Physician’s Business

Reinventing your Practice in the Midst of COVID -19  
There will be many operational, HR and telemedicine/technology changes needed to be implemented to re-invent the “New Normal” medical practice.    New staffing and practice operations changes are necessary and “thinking outside the box” is imperative.

Learning Objectives:  Participants will learn strategies to:

  • Keep patients safe, secure and still coming to the practice
  • Project revenue/expense/net income for financial viability
  • Revamp operations, staffing and business development

Topics Include:

  • Communicating with your patients –  Mail Chimp,  Constant Contact  Update patient email list and relational data base.
  • Follow CDC guidelines and California Department of Public Health
  • How to gain marketing benefits from requiring Patient safety gloves/masks, etc
  • Patient contact lists with staff that interacted with each other in case of exposure.
  • Senior Hours?
  • Evaluate staffing needs carefully and why Cross training critical.
  • How to have patients text, call into the office, use restaurant beepers before entering
  • Informed Consent and Patient education re: at home care
  • Assigning a COVID Director in the practice Staff e.g., OSHA   No touch waste disposal, disinfection, janitorial, office and equipment, PPE for staff.
  • Reduction/cost savings; Staffing, Benefits, Rent, Accounting, travel, meals/entertainment.
  • Review office schedule – Any half days not utilized, consider sublease
  • Get rid of storage units with old equipment costing you money
  • Implement Lean Six Sigma for operations.
  • Merging or expense sharing with other physicians
  • Staff issues with scrubs and uniforms in public.
  • Re-evaluate contract rates – Renegotiate PPO contracts, Hold biller/service accountable
  • Home Equity Loans and lines of credit to fund the practice.

Redesigning Your Practice:  Latest Trends to Stay Independent and Increase Profitability
Many independent practices are thriving despite challenges posed by health care delivery reforms.   Physicians and Managers are demonstrating that you can still have successful, rewarding and lucrative private practices and real life examples will be shown.  This workshop is designed for physicians and managers seeking strategies to remain competitive and independent in today’s marketplace.

Topics Include:

• The membership/access model ($200 per year)
• Employer coverage for the membership/retainer fee
• Full concierge model ($1000 plus per year)
• Cash only practices
• Out of Network models
• House Calls/Urgent Care
• Micro Practice
• Virtual Visits – Telemedicine
• Merging to stay independent
• Benchmarking – know your numbers to compare to your peers
• FTEs and Wage to Revenue to optimize staffing patterns
• Reducing overhead expense

Avoiding and Preventing Embezzlement
At the conclusion of this course, physicians and managers will learn how to:
• Identify potential embezzlers behavior and the ways they steal
• Protect the practice from employee embezzlement by instituting accounting controls, effective screening and management techniques
• Take action to prosecute and or obtain restitution

Benchmarking Your Practice – Key Medical Office Financial Ratios To Improve Practice Profitability
This workshop will teach critical skills in analyzing the practice profit/loss statement, accounts receivable ratios and cost accounting and how to access specialty comparison norms for benchmarking.
• Accounts Receivable Management and Cash Flow
• Importance of Profit/Loss Statements as Management Tools
• Benchmarking Overhead Categories by Medical Speciality
• Payroll to Collections and Full Time Equivalents Ratios for cost effective staffing levels
• Essential Ratios to Calculate on Monthly Status Reports
• Office Visits, Hospital and Surgery/Procedures Productivity to achieve desired Net Income

Bringing in a New Associate – Future Friend or Foe?
The biggest mistake to avoid in bringing in an associate is saying “let’s see how it goes with being an employee and we will figure out the partnership terms in a couple of years.”  That is a recipe for disaster!  Hence my title, “Friend or Foe.”   An open, trusting, fully transparent long term partner Friend relationship is the goal. Topics Include:
• Accessing Data on Current Compensation, Benefits and Perks
• Employment offers and contracts spelling out these terms
• Suggested Interview Questions in addition to Clinical
• What to look for when interviewing for long term partner potential
• Determining if you have the same business values
• Helping the associate make a good decision about your opportunity by also discussing lifestyle issues such as real estate, schools, recreation, culture, entertainment, and sports
• Essential clauses to put into employment agreements to protect your practice • Why creating an incentive program, which allows the associate to know what is expected of him/her in terms of productivity is crucial
• Why it is important to have the methodology and approximate cost of a buy-in to the practice decided before you begin interviewing so the associate can make a long-term decision about the future opportunities of the practice
• The importance of setting marketing goals and requiring the associate to submit a list of activities performed each month to build the practice, for example, visiting referral sources, giving community talks, grand rounds, media interviews, etc.

Transition from Training to Practice – A workshop for residents and fellows
Designed to give the physician, moving from residency to practice, the tools to assess various practice options and make a sound practice opportunity decision.

Designed to give the physician, moving from residency to practice, the tools to assess various practice options and make a sound practice opportunity decision with which s/he will be satisfied, evaluate employment, partnership and buy-in agreements and establish a sound foundation of business management principles. Shorter programs of 2-3 hours can also be provided. This seminar has been presented at the residency programs of Harvard, Tufts, Northwestern, Stanford, Georgetown, Scripps, UC Los Angeles, UC San Diego, UC Davis, UC San Francisco, Loma Linda University, University of Texas and University of Colorado.

Participants will learn:
How to assess the best practice type for yourself – Lifestyle and professional decisions (Utilizing our unique Practice Decision Grid)
Evaluating advantages/disadvantages of practice alternatives:
• Group
• Partnership
• Expense Sharing
• Solo practice
• Other Alternatives

Assessing Demand and Opportunities – Where you want to practice Interviewing and Negotiating Strategies
• Evaluating the Offer — Salary, Benefits, Employment, Buy-ins, Partnership Agreement
• Proving Your Worth/Bonus Incentives
• Income/ Distribution and Overhead Share Formulas
• Marketing Techniques to Build a Practice
• Practice Realities/Practice Management
• Managed Care Contracting
• Professional Advisory Assistance

What Medical School Didn’t Teach You About the Business Side of Your Practice
Presentation will teach essential business skills for those physicians new to practice. This course should be taught in medical school is what seminar attendees repeatedly say! New physicians entering practice as well as physicians already in practice can benefit from this course. This “hands on,” participatory workshop is designed to teach necessary business survival skills in simple, yet effective methods.

Participants will learn:
• How to Analyze Your Current Financial Picture
• What You Need to Know to Establish Your Operating Budget
• Readable Financial Reports to Monitor Your Practice Health
• Plug the Financial Drains on Your Practice
• Marketing, Do You Need It?
• Who’s Really the Boss in Your Office? — Effective Personnel Management
• Practice Systems- Front desk, Back office, Insurance
• Medical Records Management- Efficient and Effective Ways to enhance quality care
• Checklist for computer needs and to evaluate different software
• Practice Building Techniques Which Improve Your Profits
• Partnerships are like marriages- How to communicate, confront and compromise

Physicians are encouraged to bring their own financial reports from their practice to use in the sections on financial analysis and budgeting. If the physician is not yet in practice, samples for analysis are provided.

Survival Skills to Thrive in Private Practice! Workshop for Physicians and Managers
What are the top challenges facing physicians trying to remain independent or coming back into private practice from Hospital or Foundation employment?

Topics Include:

• Key Financial, A R and staffing ratios to maintain profitability
• How to run a “lean operation” to maintain net income
• The importance of marketing, internet presence and how to deal with Yelp, etc.
• Is Solo, Concierge, Out of Network or Micropractice an option?
• Why merging practices may be right for your long term success?
• How will technology, telemedicine and ancillary services keep the practice viable?
• How do I resist the urge to sell out simply because it’s in the headlines?
• If I sell, how do I negotiate the best offer and compensation with Work RVUs?
• Is it still possible to transition or sell my private practice?
• If I leave Hospital/Foundation employment, what do I need to do to join or start a private practice?

Income Distribution Formulas: Opportunities and Challenges
Just like in a marriage, differences over the way money is spent or invested is one of the biggest areas of conflict and a major reason why partnerships and groups often dissolve.   Different practice styles, in terms of the business side of the practice, particularly with income or expense distribution, leads to inevitable conflict.

Topics Include:
• Determining Practice Values – Setting the Stage for Income/Expense Formulas
• Expense Share Formulas – Fixed, Variable and Direct Costs allocation
• Income Sharing Formulas – Equal? Productivity? Combination?
• Work RVU formulas
• Units of Use or Office Condo Concept
• Pros and Cons of each type of Formula

Having It All – A Workshop for Today’s Woman Physician
A workshop for women physicians, designed to explore time and stress management techniques and the art of juggling family and career.
A one-day workshop for women physicians, designed to explore time and stress management techniques and the art of juggling family and career.

Topics include:
A Woman’s Work is Never Done:
• Juggling Your Family and Career
• Tips on Personal Time
• Stress Management

How to Develop Leadership Skills:
• Networking
• Moving into Positions of Authority
• Projecting a Powerful Professional Image

Managing Your Practice:
• Financial Management
• Marketing
• Personal Management
• Financial Self-Defense for Professional Women

Merging Practices: Marriages Made in Heaven or Hell?
In this new era of health care, consolidating practices can result in economies of scale, reduction of overhead, increased power in contracting, increased net income, ability to recruit new partners and retire partners.  But as in a marriage, good communication and shared values are key to compatibility and long term success. This workshop covers practical strategies to manage a successful merger.

Topics include:

• Defining partner mission, goals, philosophy, impediments and “sacred cows”
• Income distribution or expense share formulas to reduce potential for conflict
• Buy-In and Buy-Out formulas – Tangible assets, A/R and goodwill- included or not?
• Structuring vesting in the event of an external group purchase
• Decisions on death, disability, slowing down, dropping call and governance
• Staff restructuring and team building, operations changes and economies of scale principles

Avoiding Conflict / Achieving Consensus (or, How to Prevent Practice Divorce)
The objectives of this course are to recognize the common reasons partnerships and groups dissolve and learn prevention strategies to avoid conflict.

Just like a marriage, a partnership or group practice needs to communicate, confront and compromise to maintain a healthy, thriving, harmonious relationship which will survive and prosper in today’s environment. The objectives of this course are to recognize the common reasons partnerships and groups dissolve and learn prevention strategies to avoid conflict.

• Inequitable income distribution formulas based on varying contributions
• Consistent tardiness of one group member
• Obvious undercurrent of tension
• Repeatedly addressing the same issues with no resolution
• Inconsistent, daily, office policy changes
• Personal or personality problems which impact on patients and staff
• Costs involved with multiple types of personal preference inventories

Content and Techniques Taught Include:
• Diagnosing conflict
• Refereeing and intervention strategies
• Promoting constructive dialogue and group dynamics
• Achieving better communication and reducing hostility
• Negotiation techniques and ways to achieve group consensus
• Principles of personnel management and income distribution
• Identifying goals and understanding psychosocial interaction

Yes You Can! Start a Practice
It is possible to start a new practice either from training or leaving a Foundation/Hospital/Single or Multi-specialty group.  The tasks needed to establish a practice are presented in the order they need to be accomplished.  It is recommended to plan 4-6 months out to establish a new practice.  Learn from an experienced practice management consultant who has assisted physician start-ups with over 200 new practices with an average of 5 to 8  per year with all specialties.

Topics include:

• Deciding on what structure is allowed in your state, C or S corporation? LLC? Partnership?
• Assessing demand for your specialty in your target area
• Choosing an Attorney, CPA, Pension and advisors and questions to ask
• Revenue, Expense Proforma Projections and Capital budgets for equipment
• Setting up banking, checking account and merchant accounts to take credit cards
• Insurance credentialing, HMO, PPO, IPA – how long it takes
• Choosing a location with the right amount of space for your specialty
• Operations policies and procedures – why these are important?
• Key Financial, expense ratios, staffing and accounts receivable ratios you must know
• In-sourcing or Out Sourcing billing? What is right for your practice?
• Setting accounting controls to avoid embezzlement
• Staff leasing or being the employer – pros and cons
• Personnel and HR essentials and the need for an employee Personnel Policies and Procedures.
• Marketing, website, branding your practice and holding an open house.

Transitioning Your Practice: Retiring, Selling, or Buying a Practice
Considering retirement? Selling or wanting to buy a practice? Making this transition requires planning and sufficient time to accomplish this effectively for your patients, staff and family. It is more difficult for physicians to sell, transition, start or purchase a practice. Learn creative strategies to help you accomplish your goals. This seminar will discuss the options, including: bringing in an associate, recruiting, selling the practice, buying a practice or closing the practice. Included is the latest information on valuation methodology for selling, divorce or estate planning.

Topics Covered will include:
•Goodwill or Intangible Asset Value – Is there still value?
•Why it is important to sell the practice before discontinuing surgery or slowing down
•Methods to appraise and value the practice
•Equipment valuation techniques
•Valuing accounts receivable, equipment, leasehold improvement and supplies
•Legal and ethical duties to patients when retiring
•Buy-ins or Sale of Practice – What you need to know regarding methods to appraise the practice
•When to use a practice broker or sell the practice yourself
•Why associates need to negotiate the buy-in formula before accepting an employment offer
•Merging-equalizing assets
•Why by a practice versus start one from scratch?
•Structuring the relationship between junior and senior partner
•Hospital support – salary and overhead guarantees
•Requirements for disposal of controlled substances
•Medical Records retention/ownership – what your attorney/broker may not realize
•How to prepare for a new physician taking over the practice

Practice Options: Self Employment vs. Hospital/Foundation Affiliation? What is Your Practice Strategy for the Future?
“The Times They Are A-Changin”. There are many practice opportunities for physicians to consider for the future. Will you remain in solo practice? Merge with others to form a bigger single specialty, multi-specialty group or ACO?  Join a Foundation or University Affiliation? This workshop will present a balanced discussion of options and issues for physicians to consider before making these important practice decisions.  This workshop has been presented for the California Medical Association / Western Leadership Academy for the last three years.

Topics Include:
•Is solo or small group practice viable for the future?
– How to survive and thrive by savvy management and marketing
•Merger Mania – Should you merge with others?
– Single Specialty or Multi-Specialty – pros and cons
– Important elements in merging – deal makers and deal breakers
– Can merging reduce expenses/increase net income, maintain independence, increase contracting power to remain in private practice?
– Will merging position the group for future acquisition?
•Joining a Foundation, University Affiliation or Hospital Outpatient Clinic Model
– When to consider an offer and How to assess an offer
– Will goodwill or intangible asset value be included or excluded and how will this be valued?
– How will tangible assets including equipment be valued?
– How many years should the contract be guaranteed?
– New models such as affiliation with Universities – Private Practice but with University Contract Rates
– Governance and decision making ability?
– Compensation models including base salary and $ per WorkRVU – How this works
– What will it be like being an employee?
– What if I want to leave?
– Will I be restricted from advocating for my patient? Malpractice Risks for Physicians

“Risky Business”  The Aging, Impaired or Disruptive Physician
The aging, disruptive or impaired physician presents risk to a practice from patient injury/malpractice claims, labor law/harassment claims or loss of patients via negative social media reviews.  This is a difficult, sensitive issue for managers and physician partners to tackle, yet it must be done to protect the practice.  Learn from real life physician client practice examples and the strategies that resolved the problematic physician issues.

Topics Include:

•Difficult personalities or disruptive physician behavior which impacts staff, manager and physicians
•The aging, depressed, substance abuser or skill impairment physician and how to deal with these doctors
•Setting boundaries, policies and procedures for MD/Staff interaction
•Confrontation/intervention and careful documentation to protect the practice and avoid litigation
•Coaching and counseling the physician
•Communicating risks to the organization: Financial, litigation, loss of reputation.
•When to call in experienced professionals, consultants, counselors, physicians who conduct neuropsychological examinations and attorneys
•Critical documentation to support your case
•Resources and programs
•Recognizing the physical and emotional stress and energy drain dealing with these issues presents to managers and physician partners and strategies to compensate


Marketing and Patient Relations

Improved Patient Relations = Increased Profits
This program is designed to aid physicians and staff in their patient relations techniques to attract and retain patients.

Customer Service and Dealing with the Angry Patient
Utilizing techniques from other fields, participants will learn customer service principles and specific ways to deal with difficult patients

Managing Your Online Presence and How to Win Against Negative Reviews
What do your patients find when they Google you?  An effective on line marketing strategy encompasses much more than just a website.  This program is designed to aid physicians and managers to understand the tools you will need to use to attract new patients to the practice,  retain existing ones while creating and keeping a positive on line reputation and successful strategies to counteract negative reviews including litigation.  A case example of physician who successfully sued and won against a patient setting precedent in California will be presented.

Topics include:

• Search engine optimization, why this is important
• Website design and elements to include for search engine optimization
• Branding your image
• Social Media – Facebook, Twitter, Linked-in, blogs and how to use it successfully
• Reputation Management  Services
• Techniques for Projecting a Caring, Professional Image
• Ostensible Agency issues with  Expense share groups
• Avoiding HIPAA violations when responding to a negative review
• Avoiding the “Streisand Effect”
• SLAPP and Anti-SLAPP
• Yelp, Healthgrades and how to obtain good reviews/counteract negative ones
• Strategies and utilization of benchmark data to win a case against a patient

Employing Physician Extenders to Enhance Your Practice
This seminar will teach management of extenders to increase profits, reduce costs, increase efficiency, yet retain patient satisfaction with services.

Superlative Customer Service = Successful Practice
Professional patient relations, telephone techniques and etiquette are essential in today’s competitive medical environment. Managed care and capitation mean increased patient volume of visits at decreased reimbursement rates. Under managed care, it is important to control utilization of office visits. Appropriate screening of telephone calls, requests for appointments and advice given will assume greater importance. Quality of care and patient satisfaction is still paramount. Interactions with patients must be handled appropriately to minimize the risk of increased malpractice claims.

Topics Include:

• Understanding what today’s patients want from medical offices
• Professional etiquette, demeanor, and business language
• Skillful PR techniques to assure patients will choose your practice
• Accurate message taking
• Protocols for screening calls
• Handling difficult patients, specific techniques for turning the angry patient into a happy customer
• Handling complaints
• Creating a service oriented environment
• Telephone advice – How much, what type, how to document
• Risk Management principles stressed such as documentation, confidentiality


Liability & Regulatory

Malpractice Prevention – Strategies for the Medical Office Targets malpractice risks specific to office practice with practical solutions

Complying with OSHA Standards – This program teaches physicians and staff how to comply with OSHA’s required Injury and Illness Prevention Plan, blood borne pathogens and basic infection control program.

HIPAA Without the Hype – HIPAA presents an opportunity to streamline paperwork, cut costs and make the leap to EMR. Need to upgrade billing or scheduling software? Consider EMR as well.


Practice Management

Top 10 Strategies to Lower Overhead Costs in Your Practice
There are only three ways to improve net income in your practice: Raise fees, increase productivity or decrease overhead. Given the complexities of managed care contracting, raising fees can be difficult to accomplish. Doctors may already be working at maximum capacity, so increasing productivity may not be an option either. Therefore, greater profitability may only be achieved by controlling and reducing overhead expenses while improving efficiency. This session will discuss the best ways to reach this goal.

Learning Objectives:

• Outline the top ten strategies to lower overhead costs in your practice
• How to monitor your AR ratios to motivate billers or billing service
• Analyze most the common staffing mistakes affecting your costs
• Determine how to eliminate inefficiencies and make your practice more productive

Closing A Medical Practice
This workshop will discuss the ethical and legal tasks to close a practice.  There are many tasks that must be accomplished and having an organized plan is essential.
• Legal and ethical duties to patients when retiring
• Requirements for disposal of controlled substances and the DEA
• Medical records retention/ownership – what your attorney/broker  may not realize
• Why you should try to sell or transition your practice
• Notification letter to patients to avoid abandonment/combine with transition letter
• Staff termination or retention to help close the practice?
• Notification requirements of payors
• Selling your medical equipment or furniture or donation?
• Notification of vendors and banks
• Checklist of tasks for closing a practice

Winding Down Your Practice: Strategies for a Successful Retirement
Effectively transitioning your practice for your patients, staff, and family requires careful planning and sufficient time to accomplish. During this seminar, you will learn creative strategies to help you accomplish your goals, including: bringing in an associate, recruiting, selling the practice, or closing the practice. We will also cover the latest information on valuation methodology for selling, divorce, or estate planning.

Topics Include:

• What you need to know to sell your practice
• Latest valuation methodology for selling your practice and planning your estate
• Merging practices: equalizing assets, structure decisions, expense share, partnership corporations
• Preparing for retirement while you practice: finances, lifestyle, work/life balance
• Legal and ethical duties to patients when retiring

Managing Change
Nobody likes change except a baby! Physicians, managers and staff often find any change difficult and stressful. The healthcare landscape is changing rapidly. Managers must be proactive, nimble and able to manage change effectively within their organizations.

Topics Include:

• Assessing the landscape of the market of the practice
• Developing strategies to grow, merge or be acquired with the pros and cons of each
• Employing successful sales techniques to create the desire for change
• Involving the team with process improvement techniques and creative brainstorming
• Why holding a strategic planning session each year is important
• Planning the change in an organized, thoughtful manner
• Rewarding the team at completion

“MBA” for MDs and Managers
This seminar teaches critical business skills in Finance, Operations and Personnel Management, for today’s physicians and office managers.

Strategies to Survive and Thrive in a Down Economy
This seminar will provide you with strategies that have been successfully implemented that reduce overhead in practices.

Reducing Your Overhead…Realizing Increased Income
In this seminar, techniques to successfully reduce overhead and increase net income will be taught.

Successful Personnel Management
A seminar designed to give the physician and office manager the tools and techniques for effective personnel management, compliance with labor law, and to motivate and increase staff morale.

How to Hire Excellent Medical Office Staff, How to Hire the Superstar Employee, Hire for Attitude and Train for Aptitude
Learn how to hire the “Superstar” employee. Hire for Attitude and Train for Aptitude! Topics Include:
• Assessing staff needs based on specialty benchmarks
• Placing ads with key words to attract great employees
• “Situational Interviewing” and other interviewing techniques to learn actual skills
• Job Descriptions, elements to include and range of wages
• Offer letters to protect the employer
• Reference checks questions, Background checks and Drug screens
• Benefits that make staff want to take the position and remain employed
• Training and motivating to succeed!

Telephone, Scheduling & Patient Flow Techniques
Professional telephone and office manners and efficient scheduling of appointments are essential to good patient relations.

“Managing Up!” How to Successfully Present Recommendations to Physicians
Managers, Administrators and CEOs in medical practice positions need to successfully learn to supervise staff or manage down, but also to achieve results by influencing their physician bosses by managing up. It is difficult to communicate to your physician boss that certain behaviors are keeping the practice from achieving optimal success.

Topics Include:

• Qualities Physicians Want in a Manager
• Qualities Physicians Do Not Like in a Manager
• Coaching Physicians Toward Productivity
• Importance of Strategic Planning
• Managing Change
• 5 Steps for Presenting Recommendations for Behavioral Change
• The Toughest Issues for Managers to Mediate with Physicians
• How to instill team spirit between physicians and staff – Morale building ideas from many practices
• Group sharing of successes, team building and problems – Interactive session

Magnificently Managing Your Practice Manager
Learn how to effectively manage, evaluate and motivate your practice manager in this seminar. An excellent practice manager can increase revenues, decrease practice overhead and manage staff to highest performance. The physician owners need to set goals, monitor, and delegate and evaluate performance of the manager.

Financial Benchmarking – Key Financial Ratios to Improve Practice Profitability
Today’s physicians and office managers need a high level of business management skills particularly in the financial area. This workshop will teach critical skills in analyzing the practice profit/loss statement, accounts receivable ratios and cost accounting and how to access specialty comparison norms for benchmarking. At lease one source of comparison benchmarking will be given to each participant.
• Accounts Receivable Management and Cash Flow
• Importance of Profit/Loss Statements as Management Tools
• Benchmarking Overhead Categories by Medical Specialty
• Payroll to Collections and Full Time Equivalents Ratios for staffing levels
• Essential Ratios to Calculate on Monthly Status Reports
• Office Visits, Hospital and Surgery/Procedures Productivity to achieve desired Net Income
• Cost Accounting Techniques

Contracting: Negotiating Physician PPO Agreements Effectively
This lunch-time seminar is a must for physicians and/or their office administrators who contract with third parties. Learn to understand and utilize your power in negotiating contracts and what to look for when reviewing the contract.

Minimize the Risk, Maximize the Value of Your Practice Lease
This workshop will teach you how to negotiate a better office tenant lease and protect yourself from costly mistakes.


*All seminars and manuals are non-refundable