How to Save a Practice 101

For today's independent practice, dealing with the external factors affecting the healthcare industry can be overwhelming. There is an abundance of compliance measures from both Medicare and third-party private payers to heed, as well as various regulatory requirements, such as the upcoming rules under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA).

This is where a guy like Will Latham comes into the picture. Latham, based in Chattanooga, Tenn., runs Latham Consulting Group. He assists practices in several areas, including governance, consolidation and merger guidance, compensation structure, and more.

Quite simply, Latham can help practices navigate the murky waters of today's tumultuous environment. At this year's Medical Group Management Association (MGMA) annual meeting, held in San Francisco, he will be presenting at an interactive session on Wednesday Nov. 2 at 10 a.m., "Can this Practice be Saved?" Physicians Practice talked with Latham about this session, the biggest challenges he sees practices facing, and more.

Below are excerpts from the interview.

Talk about your work as a practice consultant and how you help medical groups and practices successfully operate in today's complex environment?

I've been providing consulting services to medical groups for about 28 years. The areas I focus on are helping groups develop strategic plans. I facilitate a lot of planning retreats. I help a lot of groups with mergers, the consolidations going on. Quite often, groups need help through that negotiation process. I also help with practice governance. … Most of my work tends to have some kind of facilitation effort. A lot of times consultants come in, review a situation, drop a report, and leave it up to the group to decide for themselves what they are going to implement. I found that to be troublesome because physicians don't always see the same future.

What are the biggest challenges that you see practices facing today?

Of course, the external world is an increasingly threatening place to independent practices. There is a lot of consolidation, health plans are consolidating, and hospitals are continuing to acquire practices, and national practice-management companies are trying to buy practices. The external world is tougher. There are so many new regulations and requirements and increasing need to have a strong information technology infrastructure, which costs money and time and effort. We're moving to this whole value-based compensation reimbursement system, where you are paid more for value and not so much for volume. We're still early in that transition, but people are very worried about that. So it's a threatening external environment, and then internally, the biggest challenge is governance. In light of all those changes, having a system to make decisions and decide how the group is going to move forward [is best].

Give us a preview of your session at MGMA16 - it's Wednesday, the last day of the conference - why should people stick around and attend?

This is a great program. It's not someone standing up and lecturing to the group. It's a hands-on, case-study type program. Managers can take their experience and they are presented with a taste of (a hypothetical) medical practice dealing with issues that I've talked about - aging partners, challenges in their local environment from hospital systems and managed care plans. Each one of the participants is given a persona - a younger physician, middle-age physician, and an older physician - each participant is assigned to play one of those roles. They spend time negotiating how their practice is going to move forward. It's a pretend board meeting made up of these different personas. They sit and organize how they want to move their practice forward.

It's an exponential type process. It's a case study and it gives them a chance to test out the tools they've picked up in other sessions, or through their experience, and negotiate from their persona's perspective where the practice is going. We've done this a few times and at the end of the session, the participants have raved about how much fun it is and how much they enjoyed the negotiation process, as opposed to sitting in a class and getting lectured [to].

More often than not does the practice get saved?

Usually they negotiate a solution and move forward. Ultimately, the proof would be in how their plans play out. In this session, we're trying to get to participants to consider the issues they are facing from a different perspective … and negotiating a plan to move forward. Typically, we'll have six to 12 board meetings going on at once. In those, we may have a few that can never negotiate a solution. Most of the participants, however, come up with some plan they've agreed to, to use to try to deal with physician retirements, new facilities, or IT [problems]. They'll come up with plans to move forward.

Why are these strategies helpful for today's practice?

I think part of the reason why MGMA is moving to these programs is they have a lot of experienced managers who come to the conference, attend for several days, and enjoy learning specific things, but are looking for new experiences or ways to use information they've gained. [MGMA] is trying to have more programs that are case study/hands on, rather than traditional lectures. Most are presentations … some have audience interaction, but something like this, 99 percent of this program is audience participation.

In terms of the strategies, each situation is unique. One that works in one place may not work another. One that I think applies [to every independent practice] is to find ways to get bigger. Find a larger organization that can afford the infrastructure [you need] to be successful and management that can put the resources in place that are needed.

Managers love this sort of [session] because they can flex their mental muscles. I hope people come to try and use their cognitive abilities.