In today's rapidly evolving healthcare environment, physicians are asked to wear many hats -- clinician, statistician, coder, manager, computer user, etc. Physicians traditionally have not received extensive training in the area of business administration, and this can make it difficult for them to identify and address issues which may be adversely affecting the productivity of the medical practice. In such situations, the objective assistance of a management consultant or attorney can be greatly beneficial. The tips listed below will help you obtain the maximum benefit from your professional relationship with a management consultant or attorney.
Examples of Situations Which May Warrant Consulting or Legal Services
Tips for Working with a Management Consultant or Attorney
Introduction
- The practice is experiencing financial difficulties
- A hospital has offered to buy the practice
- The practice is considering purchasing a computer system.
- Physician productivity is low
- The physician is preparing to sign a contract (e.g. employment, managed care, office lease, etc.)
- The practice is facing a Medicare or managed care audit
- There is conflict among the physicians in the practice
- There is high staff turnover
- The physician has been denied privileges or reimbursement
- The practice has many managed care contracts to consider
Where to Locate Management Consultants and Attorneys
There are many sources available to help you locate management consultants and attorneys.
There are many sources available to help you locate management consultants and attorneys.
- Referrals from colleagues. (This is probably your best resource)
- State and County Medical Societies. (A good source of local resources.)
- Residency Programs. (Residency programs may use consultants to assist them in developing and presenting their practice management curriculum.)
- Professional Journals. (Frequently, consultants write or are contributing editors to practice management articles that are published in such professional journals as Family Practice Management.)
- Professional Associations :
- American Academy of Family Physicians (800) 274-2237 x 4148 or http://www.aafp.org/fpassist.xml
- American Health Lawyers Association (202) 833-1100
- Medical Group Management Association (303) 397-7877
- National Association of Health Care Consultants (202) 452-8282
- Society of Medical-Dental Management Consultants (800) 826-2264
- Institute of Certified Healthcare Business Consultants (800) 447-1684
- Local Bar Associations
Types of Services Provided by Management Consultants and Attorneys
The scope of services that can be provided by management consultants and attorneys is broad, and many firms have chosen to specialize in a few key services (e.g. coding, practice valuations, group formation, etc.)
The following is a listing of some of the more commonly-requested services provided through the FP Assist.
The scope of services that can be provided by management consultants and attorneys is broad, and many firms have chosen to specialize in a few key services (e.g. coding, practice valuations, group formation, etc.)
The following is a listing of some of the more commonly-requested services provided through the FP Assist.
- Managed Care Contract Review
- Employment Contract Review
- Practice Valuation
- Practice Start-up
- Mergers and Acquisitions
- Review of Coding and Reimbursement Systems
- Medical Staff Issues
- Operations Overview
Other Factors to Consider:
Once you have located names of consultants or attorneys and have determined what type(s) of service you want them to perform, there are a few more points to consider:
- Size of the Firm. Bigger is not always necessarily better and there are pros and cons to working with both large and small firms. A large firm may have specialty departments that address such issues as coding, contract law, etc. One disadvantage is that you might not work with the same consultant over a period of time. Your job may be assigned to a consulting “team.” A smaller firm may be able to provide a more “personal” touch to the relationship with the practice, but may fall short on the range of services it is capable of providing.
- Stability of Business Entity. Longevity does not always reflect quality. However, you would be wise to ask how long a particular firm has been providing service. To be included in FP Assist, a firm has to have been in business for a minimum of two years. Each firm is asked to provide a business reference that will support its claim.
- Location of the Firm. Most consulting firms require the client to pay the consultant's travel expenses to the practice. Therefore, most clients prefer to work with firms that are located within their geographic region. Depending upon the type(s) of services the client requests, this might not always be possible. By the same token, it is not practical in some cases, to choose a firm that provides services nationally, when the problem to be addressed is regional. For example, a law firm that provides services on a national basis may not be able to address a regional medical staff or managed care issue.
Qualifications and Training of Consultants
What does it mean when a consultant has the following initials after his/her name -- CHBC, CMPE or FACMPE?
CHBC stand for Certified Healthcare Business Consultant, a certification that is administered through the Institute of Certified Healthcare Business Consultants. Formerly, the CHBC designation was CPBC (Certified Professional Business Consultant). To be eligible for certification, a consultant must have at least three years experience as an independent practice management consultant and currently serve a majority of healthcare clients. The consultant must also pass a comprehensive examination to demonstrate proficiency in areas the Institute considers essential:
What does it mean when a consultant has the following initials after his/her name -- CHBC, CMPE or FACMPE?
CHBC stand for Certified Healthcare Business Consultant, a certification that is administered through the Institute of Certified Healthcare Business Consultants. Formerly, the CHBC designation was CPBC (Certified Professional Business Consultant). To be eligible for certification, a consultant must have at least three years experience as an independent practice management consultant and currently serve a majority of healthcare clients. The consultant must also pass a comprehensive examination to demonstrate proficiency in areas the Institute considers essential:
- Financial Administration
- Patient Records Management
- Personnel Administration
- Economic Analysis
- Facilities and Equipment Information
- Practice Activities
- Operating Methods
- Associates and Corporate Organization
- Retirement Planning
- Tax Management
- Financial Planning
- Estate Planning
Certified Healthcare Business Consultants undergo an extensive training program, review course and Certification Examination. To maintain certification, CHBCs must complete at least 35 hours of approved continuing education credits annually.
CMPE and FACMPE stand for Certified Medical Practice Executive and Fellow of the American College of Certified Medical Practice Executives, certifications that are administered by the American College of Medical Practice Executives. This organization is closely affiliated with the Medical Group Management Association (MGMA). Nominees in the college advance to Certified Member status upon passing the College's examinations and completion of a minimum of 50 hours of continuing education credit. The certification examinations test the applicant's knowledge in all areas of management, focusing on the medical practice setting. Certified Members advance to Fellow status by writing either a professional paper, which documents investigation into a new area of health care management, or a series of case studies which reflect and analyze professional experience.
Questions to Ask the Consultant or Attorney
CMPE and FACMPE stand for Certified Medical Practice Executive and Fellow of the American College of Certified Medical Practice Executives, certifications that are administered by the American College of Medical Practice Executives. This organization is closely affiliated with the Medical Group Management Association (MGMA). Nominees in the college advance to Certified Member status upon passing the College's examinations and completion of a minimum of 50 hours of continuing education credit. The certification examinations test the applicant's knowledge in all areas of management, focusing on the medical practice setting. Certified Members advance to Fellow status by writing either a professional paper, which documents investigation into a new area of health care management, or a series of case studies which reflect and analyze professional experience.
Questions to Ask the Consultant or Attorney
- Availability. The first consideration is the availability of the consultant or attorney. Were you able to speak to someone right away? If not, was your phone call returned promptly? When making the initial call to a firm, ask if the phone consultation is free. If not, you might be surprised with a bill down the road. However, most firms realize the marketing potential of providing a free initial assessment. How potential clients are treated during initial encounters can serve as a barometer as to the tone of the professional relationship. Some consultants or attorneys may be so overly-subscribed that they will not have time to give your practice the attention it deserves. Find out if the consultant or attorney with whom you originally spoke will be the person assigned to work with you, or if your project will be assigned to someone else within the firm (for example, a less-experienced associate.) It is not necessarily a bad thing if the majority of work on your project is handled by someone else. The benefit is that you may receive quality work at less cost. However, ask the firm to disclose this up front, so there are no disagreements as the project progresses.
- Situation Analysis. Describe your situation to the consultant or attorney. Make certain that he or she understands what type of results you expect. The consultant or attorney should ask probing questions and help the potential client clearly and accurately describe the state of affairs. In order to have a successful relationship with the consultant, and thus, a favorable outcome, clear, accurate communication is essential.
- Experience with Family Practice. Does the individual or firm have experience in working with family physicians? If so, in what capacity? Has the firm ever worked with a practice configuration similar to yours? Has the firm ever addressed the problem you are presenting? (In order to be listed in the FP Assist, the consulting and law firms are required to have experience with family physicians.)
- Fees. How does the consulting or law firm charge for its services? Some firms bill by the hour, others will quote clients a flat rate for a particular service (e.g. contract review or practice valuation.) How does the firm expect to be paid? On retainer? In one lump sum? Are payment plans available? Is the client required to make a down payment with balance due at the conclusion of the engagement? The hourly rates charged by firms varies widely.
- Additional Costs. This is the time to assess those “hidden costs” that may surprise you after the fact. If the consultant is going to have to travel to your practice, what expenses will be billed to you? For example, if airfare is covered, does this mean coach, first class, stand-by? In addition, the practice can expect to be billed for lodging, meals, ground transportation, and incidentals such as long-distance phone calls. You also need to have the consultant clarify what follow-up services are billable. For example, if the consultant is required to return to the practice for additional staff training, is it an additional charge or is it covered in the initial fee? Find out the same information for telephone consultation and written reports.
- References. Have the consultant or attorney provide you with references, preferably from family practices or other primary care practices that have had the types of services performed that you are requesting. Refusal to provide appropriate (or any) references, is definitely a red flag. (References from family physicians are mandatory for firms listed in the FP Assist.)
- Conflict of Interest. Does the consulting firm have a vested interest in a particular product, such as a software program? If it does, that should not necessarily disqualify it. However, if the firm is aggressive about promoting its particular product, ask that it provide you with names of other comparable products so you can make an informed choice.
Request for Proposal -- Consulting Firms
Once you feel comfortable with two or three firms, it is time to solicit a formal Request for Proposal (RFP) or Request for Quote (RFQ). Ask the consultant to provide you with the following information in writing:
- Detailed description of the process to be undertaken for your practice.
- Description of desired outcome.
- Anticipated timeframe for completion of the project. Clearly spell out expectations if it is discovered that the project will not be completed within the proposed timeframe.
- Billable charges
- Estimated fee for completing the project. Clearly spell out expectations if it is discovered that the project is going to go over-budget.
- Provisions on what will be done if the client is not satisfied with the final results.
Letter of Engagement -- Law Firms
It is not necessary to ask an attorney or law firm to complete a detailed Request for Proposal. In most circumstances, the professional relationship will be of a short duration, such as to evaluate a contract. Therefore, the formality of an RFP is not required.
Ask the attorney to provide you with a proposed engagement letter. (In many states, this disclosure is required by law.) This letter should be requested at the initial meeting or discussion and should address the following points:
Ask the attorney to provide you with a proposed engagement letter. (In many states, this disclosure is required by law.) This letter should be requested at the initial meeting or discussion and should address the following points:
- Description of the services to be provided.
- Names and qualifications of the attorneys who will be working on the project.
- Proposed time frame (estimate of hours) for completing the project.
- Hourly rate.
- Billing and payment procedures.
- Charge for initial consultation. (Typically, a firm will not charge for this discussion.)
Checking References:
Never underestimate the importance of checking references. Granted, it can be time-consuming, but should be well worth it. Speak with the person who worked most closely with the consultant. In many cases, this will be the practice manager or administrator, not the physician.
The following are some sample questions to ask references:
The following are some sample questions to ask references:
- What type(s) of service(s) did the consultant or attorney provide to the practice?
- Was the project completed within the estimated time frame?
- Did the consultant or law firm adhere to the estimated costs?
- How accessible was the consultant or attorney? Was it easy to get answers to questions?
- How did the consultant (if service was provided on-site) get along with the practice personnel?
- Was the consultant available to help implement recommendations?
- Was the consultant or attorney willing to provide follow-up assistance? If so, was there an additional charge to the practice?
- Would the practice work with the consultant or attorney again?
- Would the practice recommend the consultant or attorney to a colleague?
Forging a Successful Professional Relationship
Now that you have received completed RFPs/RFQs from two or three firms and have checked references, you can make a final decision. The following are some tips to help you make the most of your experience with a management consultant or attorney:
- When formally engaging the services or a management consultant or attorney, you will need to have some type of contract or letter prepared that defines terms agreed to.
- Prepare the staff and other physicians for the arrival of the consultant(s) if the project involves working on-site. The presence of a consultant may be imposing to staff members, especially if they were unaware that problems existed in the practice.
- Cooperate with the attorney or consultant. If relevant practice information is requested, comply. For example, a consultant may want to review many years' history of insurance payments while conducting a reimbursement audit. Or, it might be necessary to pull medical records to review documentation. Assign a key staff person to be the consultant's on-site contact.
- Request ongoing progress reports. The consultant or attorney should be keeping you posted about how things are going.
- Listen to the consultant's or attorney's recommendations with an open mind. If you don't agree with something being suggested, speak up. However, be willing to compromise. The advantages a consultant or attorney bring to the situation are expertise and objectivity.
- Implement the consultant's or attorney's recommendations with a positive attitude. Impending change is daunting. An optimistic outlook conveyed by the practice's leadership can go a long way in motivating the rest of the staff towards making progress.
- If you are unhappy with the way the consultant or attorney performs, speak up. Poor communication is the most frequently-cited cause of a deteriorating relationship and unfavorable results. You not only will be doing yourself and the practice a favor, but to the consultant or attorney as well. These professionals want to do a good job for their clients and should be willing to work with you. In the rare circumstances where this may not be the case, the client has some recourse.
It is easier to address problems with attorneys. You can simply file a complaint against them with the state bar association (granted the attorney is a member.) The area is a little more gray when dealing with consultants. If the consultant works for a large firm, you can ask to speak with the firm manager or whomever has supervisory authority over the consultant. Obviously, you will not have that option when dealing with a very small or solo organization. Your best protection is to have everything clearly spelled out in writing before hiring the consultant or attorney.
Conclusion
We hope that you have found this information to be useful as you proceed through the process of selecting the management consultant or attorney that is right for you. Good luck!
For more information about FP Assist, call 1-800-274-2237, ext. 4148 or e-mail us at fpassist@aafp.org
For more information about FP Assist, call 1-800-274-2237, ext. 4148 or e-mail us at fpassist@aafp.org
FP Assist
