I hope you enjoy reading this blog.  I hope even moreso that it gives you some ideas and insights into getting more from your practice… including more joy.   I even Twitter my blogs so every evanescent thought that comes out of this brain of mine gets captured and published in some media.  But am I just an untreated narcissist? 

Well, maybe… but don’t you feel you know me a little better as a result of reading this?  And maybe trust me a little better than if you had never heard of me or “met me” in this way?  If so than find a way to do the same thing for your patients.  These days they need to understand your thinking process to trust you.

David Zahaluk, MD is a practice optimization expert and the author of The Ultimate Practice Building Book.  His firm, Ultimate Practice Builder, takes physicians to the top 10% of their specialty – in income, time off and quality indicators - within 3 years… guaranteed.  Learn more at www.UltimatePracticeBuilder.com.

Self Assessment
Rank yourself from 1-10 in each of the following practice areas:

1. Customer service
2. Charting
3. Managing data
4. Managing refills, referrals and patient questions
5. Patient education
6. New patient acquisition
7. Patient retention
8. Bookkeeping, accounting and cash managment.
9. Coding, Billing and Collection
10. Adhering to evidence based care standards
11. Staff management

Next ask your office manager, your accountant and your practice building consultant to rank you in the eleven areas.

Then ask 5 patients that have been with you the longest what could be done to improve your practice.

Put that together and… voila, you have a practice plan.  Just focus 80% of your efforts on the one thing that you do the least well.  Stay with that area until everyone agrees you function at a 9/10 or a 10/10 level.  Don’t stop improving even if you get bored along the way.

Human nature dictates that we tend to do more of what we are good at and avoid the things we aren’t good at.  Constraints theory says that it doesn’t matter how good you are at the things you do well, it’s your weakest areas that limit you the most.

Healthcare Reform

How can you reform a system that takes more money to operate than it can possibly afford?  Costs are increasing disproportionately in all areas – hospital care, outpatient care, imaging, pharmacy services and administrative costs.  Most businesses can afford to weather a short-term cost overrun in one segment of its operations, usually by raising price and/or laying off staff.

The US health system has withstood 10 years of serious price escalation and is approaching a breaking point.  And no one has the courage to break the bad news to the public.

Even Mr. Obama, who has taken huge strides forward on this issue, cannot shown us a price tag for the cost just to maintain the current level of care.  That figure will be a staggering number.  And I don’t mean the cost of what the President is proposing, I mean what it will really take.

I am a physician who has practiced both in Canada and the US.  I have experienced two different solutions to the same problem.  The US throws money at the problem and Canada rations it care.  Neither approach appears to work but somehow its citizens get by. 

What should the US do about healthcare reform?  I don’t know.  Unless we get a lot clearer on what it will cost to really overhaul the system, I don’t know how anyone can make any meaningful headway on the problem.

David Zahaluk, MD is a practice optimization expert and the author of The Ultimate Practice Building Book.  His firm, Ultimate Practice Builder, takes physicians to the top 10% of their specialty – in income, time off and quality indicators - within 3 years… guaranteed.  Learn more at www.UltimatePracticeBuilder.com.

Are you working from a written plan as you develop your practice?  Putting your plan on paper forces you to think about it in a more meaningful way.  You’ll tend to stay focused on long term goals and execute on the short term targets that facilitate growth. 

Otherwise there is a tendency to look at one idea and drop it, start something else and not finish it and pretty sooon you get depressed and discouraged and want to engage in something you know more about.  Don’t let bad habits take you down!  Work from a written plan with 3 month, 12 month and 5 year goals.  

David Zahaluk, MD is a practice optimization expert and the author of The Ultimate Practice Building Book.  His firm, Ultimate Practice Builder, takes physicians to the top 10% of their specialty – in income, time off and quality indicators - within 3 years… guaranteed.  Learn more at www.UltimatePracticeBuilder.com.

Sincere thanks from Ultimate Practice Builder to the brave military personnel who lost their lives defending the freedom and sovereignty of our nation.  To their families – we honor your loss.

I recommend you spend at least 4 hours per week working “on your practice”.  that’s 2-2hour meetings or 4-1 hour meetings.  Decide what your weakest area is and make that your focus for these meetings until that area markedly improves.
Here are some questions to ask yourself in the meetings:

1. What could be the problem?
2. What else could be the problem? (10 answers)
3. What changes or assumptions led to the problem?
4. What are 10 possible solutions to the problem (once you have clearly defined it)?
5. What resources will we need to solve the problem?

Most practicecs suffer from what I call “muddy thinking”.  Don’t let that be you.  Poor planning leads to poor execution 100% of the time.  Strive for excellence in your processes, including the process of problem solving and planning.

David Zahaluk, MD is a practice optimization expert and the author of The Ultimate Practice Building Book.  His firm, Ultimate Practice Builder, takes physicians to the top 10% of their specialty – in income, time off and quality indicators - within 3 years… guaranteed.  Learn more at www.UltimatePracticeBuilder.com.

The Worst Boss Ever

Hands down working for yourself is the hardest position to be in.  Why?  Because your boss is the worst boss ever.

You may want to cuss at me for saying that but let me explain.  Your boss is a bad boss because he or she doesn’t know what he/she doesn’t know.

You may need to pay more attention to your financials, you may need to work on customer service, you may need to learn new procedures, you may need to fire some of the less than helpful staff you have.  But you may never find out what you really need.  The problem is that your thinking got you to this particular level of success and often it takes new thinking, new perspectives, larger viewpoints to get to the next level.

Unless the self employed physician reaches out for the larger perspective, they really have a job and not a business.  And it’s the worst job ever because there isn’t enough sharing of good ideas to get unstuck and get to the next level.

David Zahaluk, MD is a practice optimization expert and the author of The Ultimate Practice Building Book.  His firm, Ultimate Practice Builder, takes physicians to the top 10% of their specialty – in income, time off and quality indicators - within 3 years… guaranteed.  Learn more at www.UltimatePracticeBuilder.com.

Last week my home computer crashed.  I didn’t have a back up system working so it was a time consuming and expensive ordeal.  You probably are backed up at work but what about at home?  Even though we found a vendor that could retrieve our data, it probably cost me about 4 hours to “work the process”.  That’s the real cost – the lost opportunity to do something more meaningful istead of managing this “crisis”.

David Zahaluk, MD is a practice optimization expert and the author of The Ultimate Practice Building Book.  His firm, Ultimate Practice Builder, takes physicians to the top 10% of their specialty – in income, time off and quality indicators - within 3 years… guaranteed.  Learn more at www.UltimatePracticeBuilder.com.

Physician Know Thy Numbers

When I consult with a new practice these days I start by asking a lot of questions.  I’m shocked at how often I get the blank deer-in-the-headlights stare at what I consider to be basic questions.  Am I off base here?  You guys and gals should know this stuff.

Here’s what stumps most clients these days when we talk about their billing:

1. What financial reports do you receive weekly and monthly?
2. What is your process for insurance verification?  Who manages that process?
3. How long is your revenue cycle? (national average = 60 days – yours should be less than half that)
4. What is your rate of unbilled charges (national average is 15% – yours should be 0)
5. What is your denial rate?  (national average is 30%)

 Only concern yourself with these questions if you want to be able to feed your family.

David Zahaluk, MD is a practice optimization expert and the author of The Ultimate Practice Building Book.  His firm, Ultimate Practice Builder, takes physicians to the top 10% of their specialty – in income, time off and quality indicators - within 3 years… guaranteed.  Learn more at www.UltimatePracticeBuilder.com

What’s in your marketing mix?  Newsletters and referral systems are still the top of my list.
When you evaluate what to put into your marketing mix, consider these questions:

1. How easy is it to do this?
2. What is the likelihood of bringing in more patients?
3. Can it be scaled up or down?
4. How much additional staff time will it take?
5. Is it outsourceable – in whole or part?
6. What is the cost (relative to your overall budget)?
7. What kind of word of mouth will it generate?
8. Is it boring, monotonous and look-alike to every other form of advertising out there?

David Zahaluk, MD is a practice optimization expert and the author of The Ultimate Practice Building Book.  His firm, Ultimate Practice Builder, takes physicians to the top 10% of their specialty – in income, time off and quality indicators - within 3 years… guaranteed.  Learn more at www.UltimatePracticeBuilder.com.