Lay management in a medical practice

By Vasilios J. Kalogredis, Esq.

As physicians know, the health care climate has indeed changed dramatically over the past several years. It is expected to become even more complex and competitive as time marches on.

In light of all of that, and with a clear understanding that good business help/lay management is needed to assist a practice in meeting its maximum potential, one of the key threshold issues any medical group must face is what kind of management is needed to make the practice successful.

Meeting Needs

There is clearly no one answer which will work for every practice. Some practices are able to get along quite nicely with an “up through the ranks” individual who has taken on the responsibilities and title of “office manager.”

In some settings, the physicians themselves are not of the mind set which would allow a lay manager/lay administrator to succeed. The doctors themselves want to manage the practice. Although, to a certain extent, the doctors should have the final say, it is increasingly rare where some sort of lay management would not make sense for a medical practice today.

Responsibilities

The duties of the individual or individuals managing one’s practice can vary a great deal. In some smaller practices, the primary responsibility of a manager is to deal with personnel management issues.

Too often, physicians have not communicated as well with their staff people as they might. Sometimes, it is because of their attitudes. In other situations, it is because of a lack of time or training. Therefore, in many medical practices, personnel management could be greatly improved with the positioning of a good office manager in the practice.

Lay management also can play a key role relative to the business systems side of a practice. This would include making recommendations to the physicians and implementing the agreed-to changes.

Depending upon the type of practice with which one is involved, it is not unusual to find that a good manager has a much better understanding of the nitty-gritty aspects of the practice than the physicians who are busy practicing medicine. It is important for doctors to recognize and take advantage of what their manager is able to provide them in the way of input in this regard.

By having good management help in properly delegating the managerial responsibilities, physicians may find relief from many of the aggravating, day-to-day hassles. Good managerial help may serve as the practice’s intermediary with the group’s advisors (attorney, accountant, consultant, investment counselor, pension people, insurance people and the like). With a manager properly handling these matters, the physicians are left free to deal exclusively with the decisions that require their input, once the manager has gathered and presented all of the facts and options in a good fashion.

Among the types of tasks which a good manager should be able to handle would be coordinating the move to a new office, opening up a satellite office, directing office renovations, dealing with asset acquisitions, interfacing with managed care companies and the like.

Qualifications

The qualifications and background of the individual or group of individuals to whom one will delegate the management functions can vary widely. Many smaller practices have had an individual move up through the ranks because of seniority and loyalty. Other practices have hired “lay administrators,” hired specifically to manage. Quite often, those individuals have experience in other settings where they have been a manager or a supervisor. This individual might have more in the way of degrees, as well (an M.B.A., for example).

In today’s world, it is not unusual to see practices engage the services of a professional practice management company, a management services organization or other companies which would provide the management services that a practice is seeking.

Attributes of a successful managerial relationship include having people in place with intelligence, perceptiveness, personality, loyalty to the practice, the willingness and ability to deal with people and a good work ethic. If a practice has such an individual in its ranks, it is indeed fortunate.

The problem in some practices is that, although they had an excellent receptionist, secretary, nurse, bookkeeper or other employee who had performed excellently in that particular role, when given managerial responsibilities, some of those individuals were not able to handle it. That can cause problems all the way around.

No matter how one goes about selecting management help, a key to success is how the physicians interface with that individual, how they develop the role of the manager in the practice and how they set the tone for the manager’s responsibilities and authority with the staff and other people. Unfortunately, in many settings the manager is given a title without the authority and clear definition of what is expected. It is very important to set forth, in writing, exactly what is expected so there will be much less chance of a misunderstanding.

Many managers have complained that they are blamed for everything, but are not supported when they make a decision about what should be done (responsibility without authority).

Developing a Good Managerial Relationship

Good management requires plenty of thinking and planning time. A good manager is able to appropriately delegate tasks. This requires not doing everything oneself. It also requires knowing to whom to delegate specific tasks to get the best results. It is unfortunate, but many managers who have worked their way up the ladder within an organization have trouble giving up responsibilities because they believe that “no one can do it as well as I can.” To be maximally effective in a managerial role, one must get past this.

In any managerial relationship, it is important that the physicians not undercut the manager. A good example of this is in the area of personnel management. If you have a manager in place, support that manager in his or her relationships with the lay staff. You will be doing everyone a disservice if your office staff believes that they can bypass the manager and go directly to the physician or physicians. If you allow that to happen, you will find that you have defeated the goal of becoming less involved in the day-to-day activities and you will also find that your manager will be much less effective.

If properly structured, a manager is a funnel through whom communications between the lay staff and physicians may flow. This does not mean that physicians should not have a friendly communication with their staff. It also does not mean that there should not be office staff meetings. However, it does mean that the manager should be the person through whom routine communications should be handled.

At least in those settings where the physicians continue to own the practice, one should not lose sight of the fact that the physicians/owners are still the bosses. The physicians must manage the manager. The doctors are still ultimately responsible.

In many group practice settings, the physicians may allocate certain areas of responsibility amongst themselves. Different doctors might interface with management regarding different areas. For example, in a smaller group practice, one physician might be the personnel partner, another might be the systems partner, another might be the financial partner.

Communication between the manager and the physicians should be a two-way street. The physicians must provide guidance. At the same time, the office manager should be responsible for keeping the physicians abreast of what is going on.

It might be wise, in many settings, to have at least one physician (perhaps the president/CEO) to have at least a 15-30 minute meeting with the manager everyday or so (at least once a week) to go over things. Also, there should be at least a monthly meeting of the physician/owners and the manager to review various matters.

It is important to have your manager involved in at least part of the inter-doctor business meetings. If the manager has the capability to handle things in this fashion, it elevates this individual to an “executive position.” That individual would participate in decision-making, even if the physicians really have the final say (which is usually the case).

The manager will prepare the agenda for the meetings, keep the minutes, present financial information, be primarily responsible for implementation of decisions made at the meetings and the like.

Corporate Management

In today’s world, many practices are getting away from the individual office manager and undertaking a relationship with a corporate manager. They might contract with a management company, management services organization or other entity which will provide the practice with management services.

There are obviously pros and cons to this approach. Usually, this sort of an arrangement does not work as well when dealing with a smaller practice. Larger practices will sometimes get involved with these groups. Obviously, if a physician works for a larger employer (whether it be part of a hospital system, a management company which has bought the practice or other organization), then the true managerial control might rest with this corporate entity as manager.

As is true in any such relationship, the physician cannot assume that he or she will no longer have to worry about anything if someone else is given the title of manager. This is true whether or not the manager is an individual or a corporate entity.

As a matter of fact, in some instances these corporate entities have less experience and are not as effective in managing practices as a solid, individual lay administrator might be. There is no canned answer. Obviously, it is difficult to generalize. The decision must be made after giving things much critical thought.

The important thing is to check references very carefully to see if the manager can do what you want, and to see if what you want is what they can do.

Vasilios J. (Bill) Kalogredis, Esq., is president and founder of Kalogredis, Tsoules and Sweeney, Ltd., a health care law firm, and Professional Practice Consulting, Inc., a health care consulting firm in the Philadelphia area.