Controlling Your Practice’s Destiny

February 2014, Vol 4, No 1

San Diego, CA—Do you know where your practice is heading? If so, you are in control of your practice’s destiny. Dennis Wipperling, FACMPE, practice administrator with Surgical Specialists of Minnesota, Minneapolis, spoke at the Medical Group Management Association’s annual conference, where he noted that planning today is not what it used to be. Whereas organizations once had 5-year plans, these plans are much shorter now, necessitated by the many changes coming from Washington, DC.

Strategic Planning and Implementation

Mr Wipperling cautioned that although strategic planning is one thing, it is equally impor­tant to develop a way to achieve the goals your organization has identified. “Strategic planning is the process, but then you need to talk about implementation,” he said. Mr Wipperling referred to an old adage to emphasize his point: “Organizations don’t plan to fail. They fail to plan.”

He illustrated this by describing the machinations of one organization that developed a 5-year strategic plan, 7 years ago. At the time, the organization had identified 5 priorities, but had managed to accomplish only 3 of them in 7 years. When he joined the group, it had begun the planning process, but shortened its vision from 5 years to 3 years. Eventually, he predicted, it would shorten the range to only 6 months.

Why Have a Strategic Plan?

A strategic plan is a process that begins with a vision that leads to an outcome. In other words, where does your practice want to be in 2 or 3 years? This process begins with gathering information, and necessitates defining goals along the way. The planning process must also be dynamic, one in which change is inherent, especially in today’s quickly evolving healthcare world.

All organizations must begin with a vision. Mr Wipperling illustrated this need with 3 case studies. In the first, a pulmonary specialist group that he helped transition to close to St. Paul, MN, once had a vision to be the predominant pulmonary critical care group and sleep medicine provider in the eastern part of the Minneapolis–St. Paul metropolis. Indeed, they once dominated the market there, covering all of the intensive care units and all of the large health systems in St. Paul. But then, things began to change. The hospital began to make changes and decisions that made the pulmonary group’s vision obsolete. Payers began to drive the changes. And with Obamacare in the works, the entire healthcare system changed rapidly. Soon enough, the group found itself with a failed vision and faced the prospect of having to close its doors. Thus, “now more than ever, strategic planning is a must,” Mr Wipperling observed.

In the second case, a physician wanted to start her own practice. Her ideas were not well conceived and she jumped from one idea to the next before the practice even had a sufficient infrastructure to build upon. Practice administrators spent most of their time doing damage control and putting out fires rather than helping the organization realize its vision. Within a 5-year period, the practice lost 13 providers. Although the practice is still in business today, they have lost a considerable amount of time and money in the process because of a lack of discipline, focus, and planning.

A third case illustrated how a comfortably established and predominant specialty group, in business for more than 20 years, finally faced competition in the form of the hospital system for which it had been the primary provider.

The hospital system became the entity introducing the competition. The practice had not felt that it needed a strategic plan, because they had operated without one for many years. As the competition from the hospital increased, the practice diminished greatly and is even now continually losing revenue.

How to Form a Strategic Plan

To form a strategic plan, it is necessary to first define your practice’s capabilities and determine how it can accomplish its vision. Referring back to the pulmonary practice, Mr Wipperling noted that its initial vision was to be the predominant player in its market. And indeed, for a time, it was. It provided value to the community.

But for the first time, and because of a set of rapid changes, this successful practice had to completely regroup and reassess the position it was in. It was forced into a reactive position because of its lack of anticipation in a quickly changing marketplace. What had worked for the practice in the past no longer applied.

This is especially true of any medical practice today. What was important even 2 years ago—electronic health records, access to care, and reimbursement—has been replaced with new issues, including pending retirements, hospital coverage, compensation and productivity, and staffing shortages.

What things still apply are a practice’s core competencies. Practices must know what they do well. In view of the current environment and even more impending changes, practices must know their priorities, have a strategic plan for coping with the changes, and be able to make sense of it all.

“One thing that should not change is your mission,” Mr Wipperling observed. “You are here to take care of a population and provide healthcare. Bear in mind that what is not working is just as important as what is working. Prepare to adjust your vision to make a course correction.” The pulmonary practice in St. Paul did not particularly like the change that occurred, but it had no choice. He recommended conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis to help gather the information necessary for them to switch gears:

  • Strengths: Know your core competencies
  • Weaknesses: Determine where your organization is most vulnerable
  • Opportunities: Determine what your organization should be doing that it is not doing now and identify unmet needs
  • Threats: Identify problems that might pose a threat to your long-term success.

The pulmonary associates were unaware—and, therefore, unprepared—that their strongest business partner (the hospital) would eventually wind up becoming their fiercest competitor.

Surveys, Plans, and Priorities

Surveys can be very useful in helping to map out the planning process and identifying potential problems. Mr Wipperling shared that a survey for one practice revealed that the physicians worked well together (an attribute that ranked high on the survey), but lacked a unified vision (an attribute that ranked low on the survey). This dichotomy showed the lack of a common vision and illustrated the need for a course correction.

He urged practices to align their priorities over the next 2 years especially. Determine which priorities are most important and attach a time line to each. But most impor­tant, limit the priorities. Having a 7-year plan might sound impressive, but in today’s environment, it makes little sense. Limit your priorities to what will have the greatest impact on your practice, and be realistic. Develop an action plan for each priority, which should include identifying the specific steps to take, establishing the time frames for accomplishing each step, assigning who will be responsible for achieving each step, and creating a review process to determine how successfully each priority has been achieved.

Mr Wipperling strongly suggested reviewing each measure regularly. He recalled how one practice had identified access for new appointments as one of its greatest challenges. The practice’s staff members determined how many new patients they wanted to see each month, and set this number as their goal. Then they developed measures and a responsible plan that required frequent reporting.

They also planned out what they would do if their vision failed: They would visit their referring physicians and identify practices that had not yet referred patients. Everyone in the practice was to play a role in the process, including the scheduler. All systems and processes would be aligned with the practice’s priorities, including same-day appointments for new patients, ensuring excellent experiences for new patients, and following up with new patients and referring physicians.

All plans require a debriefing process during which practices should determine whether their priorities are being addressed and whether they are sufficiently following through on them. When things go well, celebration and reward should be a part of the process. When things fail, it is time to drill and engage all staff, including the receptionist and whoever else has contact with patients.

Mr Wipperling noted, “It’s about having measures and being diligent and tracking this information. It’s about transparency, feedback, rewards, and celebrations.” Above all, he observed, “It’s important to ask if we are accomplishing our goals and, if not, what or who is keeping us from doing so?” During this time of unprecedented healthcare changes, practices do not have the luxury of lying down and waiting for something to happen.

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