A Practice Administrator Speaks

Award-winner Alan Beason talks about the challenges and opportunities today’s practices face, and how distributor sales reps can help.

Alan Beason

Alan Beason

Since joining Cardiovascular Consultants LLP in September 1996, Alan Beason, MS, FACMPE, has helped build the Shreveport, La.-based medical practice from five physicians and 22 employees at one location, to a practice of 11 cardiologists, four mid-level providers and 65 support staff at four full-time and three satellite locations, serving five hospitals in northwest Louisiana.

This fall, Beason – who is CEO/administrator of Cardiovascular Consultants — received the Harry J. Harwick Lifetime Achievement Award, the highest recognition bestowed by the Medical Group Management Association. It is awarded to an individual who has made nationally recognized contributions to healthcare administration, delivery and/or education in his or her career, advancing the field of medical practice management. Beason develops education for medical practice administrators and executives on effective leadership in healthcare organizations, and has served as the MGMA representative to the United Healthcare National Physician Advisory Committee, the MGMA Southern Section, and the Louisiana MGMA Board.

Cardiovascular Consultants, LLP, is an independent cardiology practice that is closely affiliated with the Willis-Knighton Health System. Its physicians are members of the medical staff of their hospitals in the Shreveport-Bossier City area of northwest Louisiana. Several of the practice’s physicians serve in governance roles within the health system and are active on a number of key medical staff committees.

Recently, Beason shared with JHC his thoughts about the role of the practice administrator, the future of medical practices, and how distributor sales reps can best provide value to their customers.

 

JHC: Since joining Cardiovascular Consultants, LLP, you have helped grow the practice from five physicians and 22 employees at one location, to a practice of 11 cardiologists, four mid-level providers and 65 support staff at four full-time and three satellite locations, serving five hospitals in northwest Louisiana. How did you achieve that growth?

Beason: I joined Cardiovascular Consultants, LLP, in September 1996. At the time, the practice had come together through the merger of three cardiology practices on one hospital campus. The separate offices of the three original practices were still operational, creating a lot of duplication and minimal integration of staff and operations.

The first order of business was to enter into an agreement with the hospital to design, build, and lease space in a new office building to consolidate the practice operations under one roof and begin the true work of creating a unified practice. Within two years, we repeated the design, build and lease strategy to have a larger facility for our main office in close proximity to the hospital’s new cath labs and expanded emergency department.

The growth of the practice came about through a combination of the addition of individual physicians through recruitment activities and our merger with a hospital-owned group. As the Willis-Knighton Health System expanded by building new hospitals in the Shreveport-Bossier City area, we added offices on those campuses to serve those new markets.

 

JHC: Is it safe to say that you believe bigger is better? Do you think Cardiovascular Consultants could have survived – and thrived – had it maintained its former size (five physicians and 22 employees at one location)?

Beason: It is sobering to consider the destiny of our practice had the physicians decided to remain a five-physician practice with one location and 22 employees. In almost any business endeavor, stagnation is a death knell, especially in a dynamic environment, let alone one driven by technology and evolving paradigms of care.

Had the practice not grown in size and scope, we could not serve the multiple locations that we do today. We would not have added subspecialists and in-office diagnostic imaging to our service lines. As a result, we would not be attractive to new physicians from a recruitment standpoint, nor to health plans from a managed-care contracting perspective.

When properly managed, growth can have a positive, snowball effect upon the financial and operational success of a practice. Conversely, stagnation can become a self-fulfilling prophecy and harbinger of the end.

 

JHC: In your opinion, what is the future of the independent medical practice (as opposed to the practice owned by a hospital or IDN)?

Beason: The future of the independent practice is largely determined by local market forces and the skill set of the management team. A practice that has a strong governance structure, a versatile and talented administrator, and the expertise of outside consultants may be able to succeed and even thrive in the evolving marketplace. It is also driven by the degree to which the physicians embody an entrepreneurial spirit and value their independence.

However, hospital systems and integrated delivery networks do offer a number of advantages in terms of economies of scale and clout that an independent practice may not be able to match. As accountable care organizations and alternative delivery models gain traction, the market dynamics will change. For the independent practice, those evolutionary changes may reach the tipping point where the advantages of integration outweigh the benefits of independence.

 

JHC: Can you name two or three ways in which you are a better CEO/administrator/practice manager today than you were, say, 10 or 15 years ago?

Beason: In the past 10 or 15 years, I have gained experience facing new situations and benefitted from the “lessons learned” from each event. In an 11-physician practice, relationships and personalities are every bit as important as financial or operational considerations. So striving to reach consensus through communication and advance coordination has been vital in the decision-making process. That takes a lot of time, effort, and energy. Over time, the virtue of patience has helped in that regard.

We are blessed to have embraced the physician-administrator dyad model and that my counterpart, Dr. Jerome Danzell, is a terrific listener with enviable people skills.

A second area that has improved in my skill set is the realization that every organization has a culture that must be acknowledged and nourished. For the employees, nine little words that have become our motto embody our culture: “Serve the patient. Serve the doctor. Help one another.” Staff knows that if they can frame their actions or decisions in those nine little words, they will inevitably reach the right decision. That is vital when we depend largely on self-directed employee teams in order to do more with fewer resources.

A third area where time and experience have helped me is expanding upon the adage “surround yourself with good people,” by insisting that those individuals be genuinely nice people. At some point in our careers, we have been exposed to highly talented individuals who tend to be difficult, often impeding communication and coordination among team members. At best, harmony is compromised. At worst, patient safety is jeopardized. By the time a person reaches the age of five, their personality is pretty well set. You can teach a person a skill or cultivate an innate talent, but you cannot teach them to be nice. Either they have that trait or they don’t.

 

JHC: Can you explain the physician-administrator dyad model?

Beason: The governance structure of our practice uses a three-physician Executive Committee, which is elected by the partner physicians. The Executive Committee, in turn, elects the Administrative Partner Physician to work with me. Under our dyad model, I am responsible for the business and clinical operations of the practice, while the Administrative Partner physician is responsible for being a champion for change and a conduit for communication among the physicians on a peer-to-peer basis. We balance one another’s skills and weaknesses as well as serve as a sounding board to vet ideas and plans at an early stage of development.

 

JHC: My understanding is that you develop education for medical practice administrators. Can you name two or three areas in which medical practice administrators could stand to improve?

Beason: There are three broad areas where practice administrators could stand to improve their knowledge and skill set. The first is a strong working knowledge of the new payment models. From quality and efficiency reporting programs to the coming Medicare Merit-based Incentive Payment System (MIPS), these new payment models are rapidly supplanting traditional fee-for-service as the basis of payment. These programs may have bonus or financial penalty implications that can have a significant impact now and in the future. As an example, the Medicare fee schedule penalties for non-participation in the Physician Quality Reporting System (PQRS) impact payments in the second year after the reporting period has ended.

A second area of concern is the growing volume of regulations and oversight that medical practices face. The regulatory environment is growing increasingly complex. Compliance issues pervade all aspects of a practice’s operations.

Finally, the manner by which we operate and the services that we provide are in an accelerating state of evolution. The growth of accountable care organizations and other delivery models will change the manner in which we deliver care and the partners with whom we are engaged. Advances in technology and techniques will change the services that we offer.

In essence, the practice administrator needs to be able to envision what the environment for the practice will be several years down the road, have the financial and operational resources to maneuver the practice to be successful in that new environment, and the acumen to avoid the regulatory pitfalls along the way. Those are daunting challenges indeed.

 

JHC: Our readers are the men and women who call on you from med/surg distributors. What one or two things about practice managers should sales reps NEVER forget about the role and/or the needs of the medical practice manager?

Beason: The practice manager or administrator is held accountable for a multitude of activities. They can ill afford to be blindsided by a development. They need to be kept in the loop, so frequent and open communication is important. They need accurate and concise information to be effective in decision-making and advocating for a new product or technique.

Likewise, the time demands upon the practice manager or administrator can be daunting. Be respectful of their time and the priorities they are facing at the moment.

Finally, the practice manager or administrator appreciates product representatives that view the relationship with the physicians and practice administrator as a partnership. They cherish product representatives who are involved in the feasibility and consideration stage of the relationship with actionable facts. They respect reps who are an integral part of the staff training and deployment of their product. They appreciate vendors who are readily accessible for support when problems arise, as they always will. A partner is there to work through problems, and the administrator will always remember and appreciate that fact. Likewise, an administrator will never forget the helpless feeling when they need help from a vendor and that help is slow in coming.