Practice Management Alert

How to leverage your practice’s scale for more efficiency and profit.

It has never been easier or harder to run a multi-location practice. Easier, because of the rise of online technologies that make record-sharing and communication between distant offices possible. Harder, because of the same financial, regulatory, and administrative challenges that all practices struggle with now (compounded by the scale of multiple locations).

For practices that are just opening their second location or facing growing pains with their tenth, the following advice can smooth the way to more profitable and effective operations:

Tie Your Locations Together Online

The biggest administrative obstacle for multi-location practices used to be the challenge of getting the right physical health records to the right location on the right day. “Patients don’t always go to the same offices, so in the old days, they would pull the charts the day before and the doctors would actually carry the charts with them to the other office,” remembers Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO AAPC Fellow, Vice President of Stark Coding & Consulting in New Jersey.

With the recent federally encouraged move toward electronic health records, that obstacle has been removed. Now all locations can share all records interchangeably, without the anxiety of misplacing patients’ important, private information. “The days of the chart hunt have been nearly eliminated,” says Elizabeth Holloway, Principal and Senior Consultant for BSM Consulting in Florida.

The same goes for Practice Management software, which should be easily accessible at all practice locations. Of course, even a single-location practice can benefit from great EHR and PM software, but these tools are absolutely essential to running a modern multi-location practice. Above all, experts recommend using a cloud-based system, rather than an on-site server. Physical servers “won’t always have the IT support or technology to connect everybody in remotely,” warns Cobuzzi, and they can be more vulnerable to failure or hacking.

Grow Your Own Staff

Staffing is a continual challenge for even a small, single-location practice. Reliable and self-starting employees can be so difficult to find, let alone retain when their skills are in high demand everywhere. Now multiply those staffing needs by multiple locations, and the challenge can seem overwhelming.

The surest solution to staffing problems (and one that multi-location practices are especially well-positioned to take advantage of) is training and promoting from within. Instead of searching everywhere for an experienced professional to fill a mid-level position, you can raise existing staff up a ladder of experience within your practice. That way, whenever a new position opens at one of your locations, there is an employee ready to fill it.

“If you have an employee in your front office who is hungry, wants to excel further in their career and is reliable, promote them, train them, and encourage them!” says Tina Allen, Operations Manager at Eye Surgeons of Indiana, a multi-location practice based in Indianapolis. “These employees already know your business and there is less of a learning curve.” Internal promotion is also the best way to make sure that your employees stick around: “Employees need to feel like there is opportunity for growth within your organization,” Allen says. Otherwise, you’ll always be scrambling to retain current employees and find new ones.

Save Money and Staffing Worries by Centralizing

Just because you have five locations doesn’t mean you need to staff each location in exactly the same way. One location might have shorter hours or fewer patients than another, for example. But most importantly, having multiple locations offers your practice a vital economy of scale: the ability to centralize certain operations.

At the top of the list for centralization is your coding and billing department. “You’ll have someone who can enter charges at each checkout desk,” says Barbara Cobuzzi, “but it’s unrealistic and wasteful to have a coding and billing operation at each office. Usually the practice has one centralized office. It might be in the main office or, as some practices are doing now, they rent cheaper space for their coding and billing office (because physician space is very expensive).”

Not only do you save money by hiring fewer staffers to cover coding and billing, but you also end up with much more consistent processes. Staff at each location aren’t making up their own separate systems, but instead submitting all charges in a single way dictated by the main billing office. And each office administrator can concentrate on creating a great patient experience, not on becoming a coding expert.

One counterintuitive process to centralize is call-answering. Front desk personnel may think of answering calls as an essential duty, but what it really does is take time away from face-to-face patient interaction. “Instead of having the calls come into the front desk, interrupting what it’s doing,”

Cobuzzi recommends “having the calls come into a centralized operator phone bank.” In one Detroit office she knows, “they have a small room with four operators, and they just handle phone calls and make appointments and forward the prescription renewals instead of bothering the front desk. It’s on site in the main office at this particular practice, but it doesn’t have to be.”

And while front desk staff need extensive training to handle patients, almost anyone can learn to answer telephones. That makes operators much easier to find, and much less costly to train and employ. Also, a front desk employee who isn’t distracted by constant calls is less likely to make mistakes that inconvenience or even harm patients.

Standardize Everything You Do

The surest way to save time and money is by setting up procedures for every task your practice performs. This is particularly helpful at a multi-location practice, which features many more staff members to supervise, all operating at (and sometimes rotating between) different offices. For quality control and smooth operations, standardization is a must.

“The receptionist will be more successful if all of the front desks are set up the same way and the check-in processes are identical between offices,” offers Holloway. “Having a uniform operations strategy also allows staff members to reduce errors, especially when the office gets hectic.” Compliance becomes much smoother too when the practice standardizes all its processes, because every rule finds its way onto a checklist.

Solve the Scheduling Puzzle

Real challenges crop up alongside the advantages offered by a multi-location practice. In particular, scheduling physicians, nurses and assistants can become much more difficult when they must travel from one location to the next on a daily basis.

Cobuzzi offers a picture of the potential complexity: “One doctor may be at location 1 on Mondays and Wednesdays, and location 2 on Tuesday mornings, and location 3 on Tuesday afternoons, etc. Depending on how the doctors are staffed, it can be hard for them to manage their days. It gets harder when a patient wants a specific location and doctor, and that doctor isn’t at that location at the time they want to come in. It’s hard enough getting patients the appointments they want anyway, but having multiple locations makes that harder.”

To ease this complexity (some of which is unavoidable), Elizabeth Holloway recommends analyzing the support staffing needs of each physician. “Some practices elect to have a dedicated team for each physician, and that team then travels to different locations with their doctor,” she explains. “Other practices choose to have all of the staff trained to work with all of the physicians, allowing staff to be more interchangeable between physicians and offices. Ultimately, staffing for each location needs to be aligned with the number of physicians and patient volume for each location.”

Staff flexibility can offer a major benefit. Holloway recommends that practices ask “where they can consolidate or share personnel, or train staff to move effectively between locations and functions. Cross-training is critical to having an agile workforce. When the team is knowledgeable and can work in more than one position in the office, we have better options to cover vacations and unplanned absences. I am also an advocate of training staff such that they can work with more than one physician.” The more flexibility and consistency within the support staff, the more easily the physicians can jump locations.

Communication is Key

The real challenge for multi-location practices is communication; with staff separated by (in some cases) many miles, how do you guarantee that everyone is on the same page?

“Communication between offices, physician partners, management, and staff must be frequent and consistent,” Holloway advises. Regular all-staff meetings should actually include all staff, and if gathering in a single location is impossible, then make sure that you have a reliable web conferencing service to make everyone feel included.

Beyond in-person meetings, electronic communication is essential to a practice with many locations. At her practice, Allen reports, “every Monday management sends out a ‘weekly communication’ email that includes information about who is out of the office, upcoming training sessions, MIPS reminders, tips on how to improve our patient experience, new projects on the horizon, etc.” Looping in staff will ensure that they don’t feel like they’re on a remote island unconnected to the main office.

What’s Good for One Location is Better for Multiples

Holloway points out that the same principles that lead to managing a single location well also apply to running multiple locations. “But when you start adding locations, you must be crystal clear on who you are as an organization and what you want to accomplish.” She offers a six-point plan to keep your compass as you grow:

1) Define your culture.
2) Be clear on your mission and goals.
3) Communicate those goals to employees in every office.
4) Invest in your people.
5) Develop systems and protocols to ensure patient standard of care
6) Celebrate success when goals are met.

Never Stop Learning

The above information is just a starting point. Ask for advice from friends and colleagues who work in other multi-location practices, and attend conferences whenever possible to hear from experts in the field. The procedures that can make your practice more efficient and profitable (no matter how many locations you operate) are out there for you to find and implement!