Medical Practice management represents everything that goes into the practice of managing the finance and administration of a doctor's office or an office of a medical professional. It consists of financial management and business operations, information technology and medical practice management systems, patient management, compliance, quality control and risk management, human resources, and organizational operations.
Change occurs in every industry, and healthcare is no exception. New technologies, trends, regulations, and research continually shape the industry. The implementation more than a decade ago of the Affordable Care Act and the move from fee-for-service to value-based care have impacted patient care and the way physician practices operate.
Although doctors have administrative tasks in addition to their focus on patient care, it’s almost impossible for them to manage their practice without assistance. That’s where practice management comes in.
According to the American Academy of Professional Coders (AAPC), the role of a practice manager is to manage all aspects of a medical practice, including financials, human resources, information technology, compliance, marketing, and operations. Their goal is to enhance patient care, ensure day-to-day operations of the practice run smoothly, and alleviate administrative burden on the physician(s).
The key component to running a successful physician practice is proficient financial management. Even if a clinician provides excellent care to his or her patients, the practice isn’t going to be sustainable without the necessary revenue.
Myriad facets are necessary to achieve and maintain streamlined financial operations, and many of them fall into the category of revenue cycle management (RCM).
RCM is defined as all administrative, financial, and clinical functions that contribute to the capture, billing, collection, and management of patient service revenue.” Some of these functions include:
One metric many practice managers utilize to accomplish these functions is relative value units (RVUs). Through a cost analysis based on RVUs, physician practices are able to establish productivity-based compensation, evaluate and renegotiate payer contracts, evaluate procedures and services, and set practice fees.
Two key functions that should be included in financial management of a practice are medical billing and coding audits. By auditing and analyzing past results of your practice, you achieve an in-depth review of your practice’s performance and identify what improvements might be needed for optimal efficiency.
Focusing on patient care should be the goal of every physician. As noted by MGMA, patient-centered care refers to the ability to create an environment and develop processes that support the best possible patient encounters. A practice manager can assist in that endeavor by performing care coordination, striving to ensure patient safety, and optimizing office workflow to promote patient satisfaction.
Patient satisfaction can be increased through patient engagement because those who are fully engaged in their care are more likely to maintain treatment plans, track their health and ask their providers questions. Technologies such as patient portals, automated appointment reminder systems, check-in applications, telehealth, digital payment options, and data analytics have been found to have profound impacts on both patient engagement and practice workflow.
Another role of a practice manager in patient management is supporting and overseeing quality initiatives and measurement activities. There are three types of quality measures in healthcare: structural, process, and outcome. One such measure is the Institute for Healthcare Improvement (IHI) Triple Aim of healthcare, which is designed to improve the patient experience of care and the health of populations and reduce the per capita cost of healthcare.
It takes a skilled team of physicians, nurses and support staff to run a successful practice. Most functions of the office that center on these employees are the job of a practice manager. However, human resource management is not solely about recruiting, hiring, retaining, and dismissing staff members. It’s about handling the scheduling, processing payroll, conducting clinical and administrative training, developing personnel policies and procedures, performing staff evaluations, and more.
Developing and administering compensation and benefits programs for practice employees is essential in human resource management. Processing payroll is just one part of this process. A practice manager has to have knowledge of different physician compensation models, ensure compliance with federal, state, and local employment laws and regulations, and which benefits best assist in recruiting and retaining staff members.
Before hiring a new physician, a practice manager must perform medical credentialing. Also referred to as provider or physician credentialing, it’s an extensive process that examines and reviews a provider's qualifications and career experience and is required to be completed before he or she is hired. Areas covered during medical credentialing include education, certification, training, and licensing.
According to the American College of Medical Practice Executives (ACMPE) Guide to the Body of Knowledge for Medical Practice Management, additional human resource management skills are:
Utilizing technology in healthcare can reduce costs by automating administrative tasks for more efficient use of physicians’ time, lowering staffing costs by using scheduling apps, reaching more new patients with targeted digital marketing, improving claims processing and collections, and optimizing the supply chain for value-based care. Most of these solutions are designed to help physician practices streamline workflow, reduce administrative burden, and improve patient care.
Managing IT in a physician office entails assessing the need for and selecting medical practice software and other solutions that securely integrate clinicals and financials, offer comprehensive reporting features, include broad vendor support, promote adherence to compliance regulations, and streamline revenue cycle functions. It also consists of planning and conducting employee training on technologies used in the practice and ensuring staff members know how to optimize the capabilities.
One of the primary technologies used in physician practices is an electronic health record (EHR) system. A well-designed EHR should be customizable for your practice’s specific needs and automate time-consuming administrative tasks, allowing you to focus more attention on patient engagement and experiences. It also must provide secure, real-time access to patient health information at any time and from any location.
Following the numerous guidelines of HIPAA, MACRA, OSHA, the Stark Law, CMS, and the HHS Office of Inspector General, and others is part of the responsibilities of a practice manager. They’re also tasked with establishing and monitoring quality standards, ensuring highest levels of data encryption, mitigating all possible emergency situations, and addressing potential legal issues all while ensuring compliance with state and federal regulations.
Practice managers and the physician(s) for whom they work can avoid significant personal and entity liability by:
Risk management also is essential to sustain a financially-secure physician practice. The skills of a practice manager in mitigating risk include continually assessing potential medical practice risks to prevent malpractice suits, loss control issues, and government claims of abuse; communicating consistently to medical practice staff via most appropriate media the commitment to minimize risk and maximize compliance to ensure high-quality patient care; investigating all claims against the practice and its physicians and staff to ensure patients and staff are treated correctly; and negotiating contracts (including capitation agreements) with payors, contractors, vendors, and other outside resources to eliminate risks for the practice.
In addition to managing the daily operations of a physician practice, developing and administering policies and procedures to establish office standards and ensuring quality customer services encompass only part of a practice manager’s role. Operations management objectives also encompass implementation of an effective business plan; process improvement; purchasing and asset management; identification of outsourced business services and external expertise; communications, marketing, and community relations; and creation of physician conduct and performance expectations.
Key business and clinical operations skills a practice manager should utilize are: