Consolidations and mergers have dramatically changed the face of the medical practice. From governance issues to information technology, today's practice managers face a host of new complexities and competing priorities that demand more robust skills and knowledge than ever before.
Fundamentals of Medical Practice Management uniquely addresses the educational needs of the modern practice manager. The author, who studied under quality guru W. Edwards Deming, combines a focus on quality and excellence with an important thesis: that working together and putting people first is the best path to success in healthcare.
The author argues that win–lose games and quick-fix solutions have begun to deliver diminished returns in healthcare—not only economically but emotionally and societally. Although the book delves into many practical topics, its aim is to shape the reader's mind-set for a new era of people-focused practice management.
Fundamentals of Medical Practice Management covers these areas and more:
• Information technology and management
• Regulatory issues, law, and practice management
• Strategic planning, project management, and marketing
• Third-party payers and revenue cycle
• Human resources management
• Quality and emergency management
This book will appeal to a wide range of learners, including those in organizational programs, undergraduate and master of health administration programs, and practice management certificate programs. Its insights will not only prepare those new to the field but also help current practice managers to retool and refocus.
Consolidations and mergers have dramatically changed the face of the medical practice. From governance issues to information technology, today's practice managers face a host of new complexities and competing priorities that demand more robust skills and knowledge than ever before.
Fundamentals of Medical Practice Management uniquely addresses the educational needs of the modern practice manager. The author, who studied under quality guru W. Edwards Deming, combines a focus on quality and excellence with an important thesis: that working together and putting people first is the best path to success in healthcare.
The author argues that win–lose games and quick-fix solutions have begun to deliver diminished returns in healthcare—not only economically but emotionally and societally. Although the book delves into many practical topics, its aim is to shape the reader's mind-set for a new era of people-focused practice management.
Fundamentals of Medical Practice Management covers these areas and more:
• Information technology and management
• Regulatory issues, law, and practice management
• Strategic planning, project management, and marketing
• Third-party payers and revenue cycle
• Human resources management
• Quality and emergency management
This book will appeal to a wide range of learners, including those in organizational programs, undergraduate and master of health administration programs, and practice management certificate programs. Its insights will not only prepare those new to the field but also help current practice managers to retool and refocus.
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Overview
Consolidations and mergers have dramatically changed the face of the medical practice. From governance issues to information technology, today's practice managers face a host of new complexities and competing priorities that demand more robust skills and knowledge than ever before.
Fundamentals of Medical Practice Management uniquely addresses the educational needs of the modern practice manager. The author, who studied under quality guru W. Edwards Deming, combines a focus on quality and excellence with an important thesis: that working together and putting people first is the best path to success in healthcare.
The author argues that win–lose games and quick-fix solutions have begun to deliver diminished returns in healthcare—not only economically but emotionally and societally. Although the book delves into many practical topics, its aim is to shape the reader's mind-set for a new era of people-focused practice management.
Fundamentals of Medical Practice Management covers these areas and more:
• Information technology and management
• Regulatory issues, law, and practice management
• Strategic planning, project management, and marketing
• Third-party payers and revenue cycle
• Human resources management
• Quality and emergency management
This book will appeal to a wide range of learners, including those in organizational programs, undergraduate and master of health administration programs, and practice management certificate programs. Its insights will not only prepare those new to the field but also help current practice managers to retool and refocus.
Product Details
ISBN-13: | 9781567939330 |
---|---|
Publisher: | Health Administration Press |
Publication date: | 10/04/2017 |
Series: | Gateway to Healthcare Management |
Sold by: | Barnes & Noble |
Format: | eBook |
Pages: | 341 |
File size: | 9 MB |
About the Author
Read an Excerpt
CHAPTER 1
THE ORIGINS AND HISTORY OF MEDICINE AND MEDICAL PRACTICE
Not everything that counts can be counted, and not everything that can be counted counts.
— William Bruce Cameron
LEARNING OBJECTIVES
* Appreciate the history of medical practice.
* Explore the eight domains of medical practice management.
* Understand the forces of change affecting medical practice.
* Develop a perspective on the changes affecting medical practice.
* Understand the importance of the medical practitioner.
Introduction
Healthcare tends to be an accurate barometer of US society. Consider that virtually every aspect of social dysfunction, or of the human enterprise in general, becomes intertwined with the healthcare system. Most of the US population is born in a hospital, and many die there. The healthcare system is a place of joy and sorrow, hope and despair. The importance of the health system is hard to overstate, and the role that the medical providers play is a key factor in how the future system of care will take shape. This near-universal involvement with the healthcare system of virtually every person makes healthcare an accurate barometer of our society.
Often, the physician practice is the first line of care delivery, and for many patients, the physician provides the longitudinal care that sustains health and well-being (DiMatteo 1998). Therefore, the medical practice is a fundamental component of the healthcare delivery system, making the management and leadership of the medical practice a key to reforming that system. Because the physician practice is often the entry point for most patients into the healthcare system, in many ways it embodies the challenges of practice management, and the choices made to overcome these challenges may be endless and require achieving a careful balance of the art and the science of management.
This balance requires what W. Edwards Deming, the father of modern quality management, referred to as "profound knowledge," as well as the expertise to know when and how to use it (Deming Institute 2016). Deming's concept of profound knowledge is based in systems theory. It holds that every organization is composed of four main interrelated components, people, and processes, which depend on management to carefully orchestrate this interaction:
* Appreciation of a system
* Theory of knowledge
* Psychology of change
* Knowledge about variation
How do we keep up with the rapidly changing environment of healthcare in this new era? What metrics do we use, and what do we ignore? This journey demands that we answer these and more questions to bring about change in our healthcare system. It requires the full engagement of the provider community if meaningful and lasting change is to occur. Once change is effected, a new paradigm of care delivery will require a new mind-set that moves the industry from healthcare as the goal of the US healthcare system to well-being (Gawande 2014, 2016). Although health is critical to overall well-being, it is not the only issue. This text provides technical information on the management of the medical practice, but it also offers insight into necessary new skill sets providers and other healthcare leaders must have and roles they must play to create a paradigm of sustainable care for the future to optimize well-being as well as health.
Lifelong Learning
Practice management is changing rapidly in response to the ever-changing landscape of healthcare and the medical practice. Practice managers need to be committed to lifelong learning and be active in our professional organizations to ensure they are up-to-date on current knowledge.
The Medical Group Management Association (MGMA), with its academic arm, the American College of Medical Practice Executives (ACMPE), is the premier practice management education and networking group for practice managers. The organization dates back to 1926 and represents more than 33,000 administrators and executives in 18,000 healthcare organizations in which 385,000 physicians practice. MGMA (2016a) has been instrumental in advancing the knowledge of practice management, and ACMPE offers a rigorous certification program in practice management that is widely recognized in the industry.
ACMPE has identified eight areas that are essential for the practice manager to understand (exhibit 1.1).
This text examines each of these domains of the practice management body of knowledge to provide a sound, fundamental base for practice managers and practice leaders. It includes a comprehensive overview that does not assume a great deal of prior education in the field of practice management. Furthermore, it seeks to provide not only specific information about the management of the medical practice but also context in the larger US healthcare system. Too often, different segments of the healthcare system see themselves as operating in isolation. This point of view must change if medical practices are to transform and if managers are to lead successful practices in the future, whether a small, free-standing practice or a large practice integrated with a major healthcare system.
Another prominent organization for the education and advancement of practice management is the American College of Healthcare Executives (ACHE). ACHE is a professional organization of more than 40,000 US and international healthcare executives who lead healthcare systems, hospitals, and other healthcare organizations. Currently with 78 chapters, ACHE offers board certification in healthcare management as a Fellow of ACHE, a highly regarded designation for healthcare management professionals (ACHE 2016).
The American Healthcare System
The practice of medicine drives the US healthcare system and its components, and medicine is heavily influenced by the system as well. Medical practice and the healthcare system both are built on the foundation of the physician–patient relationship. Although the percentage of total healthcare costs attributed to physicians and other clinical practitioners was 20 percent in 2015, the so-called clinician's pen, representing the prescribing and referral power of medical practice clinicians, indirectly accounts for most healthcare system costs. Administrators do not prescribe medication, admit patients, or order tests and services. This fact is just one illustration of a fragmented system whose segments can act independently. This fragmentation must be addressed if medical practices are to provide high-quality healthcare to patients at the lowest cost possible.
To begin our study of practice management, the book first offers some perspective of medical practices in terms of the overall US healthcare system. A complete history of the practice of medicine is beyond the scope of this text, but the lengthy and enduring nature of medical practice is important to recognize. The first known mention of the practice of medicine is from the Old Kingdom of Ancient Egypt, dating back to about 2600 BC. Later, the first known code of conduct, the Code of Hammurabi, dealt with many aspects of human behavior and, most importantly for our study, established laws governing the practice of medicine. The first medical text was written about 250 years later (Nunn 2002).
Exhibit 1.2 provides a sample of some significant points in the development of the physician medical practice from ancient times to the present. The reader may wonder why such a diverse series of events is listed, ranging from the recognition of the first physician to the occurrence of natural disasters and terrorist acts. Medicine, whether directly or indirectly, influences virtually every aspect of human life. Events such as Hurricane Katrina, the 9/11 terrorist attacks, the emergence of the human immunodeficiency virus (HIV), and the Ebola virus outbreak have had major impacts on the healthcare system and physician practice. Before 9/11, medical practices thought little about emergency preparedness and management; such activities were seen as under the purview of government agencies. Until HIV was identified in 1983 as the cause of acquired immunodeficiency syndrome (AIDS), and reinforced by the Ebola crisis of 2014, medical practices spent few resources and little time thinking about deadly infectious disease and the potential for it to arrive from distant locales. A traveler can reach virtually any destination in the world within a 24-hour period, which is well within the incubation period of most infectious agents. Modern air travel has made the world of disease a single place, so practices must be mindful of patients' origins and travels.
The evolution of medical practices has coincided with and been driven in part by the development of medical technology and the scientific revolution. Medicine was limited in scope and primitive until the middle of the nineteenth century. Theories of disease were arcane, and diagnostic tools were largely absent (Rosenberg and Vogel 1979). Prior to 1850, medical education constituted an apprenticeship that was inconsistent and poorly preceptored, with no standard curriculum (Rothstein 1972). Procedures focused on expelling the disease with bleedings and emetics. Surgery was limited because of the lack of anesthesia, and as a result, being fast was better than being good. Patients often directed the physician as to the care they should receive. One might say early medical practice was the first iteration of patient-centered care (Burke 1985).
Practice Management Resources
Now, however, the amount of information available about medicine and medical practice management is virtually endless, representing many points of view; ideas; political world views; notions about funding and access; and the numerous disciplines in the broader management field, such as accounting, finance, human resources management, organization development, and logistics. With the vast expanse of knowledge available, students of healthcare and practice management are encouraged to develop lifelong learning skills. The field is changing so rapidly that the need for continuous updating of knowledge and skills is essential.
For example, practice managers need to build a virtual library of accurate and reliable sources. The list that follows comprises the foundation of that library, which should be referred to frequently (see the appendix to this text for each resource's website):
* Centers for Medicare & Medicaid Services (CMS)
* Advisory Board
* Dartmouth Atlas
* National Committee for Quality Assurance
* Institute for Healthcare Improvement
* Institute of Medicine
* Institute for Health Policy and Innovation
* Kaiser Family Foundation
* Robert Wood Johnson Foundation
* Annenberg Foundation
* Commonwealth Fund
* Centers for Disease Control and Prevention
* Agency for Healthcare Research and Quality
The Dimensions of Medical Practice
Medical practices can take many forms, ranging from small sole proprietorships to large multispecialty medical practices. Recent years have seen more medical practices embedded in large healthcare organizations, which also may be solo practices or large multispecialty entities (see exhibit 1.3).
A group practice is defined as a medical practice consisting of two or more practitioners working in a common management and administrative structure. Single-specialty groups are those that focus on one aspect of medicine, such as general surgery, family practice, orthopedics, cardiology, or internal medicine. Multispecialty medical groups contain more than one medical specialty in the organization. Multispecialty practices are highly integrated, with a common governance leadership and common management structure, and they have a highly developed corporate system for managing finances and dealing with regulatory agencies. Their operation and function are much more complex than those of solo or small practices.
Integrated delivery systems (IDSs) are networks of healthcare organizations under a single holding company or parent organization that contain multiple components of healthcare delivery. An IDS often includes hospitals, physicians and other clinicians, and payment organizations, often referred to as third-party payer organizations. The goal is to provide as complete a continuum of care as possible.
Types of Practitioners
Physicians have, of course, played a pivotal role in the US healthcare system since its inception. Physicians — and now, other nonphysician providers such as nurse practitioners (discussed later) — care for patients by
* assessing the patient's health status,
* diagnosing the patient's condition, and
* prescribing and performing treatment.
It has been said that the most expensive instrument in the healthcare industry is the provider's pen. An amusing statement, it also carries a lot of truth because all diagnostic and surgical procedures as well as office-based and hospital-based assessments — in fact, all care in general — is either performed or ordered by a provider.
Furthermore, the medical practice is unlike any other organization in the medical field because the nature and identity of the practice is closely linked to the individual providers in the practice. The providers are the primary producers and the primary governance body, and they are held accountable for the performance of the practice in a personal way. Their income is directly tied to the practice's performance, more closely than for other medical field workers. Exhibit 1.4 shows the fundamental components of a medical practice.
Often, the challenge in practice management is to serve the interests of the providers while maintaining a focus on the patient, with patient focus being the True North of the practice.
"True North" is a concept taken from Lean management that embodies the ideal state of a practice, its providers' vision of perfection, and the type and quality of practice it should strive to achieve every day. True North should transcend the individual and his or her personal goals or actions. Achieving personal objectives is not mutually exclusive but coincidental with True North.
Exhibit 1.5 shows the number of physicians practicing in the United States. This number can be further broken down into the number of practices by size and multispecialty versus single specialty, as shown in exhibit 1.6. Note the increasing size of practices over time, a trend that is expected to continue.
A primary care physician (PCP) is often the first contact for a patient with an undiagnosed health concern. In addition, PCPs frequently provide continuing care for many medical conditions that are not limited by cause, organ system, or diagnosis. This purview of practice differs from that of a medical specialist, who has completed advanced education and clinical training in a specific area of medicine and typically focuses on the diagnosis and treatment of one organ system of the body and its diseases.
Nurse practitioners and physician assistants are a growing segment of medical service provider, as seen in exhibit 1.7. A physician assistant (PA) is a nationally certified and state-licensed medical professional. PAs practice medicine with physicians and other providers and are allowed to prescribe medication in all 50 states, the District of Columbia, the majority of US territories, and the uniformed services. A nurse practitioner (NP) is a registered nurse qualified, through advanced training, to assume some of the duties and responsibilities of a physician.
PAs and NPs are sometimes referred to as advanced practice professionals or mid-level providers; however, the term mid-level provider is considered obsolete.
State laws vary as to the specific duties PAs and NPs are allowed to perform, so the practice manager must be fully informed on these regulations.
Advanced practice professionals are becoming increasingly important to medical practices because they can replace physicians in care delivery for many services, reserving the physician for more complex care requiring their expertise. For example, PAs and NPs often work as part of a care team with physicians. They may examine the patient first; collect facts and findings; and then, in collaboration with the physician, make a diagnosis and develop a treatment plan. The physician supervises the process and conducts his or her own examination of the patients to ensure that the proper care is delivered. The physician often checks critical elements of the exam and establishes a relationship with the patient. The PA or NP typically follows up with the patient once the treatment plan is established.
Practice Ownership
In addition to the area of medicine practiced, physician practices can be classified by type of ownership. Exhibit 1.8 shows the distribution of medical practices by ownership. Note the trend — also expected to continue — toward practice ownership by hospitals and healthcare systems.
Licensing Physicians
All 50 states require physicians and medical providers to hold a license. The licensing of medical providers is performed under the auspices of a medical examining board. These boards have the right to grant a license to practice medicine and the responsibility to investigate and discipline providers in cases of inappropriate conduct.
(Continues…)
Excerpted from "Fundamentals of Medical Practice Management"
by .
Copyright © 2018 Foundation of the American College of Healthcare Executives.
Excerpted by permission of Health Administration Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Preface xv
Acknowledgments xix
Chapter 1 The Origins and History of Medicine and Medical Practice 1
Learning Objectives 1
Introduction 1
Lifelong Learning 3
The American Healthcare System 4
Practice Management Resources 7
The Dimensions of Medical Practice 8
Types of Practitioners 9
Practice Ownership 12
Licensing Physicians 12
Medical Training 13
What Is Changing? 14
What Are Some of Today's Challenges? 16
Leadership Challenges 27
The Cloud of Anxiety 31
Discussion Questions 32
References 32
Chapter 2 Practice Models and Legal Organization 39
Learning Objectives 39
Structures and Organization 39
Affiliation Versus Employment Models and the Corporate Practice of Medicine 46
Culture and Organization 50
Academic Medical Centers and Physician Practice Management 52
Accountable Care Organizations 53
Clinical Integration 54
Patient-Centered Medical Homes 55
Integrated Delivery Systems 58
Mergers and Acquisitions 60
The "Great Double Cross" 66
Discussion Questions 67
References 67
Chapter 3 Information Technology and Management 71
Learning Objectives 71
Introduction 71
Performance 72
Interface 73
Education and Training 73
Meaningful Use 74
Practice Management Systems 77
Other Important Systems in the Medical Practice 78
The Patient Flow Process and IT's Role 82
Interoperability 83
Value-Based Care and IT 84
Practical Aspects of Medical Practice Information Systems 85
Discussion Questions 96
References 96
Chapter 4 Regulatory Issues, the Law, and Practice Management 99
Learning Objectives 99
Introduction 99
Jurisdiction 101
Laws Regulating the Organization and Governance of Corporations 101
Corporate Organizational Documents 102
Contract Law 105
Federal and State Taxation 105
Antitrust Laws 106
Labor Laws 107
Federal Laws Governing Medicare Fraud and Abuse 108
Medical Records Regulations 113
Malpractice 114
The Medical Practices Act 115
Certificate-of-Need Laws 116
Risk Assessment 116
Discussion Questions 119
References 120
Chapter 5 Strategic Planning, Project Management, and Marketing in Practice Management 125
Learning Objectives 125
Introduction 125
Strategic Planning 126
Developing a Communication Plan 127
Strengths, Weaknesses, Opportunities, and Threats Analysis 128
Force Field Analysis 131
Economic Analysis of New or Improved Service 133
Analysis of a Capital Investment 134
Project Management 139
What Is Marketing? 142
Discussion Questions 149
References 149
Chapter 6 Third-Party Payers, the Revenue Cycle, and the Medical Practice 151
Learning Objectives 151
Introduction 151
Role and Scope of Financing Healthcare 152
Management Decisions 153
Insurance Concepts 154
Types of Health Coverage 157
An Illness System, Not a Health System 162
Managed Care 164
Government Health Insurance Programs 170
The Revenue Cycle 173
Resource-Based Relative Value Scale 178
Medicare Access and CHIP Reauthorization Act 180
Discussion Questions 183
References 184
Chapter 7 Financial Management and Managerial Accounting in the Physician Practice 187
Learning Objectives 187
Introduction 187
Cost Behavior 188
Accounting Methods 190
Budgeting 191
Financial Statements 196
Monitoring Financial Performance 201
Physician and Other Provider Compensation 205
The Future of Practice Financial Management 212
Discussion Questions 212
References 212
Chapter 8 Human Resources Management 215
Learning Objectives 215
Introduction 215
The People in the Practice 216
The Employment, Recruiting, and Hiring Process 216
Talent Management 223
Employment Policies and Procedures 229
Organization Development 230
Employee Development 230
Change Management 231
Conflict Management 239
Diversity and Inclusion 241
Reward and Recognition 242
The Future Workforce 243
Burnout 243
Discussion Questions 247
References 247
Chapter 9 Leading, Managing, and Governing Within Organizational Dynamics 251
Learning Objectives 251
Introduction 251
The Basics and Theories of Leadership 252
Leadership Versus Management 255
The Dyad Leadership Model in Practice Management 256
Leadership: Mission, Vision, and Values 260
Professionalism 262
Leadership Styles 265
Organizational Conscientiousness 266
Emotional Intelligence 266
Generational Issues in the Medical Practice 268
Diversity and Inclusion Issues for Leadership 269
Giving and Receiving Feedback 271
Governance and Organizational Dynamics 274
Conducting Meetings 277
Assessing Leadership Success 279
Discussion Questions 280
References 280
Additional Reading 283
Chapter 10 Quality Management in the Physician Practice 285
Learning Objectives 285
Introduction 285
Quality and Safety Improvement 286
The Triple Aim 288
Quality Improvement Processes 290
Quality Improvement Tools 301
Data Analytics 305
Discussion Questions 306
References 306
Chapter 11 Emergency Management and the Medical Practice 309
Learning Objectives 309
Introduction 309
The New Nature of Emergencies 310
The Key Dilemma 313
Emergency Management 314
Developing an Emergency Preparedness Plan for the Practice 315
Who Is an Emergency Manager? 319
Community Emergency Response Teams 322
Special Situations 322
Collaborative Emergency Management 328
Discussion Questions 329
References 329
Chapter 12 The Future and Medical Practice Innovation 333
Learning Objectives 333
Introduction 333
Forces of Change 337
The Lesson of the Affordable Care Act 340
The Promise of Community-Based Primary Care 340
Future Workforce Challenges 341
Global Threats and International Cooperation 342
Advances in Imaging and Laboratory Testing 343
Evidence-Based Healthcare 344
Data Analytics and Artificial Intelligence 345
Population Health 346
Chronic Disease 350
Underserved Areas and Community Health Centers 352
Genomics and Precision Medicine 353
The Internet and Self-Efficacy 356
Patients' Interactions with Healthcare Providers 359
Nontraditional Providers 360
Site-Based Corporate Medical Services 361
Concierge Practices 362
Wearables and Internet-Based Medical Services 363
Social Media 364
Alternative and Complementary Medicine 365
Behavioral Economics and Changing Patient Behavior 365
Discussion Questions 368
References 369
Appendix 377
Glossary 381
Index 385
About the Author 411