Secrets to Great Physician-Administrator Teams

For medical practices to truly succeed, the defined lines between physicians, administrators, and how they interact need to be blurred. 

That was the message delivered by pediatrician Rebecca Fox and practice administrator Lucien Roberts during their session, "Blurred Lines: The New Administrator-Physician Teams," presented at the 2014 Medical Group Management Association (MGMA) Annual Conference on Mon., Oct. 27.

"To have my administrator be more successful, I need to meet him halfway and learn new things," said Fox, of Leesburg, Va.-based Loudoun Pediatric Associates. "I need to meet him halfway … in preparing for the health of my practice."

From the physician perspective, Fox said that her first thought is patients: getting them on her schedule, getting them seen, and getting them well. But the job of practice administrator has become more complex, from dealing with various federal and state regulations to negotiating with payers, so physicians need to not only focus on the wellness of their patients, but the well-being of their practice with equal dedication.

One example of where physicians need to learn new things and must work with administrators to address is coding and documentation, said Fox and Roberts. If you are in a group where one physician's coding and documentation lapses are costing money, it isn't just that provider's problem.

"If you have somebody like that [at your practice], you need to have a spine and say, 'This is not just about you … it is affecting me too,'" said Fox. "It affects all of us at the practice. That will hit some [physicians] hard … but you need to sit physician-to-physician and say it is not just about you but us."

Another area where physicians and administrators need to communicate and be united is in human resources, noted Roberts, an assistant administrator for Gastrointestinal Specialists in Glen Allen, Va. If you have a problem employee, don't just rely on the administrator's skill set, rely on the skill set of your physicians.

"Physicians don't like to deal with [human resources issues]," Fox said. "But you do it every day with your patients. We discuss difficult, gut-wrenching decisions with them, so you have the skill set to do this with employees at your practice. As physicians, we need to bear witness and back up our administrators."

Roberts said both physicians and administrators need a "common language" when it comes to finances. The goal, he said, is to get physicians to see if they are earning their keep when it comes to their patient panel and what they truly contribute to the practice.

The key and an ideal place for practices to start, added Fox, is to "give physicians a worksheet - we love worksheets because we love to have all the answers," and have them provide five numbers: total days the provider worked; total charges; total number of patients; the cost of the provider (including salary, malpractice, overhead, etc.); and their collection rate percentage. Then, utilizing a formula with information from the administrator (the pair prepared this "breakeven analysis worksheet" for attendees), you can determine the physician's financial contribution to the practice.  An ideal outcome is a positive profit per day for all your providers.

"We want someone profitable for the practice," Fox said. "It helps prove to the physician, 'Am I earning my keep? Am I helping this practice?'"

Roberts added that while the manager can help, it is important for the physicians to do the calculation so they get the true value and compare with peers at the practice. "They'll compare," he said. "They love to know their numbers, but they'll also want to know others'."

Fox added that often, there's the perception that physician don't care about that information, but it's that the lines of each person's role and responsibilities stopped the transfer of knowledge.  And these days, those lines need to be blurred.

"It's not that I don't care [about my contribution to the practice], it's that I don't understand," she said. "We don't know this, but we can learn it, so it's not that we don't care, administrators. The business of medicine has changed and we need to work together … to share and evolve.  We can't each stay in our little boxes anymore."