Aligning the Practice Team for Profitability – Leaders, Managers and Staff

Key Points: Navigating change dynamics. Leading and retuning practice infrastructure. Key assets – Leaders, managers, staff.  

Healthcare continues to undergo tremendous change as it moves from volume fee-for-service models to value-based care. This evolution, for many, is altering traditional practice management norms, staffing models, recruitment and retention as well as operating costs. Translation: Todays health care environment has a growing impact on practice payments models and net profits. The key word here is money. This can, and often does, create a complex and often adversarial relationship. Payors seek profits and opportunities to grow revenue streams aligned with increasing oversite mandates to ensure value for their payments. Physicians are at the other end, uncomfortable with payor’s intrusion into medical decisions and patient care. Expect these dynamics to continue along with a growing need for practice management talent, analytics and operational efficiencies.

The business of medicine is complex and requires experienced leaders and a skilled practice team to successfully adapt and compete. Achieving these goals places a premium on effective communications, collaboration, coaching, harnessing key resources and implementing a successful strategic vision.  For practice leaders, this often means being equally unfair to all sides. This is an interesting concept, but essential for cultivating a competitive, winning culture. We consistently see, in better performing groups, that culture and leadership trumps strategy and theory. Bottom line: You need effective leaders to survive, good managers to execute tasks and a team to win.

For this article we will review some strategies for aligning the successful practice team. Working with many groups, we see unprecedented change requirements and a growing need for talent, expertise and experienced hands on actions. To put this in perspective, think how your practice has changed in the last 24 months. Rest assured new challenges are on the  horizon. At the front end of these broad based financial and operations changes:

  1. New value-based reimbursement models.
  2. Rising financial exposure to practice net income.
  3. Increasing patient demographic demands.
  4. Pervasive use of EHRs and need for administrative ease/simplification for new technologies.
  5. More payer driven transparency focused on quality and value.
  6. Growing payor and government cost containment models.

For many practices, the ongoing turmoil is upending operations and ultimately revenue streams. Add in rising operating expense and escalating costs of providing quality medical care and you’ll find these financial and staffing issues are impossible to ignore. Translation: Physicians will need to move forward with payor driven value-based care and new payment models to stay on pace with healthcare’s new trajectory.

During times of stagnant and declining net revenues, simple, time-honored dictums stand out

Poor business management practices operate at the margins and their effect is cumulative. Sooner, rather the later, these poor actions exact an economic cost and can ultimately upend organizational cohesion. As with the previous article, “Outsourcing Medical Practice Billing Services” – Improving Practice Revenue Cycle Management, we will continue to review some key strategies to assist the practice moving forward. Working with groups around the country we see first-hand both problems and workable solutions.

Healthcare’s sweeping changes are affecting practice staffing models and skill levels. For example: Staffing support to assist patients with navigating new access channels, new value-based care models, help with patient HD plans and escalating cost share responsibility collections. Add staff deployed to meet growing patient education needs and assist with navigating technology systems and you’ll find these can increase practice operating costs but not necessarily increase overall practice net revenue.  Translation: Staff must master new technologies and demonstrate new knowledge and skills sets so the team can seamlessly work together. As those reading this article are painfully aware, recruiting, retaining, and training quality staff is costly and a major stressor. 

Successful Collection Strategies 

Collecting patient responsibility payments in concert with rising high-deductible health plans and new payment models is a growing challenge. Even though high-deductible health plans (HDHPs) are not new, many practices still struggle to collect patient balances.  Unfortunately, we see practices without clear financial policies and collection protocols, which can easily delay proper patient payments. Successfully engaging patients upfront and using technology for Pre service and Point of Service will help drive accurate and timely account payments. If you want to collect accurate payments, begin with effective Front-End processes and investing time/resources to ensure staff are trained.

Some fundamental staffing solutions.

  1. Determine the right number and skill mix of staff needed.
  2. Define and build an optimal staffing model to drive efficient key patient flow and effective administrative processes.
  3. Fully integrate processes practice wide.
  4. Create new staffing roles to deliver value-based care models.
  5. Retune work flow aligned to encourage effective patient encounters and internal support models.
  6. Build flexible staffing models including FTEs and PTEs.
  7. Train, educate and retain for better performance.
  8. Monitor key metrics and trends – never stop.

Successful staff performance requires leaders and managers to work together with ongoing education and training. Too often we see the folly of recruiting new staff pushed into a position without adequate training and support. When this fails, whose fault is it? We know all too well that finding and retaining key staff is difficult. The goal is to recruit and onboard staff who have good skills, can solve issues, and work effectively together. Better performing practices support practice team education/training and respect. Investing in effective training and onboarding programs for Front End teams will improve the practice revenue stream.

Employee Retention and Turnover.

This is a big problem that negatively impacts both practice operations and revenue. Overall, better-performing practices have significantly lower turnover rates and maintain higher retention. The obvious warning signal that will require a focus on employee retention programs is high turnover. When it becomes a pattern, there are almost always key reasons. We often see recurring  trends: 1. Poor leaders and business practices which limit management support. 2. Poor compensation models that do not reward performance and value. 3.  Limited time or money for education and training.

Leaders and managers must be good listeners. And yes, money is important so benchmarking staff compensation metrics and strategies against other similarly sized organizations can be helpful.


In closing, practice productivity and its ultimate success depends largely on the quality and performance of its managers and supervisors. These critical assets; managers, supervisors and team champions, strongly influence the overall performance of the practice. Recruiting and retaining the right managers and staff is step one if you want a successful team. Yes, attractive compensation and senior leadership are important but key managers and staff champions are often the catalyst that promote success. Hire smartly, reward appropriately and you will be far better positioned for success.

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Larry A. Kemp, M.A, M.S., is a Fellow with the American College of Healthcare Executives, a managing Partner of PRS Consulting, LLC and CEO of Kemp Healthcare Consulting, LLC. He has over 25 years of experience with diverse healthcare operations and successful business development with physicians, medical groups, hospital-systems, corporate entities, consulting, education and training and medical product launch. He has a broad range of executive leadership responsibilities in a variety of healthcare settings including: Facility CEO, COO, CFO and administrator positions, practice management consulting with physician multi and single-specialty groups, IPA’s, GPO’s, new group start-ups and integration and mergers, and hospital employment alignments and exit models. He is a nationally recognize healthcare business and physician reimbursement consultant, author, educator, and keynote speaker to physicians, medical groups, and corporate healthcare for healthcare business solutions, relationship building, new business development, educational training programs and strategic advisory.