As part of our Practice Manager Viewpoint Series, we present a conversation with Brandon Betancourt, practice administrator for Salud Pediatrics in Chicago and healthcare business management consultant.
Q: What do you see as the most significant challenges facing medical practices today?
Brandon: There are a variety of challenges. Almost too many to list. However, from an independent private practice perspective—which is the sector of healthcare I’m most familiar with—I would say the U.S. healthcare system is not set up to help doctors succeed. One example is the administrative burden placed on physicians. Simply put: Doctors are overwhelmed.
Q: What would you say is driving the overwhelming sentiment?
Brandon: There are many reasons. Among them is the infamous EHR. While there are many advantages to having patient data stored electronically, EHRs have done little to optimize productivity, improve workflow, and help provide better care.
Health insurance companies have also increased the burden by requiring doctors—and their staff—to complete additional paperwork.
Take a prescription, for example. We often receive calls from patients/parents telling us that their health insurance will not cover the medicine the doctor prescribed unless additional paperwork or a phone call is made to the health insurance company. In other words, the doctor has to justify the reason she is prescribing the medication.
Q: In what other ways do you think health insurance companies have played a role in the delivery of healthcare and its challenges?
Brandon: The proliferation and adoption of high-deductible plans have caused considerable challenges. These insurance products are intended to shift the cost from health insurance companies to patients in exchange for less expensive premiums.
Patients, reluctant to incur significant expenses, often request that medical advice be provided over the phone instead of making an appointment and having the medical provider perform a complete examination.
This dynamic puts the doctor in a challenging position. On the one hand, many doctors are sensitive to patients’ healthcare expenses. On the other hand, diagnosing or providing medical advice without an examination can be risky. Quick, informal care can become a potential liability.
Complicating matters is that the clinic does not get paid unless they see the patient.
Unfortunately, patients sometimes have difficulty understanding the complexities of the system, which can cause tension between a patient who just wants to get a seemingly simple question answered and an empathetic doctor wanting to do what is right.
Q: How can a practice begin to address these issues?
Brandon: In our practice, our approach was to define core values. These values serve as a blueprint for the best course of action when faced with difficult situations like the ones I mentioned.
They also help us remain focused when faced with challenging circumstances such as a negative online review or loss of revenue.
Q: Can you describe the process by which your practice defined these core values?
Brandon: First, let me say that it wasn’t a simple process. I also have to say that it took us a long time to complete the process of defining our core values. However, in a nutshell, we wrote down the things that mattered to us the most, driven by what we wanted to accomplish, what motivated us to come to work, and what type of practice we wanted to be.
Q: Can you give an example of one of your core values and how it serves as a blueprint?
Brandon: Among our core values is do things with excellence. As a result, we follow the American Academy of Pediatrics (AAP) Bright Future Guidelines, which is the golden standard of care for pediatrics.
The Bright Future Guidelines recommend that vision screens be performed at certain ages. As it turns out, not all health insurance companies pay for this screening, despite the fact that the AAP recommends it and it has its CPT code.
However, because of our core value, we offer the age-appropriate vision screen—per the recommended guidelines—despite the service being a revenue loss for the practice.
Q: Are there other areas where your core values have helped you overcome challenges?
Brandon: Similar to the patient/parents requesting medical advice over the phone without having a prior examination, sometimes patient/parents request a medication to be called in, such as an antibiotic.
Striving for excellence in everything we do helps us remain firm when dealing with patients who decline an appointment and instead request for a provider to just call in an antibiotic to the pharmacy.
Q: Would you recommend other practices define their own values?
Brandon: Yes. I think it is vital that practices take the time to define their core values and put them in place. It ensures that employees have a roadmap to guide their decisions.
We have rules and guidelines too. However, we focused on writing and implementing a set of core values because values offer flexibility for those situations that are not clear. In other words, it would be difficult—perhaps impossible—to establish rules for every possible case that occurs in the practice.
Values, however, provide the framework to make the right choice.
Let’s say an office has a rule in place that it closes at 5 p.m. If a patient calls or shows up at 5:02 p.m., a provider can turn that patient away because the rule says the office closes at 5 p.m.
But let’s say one of your values is that you always go the extra mile for patients; go above and beyond; deliver on the unexpected. Now circumstances change.
Although office hours may be until 5 p.m., having a core value that emphasizes doing more than expected means the front desk clerk does not have to impose a rule on the patient who arrives at 5:02 p.m., but is instead is empowered to accommodate her.
Read more articles in our Practice Manager Viewpoint Series:
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.