How the Role of Practice Manager is Changing Due to Reform

Over the past few months, Kelly Marulanda, who manages a four-physician pediatric practice in Woodstock, Ga., has experienced many changes in her day-to-day responsibilities. One of the biggest: She's spending more time assessing patients' insurance, and explaining how it works.

"With all of the new insurances that are on the [health insurance] exchanges, a lot of people are signing up for insurance and they really do not understand what they signed up for," says Marulanda. "I have to really pay closer attention to patients who come into the office in terms of what insurance they have, what does their insurance cover."

Further complicating matters, Marulanda says she often has to explain to patients that the insurance they recently purchased covers less than they anticipated."I may have to have a conversation with the patient when they come into the office because they may not realize that they have a $55 copay when last year their copay was $25," she says, adding that many of the plans purchased through the exchanges require higher patient cost sharing. "They get to the office, we request their copay, and they don't want to pay it."

Marulanda is not the only practice manager facing the additional responsibility of clearing up patient confusion due to reform-related insurance changes, nor is that the only additional responsibility that she and other practice managers need to take on due to healthcare reform. Here's more on how managers must change their roles in order to help their practices navigate the shifting waters.

Role: Contract connoisseur

In addition to educating patients more thoroughly about their insurance, Marulanda is spending more time educating her staff about how these new plans work and how they will affect patients. "Initially, we did not think that it was going to change our daily routine that much, but as January started rolling around and we had more patients coming in ... we realized that we were going to have to educate our staff about how to hold a conversation with someone about their insurance plan," she says. To prepare staff, Marulanda often spends a portion of her regular staff meetings discussing reform and insurance changes. "We try to keep them updated with current events to inform them: This is what the [Affordable Care Act] is," she says. "Be ready. You just have to be ready with these conversations [with patients]."

There's still more, however, that managers need to do to help their practices navigate insurance changes, says Mary Pat Whaley, a practice administrator for more than 25 years and founder of Manage My Practice consulting firm. A top priority for managers, she says, must be learning more about how the plans work and how they will affect their practices. For instance, managers should understand which exchange plans have listed their providers as in-network or out-of-network; what the rates are within these plans; and whether the practice can, or should, opt-in or out of any of the plans. There is a "whole new level of complexity in trying to understand what they're contracted with and what they're not contracted with," says Whaley. " ... There's probably never been a more important time to know your contracts."

Role: Information gatherer

Of course, reform is bringing about much more than just insurance changes. New reform-related regulations, requirements, and initiatives seem to occur on an almost weekly basis. To understand how these new rules and initiatives will affect their practices, and how their practices should respond, practice managers need to take their information gathering abilities to a whole new level, says Judy Bee, a principal at Practice Performance Group consulting firm.

That doesn't necessarily mean managers need to spend more time in front of their computers conducting research each day. But they do need to get engaged with various associations, such as the Medical Group Management Association (MGMA) and the practice management divisions of their specialty associations, says Bee, a former practice administrator. Getting involved will help managers stay informed, and it will provide valuable networking opportunities at meetings, conferences, and even online, says Bee. "There is a chat room that my partner belongs to with MGMA, and it's people saying, 'I've got this problem, has anybody else had it?' He is so impressed with the breadth of knowledge and wealth of information [available] - that somebody who's just stumped can participate in a thread and get the problem answered."

Networking will also provide managers with opportunities to learn from other, similar practices that are facing the same reform-related decisions, such as whether they should join an accountable care organization (ACO). "I have an OB/GYN client right now whose admitting hospital has not formed an ACO yet, and they don't know quite what to do," says Bee, adding that the manager does not network or attend relevant meetings. "She should be far more knowledgeable than she is."

Role: Large-scale project manager

Just as managers must step up their information gathering abilities, they must also broaden their project management skills. Due to reform, many practices are embarking on projects of a larger size and scope than they have in the past, says Laura Palmer, an MGMA senior industry analyst. Examples of such projects include forming a Patient-Centered Medical Home, participating in an ACO, or merging with another practice.

"It may be a much broader project than they've had before," says Palmer. "In other words, if they were going to buy a new piece of equipment and learn how to use that in their practice, that was very localized, it was within their practice. But when you're talking about forming a relationship with  potentially [providers that] may have been competitors of yours in the past, or you may have some sort of adversarial relationship with, or you may have been affiliated with one hospital group, for example, and now you're having to broaden those relationships, it's really going to change the scope of their projects and the number of players in that picture."

To successfully lead these larger-scale projects, managers must focus on creating strong project timelines, embracing long-term planning, practicing great documentation regarding decision making, and so on, says Palmer. "More people are going to be involved, more money will be involved, and they are going to be longer term with more financial impact."

Role: Fearless delegator

At this point, most practice managers reading this article are probably wondering: How on earth am I going to be able to handle all of these new responsibilities? The answer, says Bee, is making sure you are delegating to other staff in smart and productive ways. As managers take more on, she says, they must ask their staff to pitch in and pick up the slack when necessary.

"If you're busy working on a Patient-Centered Medical Home, and it's taking you out of the office for a jillion meetings, and some of them involving travel, and not only is it taking the administrator [but] also taking a doctor out of the practice ... who's running the store?" says Bee. "When you take on that project management, you have got to have a system in place with leadership ... you need to have foremen."

These foremen, Bee says, are staff members who are recognized as leaders within each department in the practice, and who the manager trusts to fulfill additional leadership responsibilities when necessary. "They're not going to make policy decisions, they're not going to change anything major, but they're going to keep product moving," says Bee. "They know how to do that, they are respected by their departments, and they work collaboratively with other foremen."

Role: Team motivator

As practices become more involved in reform-related initiatives, managers must remember that they - and their foremen - are not the only members of the practice who are taking on more responsibilities. All of the practice's staff members will feel the effects.

As a result, managers must work harder to keep staff motivated. The key, says Bee, is understanding that there's no one-size-fits-all approach to staff motivation. Managers should tailor their approach depending on who they are interacting with. Some staff, for instance, will appreciate frequent check-ins during a difficult transition; others will appreciate a positive e-mail sent after a job well done. "Little Mary Sunshine running around with pom-poms is going to be fine for some people and drive other people crazy," says Bee.

Managers must also acknowledge a job well done by the entire team, for example, after the practice has completed a major project or met a target goal. "You need to have a pizza party, you need to have a luau, you need to do something," says Bee. "You've got to notice it."

Transparent management

As practices make changes due to health reform initiatives, managers must remember that change can be a scary thing for staff members. They may fear that their jobs are in jeopardy, or that leadership is going to change in a negative way.

To keep such fears from escalating, Laura Palmer, a senior industry analyst at the MGMA, says managers must be as transparent as possible during times of change - even if they don't have all the answers to provide staff.

For instance, managers should attempt to provide staff with an expected timeline regarding the project or transition, give them some sense of how it will affect the practice, make it clear that staff will be notified as soon as decisions are made, and reassure staff that providing great patient care remains a top priority.

Aubrey Westgate is senior editor for Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the July/August 2014 issue of Physicians Practice.