Becoming a Successful Practice Manager

The charismatic practice manager starts out by knowing her job and the staff assigned to her, and by planning, setting priorities, and meeting deadlines. But she also is able to communicate what her goals are for the practice and takes the time to explain why certain tasks are required, where the practice is headed, and how it is going to get there. Accomplishing the mission within the capabilities of the practice and the resources allowed, while maintaining high morale, is the goal of every practice manager. An astute practice manager can become a high achiever by applying basic management and leadership principles to the practice of which she is a part. The manager begins this process by becoming as professional in her duties as she can. Here are five aspects of this process:

 1. Knowing the job

The basis of successful leadership is making things happen through people, but first a practice manager must know her job. The team she is working with will give her some slack when she is new to the practice, but that slack is rapidly used up if she does not seek to learn all she can about the practice operations. In the long run, staff will care only whether she knows what she is doing, especially in difficult tasks.

2.  Planning

Accomplishing the mission requires planning and monitoring. Planning is the development of action steps needed to achieve an objective or goal. The Ability to plan is closely related to the other skills required of practice managers, such as anticipating requirements, establishing priorities, and meeting deadlines. The plan should be flexible enough to handle the changes that inevitably will occur.

3.  Implementation

Once the plan is set, the practice manager has to consider priorities and prepare to meet deadlines, because she will never have the luxury of working on only one task at a time. A physician practice is much too dynamic an organization to permit single task operations, and the practice manager has to learn how to keep several balls in the air simultaneously. It is a skill that starts with a plan, just like organizing homework and professional responsibilities at school. Last-minute preparations rarely camouflage the lack of a routine approach to tasks. A methodical daily effort will produce well-qualified and motivated team members as well as an efficient practice. Crisis management and its negative impact on morale must be averted wherever possible.

4.  Monitoring progress

A good plan must continually be monitored. There is a military adage that “you get what you inspect, not what you expect.” Practice managers should never just assume that a plan is working. Rather, managers must monitor effectiveness by following up on it by becoming personally involved.

5.  Motivation

Mission accomplishment and high morale occur in tandem. In other words, good practice managers get the job done and maintain high morale. The ability to get others to respond is a primary leadership requisite. The least a practice manger can learn to do is to delegate effectively. The ability to inspire others to perform is more difficult.

A practice manager must apply fundamental principles of administration and leadership as she learns how to accomplish tasks with her staff. Effective practice management is the ability to influence people so that they willingly and enthusiastically strive toward the achievement of practice goals. Hard work and high morale are compatible and good practice managers can inspire and direct their people under both normal and adverse conditions.


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Job Classification

Recently I read a discussion in a medical association journal regarding exempt vs nonexempt job classification and thought I would comment on the topic.  Physician employers must be ever vigilant when seeking to classify an employee as salaried and exempt from overtime pay.

It is a recurrent challenge for human resource professionals: Determining whether an employee is exempt from the overtime requirements of the Fair Labor Standards Act (FLSA). The FLSA is the federal law that governs minimum wage, overtime pay and working hours. Consequently, the classification criteria for exempt and nonexempt workers are part of that law. It is the employer’s responsibility to determine whether to classify an employee as exempt or nonexempt under the FLSA. The key consideration: Exempt workers aren’t eligible for overtime pay. Rather, they’re paid for the job they do, not the hours they keep.

I have often seen practices classify an employee as “salaried” with the belief that they then do not have to pay overtime to this employee. However, it is not nearly that simple. Recently there was an article in the Wall Street Journal (“Can You Sue the Boss for Making You Answer Late-Night E-mail?”) discussing the legalities of overtime pay for employees who answer late-night e-mails and texts over the weekend. To comply with the FLSA, employers need to regularly review their employee classifications. Generally, two requirements must be met to classify an employee as exempt: 1) they must earn a salary and 2) hold a position with duties the U.S. Labor Department designates as appropriate for exempt positions.

Employees whose jobs are governed by the FLSA are either “exempt” or “nonexempt.” Nonexempt employees are entitled to overtime pay. Exempt employees are not. Most employees covered by the FLSA are nonexempt. For most employees, however, whether they are exempt or nonexempt depends on (a) how much they are paid, (b) how they are paid, and (c) what kind of work they do. These requirements are outlined in the FLSA Regulations (promulgated by the U.S. Department of Labor). Most employees must meet all three “tests” to be exempt: salary level test, salary basis test, and the duties test.

The differences between exempt employees and nonexempt employees can cause a lot of confusion for both workers and employers. Whether or not you are entitled to minimum wage and/or overtime pay for working more than 40 hours per week depends on your exemption status, as governed by FLSA. The FLSA regulations concerning salary basis employees require at least a minimum of $455 per week for consideration as a salaried employee. Some states have a higher minimum weekly wage for salaried employees. To complicate matters further, many states have wage and hour laws that may have more requirements than the FLSA. Employers must make sure they abide by both federal and state wage and hour laws to avoid legal trouble.

Furthermore, there are other issues to consider such as employee comp time and breaks. Although there are exceptions, it’s usually illegal to give nonexempt employees comp time (time off) instead of paying them overtime. Employers also need to make sure they follow federal and state law requirements regarding breaks, including meal breaks, for workers. The FLSA doesn’t require meal or rest breaks, but many states have laws that do. For breaks to be unpaid, the employee normally must be relieved of all work duties. Rest breaks of less than 30 minutes must be on the clock.

It is extremely important to take the time to periodically review the classification of your employees. To help in that endeavor, there are free FLSA exemption test questionnaires on the Internet. However, there are many nuances to consider as it relates to your particular practice and you should have a qualified individual carefully review your employee classifications.

The Truth Regarding ACOs

The Centers for Medicare & Medicaid Services (CMS) released 2014 financial performance results for Medicare Accountable Care Organizations (ACOs) and despite CMS’ press release on the subject, the true results are still dismal.

Several months back, the National Association of ACOs (NAACOS) produced a report showing that of those participating in the Medicare Shared Savings Program, 66% did not intend to stay with the program and another 26% were undecided.  The president of NAACOS stated that if CMS doesn’t address issues, the program “will no longer exist and the high hopes of DC policy-makers to migrate ACOs to capitation and two-sided risk will be impossible.”  This report showed that respondents reported an annual mean of $1.5 million management costs directly attributable to ACO operations.

In CMS’ recent report, they correctly note that Pioneer ACOs “tend to be more experienced, have an established care coordination infrastructure, and assume greater performance-based financial risk.”  What they don’t mention in this release is that 37.5% of the original Pioneer ACOs have dropped out of the program.  “The drop in Pioneer ACOs is significant, because the shared-savings ACOs are supposed to end up looking like the Pioneer ACOs,” said David Muhlestein, PhD, director of research at Leavitt Partners, a Salt Lake City healthcare intelligence firm that tracks ACOs.

Of those remaining in the Pioneer ACO program, the CMS report shows that 11 qualified for shared savings payments.  It also notes that 25% of the Pioneer ACOs generated losses with penalties totaling $9 million to be paid back to CMS.  Leading health economist Paul Keckley, Ph.D. has commented that “It’s going to cost ACOs more than they save.”

Dr. Robert Pearl, chairman of the Council of Accountable Physician Practices confirms this notion.  “While ACOs might receive payment on a prepaid basis, the physicians and hospitals inside the ACO are often still reimbursed based on volume.  As a result, providers often don’t have an incentive to work together to find more effective ways to deliver clinical care. And when patients seek care outside of the ACO, physicians are at financial risk for care that may be unnecessary or inappropriate.”

So, are ACOs sustainable?  It most certainly does not seem so at this point in time.  As Dr. Pearl stated, “Even among the most efficient practices, the cost of delivering care must be adequately funded.  When payments are too low for physicians to deliver quality care and keep their practices viable, there is no good solution.”  And once again, healthcare reform fails to consider physicians as stakeholders.  “Physicians often feel relatively powerless and struggle to commit fully to the goals of performance improvement and cost containment,” says Dr. Pearl.


Contact ABISA, a consultancy specializing in solo and small group practice management.  Visit us at

Green Hospitals

Going green has been a trend recently, partly due to its popularity as a concept and also as a potential avenue to save certain costs.  “At Virginia Mason, we select sustainability projects that benefit health and well-being, either through improved quality of care or improved quality of life,” says Brenna Davis, Director of Sustainability at Virginia Mason.  “If a project is outside these parameters, then it is not core to our work, and we do not pursue it.”  Indeed many hospitals want to “go green” and modify their energy consumption, waste disposal and chemical use to lessen their impact on the environment.  Brian Bravo, Corporate Procurement Officer and Director of Materials Management at Broward Health states, “Broward Health has been able to divert over 2,870,370 pounds of waste from landfills within just three of its reprocessing of single-use devices, operating room waste reduction, and integrated waste-stream solution programs alone and has been able to save $1,897,609 with these programs.”

Wharton University of Pennsylvania produced a report this year on the topic of building sustainability in hospitals.  Here are some of the highlights of the report:

94% of hospitals say they want medical product manufacturers to lower the cost of their sustainable products.

90% of hospitals would like their existing products to be made more sustainable.

90% of hospitals state they want medical product manufacturers to provide information on sustainability benefits.

80% of healthcare professionals claim the cost of implementing a sustainable program is a major barrier.

79% of healthcare professionals cite green product affordability as a barrier to implementing a sustainable program.

69% of healthcare professionals state availability of green products is a concern.

60% of healthcare professionals claim they have a strong commitment to sustainability from top management.

55% of healthcare professionals believe that sustainability improves health outcomes.

The report also notes that hospitals expect to increase sustainable product purchasing in 2016 by 45% and the report deduces that the healthcare industry would save $15 billion over 10 years by implementing energy conservation programs, reducing waste and purchasing products more efficiently.

The report can be found here.


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