Getting Advice: How to Hire a Consultant

When pediatrician Krekamey Craig became a partner at Denville Pediatric Group in New Jersey two years ago, she soon noticed a general disarray in the business aspects of the practice. “People would have random thoughts - we’ve got to do ‘this’ better,” she says. But with no defined action plan, nothing of real significance would ever really change.

Then last year, Craig attended the Goryeb Children’s Hospital 9th Annual CME Conference in Skytop, Pa., where she heard Chip Hart, pediatric solutions manager for Physician’s Computer Company (PCC) in Winooski, Vt., give a talk titled, “Problems and Pitfalls with Practices.”

“We basically fit every problem and pitfall,” says Craig.

PCC was already familiar to Craig, as Denville Pediatric Group uses its pediatric-focused software, but not its consulting services. She asked Hart for a meeting. “He sat down with me for about an hour. It absolutely blew my mind, the numbers he presented to me. Nobody knew the answers; he did,” she says.

Such an epiphany of understanding as to the potential value of expert advice can be hard for physicians. You’re smart. You made it through medical school, after all - no small feat. But how many of your classes focused on running your practice as a business? “It’s hard for doctors to believe they really don’t have a clue,” says Craig. “But there’s so much to understand on how a practice can run. Even as a partner, it’s not why you went into medicine. But if you want to continue getting paid every month you’ve got to pay attention to it.”

However, wise leaders understand that paying attention to business matters sometimes translates into delegating tasks to experts; namely, using consultants. But how do you select a qualified one that knows his business - and yours? Read on for what to look for before you sign on the dotted line.

The right stuff

Think of a practice management consultant as computer security software for your medical practice. Just as your computer must be constantly updated and patched to fend off the latest bugs, glitches, and viruses, your practice requires similar vigilance to keep it current and running smoothly. “It’s such a changing field,” says Craig.

Such watchful attention includes staying apprised of important federal, state, and local policy or regulatory changes concerning healthcare. And then there’s the constant influx of modifications - often poorly publicized - from your insurance payers. The repercussions of missing any of these important memos could be financially significant. A skilled consultant can help you build procedures into your practice operations to stay abreast of all this.

A consultant can also help with improving office flow, setting up procedures, buying or upgrading major technology, or even just getting someone to listen to reason. “I have been in many situations where the solution is obvious to everyone in the room except one person,” says Hart. “They need me to break apart a log jam.”

But just like anti-virus software, there’s no shortage of practice management consultants to choose from. Their skills range from topnotch to adequate to downright heinous. What key indicators can help you determine the best consultant for you?

• Experience - Time-accumulated wisdom, as opposed to textbook knowledge, is invaluable. Let’s say you’ve just divulged to a prospective consultant your severe patient no-show problem, which you just know is due to factors you can’t control: a low socio-economic area with a high percentage of Medicaid patients. But he responds with “Hmm. Are you chronically late with your appointments?”

Veteran consultants are intimately acquainted with such typical cause-and-effect scenarios. Owen Dahl, a healthcare consultant based in Houston, says, “Every time I hear about a no-show problem, that’s the first thing I ask. What happens is that patients get frustrated with sitting around and waiting for their long-past appointments. By no-showing as a group, they essentially fix the doctor’s lateness problem.”

Hart concurs. “I can usually tell a pediatrician how much he makes within 10 grand after just a few questions. … When you’re right, you knock them out of their preconceived notions that their problems are unique; they wake up and listen more to you.”

Of course, you may truly have a less-seen concern that requires more in-depth probing, but largely, yours will be a common problem (sorry, but really, there are better ways to be unique). So even though it may sound like a parlor trick, if a consultant responds with “let me guess” and then he nails some detail or issue about your practice, take notice. This is a consultant who has been around the practice block many times; take advantage of his knowledge.

• Trust through good rapport - Feeling a positive connection with a consultant is imperative. “You must get along so you can have meaningful discussions. If you don’t have that, you don’t have the trust level you need,” says Ankur Doshi, a Houston-based solo internist. Trust is especially critical for solving complex operational problems. “A lot of the problems we solve are not solvable with a single solution,” says Hart. “You have to do one thing ‘here’ before you can move ahead and do something else ‘there.’”

That sounds like code for “pricey.” But a qualified consultant can help you break a gargantuan project down into manageable - and affordable - parts. Dropping an insurance plan because of poor reimbursements might be the best solution, but a scary one. “If you’re going to drop a plan, you need to have a way to replace the 20 percent of patients,” explains Hart. “As a consultant, that’s actually tricky; a lot of people are reluctant to follow along with you.” But trust the path if you want the task accomplished.

• Flexible dependability - Often, there are multiple solutions to one problem. It’s natural for any expert to have her “favorites.” But the person you want will also pull Plan B, or C, or Q, out of her Mrs. Fixit bag o’ tricks to fit your personality and your learning style.

Still, there’s a fine balance between adjusting solutions and never getting done. Your dream consultant will be highly conscious of deadlines, which must be both clear and maintained. This is not to say they’ll never shift due to unforeseen circumstances. Stuff happens. But good communication based on the aforementioned good rapport will keep both sides on the right track. Ask for references to check on your candidate’s track record.

• Professionally ethical - Ask a candidate how long she has a client on average, or what her “usual” terms are. You want an adviser, not a Rasputinesque dependency. In fact, knowing when to take a client’s training wheels off - and apprising the client of that moment - is an earmark of the sort of helper you want for your practice. “The best consultant puts himself out of business,” says Hart. “The best consultant lets people stand on their own.”

• Credentialed - This is not an absolute requirement, but knowing that the expert you hire is indeed certified by a legitimate credentialing body such as the National Society of Certified Healthcare Business Consultants will help to shore up confidence in your decision.

One more housekeeping item: Keep your relationship running smoothly with a signed, written service agreement between your practice and your chosen consultant. Note that payment can be set up in a few different ways - a “per-job” flat fee, on retainer, or by the hour - depending on why you sought out the help and what you need done. Clearly delineate all terms, from the assessment to the exit strategy, for the benefit of both sides.

A two-sided affair

A consulting relationship works both ways. Yes, you’re paying the consultant, but he’s also “paying” you - by improving your practice. Know that you’re being scoped out in much the same way as described above. Why? Because consultants want to avoid regretting taking you on as a client because you’re a nightmare to work with. “[Such clients] want to hear that there’s a simple, nonconfrontational way to fix their problems,” Hart says. “Sometimes, it’s just not that easy.”

Veteran consultants don’t necessarily mind a demanding client, explains Hart, depending on the focus of those demands. Is it about the exactitude of a solution? Or just the money? “When I’m starting to work with a customer (before signing the agreement), and early on he questions the dollars - ‘why am I paying $1500?!’ - that’s a situation when I know I’m going to be unhappy.”

Every practice (every business, even) can benefit from a little outside advice. But change is hard, even if you know deep down that it’s the right thing to do. You must be ready for it. So before bringing in another party whose job it is to give you an honest assessment of a problem, be honest with yourself. “If you’re not prepared to get the bad news and make a change, then don’t bother. You’ll only make things worse,” says Hart.

Objections, interrupted

So let’s say you are mentally prepared for a brave, new practice. Great. But your good attitude won’t pay the bill, will it? Wondering how this is all going to pay off is surely a normal qualm, especially in a new consulting relationship. But take the leap of faith, says Craig. “Each practice has individual needs and ways of improving revenue.”

This increased revenue - which likely will far outpace the bill - is exactly how you pay for the advice. Case in point: After just one year of expert assistance, Denville Pediatric Group’s profits are up 25 percent to 30 percent. “This reflects a huge number of changes,” Craig points out, “from raising prices to increasing our number of well exams to increasing our number of visits. We were able to pinpoint slow points and modify our schedule accordingly.”

Notably, she says, one intangible - but no less valuable - result of this consultant-driven schedule overhaul is higher patient satisfaction because the wait time to get in for a well-child visit has been significantly reduced.

Craig says that despite how much she has learned in the past year about running a practice, she knows where her true competencies lie - in clinical medicine. “I still don’t see myself as a great business person. I know there are more things that could be done. It would be silly not to consult an expert. We are a happier, better-run practice now.”

Shirley Grace is an associate editor on staff with Physicians Practice. She can be reached at sgrace@physicianspractice.com.

This article originally appeared in the July/August 2008 issue of Physicians Practice.