Managing the rate of change in healthcare has been the most challenging aspect of the job for practice managers, said Steven Burkett, CEO of UT Medical Group, one of the southeast’s largest practice management groups.

 

“In relatively short periods of time, many issues can change rapidly and fairly dramatically,” he explained, “whether it’s recruiting physicians, or medical professionals figuring out how to balance their careers with their teaching and research passions as well as their clinical care passions, or issues relating to reimbursement and capital financing.

 

“For instance, 10 to 15 years ago, a physician group practice didn’t need a compliance department, or credentialing, security IT, and other recently required functions within a group. All of those things bring expense to a physician practice and not necessarily any additional revenue. As the world around us and business in general gets more sophisticated and happens at a faster rate, and when the economy is more volatile, so it is with the physician practice.”

 

Even though trade journals tout small businesses as the stalwart of the economy, it’s more difficult for solo practitioners, or even practices with five to 10 physicians, to attract the necessary personnel and capital, and to handle business functions such as marketing, negotiating insurance contracts maintaining computer technology services, said Burkett.

 

“Myriad things have to be done to successfully position a physician or physician group in the marketplace,” he said. “My hat goes off to many, many clinicians and practices because they have some of the toughest challenges I’ve ever seen. With

 

the economy as it is today, it’s likely to get worse before it gets better. That’s simply my opinion, of course.”

 

From a business perspective, difficult decisions not only involve payroll and HR functions, but also making long-term decisions that keep practices on the offensive, not the defensive.

 

“How do they strategically plan? How do they position themselves? How do they determine where services are going to lead over time? Take the emergence many years ago of ambulatory surgery. How long has it been since most procedures typically done in a traditional inpatient surgical setting have been overshadowed by those being done on an outpatient basis? I don’t see how smaller physician groups do well without access to such information and business support.”

 

The federal push for electronic health/medical records (EHR, EMR) will add to the labyrinth maze of issues facing physicians.

 

“The advent of electronic records marks the introduction of a new technology into the practice of medicine, which has been going on for eons,” he said. “Changing the process and work flow of physicians gets into the personal characteristics of how a physician wishes to care for patients. The electronic format requires standardization in a way that paper doesn’t. Do I believe there’s great value in electronic records? Undoubtedly. But it will take time and a generation of physicians utilizing the EHR to realize the benefits of the electronic record and not just consider it an electronic repository. It is a tool that will help us as patients while also creating opportunities to improve health status with populations. For example, Memphis has a bad reputation for obesity, and diabetes. The EHR could be used by physicians and patients to educate and better manage those conditions.”

 

Burkett said the key to making electronic records commonplace rests in behavioral change.

 

“People who develop the EHRs and technology supporting the delivery of care must understand how their products impact the workflow of physicians and other clinicians. Medical professionals will come to understand what they have to do differently to use the technology, and how the process helps them take better care of their patient, gives them greater value, and provides greater patient satisfaction. You’re going to see a lot of activity around electronic records over the next several years, and will look a lot like going on a diet and increasing your exercise to lose weight. Not many people will like it initially.”

 

Concerning the Memphis safety net system, Burkett is optimistic about The MED hiring new CEO Reginald Coopwood, MD. He also believes they have achieved a brief window of financial and operational stability, “a period of time to right the ship and size the services,” he said. “I’d be surprised if we saw the Emergency Room close or close certain services in the immediate future. That doesn’t mean they wouldn’t go on diversion. Given the governor’s call for a plan for The MED in his budget message this year, people in the medical community are paying a lot of attention to The MED. Simply consider Mayor Ford’s initiatives.”