The future of outpatient care: The illusion of practice management that works

Data, facts and instruments on the German health system

What it’s all about

Necessary adjustments to practice management are often omitted because practice owners follow inappropriate mindsets, assumptions, and observations in their decision making.

The big mistake

Laboratory testing of blood is an indispensable part of the diagnostic activities of physicians. It makes it possible to obtain comprehensive insights into the physical condition of a patient. General guideline values help in the classification, and the relationship of individual values to each other also provides concrete information for the orientation of the subsequent therapeutic procedure. No physician would dispense with these values in his work and instead work with assumptions or simply treat on the basis of symptoms alone.On the other hand, when it comes to diagnosing practice management, for example to eliminate recurring problems, to create time freedoms, to increase efficiency and productivity or to align it with future requirements, practice owners rely on their gut feeling. When asked about the working conditions in their practices, they often express themselves in this or similar terms:

  • „My practice is doing great!“
  • „By and large, everything is okay.“
  • „I can’t complain and, after all, other practices struggle with the little recurring problems.“
  • „The only thing that bothers me is the bureaucracy.“

Possibilities for improvement are hardly seen, the existing routines are considered good. But:

However, the experience of conducting more than 15,000 practice management business comparisons shows that even in businesses whose practice owners are convinced, as described above, that the work is working well, an average of forty opportunities for change can be identified.

They eliminate existing but unperceived risk factors or misalignments and thereby noticeably improve parameters such as quality of care, efficiency, productivity and / or success, but also work quality and motivation or free time.

The implementation of the discovered options means concretely that the same result of the practice activity can be achieved with a lower work input or that reserves exist to complete a larger amount of work with the current work input.

Even experienced practice owners are always surprised when they experience the effects of using these unused approaches.

But how is it that physicians overlook many of these „stumbling blocks“ on the road to optimized practice management?

  • One reason is the very low level of analysis activity on the topic of „practice management“ and the aforementioned dominance of gut feeling in evaluating the suitability, functionality and quality of structures, processes as well as results. For example, the absence of patient complaints is still seen as a sign of well-functioning work. Too few physicians are aware of the fact that measurement and performance indicators exist for practice management that have far-reaching, detailed and validated indicator functions.
  • In addition, once routines have been established, they are usually never reviewed again. Moreover, the issue of „operational blindness“ also plays a role in medical practices, as it does in all companies. A large proportion of German practice teams basically work with the structures and processes that were established when the practice was founded, taken over or cooperated with.
  • Another cause of perceived errors is the predominantly symptom-oriented attempts to eliminate them. However, the management of a practice is an extremely complex process that is based on many interdependencies of the individual areas of action such as planning, organization, patient management, leadership or controlling. On the one hand, changes in one area also have an impact on others; on the other hand, the causes of problems often do not lie in the area in which they lead to effects.
  • Other practice owners derive the positive assessment of their practice management from the satisfactory economic success of their operations. But this is not a suitable criterion, because the amount of work caused by misalignments in practice management can – as described above – be significantly higher than necessary, or the identification and elimination of weak points could result in a significant increase in profit for the same amount of work.
  • But even the existence of a quality management system or even certification often conceals mistakes in practice management.
  • And last but not least, it is primarily false beliefs that have run through practice work since time immemorial and determine actions („We have always done it this way!“, „The patients don’t want that!“, or „The employees won’t go along with that!“). This context also includes the „demonization“ of business management methods, the use of which is considered unethical.

All the aspects mentioned show that only a radical rethinking („mindshift“) can lead outpatient practice management out of the impasse of inadequate management.

Why are these stumbling blocks so dangerous, the practice performance is nevertheless good in the assessment?

The dangerousness arises first of all from the special function of practice management, which acts as a transmitter of the medical competence of physicians, the activities of medical assistants and the resources used into the concrete care of patients. The quality of its design determines

  • the extent to which the skills of the physicians and the abilities of the staff are made available to the patients in the form of comprehensive assistance,
  • moreover, it determines how quickly practice teams can react to changes of any kind, implement them and benefit from them (example: digitization),
  • and last but not least, it influences costs, turnover and profit.

Consequently, this means that undiscovered stumbling blocks reduce the opportunities for quality of care.

In addition to the external effect, however, the undiscovered deficits also influence the internal quality of work.

They lead to stress, demotivation and overwork, job satisfaction is lost and private life is restricted.

In addition, opportunity costs are incurred. However, the term does not refer to costs that are actually incurred, but to hypothetical costs that arise as a result,

that wrong activities prevent other alternatively possible work, which brings a larger use.

Solution Operational comparison

The explanations make it clear that the criteria usually used in medical practices to evaluate practice management quality do not provide any certainty, as they do not identify the invisible stumbling blocks, because only the practice’s internal view is used. This inevitably leads to errors in interpretation and the resulting errors in action. Only a practice management comparison can shed light on this. This proven and validated system makes it possible to compare the entire practice management of a general practice or specialist practice and the effects achieved with two reference benchmarks:

  • the specialty group standard, which represents the realities of practice management in practices of one’s own specialty, and
  • the best practice standard, i.e. the regulations, instruments and behaviors that ensure smoothly functioning practice operations. It is composed of the practice management conditions in above-average successful medical practices and the basic principles necessary for business management.

The comparison is suitable for all specialties, practice types and sizes. Optionally, in the case of MVZs or supra-regionally active practices and physician networks, an internal practice management comparison between individual therapy areas or members can also be carried out.

What benefits do physicians derive from an implementation?

A practice management comparison offers general practitioners and specialists ten fundamental advantages for systematically and sustainably optimizing practice management:

Objective status determination for practice management

The operational comparison uses objective parameters to show where a practice „stands“ by expanding the practice’s internally directed view to include the relevant external environment for action – practice management in operations of the same specialty and the functional rules of successful practice management. This juxtaposition

  • leads to a comprehensive, structured 360-degree insight into the current practice management constellation, evaluated on the basis of reality,
  • Strengths and weaknesses, but also threats and opportunities are identified and named.

This increases – overall – both the quality of analysis and the quality of decision-making.

The Practice Management Comparison© is an indispensable tool for obtaining important information for the analysis, planning, control and management of practice operations:

  • thereby practice teams can easily adjust to already changed or developing conditions of action,
  • carried out regularly, the business comparison ensures that the practice work is always up to date,
  • after the establishment of a new practice and subsequently, before practice takeovers and cooperations, as well as for determining the value of the practice, its use is a must.

Fine tuning the quality of care

Practice management acts as a transmitter of medical expertise into patient care. The company comparison supports practice owners in this process,

  • the quality of this transfer process by mirroring it with the outside perspective and thereby also
  • the dynamic upheaval taking place in the healthcare sector.

Security through orientation

Practice management is a complex process with various areas of action that are closely interlinked and, to a large extent, mutually dependent and influential. One example is the intensive interaction between management and organization. For optimal functioning, the design parameters of these and all other areas must mesh like finely tuned gears.

The Practice Management Comparison

  • systematizes these interrelationships with the help of key performance indicators,
  • ensures transparency and controllability and
  • thus creates the „good feeling“ of always having everything in view.

Information and action advantage

Only by systematically „looking beyond the end of one’s nose“, which a company comparison makes possible, does one arrive at new insights and become motivated to eliminate weaknesses identified by the system:

  • By comparing one’s own management potential with the requirements and conditions of the care landscape, it becomes clear to what extent the work is suitable for implementing the pursued practice strategy in a targeted manner.
  • Physicians who deal with their performance quality in this way are able to make better operational decisions much more easily and precisely,.
  • knowledge of one’s own relative position also becomes all the more important the higher the intensity of competition within one’s own catchment area: practice teams that are located in an intensely competitive environment are put in a position to be able to confidently assess the competitive position of their operation by comparing operations.

Error and risk minimization

The operational comparison is able to uncover misalignments and risk factors and to categorize them in terms of their impact, which can lead to an impairment of

  • both the operational activity and
  • strategic development.

Creation of room for maneuver

The system also identifies previously unused optimization approaches and development opportunities that can be used to further increase the success of practical work. This creates room for maneuver,

  • which increase management flexibility,
  • so that changes in the practice environment can be proactively addressed at any time.

Replacing assumptions with facts

The twofold comparison ensures an objective and realistic assessment of the practice management situation with the help of key figures:

  • Subjective assessments are replaced by concrete facts, thus counteracting possible wrong decisions in a targeted manner,
  • false interpretations of causalities and
  • overestimation of strengths are avoided.

Avoiding operational blindness

Routines help practice teams to meet daily work requirements. Operational blindness occurs when these are not reviewed over time or are reviewed inadequately and leads to declining performance. The Praxismanagement-Betriebsvergleich© counteracts this. It helps

  • define realistic goals,
  • set appropriate priorities for the daily work and
  • use the practice’s resources in line with requirements.

Cockpit for practice management control

The structured preparation of practice management using indicators enables,

  • define concrete target parameters for practice work and
  • to systematically check their development in follow-up examinations.

Improving the financial situation

Optimization of practice management always has a direct positive effect on the cost situation.

  • on the cost situation,
  • turnover and
  • the practice’s bottom line.

Saving practice consulting costs.

Developments in the health care market and their impact on work in family and specialist practices are leading more and more practice owners to consider seeking external help in the form of practice consultations in order to

  • either eliminate their acute work problems
  • or to put their work on a sustainable, effective and secure footing.

However, this help is often expensive, because those who deal more intensively with the topic of „practice analysis / practice consulting“ as a general practitioner or specialist must come to terms with the fact that such support services are often associated with high costs. For example, the average daily rate for consultants in practices is currently €1,800, which corresponds to an hourly rate of €225.

One cost-driving component here is the fact that many physicians can only describe their problems in non-specific terms, and consultants are forced to search the breadth of practice management. This search is time-consuming and thereby naturally cost-intensive, under two consulting days plus additional expenses, on the average 3,900 €. accordingly, an analysis is hardly convertible.

But there is a simple way to shorten the search of consultants to the point, thereby shortening and saving a lot of money. It consists of carrying out initially a practice management company comparison.

The system works with validated documentation sheets on the current practice management (doctor / doctors, MFA and patients), its implementation is done entirely without the need for an on-site consultant, because the necessary documents can be downloaded from the Internet. With its help, all action areas of practice management are quickly and easily aligned with the best practice standard of practice management. It includes all regulations, procedures and behaviors required for smoothly functioning practice operations. In parallel, a comparison is made with the practice management conditions in the associated specialist group.

In this way, an accurate and detailed 360-degree status report is produced, listing all the strengths, weaknesses, threats and opportunities of the practice work. The resulting action plan shows the necessary changes and enables the physician to decide which measures he wants to / can implement with his team on his own and for which he actually needs external help.

The latter point then forms the briefing for the consultant, who can now be deployed with pinpoint accuracy for specific services. The costs of the resulting support service are far below the amount that would be necessary for an unspecific search.

Experiences with the use of practice management company comparisons as preparation for practice consultations show:

The investment amounting to the cost of one consulting hour for the business comparison saves on average the cost of at least one consulting day.

If one takes the amount of 3,900 € listed at the beginning, it would be reduced by an investment of 200 € for the farm comparison to a total of 2,300 € or even less. The reason: with the results determined by an operational comparison, in most cases external help to eliminate problems is not necessary at all. The changes that need to be made can also be eliminated by the practice teams themselves, and the volume of savings is even greater.

All information about the possibilities of the Practice Management Business Comparison© for general practitioners and specialists at a glance (German)…

©IFABS / Thill