online scheduling.
Some may prefer a phone call.Some may prefer text. Figure out
what the mechanisms are that youcan offer multiple resources to
(24:38):
that patient so that they cancommunicate in the way that
feels most comfortable to them.
Daniel Williams (24:43):
Okay. Time for a couple more questions then.
You mentioned complianceearlier. So what are the
challenges then involved inregulatory compliance, risk
management in the practice? Whatdo you set in place to mitigate
those risks to make sure thatyou are compliant?
Dawn Plested (25:03):
Compliance is a big one. And one of the bigger
challenges for most practices,think very few practices can
afford. Nor do they need a fulltime in house legal counsel. And
yet regulatory has the potentialto be one of the biggest hurdles
facing a practice. So really,there are a number of ways to
(25:23):
stay on top of it, but you needto start with a good compliance
assessment.
Make sure that you have in placea robust policy and procedure
manual, that you have anemployee manual in place, that
you have somebody walk throughwith you the HR and the OSHA
needs for your practice. Youwant to think through what are
the state and federalregulations specific to your
(25:46):
specialty and get a handle onwhat those policies and
procedures need to look like.Get it documented. Get it
trained. Make sure that yourtraining process with staff has
a documented process to it.
So it's not a simple lunch andlearn or a morning meeting, and
then everybody goes on theirway. Have a formal training and
(26:09):
sign off on these importantregulatory considerations. From
a financial perspective, youshould have a compliance manual
in place. Fraud, waste, andabuse is a huge focus at the
federal level. You do not wantto get hung up on that.
And you really want to thinkabout what is your risk
management framework? Thinkabout continuous quality
(26:30):
improvement initiatives. Work tomitigate the risks by ensuring
compliance, reducing errors,ongoing training. A really great
resource tends to be yourprofessional liability insurance
companies. They'll provide somefree training to you and your
staff and help you stay on topof that.
They don't want you to get introuble either, But don't rely
(26:53):
solely on them. You're going tofind webinars, different pieces
of information. You can send adesignated employee who maybe
takes on your risk and safety tosome smaller conferences. And
make sure that you haveindividuals who are designated
as responsible for areas ofcompliance so that you can
(27:14):
ensure that you're staying ontop of those things.
Daniel Williams (27:16):
Okay. In the remaining time, I want to ask
you one more question becauseyou have covered so much ground
here, and it's a lot forsomebody to take in. So what are
the some of the key lessonslearned, some of the takeaways
for our listeners regardingadministrative structures in in
a medical practice?
Dawn Plested (27:36):
Yeah. I think the key that I would really share is
be strategic, be thoughtful, beintentional with your design. So
be strategic sounds a littlebroad. Set aside time annually
for your strategic planning andintegrate these considerations
into that strategic plan. Makesure that you're adaptable.
(27:57):
The environment changes soquickly and there is so much
data coming in that you reallyneed to be nimble enough to
pivot as needed. Keep your focusthe focus. Have a handle on what
your mission, your vision, yourvalues are, and stay centered on
(28:18):
that. Remember who it is thatyou're there to serve. You're
there to serve the patient.
Think through the lens of yourpatient and what makes for good
patient care. What would youwant your mother, your father,
your spouse, your child,yourself to experience in a
similar situation and designbased around that and really
(28:38):
focus on continuous improvement.Effective leadership, financial
management, technology adoption,those are critical pieces for
success in the medical practiceadministration.
Daniel Williams (28:50):
All right, Dawn, it's always great catching
up with you. Thanks again forjoining us on the MGMA podcast.
Dawn Plested (28:57):
Thank you so much for having me. I appreciate it.
Daniel Williams (29:00):
Yeah, that is going to do it for this episode
of the Consultant's Corner, MGMApodcast. We've had our guests,
Dawn Plusted, an MGMA consultantback on with us today, talking
about administrative structuresat a medical practice. We will
be using this as part of aseries talking with different
(29:20):
consultants and MGMA experts andhealthcare experts out there. So
be on the lookout for those. Andthanks for being an MGMA podcast
listener.
Hey, everyone. This is Daniel Williams, senior
editor at MGMA, host of the MGMApodcast network. I am here today
with Dawn Plustidge. She's anMGMA consultant, and she's
exploring the ideas of medicalpractice operations,
administrative structures inthose practices, and a lot of
(00:27):
other issues related to medicalpractice operations. Dawn,
welcome.
Good to see you again. Thank
Dawn Plested (00:34):
you so much. Thanks for having me. I'm very
excited to talk about thistopic. Very, very relevant, very
important to what we do. Sothanks again for having me.
Daniel Williams (00:43):
You got it. So we've got a lot of questions.
We're gonna try to get throughthese as in as thorough and as
complete a fashion as we can. Sothe first question I have for
you is what is the importance ofadministrative structures in a
medical practice, and how doesit relate to the advanced
strategy operations perspective?
Dawn Plested (01:05):
Yeah. So your administrative structures are
really the backbone of yourmedical practice. It's
foundational. And I will saythis, I think that so many
medical schools, and this is mylittle soapbox, don't do a lot
of training on the front endwith providers on how to run
(01:25):
their medical practice. And youhave physicians who are just
brilliant, excellent clinicianscoming out of school or mid
career looking to start theirmedical practice.
And there's a ton of enthusiasmaround taking ownership over
their care delivery model, butthere's maybe not the science
and attention that needs to bepaid to your administrative
(01:48):
structures. And laying those outwell and thoughtfully and
strategically on the front end,it's crucial for ensuring your
efficient operations, thatyou're compliant with
regulations, just generaldelivery of patient care to
ensure that your revenues areflowing and that your expenses
are managed. From an advancedstrategy and operations
(02:12):
perspective, effectiveadministrative structures really
plays a central role in aligningyour goals with your functions.
So it ensures that yourresources are used, they're used
effectively, that you're readyto adapt to change in the
healthcare environment, that youcan anticipate changing and
(02:34):
moving landscape around you.Again, I say again, because I
mention this every time we doone of these podcasts, but COVID
had such a profound impact onthe industry.
And you can really see thedifference between medical
practices that were ready toanticipate and pivot and move
with changing and unexpectedcircumstances and those who
(02:55):
weren't. And frankly, at thefoundation of that is really
effective administrativestructures, because those are
that that concept's predicatedon the idea that you're ready to
pivot as changes occur.
Daniel Williams (03:11):
Okay. So given the idea that you are gonna make
some changes there, develop thestructure you want, how does
leadership then contribute toshaping administrative
structures in a practice? Andthen what are the implications
of different leadership models?
Dawn Plested (03:27):
Yeah. So leadership is foundational.
There's a cliche that goesculture eats strategy for
breakfast, and it's a age oldbusiness cliche that everybody's
heard a thousand times. Whatthat means is the culture of
your organization really defineswhat you're going to accomplish,
(03:47):
and your best of intentions aredefined by your organizational
culture. Why do I talk aboutculture when you ask about
leadership?
Because leadership defines whatyour culture is going to look
like. And it it has an, aprofound impact on your
administrative structures. Youreally can't build out your
medical practice. That build outoccurs under leadership. And
(04:10):
there's a number of differentleadership models that people
have heard of.
You have servant leadership. Youhave the classic authoritative
leadership or hierarchicalleadership. You have
transformative leadership.There's rule by committee.
There's a number of differentleadership styles, and that
impacts your decision making,communication.
(04:33):
It can impact the patientengagement and experience,
employee engagement, patientsatisfaction. It will very much
have an impact on your abilityto pivot. Back to what we talked
about in the previous question,if you're not a nimble
organization, first of all, Iask, why are you an independent
(04:54):
practice who is not a nimbleorganization? You should be able
to move. You're not, in theory,bogged down by bureaucratic
layers that you can see in theselarger Byzantine systems.
And so one but but with thatsaid, you have to have your
administrative structurescorrectly in place, and that
will come to a leadership style.And I do wanna say within that
(05:17):
leadership style, there thereare a number of different styles
that I just listed out that canbe effective at different times
and in different circumstances.But I think throughout, you
really have to have the abilityto trust and delegate to your
employees and have thestructures in place from an
(05:38):
administrative perspective thatallow you to have the confidence
that there are guardrails up andthat you can release some some
of that control to the folks youwork with. Otherwise, you won't
have that ability to pivot andbe nimble.
Daniel Williams (05:54):
All right, Dawn. What factors then should
be considered when choosing theappropriate organizational
structure? I know you talkedabout some of the different
ones. What are those factorsthen that you're looking for?
Dawn Plested (06:06):
Yeah. So in terms of your org structure, first of
all, there are a number ofdifferent types, you know, that
you'll have varying degrees ofcontrol over. You're gonna have
everything from a solo practice,group practices, partnerships,
hospitals, ownership models,integrated health systems, for
(06:27):
profit structures, telehealthcompanies.
Daniel Williams (06:30):
And
Dawn Plested (06:33):
really, of course, now we're seeing, and I'm
getting a little far afield interms of org structure, but I
think it makes a difference. Yousee these kind of alternative
healthcare environments such asCVS or Rite Aid, some of the
pharmacies are getting into itfor a little while there. Amazon
was giving it their best shot.And those would of course change
(06:55):
your org structures. But yourtraditional ones are really your
solo practitioner, yourpartnerships, your group
practice, your hospital employedmodel, and your integrated
health system.
In terms of if the sky's thelimit, if you get to decide what
your practice looks like, whatyou really want to consider is a
(07:16):
number of different factors indetermining what that org
structure should be and whatmakes sense for you. You're
going to want to consider whatyour own goals are, what type of
medicine you want to practice,what amount of autonomy, and in
coupling with that autonomy,what amount of responsibility
you want to have over thebusiness functions of your
(07:38):
practice. You're going to wantto consider the size of practice
you want to have as well as thesize of the patient population
you want to serve. You're goingto think about your
specialization, any kind ofregulations, both locally at the
state level, at the federallevel. And so I think those are
(08:00):
your primary factors that reallyshould play into what that
organizational structure lookslike.
Daniel Williams (08:06):
Thanks for that, Dawn. So next issue I want
to talk about here in relationto organizational structures is
related to staffingconsiderations. So when you're
developing that structure, whatstrategic staffing
considerations should be takeninto account and base those on
(08:27):
patient volume, servicesoffered, and any other factors
as well?
Dawn Plested (08:33):
Yeah, so staffing, the million dollar question.
This is something that practicesreally need to pay close
attention to. I recently did asession, a podcast session, and
we touched on staffing and justthe challenges involved in that.
And I'll say this. There's acouple reasons, well, few
(08:53):
reasons why I would say thatthis is so important to your
strategy.
And number one is because stafftends to be one of the larger
costs to a medical practice,Ensuring that you have the staff
that you need doing the rolesthat they need to be doing is
critical. And you also need tomake sure that you have the
budget to cover that and thatyou're allowing and allocating
(09:17):
the resources needed to supportyour staff and to support the
size of the staff that you need.I think the other reason it's
such a large area of concern isbecause staff can be very highly
specialized depending on therole that they're going to fit
for your organization. So havinga handle on who you need and
(09:41):
what you need them to do is key.And then recruitment can take,
can be very all consuming.
So that's a very, that's a verybig consideration. And then of
course, the elephant in theroom, which is the staffing
shortage we've experienced,particularly since COVID. The
(10:02):
burnout levels in healthcare arejust extraordinary and have been
extraordinary in recent years.And that really just leads to a
vacuum of availability in yourlabor pool. And so you need to
be very strategic about this.
As you mentioned, looking at itthrough the lens of that patient
(10:22):
volume, the services that you'relooking to offer, you need to
think through strategies forrecruitment. That should play
into your strategic planningprocess. That should be part of
your long range work that you'redoing as you build out your
staffing model. And you need tobe thoughtful about both
(10:44):
recruitment, but also retention.You really want to make sure
your compensation packages arecompetitive.
You want to invest in yourstaff, help have them feel and
sense and understand the growthopportunities for their career.
And provide ways for staff todevelop within your own
(11:07):
organization. Nobody wants towork the same job indefinitely
and really with no hope ofcareer advancement or growth or
additional challenges. You wantto really think about your
training. I see training asbeing an area that a number of
practices skimp on.
And I can't tell you the numberof times that I have been called
(11:30):
in to do an operationalassessment for an organization.
I go to their varyingdepartments, and what I find is
you have some people who aredoing everything perfectly,
fantastically. They could writea textbook on it. But you have
other people just doing itridiculously. And it's a
completely nonstandard process,and it's because there's no
(11:52):
standardization in the training.
Start with documenting yourtraining processes, your
expectations, have a standardoperating procedure, and then
get serious about training. Justbecause you've got this person
over here who's doing everythingperfectly and can write a
textbook on it actually doesn'tmean that they can train. It's a
(12:14):
skill. Teaching otherindividuals how to do the work
is a skill. So really investingin that training goes hand in
hand with your staffdevelopment.
Then I would also say whenyou're thinking about your
staffing, culture is just a hugepart of that. We see with the
younger generation that theywant a purpose driven work. They
(12:39):
want purpose driven work. Theywant to feel that they are
making a difference with whatthey do. And that needs to just
here's the good news.
Healthcare is a fantastic placeto provide purpose driven work.
We are not pushing pencil saleshere. We are saving people's
lives, and we have a hugeopportunity to impact people's
(13:02):
health in such a positive way.There can be nothing more
meaningful. But we can losesight of that pretty darn quick
if we're not very thoughtfulabout the culture we're trying
to build.
So you really want to work onthat culture of patient care,
having that mission, thatvision, that clarity of your
values and your purposefuldriven work. And then foster,
(13:26):
build a positive workenvironment. So you're working
on patient driven work. Itdoesn't have to be grueling. It
can, we can have fun.
We can care about each other. Wespend more time with our
coworkers than we do with ourfamilies in a lot of cases. And
you should like the people youwork with. Build an environment
(13:48):
where it's enjoyable to bearound each other. It's
enjoyable to spend timetogether.
I think that's very criticalwhen you think through your
staffing structures.
Daniel Williams (13:58):
Okay. Another key aspect in any structure is
what the health informationsystem looks like. So talk about
that. Walk us through thatprocess. What are the key
considerations for implementingEHRs, practice management
systems, whatever else orwhatever other platforms you may
(14:19):
need in that practice?
Dawn Plested (14:21):
Yeah. So, you know, your tech tools have an
opportunity to be one of thebiggest time savers and cost
savers for your practice, andthey have the potential to be
one of the most costly soulsucking components of your
practice. It really is thatimportant. I really, so I will
(14:46):
say this. I think the toolsavailable to us today are just
extraordinary.
The list goes on and on in termsof what you can automate. The
question that you always need tostart with is, what do we need?
And then you really, at thefront end, need to employ so
(15:09):
much due diligence in a reviewof the technology tools that
you're considering. There is noend of vendors who will promise
you the moon. You really have todive deep to figure out can they
deliver?
And not everybody can. And I'mhere to tell you that can be
soul crushing, as a smallpractice or a practice startup.
(15:33):
But quite frankly, at any level,if your EHR is not effective,
not effectively aligned withyour other technology pieces,
not user friendly, it is justgoing to be such a resource and
time drain for your practice. Itjust there can be I can think of
(15:53):
few things that would have amore negative impact on your
practice than that. And so onething that I do want to say is a
potential risk area that I seefor a number of practices is
they either seem to focus reallyheavily on if the EHR is a
clinical fit for the physicians,or they're heavily focused on
(16:18):
does it do what needs to be doneon the revenue cycle side of the
ledger.
It is not an eitherorproposition. You really need to
make sure that you have an EHRand you have the tools and
technology, so a practicemanagement system, payment
management system, that canhandle both sides of the
(16:40):
practice, because one withoutthe other is not effective. And
there is a balance to be struck.I have never met yet a doctor
who wants more clicks in theirEHR. And I get it.
But some clicks are going to benecessary to ensure that your
billing is happening in a timelyand efficient and effective
manner. And so you need to findwhat's going to be the most
(17:03):
effective method to get both therevenue cycle flowing and the
clinical side flowing correctly.You need to think about all
sorts of things. You need tothink about your patient
management, data access, patientportals, of course, billing
processes, scheduling. And thenI strongly feel that
(17:26):
interoperability, particularlywith other tools and technology,
is such a key piece.
Your EHR really needs to workand work with a lot of different
tools. So while I'm not a shillfor the commonly used EHRs out
there, There is something to besaid for working with a known
(17:46):
vendor because theinteroperability is stronger
with new and incomingtechnologies. And again, I don't
want to spend too much time onartificial intelligence and some
of the additional technologiesthat are available. But the
tools that are being madeavailable to us are really
(18:07):
happening at the speed ofbusiness. It's just daily,
there's a new opportunity toinnovate, standardize, automate
different functions of themedical practice.
That is only as effective as howwell those tools can integrate
with your EHR.
Daniel Williams (18:25):
Okay. So let's go, Dawn, to the next key
aspect, one one of the buildingblocks of a medical practice.
That is the financial managementside of it. When you're building
out this structure, What are thekey decisions you need to make
in terms of whether it'sbudgeting, revenue cycle
management, any kind ofstrategies for cost
(18:48):
optimization, revenueenhancement? Anything else you
wanna share with us there?
Dawn Plested (18:53):
Yeah. Financial management is probably the key
part of a successful practice.And I would say maybe the most
challenging part. Again, I'veworked with so many amazing
clinicians and physicians, Butfinancial management isn't core
learning in med school, andthat's fair. And fabulous
(19:14):
practice managers out there.
And again, a lot of focus on thepatient safety and quality side
of the ledger, which isincredibly important. Financial
management needs to be thebackbone of your practice. So
let me say this. I think youneed to think about your
financial management in terms ofrevenue. So you need to start
(19:37):
with your foundation, which isyour budget.
No practice should be without abudget that's going to talk
about your assets, yourliabilities, your expenses, and
your revenue. But layered righton top of that is your revenue
cycle management. And I thinkthat there is some confusion in
practices that revenue cycle isyour billing. And really,
(20:01):
revenue cycle starts from themoment the patient makes contact
all the way until you've donefinal collection, bill fully
paid, services and clinicalservices completed. Every step
of the way impacts your revenuecycle.
And so you really need to have ahandle on that. And as mentioned
(20:26):
before, your EHR and yourpractice management system has a
huge impact on that revenuecycle system. Automate where you
can. Standardize where you can.Make sure your training is on
point and solid, consistent, andstandardized.
Very key. And then look at thereports. That it's shocking the
(20:49):
number of practices that don'thave a regular mechanism in
place for reviewing theirreports. Look at your AR, look
at your billing, look at yourdenials, look at your expenses,
look at your revenues. Try tounderstand what the flow is in
terms of patient volumes orservices, and adjust staffing
(21:11):
accordingly.
Make strategic decisions andmake it based on solid data,
which there is no data moresolid than how your finances are
running. Really think aboutstrategically, consistently
think about growth. Think aboutadding service lines. Think
about how you're going to growyour practice. At no point
(21:33):
should you grow your practicejust for the sake of growing.
But at all times, you need to beconsidering the financial health
of your practice, and growth isa very important part of that
overall picture of yourfinancial health.
Daniel Williams (21:49):
Okay. Another piece of that is how do you
improve patient engagement andsatisfaction? And by doing that,
how do you look at that, amedical practice design, so you
have a patient centricadministrative process that
builds these out? How do you dothat?
Dawn Plested (22:07):
I think with all human interactions, so human
centered design, that oldbuzzword, what's the core of it
is communication. You reallyneed to make sure, and
communication is not a one waystreet. It's you info dumping or
telling the patient what youthink they need to hear. It's a
two way street. And so patientsreally need to have a feedback
(22:31):
loop.
They need to have a mechanismwhere they feel heard. And you
really need to be thoughtfulthroughout the design of your
practice operations to ensurethat, listen, the patient is
actually driving this show andunderstanding what they have to
say, and this is a really keypart. And you can see that being
(22:52):
problematic in any number oflevels for practices, whether
there are a number of challengesin just scheduling an
appointment. I've worked withpractices where there will be
two to three phone calls to getinsurance information and
patient demographics and so onand so forth, just to get the
patient scheduled, to get a newpatient in the system and
(23:15):
schedule. How frustrating forthe patient.
How much that must make themfeel like they're not being
heard or listened to or caredabout. And then you see it all
the time when a patient goes into see the doctor. I understand
that there is a balance and youcan have patients talking to you
for two hours if you let them,but a patient needs to be heard
(23:35):
in that exam room. And there isnothing that makes them feel
less heard than a doctor whobustles in and sits down at
their computer and asks them afew questions and pokes a
stethoscope at them and bustlesout in five minutes. They want
to talk about why they're there.
And so I think just ensuringthat there is, again, an open
(23:56):
door communication process.Think about all the places where
there is a patient touchpoint,whether it is scheduling,
whether it is within the office,whether it is follow-up with
results. And think about, A, howyou can streamline that
information in terms of thetiming to get the patient to the
(24:16):
end result that they're lookingfor. And then are there multiple
ways you can offer thatinformation or that interaction
to occur? Some patients, forexample, on scheduling may
prefer online scheduling.
Some may prefer a phone call.Some may prefer text. Figure out
what the mechanisms are that youcan offer multiple resources to
(24:38):
that patient so that they cancommunicate in the way that
feels most comfortable to them.
Daniel Williams (24:43):
Okay. Time for a couple more questions then.
You mentioned complianceearlier. So what are the
challenges then involved inregulatory compliance, risk
management in the practice? Whatdo you set in place to mitigate
those risks to make sure thatyou are compliant?
Dawn Plested (25:03):
Compliance is a big one. And one of the bigger
challenges for most practices,think very few practices can
afford. Nor do they need a fulltime in house legal counsel. And
yet regulatory has the potentialto be one of the biggest hurdles
facing a practice. So really,there are a number of ways to
(25:23):
stay on top of it, but you needto start with a good compliance
assessment.
Make sure that you have in placea robust policy and procedure
manual, that you have anemployee manual in place, that
you have somebody walk throughwith you the HR and the OSHA
needs for your practice. Youwant to think through what are
the state and federalregulations specific to your
(25:46):
specialty and get a handle onwhat those policies and
procedures need to look like.Get it documented. Get it
trained. Make sure that yourtraining process with staff has
a documented process to it.
So it's not a simple lunch andlearn or a morning meeting, and
then everybody goes on theirway. Have a formal training and
(26:09):
sign off on these importantregulatory considerations. From
a financial perspective, youshould have a compliance manual
in place. Fraud, waste, andabuse is a huge focus at the
federal level. You do not wantto get hung up on that.
And you really want to thinkabout what is your risk
management framework? Thinkabout continuous quality
(26:30):
improvement initiatives. Work tomitigate the risks by ensuring
compliance, reducing errors,ongoing training. A really great
resource tends to be yourprofessional liability insurance
companies. They'll provide somefree training to you and your
staff and help you stay on topof that.
They don't want you to get introuble either, But don't rely
(26:53):
solely on them. You're going tofind webinars, different pieces
of information. You can send adesignated employee who maybe
takes on your risk and safety tosome smaller conferences. And
make sure that you haveindividuals who are designated
as responsible for areas ofcompliance so that you can
(27:14):
ensure that you're staying ontop of those things.
Daniel Williams (27:16):
Okay. In the remaining time, I want to ask
you one more question becauseyou have covered so much ground
here, and it's a lot forsomebody to take in. So what are
the some of the key lessonslearned, some of the takeaways
for our listeners regardingadministrative structures in in
a medical practice?
Dawn Plested (27:36):
Yeah. I think the key that I would really share is
be strategic, be thoughtful, beintentional with your design. So
be strategic sounds a littlebroad. Set aside time annually
for your strategic planning andintegrate these considerations
into that strategic plan. Makesure that you're adaptable.
(27:57):
The environment changes soquickly and there is so much
data coming in that you reallyneed to be nimble enough to
pivot as needed. Keep your focusthe focus. Have a handle on what
your mission, your vision, yourvalues are, and stay centered on
(28:18):
that. Remember who it is thatyou're there to serve. You're
there to serve the patient.
Think through the lens of yourpatient and what makes for good
patient care. What would youwant your mother, your father,
your spouse, your child,yourself to experience in a
similar situation and designbased around that and really
(28:38):
focus on continuous improvement.Effective leadership, financial
management, technology adoption,those are critical pieces for
success in the medical practiceadministration.
Daniel Williams (28:50):
All right, Dawn, it's always great catching
up with you. Thanks again forjoining us on the MGMA podcast.
Dawn Plested (28:57):
Thank you so much for having me. I appreciate it.
Daniel Williams (29:00):
Yeah, that is going to do it for this episode
of the Consultant's Corner, MGMApodcast. We've had our guests,
Dawn Plusted, an MGMA consultantback on with us today, talking
about administrative structuresat a medical practice. We will
be using this as part of aseries talking with different
(29:20):
consultants and MGMA experts andhealthcare experts out there. So
be on the lookout for those. Andthanks for being an MGMA podcast
listener.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com