Cooperation Needed Between Administrators and Providers

In many ways, office administrators are the yin to a healthcare provider's yang. They manage business operations (overhead, collections, and regulatory compliance), so physicians can focus on patient care, which generates revenue. One needs the other to survive. Yet, because their skill sets are so different, they often fail to communicate effectively, which can impact productivity and patient outcomes. To meet performance metrics today - and maximize reimbursement in a system that increasingly rewards for value - clinicians and office managers must work together in the drive toward better quality.

"Administrators and physicians are really in partnership together and that's how it should be looked at," says Jamie Claypool, a practice management consultant with J. Claypool & Associates in Spicewood, Texas. "The administrator cannot run a practice without the input and support of the physician owners."

Indeed, to ensure both parties are on the same page, physicians must clarify expectations, define the administrator's role, and clearly communicate their priorities. They should similarly set their office manager up to succeed by establishing attainable goals, which may include improved patient safety, more referrals, or increased collections. Administrators should not only be held accountable for meeting those goals, but rewarded when milestones are met, says Claypool.

"I feel that administrators do much better when there's some sort of financial incentive provided, which may be based on profit growth or some other threshold," she says, noting the administrator might receive a bonus based on his ability to boost revenue, remain in compliance, hold down overhead, or ensure revenue cycle integrity. That requires an annual performance review, says Claypool. "I think the administrators should be reviewed annually not just by the physicians, but by the staff," she says. "Good administrators want that kind of feedback."

Laura Palmer, a senior industry analyst for MGMA and former practice administrator, says the better performing practices view both clinical and clerical staff as a single unit in the care delivery team. "In the past, it was really more of a front office versus back office situation, which didn't work effectively," she says. "Now we're seeing a dramatic change in that everybody is part of the patient experience. There's more interaction between physicians and administrators looking at patient care as a whole, so the clinical portion of the visit isn't separated from the business."

Many practices, Palmer says, start the day with a morning huddle in which the entire team reviews the patient schedule.  "If one of the patients has a mobility issue, or dementia, or there are caretakers involved, that gets factored in," she says. "It's a chance to discuss what support staff they need to commit to that patient and how it might impact the schedule." Primary-care practices that do a large volume of physical exams and specialist offices with a higher percentage of new patients can particularly benefit from morning huddles, in which the entire team identifies opportunities to streamline work flow. They may, for example, opt to change their admission process by asking patients to report 15 minutes prior to their appointment to complete paperwork.

Physicians and office managers should separately build in time for regular meetings to address any personnel or financial issues that may arise and pinpoint areas of inefficiency, says Palmer. A formal sit down keeps the lines of communication open and helps to cultivate a teamwork mentality. "The practices in which physicians and managers have the best relationships have a set time to meet, rather than catching each other in the hallway or leaving Post-it notes on each other's desks," says Palmer.

Collaborative Environment

The efficiencies derived from team-based care will become increasingly important as third-party payers shift to reimbursement models that reward for quality and cost control, Palmer says. "The best practices have already optimized financial processes like collecting deductibles and copays and making it easy for people to understand their insurance benefits, but they now must focus on how to maximize the clinical experience as well," she says. "It's really a collaborative effort. Physicians are well aware of the cost of patient-care management and they know they need to work on processes internally." That means increasing patient access, ordering and reviewing tests in a timely fashion, and helping patients understand next steps.

For his part, Robert Wergin, a family physician in Milford, Neb., and president of the American Academy of Family Physicians, says he and his office manager communicate daily, and seek each other's wisdom in implementing new ideas for process improvement. "We often exchange links to articles via text or e-mail that may be related to ICD-10 or patient scheduling," he says. "She might send me an interesting article on an issue related to chronic pain management or patient scheduling and I might write her a message that says, 'Boy, that's an interesting approach to getting ready for ICD-10.' In that way, I have an interest in the business aspect as well. It begins a conversation."

Physicians can also foster a healthy working relationship with their managers by delegating and letting them lead, says Claypool. Once goals are communicated and competency is established, physicians should resist the urge to micromanage. More important still, they should always have their office manager's back. A doctor who declares that the administrator's directive does not apply to his long-time nurse, for example, undermines the administrator's authority. "Physicians need to realize that their support of the administrator should be demonstrated in front of their staff," says Claypool. "The thing that destroys relationships more than anything else between physicians and their administrator is lack of support." 

And don't forget common courtesy. "I constantly say to my administrator, 'Thanks for doing that. That saved me so much time,'" says Wergin, noting physicians and administrators should look for opportunities to praise each other for a job well done. "Respect, value and communication is the key," he says. "Sometimes the administrator needs to say they value you as a provider and the physician must do the same. Change is hard for physicians in this environment, but working together can take away much of that anxiety."

Shelly K. Schwartz,a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.