InVisage InVitation

Over the past few months I've hinted about a group of progressive physical therapy practice owners that have come together from across the country to redefine competitive advantage and in doing so create new possibilities and prosperity for their practices. They are clear-eyed professionals who understand one does not take the lead by playing follow-the-leader or running with the crowd. 


When everyone is zigging there's a lot of value in zagging. They are zagging - big time! 


Maybe you should too...


Each has purpose, autonomy, and mastery in their clinic practice, business operations,  marketing, and in themselves as leaders. Each is practicing differently, each is practicing better, each has taken control of their own future and reward is seeking them out. 


Times have changed. Old patterns of practice are no longer adequate.Old patterns of professional association have lost potency. The playing field is not level and will not become level. Risks are greater as are their consequences. The rules and economics of practice have changed forever.


This coming together of like-minded private practice owners is called InVisage. It is doing together what no one practice could do alone. InVisage is a game changer. It is an exclusive collaboration of premier practices in exclusive markets that are innovating fast, gaining momentum, and getting results. InVisage is not out to change the profession; but rather to progress beyond the profession. Its not about surviving. It is about thriving.Invisage is for progressive physical therapy private practice owners who belief there is more, much more, than the tightening constraints and frustrations of traditional PT practice.  


Interested? Contact me. 


Perhaps InVisage is in your future...

All the Best!


Bob


(c) copyright 2011 
Performance Builders

Game Changers - Performance Tracking

Industry Leaders are well aware that the Game is Changing around them; and because they are committed to excellence, improvement, and innovation, they are restless. Restless is a good thing - I suspect you sense the restlessness too.


Its been said, if you don't know where you are going, any road will take you there. It's also been said that if you don't know where you are going you're likely to end up there. And, if you don't know where you are, how will you ever get to where you want to be?


I took a road trip in Europe recently - it was not my first but it was certainly my most enjoyable. Of course the French wines and the Christmas markets had something to do with it. But there was something else - something of a Game Changer. It was a GPS unit (Global Positioning System).WOW!


If you've walked or driven in the old cities of Europe you appreciate the labyrinth of streets, walks, and alleyways. They twist and turn. Street names change frequently from block to block. There are one-way and dead-end streets. . Missed and wrong turns are a given. It often seems that, "you can't get there from here!" Being lost is a regular part of every day.


GPS offers several benefits. First, it tells you where you are. Secondly, it tells you how to get to where you want to go. Third, it suggests places you might want to go if you knew you had the option. Fourth, it tells you without emotion or judgement when you have gotten off course - "Please turn around when possible".


GPS is all about performance tracking -about getting from point A to point B. It responds to your specific purposes and goals. Almost instantly it sorts through millions of possible routes to quickly direct you to the best one. It advises you of what's up ahead - a curve, a turn, a lane change, your next strategic decision, or your next critical move. If you get off course it will easily bring back on course.


GPS leverages the integration of multiple high level perspectives (satellites) with on the ground purpose, orientation, movement, and communications.


Like old European cities, practice management can be confusing, disorienting, and challenging to get one's arms and mind around. 


Performance Tracking in one's practice is very similar to GPS. It measures all an only the information that is needed, processes it quickly, interprets the situation, and provides timely direction. It is sensitive to your destination and timing. It lets you know when a decision or action is needed. It tells you when to: "stay in your lane", "keep right", "take the next exit", "turn around when possible, and that "you have arrived at your destination". 


Performance Tracking is the strategy, technology, and tool that elevates leading practices above the rest. It provides them with perspective, directions, efficiency, and alternative options. It provides opportunity to explore without getting lost. Together with Performance Standards, Performance Benchmarking, and Strategic Planning, Performance Tracking provides owners and managers with a three dimensional perspective of where the practice is and how to most efficiently and effectively arrive at the desired destination on time and with the attitude and energy to enjoy it. 


Think of Performance Tracking as your Guided Performance System - its an incredible Game Changer!


Got Tracking?


All The Best!


Bob  


(c) Copyright 2010
Performance Builders

Game Changers – Operational Standards

Leading practices take the lead and stay there because they have performance standards for which they train to attain. They scout the competition, assess their own potential, establish expectations, develop strategy, and manage resources. Like sports teams, industry leaders go into the season and every day expecting to perform to their potential and leave the winner. They play as professionals and constantly step up to new challenges.

Professionals are energized by performance standards because they empower them to bring out their best.  

Every professional athlete and team is defined by their statistics. They know what is expected of them and deliver reliably. They understand that their compensation and job security depend on how well they perform every day. They can never rest on past accomplishments. If stats or attendance are down, players, coaches and managers are held accountable. There are always contenders who will readily step into any performance gap.

Without performance standards, accountability, and consequences there is no excellence – there is no superior performance.  Top performers earn the reputation and hold the title only so long as performance excels. They reliably adapt to deliver under new challenges and changing conditions.

In practice, operational standards include clinical outcomes, sales, revenue, expense, charges, collection, cash flow, utilization, productivity, profit, and market share. Everyone has their stats and every statistic has an owner. Every decision and action impacts performance by helping or hurting – neutral impact does not exist.


There are three reasons Practices are not top performers - no standards, the wrong standards, or inadequate management implementing standards.

Performance standards are a strategic tool. Each standard influences, and is influenced by, the other standards. They are crafted not cast. Management’s most important task each season is the definition of performance standards – it is the cornerstone of business strategy.

It’s about more than budgeting. It’s about the orchestration of priorities, resources, and deliverables that will ensure a championship performance by the team. It’s about setting the bar; and it’s about going over the bar day after day.

Operational Standards are a sign of professionalism. They separate front runners from the pack.

Operational Standards are incredible Game Changers for those who know how to use them. There is nothing that creates more value in less time and at less expense than Operational Performance Standards. They are powerful and potent. They do more than change the game – they transform the culture of the team. They transform players into professionals. They establish competitive advantage.

Got Standards?

All The Best!

Bob

© Copyright 2010

Performance Builders

Game Changers - Profit Planning

Leading practices understand that profit is the life blood of their practice. It is what enables them to improve and innovate, attract and retain talent, and earn a reasonable return on their investment and risk. Profit, or the lack thereof, is a huge Game Changer. Profit is particularly important during challenging times of change, such as we find ourselves in now, because it enables options and choice in responding to new challenges.

Profit is the ultimate measure of a practices relevance, service, knowledge, judgment, skill, discipline and planning. Profit is too important to leave to chance. To be optimized profit must be planned.

Too often practice owners and managers think of profit as something that is leftover rather than built in. When that is one’s perspective, performance always falls short of potential. It’s amazing how many practices operate without a coherent strategy or financial plan. Its startling how few practice owners and managers even know their intended and actual profitability.

Profit begins with planning.

Planning involves establishing expectations, positioning operations for success, managing behaviors, and delivering results.

So what factors into planning?

Most practices define expenses first, then chase revenue with hopes of achieving a profit. Leaders use a different approach – they define intended profit and realistic revenue first and then manage expense within predetermined constraints. Doing so empowers them to manage by making disciplined decisions.

Capitalization, equity, debt, credit, cash flow, pricing, contracts, and collections are obviously important factors. Then there are labor considerations including staff levels, mix, assignments, compensation, training,  and productivity. Facility related matters are also part of the plan – location, size, design, and occupancy expense. Operational factors such as policy, procedure, workflow, offerings, services, utilization, communications, and marketing are also critical. Each factor has its own impact but together the impact can be exponential. These are just some of the big rocks.

Other factors involve performance history, competition, vision, market changes, and comparative performance benchmarks.

Every factor and every decision either enhances or diminishes potential profitability.Whether one earns a profit or not is simply a matter of choice!

Leading practices are Game Changers for their competitors.  Through profit planning Leaders strengthen their positions, their choices, their influence, and their advantage. They set the pace and widen the lead. They do so at their competitors expense. They do so to their community's benefit. That’s what makes them leaders. It begins with intent, commitment and planning. Profit follows…

Profit planning has never been more important than it is today. A growing market and eroding reimbursement demands innovation and profitability to implement it. It’s not just about surviving it’s about thriving.

There is nothing more strategically important or financially rewarding than Profit Planning! It’s impact is immediate.


You’ll be surprised by its potential.


“Profitability is not the purpose of, but a limiting factor on, business enterprise and business activity. Profit is not the explanation, cause, or rationale of business behavior and business decisions, but rather the test of their validity”. – Peter Drucker

All The Best!

Bob

© Copyright 2010

Performance Builders

Game Changers - Documentation

Leading practices have realized that clinical documentation is a key strategy in a Game Changing practice environment where efficiency and productivity are becoming ever more critical and service justification essential. Why? Because documentation takes time away from service provision and revenue production; and third party payers are always looking for ways to reject payment.  

There are five primary reasons for clinical documentation.

1.  For  continuity  and  quality  of  care  –  Clinicians  forget  things  and  sometimes need  to  have  someone  else  provide care. 
2. For  reimbursement  –  Payers  want  to know  that  services  are needed, appropriate, beneficial,and delivered. 
3. For medical‐legal  liability – Occasionally things  go  wrong  and  need  to  be investigated.  Truth  is,  too  much information  can  be  as  harmful  as  too little and therapist malpractice rates are a testament to low risk.  
4.  For  research  –  Learning is  important. But fact is that very few practices or clinicians are actively involved in clinical research, so many practices track far more information than they gain value from. 
5. For marketing – optimized documentation tells a story of efficiency and effectiveness that can be used strategically for competitive advantage and growth.

 Documentation is another Goldilocks Issue – not too big, not too small, not too hard, and certainly not a bear! It needs to be kept “just right”! Too big wastes time, while too small compromises clinical care and reimbursement. “Just right” adds value!

So what does “just right” look like?

It begins with three simple rules:

1. Do all and only what needs to be done. 
2. Do it once and do it right.
3. Do it fast, cheap, and accurate.   

Then certain key strategies are leveraged…

1. A standardized minimum data set captures all and only what information is needed.
2. Exception reporting is leveraged to reduce volume and simplify content
3. Workflow offloads tasks and simplifies administration and management
4. Computerization is deployed strategically, not as an end in itself - yes there are things that should not be computerized
5. Data is interpreted and not just dumped on recipients
6. Reports are audience specific and tailored to their need to know
7. Narratives are replaced by information mapping
8. Repetitive tasks, content and analysis  are templated and automated
9. Accountability is built in - think progress against stated discharge criteria - not just goals
10. Documentation is completed in real-time but never at the expense of patient interaction

Inefficient documentation is common, even where computerization has been implemented. It wastes valuable resources and undermines service capacity. Good documentation systems add multidimensional value.

Optimized documentation is more a matter of strategy than software.  So it’s no surprise that so many (most) practices are disappointed with their software investments.  

The solution is revolution not evolution.  

Leading practices recognize the need to do more for less and that in matters of documentation less is more! When done well, the cost of documentation can be reduced by half or more while revenue is improved. No wonder its caught the attention of leading practices.

I have strong opinions on documentation. It comes from working on clinical documentation systems for over 20 year. I've had the privilege to design and implemented several proprietary computerized clinical documentation systems. Systems that were built from the bottom up with productivity built in. The opportunities came because my clients found they were unable to find commercial systems that provided the functionality, features, and efficiency they were seeking.  

Commercial clinical documentation systems are designed to allow customers unlimited customization - the only limit is what the client can afford to spend for customization - usually customization only perpetuates inefficiency and unnecessary expense. There are are better ways. What I've shared here is the tip of the iceberg.

Optimized clinical documentation is a dependable Game Changer that can yield a positive return on investment every day. Documentation is one game that most practices need to change. Its not about computerizing old habits but rather about innovating better and more efficient habits. The former is equivalent to paving wondering cow paths - that latter is like building a multi-lane expressway between point A and point B.


Is it time to get strategic? Is it time to reduce cost and increase profitability with every patient encounter? Is it time to realize a built in competitive advantage? Now you've got the idea!


Next Post - Profit Planning.

All The Best!

Bob

© Copyright 2010

Performance Builders

Game Changers - Utilization

Leading practices across the country are taking a fresh look at Utilization. Why? Because Utilization is a key indicator of care planning and management, service value and outcomes, resource consumption, professional contribution, and financial performance.  Utilization tells an important story for those who are willing to hear it and are committed to excellence.

As we have discussed previously in this Game Changer Series, the twenty-first century healthcare environment is defined by the rapidly rising consumption of health services, increasing consumer expectations, exploding health care costs, and eroding provider reimbursement. These are not passing trends but rather the new normal.

Utilization metrics incorporate three core performance parameters that are relevant to care services, strategic planning, and financial management  – Visits/Case, Units/Visit, and Expense/Unit.

Utilization is all about goals, outcomes, right-sizing, and efficacy. Let’s consider each of these briefly…

Goals establish priorities, define expectations, and set direction. They are defined in care plans, implemented with scheduling, evaluated throughout the service cycle, reported in documentation, validated to justify reimbursement, cited for marketing purposes, and rewarded by compensation. Goals drive utilization. Utilization is dependent upon one's intervention focus – education, home instruction, pain relief, isolated segmental restoration, holistic functional rehabilitation, re-injury prevention, or performance optimization.

Goals involve both qualitative priorities (improved balance) and quantitative outcomes (Olympic gold medal on the balance beam).  Outcomes consider how high one sets the bar. Outcome expectations and their achievement often become self-fulfilling prophesies. What would patients want if they understood the difference between what was permitted, probable, and possible? What expectations are your utilization standards creating? What innovation are your standards driving?

Utilization decisions are influenced by who has knowledge,  power  and control over the intervention priorities and outcomes that are/can be established – the payor, provider, or patient.

Utilization constraints can be artificially introduced by payor benefits as in examples such as: 6 visits/case, 2 units/visit, or $75/visit. Such constaints are prone to protect payor profitability at the expense of patient needs.

Utilization can also be constrained by providers using one-size-fits-all planning and scheduling. When utilization is routinely defined as, “one-on-one for 60-minutes, three times a week for 4 weeks”, the primary constraint is that of provider habit where preference trumps possibility. One size does not fit all.


Utilization constraints such as a client’s community, family responsibilities, travel distance, transportation, work schedule, financial resources, insurance or lack thereof, benefit plan, and even the weather also affect utilization.

With all those utilization variables there are a lot of opportunities for a perceptive and innovative manager!


As Goldilocks discovered, in The Three Bears' world of “too big or too small”, “too hard or too soft”, “too hot or too cold”, there is tremendous value in “just right”. Right-sizing recognizes that utilization is influenced by constraints within an infinite spectrum of possibilities. Utilization must be actively and creatively managed.


Efficacy involves effectiveness and optimization – doing all and only that which will produce the best benefits in the shortest time, for the least resources. Often efficacy is assumed, with interventions being based more on matters of training, tradition, protocol, economics, and egos than on scientific evidence. Efficacy always impacts utilization either favorably or unfavorably. There is room for improvement. It is interesting that  nearly every professional claims/believes that they provide superior efficacy – just ask them! However, statistically we know with certainty that 75% of professionals do not. Utilization is greatly impacted by, as Will Rogers said, “What we think we know that just ain’t so.”

So what story is utilization telling us?

1.       1. Utilization increases when outcome priorities shift from pain relief to functional restoration.

2.       2. Utilization decreases when outcome priorities shift from functional restoration to payor profit.

3.       3. Utilization is optimized when priorities shift from medical diagnosis to functional impairment.

4.       4. Utilization is optimized when focus shifts from symptom relief to biomechanical cause.

5.       5. One-size-fits-all utilization dosage won’t work, doesn't work, and never did.

6.       6. Industry leaders will be those who understand the complexity of Utilization and get it right.

7.       7.  Industry laggards will be those who won’t let go.

Industry leaders understand that utilization management, like investment management, is optimized in the context of a portfolio where diversification, risk mitigation, short and long term goals, value, performance, and return on investment considerations are all interlinked. The simplistic management of utilization fails to deliver value! They recognize the complexities and opportunities of utilization and strategically optimize utilization for the benefit of those they serve.

The lesson of utilization is simply, “play smart or go home”.

All The Best!

Bob

© Copyright 2010

PerformanceBuilders

Game Changers - Productivity (Part 3 of 3)

Like it or not, the Game Has Changed. So too must productivity. To simply maintain productivity is to fall further behind every day. Why? Because reimbursement continues to erode - a trend that is certain to continue given rising healthcare costs.


By way of a recent example, California experienced a significant decrease in Anthem Blue Cross reimbursement for PT providers ($75/visit cap) this month (Feb 2010). Meanwhile Anthem also announced premium increases for members of 39%. Then of course there is the proposed 21+% decrease in Medicare fees for 2010... Will there be more cuts? Count on it!


With eroding payments productivity must increase if compensation and profits are to be maintained, much less increased. And of course, increased quality of care does not come without investment!


So what does it take to improve productivity in practices today?


1. It begins with acknowledgment that: the “Game has Changed” and that the pace of change is quickening and irreversible... that productivity in current business models is not stable, sustainable, or scalable... that it's time for decisive action.


2. It progresses in dialog with key stakeholders with whom tough realities are discussed candidly and unemotionally, and implications are explored broadly. A consensus is formed and articulated as nonnegotiable business principles.


3. The dialog then expands to engage staff in a series of conversations (not presentations or proclamations) through which realities are explored, shared understandings are formed, implications are considered, loyalties are tested, and commitments are volunteered.


4. It is through talking, dreaming, debating, and yes, arguing that comprehensive plans are formulated and funded.


5. The Game Changes. The implementation of priorities, performance standards, training, responsibilities/accountabilities, work processes/flow/deliverables, information systems, advancement and compensation are all part of the process.


6. Finally, those Changes are leveraged to secure new business opportunity and competitive advantage for profitable growth!


Anything less, is less than serious. Anything is will predictably fail. The cost of not improving productivity is high.


The need for such change surpasses individual practices and encompasses the profession in its entirety; including professional and trade associations, universities that prepare professionals, continuing education, and even vendors. But first, it will take root and form in a small nucleus of practices that will set the pace for the profession and will find considerable opportunity and reward in doing so.


Productivity is a potent Game Changer and potency is what the current market environment demands.


Futures are being determined in the productivity decisions that are made and in the actions that are being taken, whether those decisions are consciously intentional or not.


The automobile industry is being framed by fuel efficiency and value; and so too is the health industry.The game has moved from the friendly, comfort, and predictable to the aggressive, competitive, and chaotic. The new game is fueled by productivity and innovation. The market demands that we lead, follow or get out of the way. Which will it be?


Are you a Game Changer? Got your game face on? Got your game on?


Get productive!


In the next Game Changer post we'll consider Utilization...


All The Best!


Bob

© Copyright 2010
Performance Builders

Game Changers - Productivity (Part 2 of 3)

To repeat where we left off...


While external factors have had their impact on productivity, there have also been critical internal factors at play – education and training, infrastructure investment, management priorities, and matters of professional comfort and convenience.


Despite the elevation of entry level education to the doctoral level for PTs, most enter the profession with little if any business orientation; this despite the fact, that healthcare accounts for 1/6th of the US economy.


Most therapists also arrive with little if any structured training or experience in delegation to support staff – even to staff who are credentialed professionals (e.g. PTAs). Task stratification, work assignments, and supervised delegation are cornerstones of productivity but remain under leveraged at best and unleveraged at worst within the profession. The result is underperformance and unnecessarliy constrained capacity within practices and the profession as a whole.


Infrastructue investment has been another internal detriment to productivity. Simply stated there has been too little. There are also matters of investment with good intentions but disappointing results. A prime example of that is the current rush toward the perceived need for electronic medical records in rehab with too little regard or understanding of productivity and return on investment implications. (more about that in another post).


It is extremely rare to find practices strategically and systematically investing in making their people more productive. That despite the fact that practices are service based with labor the single largest expense. Optimizing staff productivity and capacity through training and infrastructure investment should be the primary expense management strategy of practices but seldom is!


Too often productivity improvement is no more than owners, administrators, or managers periodically mounting their bully-pulpit or soap-box to threaten, admonish, cajole, plead, or beg staff to work harder or longer or to bill more units. Staff without adequate understanding, training, systems, resources, performance standards and accountability are not to blame, and thus are not the primary solution.


Productivity begins with purpose, leadership, strategy, and investment. It begins with an end in mind and is executed with passion and attention to detail. Only then can the benefits of productivity be harvested and respect for individuals be protected.


That is not to say that front line clinical professionals are not a critical part of the problem and of the solution. Professionals are afterall people first. All people have a tendency to do what they perceive to be in their own best interest. Work related comfort and convenience are important.


Change takes energy and comes with uncertainty. Lives are busy. One-on-one services packaged in one hour appointments for all patients, without delegation responsibilities are comfortable and satisfying for the professional on multiple levels. But, it is neither a clinical or business model that is financially stable, sustainable, or scalable! That’s the simple truth.


Let’s be honest and respectful with each other – it’s the way professionals relate. There is a significant culture of comfortable productivity that dominates the rehabilitation profession. That culture is protected and perpetuated whenever the quality trump card is played in productivity discussions.


Why does it have to be quality or productivity? Why not quality and productivity? It is where quality and productivity intersect that value is created, patients and communities benefit, professions are advanced, and future opportunities are secured. Professional advancement, job security and financial prosperity is dependent on value creation as measured by clinical and business outcomes – not one or the other, but BOTH.


Only by enhancing productivity and value (i.e. providing better results for more people at less cost) can professional security and prosperity be expanded. The simple reality is this: the need for health, rehabilitation, and fitness services is increasing rapidly and will continue to do for several decades. Those who expand capacity and value will be well rewarded. Those who don't will eventually be replaced. It is the way of the market. There is no place to hide. It is true for professionals, practices, and the profession. Evolve and adapt or go extinct.


Productivity is a measure of contribution, relevence, value, and vitality. Productivity is a matter of professional pride and possibility. Productivity means potential and prosperity. Productivity is a Game Changer!


Leading practices are Changing the Game today! They are doing so from the inside out while they have time. They are not blaming others and are not waiting for the inevitable. They are listening to the worries, needs, and preferences of the communities they serve. They are responding with new services provided in new ways with enhanced value to more people. And, they are being recognized and rewarded. They are sparking a revolution.


It was during the American Revolution that patriot Thomas Paine said, "Lead, follow, or get out of the way!"  And so it is today with productivity in healthcare...


To be Continued...


All The Best!


Bob

© Copyright 2010 Performance Builders

Game Changers - Productivity (Part 1 of 3)

The Western civilization’s enviable standard of living that we have come to take for granted is premised on improving productivity in the workplace – i.e. reliably doing more for less year after year, decade upon decade. In fact, US productivity has improved an average of 2.7% compounded annually over the last 50+ years. Productivity defines our standard of living and determines its sustainability.


Productivity is the fuel that drives prosperity. Productivity is a huge Game Changer. Prosperity follows productivity trends upward and downward! Prosperity erodes when productivity remains stagnant in an improving economy; and turns toxic in falling economic times.


Rising prosperity for rehabilitation professionals over the past half century has been leveraged largely by labor shortages, limited competition, relative affluence in matters of reimbursement, and limited financial accountability. But that is past tense.


Things began to change, first in the mid 60’s with the introduction of Medicare, and then again in the 90s with the introduction of managed care and its various derivatives. Both were Game Changers. Changing population demographics, particularly aging and obesity, along with technology costs, and administrative overhead drive the emerging national health cost crisis. It too promises to be a Game Changer.


With Medicare came increased documentation burdens that began to compete with patient care resources. Then came Intermediaries, fee schedules with ICD-9s, CPTs, RBRVUs, prospective payment with reimbursement literally by the minute, and rules – the rule of 8s, the Rule of one-on-one, and so on...


With Managed Care came more documentation demands, Gate-Keepers, preauthorization, provider networks and contracts, more fee schedules and various payment caps.

From a productivity perspective such regulatory add-ons over time also resulted in the evolution of cumbersome and inefficient practice operations. The efficiency never got built in because systems were layered rather than integrated. The result was operational fragmentation, redundancy, and gaps which are now apparent in diminished productivity that goes unrecognized because "its always been that way" and staff accept it because, "that's just the way it is".

Like an old home that has been repeatedly remodeled over the years, evolved practices just don't flow right because they were designed for compliance not efficiency.

Efficiency is compromised in practices by communication systems, paper work and documentation, work processes and flow, facility layout, construction and traffic patterns, and so much more.

Productivity has also been compromised by the going and coming of staff over the years. Each introduced new layers of operational clutter by importing old compliance forms and processes they packed along from practices where they had previously worked - not because they were efficient but because they were familiar.

With layers, clutter, and variation comes inefficiency. Routine work that needs to be performed repeatedly should be performed consistently with optimal efficiency. The criteria for performing such work should be fast, cheap, and accurate where one size fits all.

Like an archeological dig, the excavation of a practice tells a story of evolution over time. And, practices like garages benefit from periodic reorganization. In practices the reorganization is less physical than it is operationally strategic. The result when done well can transform productivity.

Together Medicare and Managed care have operated on the premise and claim of enhancing quality of care – who could possibly be against that? And to be fair, there have been benefits to the public. But also to be fair, operationally "quality of care" has primarily translated into rule based strategies that have helped assure third party payer profitability at the expense of provider productivity.


Such controls are not conducive to productivity or innovation; both of which are critically needed in the context of national health challenges inclusive of the expanding physical functional needs of the US population to remain healthy, independent, and avoid costly institutional care. Where would innovation, capacity, and culture be in emergency departments if they were operated and reimbursed like rehabilitation departments?


While those external factors have had their impact on productivity, there have also been critical internal factors at play – education and training, investment, management, infrastructure, and professional convenience. We will consider internal productivity matters and attitudes next post.


To be continued...
All The Best!


Bob

© Copyright 2010 Performance Builders

Game Changers - Restructuring (continued...)

Now, I’m not suggesting that “the sky is falling” but the imperative to re-imagine, re-structure, re-tool, and re-create health service practices should be obvious. The signs and symptoms are all around us.


Leading practices are pausing to take the time to carefully examine practice performance, to reassess purpose and priorities, to reconsider business models, to redesign operating systems. to streamline processes, to reinvent service offerings, to re-message marketing, to redistribute responsibility and accountability, to reinvigorate or replace staff, and to reap new rewards.


“To become something new we must first acquire all that we can no longer be.” – Kevin Kelly


Every practice begins with an entrepreneur’s vision and passion. Risks are taken and along hours are committed to make things work – there’s no excess baggage and focus is keen. But over time, entrepreneurs settle-in or move-on. Practice priorities shift from “make it work” to “keep it working”. There is a certain comfort, albeit a false comfort, in status-quo. Remaking a Practice requires a return to its entrepreneurial roots which may, or may not, have remained with the practice.


Restructuring for success begins with an entrepreneur’s vision and passion... something leading practices understand and something other practices will never quite get.


It’s very likely that your practice is built on a foundation of management philosophies, business models, marketing strategies, clinical techniques, and operational systems that are at least three to four decades old. It’s prudent to ask if that foundation is sustainable for another decade or more.


This year, 2010, marks the beginning of a new decade. Is it time for you to wring out the old and ring in the new? Is it time for your Extreme Practice Makeover? Will your practice value rise with its relevance or fall with its failure?


It has been said that, “Every practice is perfectly designed to get the results it gets!” What is the design of your practice?


Today there is an opportunity for you to decide. Tomorrow the market may decide for you.


In my next post, we will consider game changing productivity.


All The Best!


Bob


© Copyright 2010 Performance Builders

Game Changers – Restructuring

Perhaps the ultimate Game Changer response to changing trends in the marketplace could be described as Extreme Practice Makeover (EPM). Market leaders have already begun.


Like the hit TV show Extreme Home Makeover, it’s “down with the old and up in the new.” It’s all about restructuring for success. While EPM occasionally involves physical facilities more often it’s about restructuring attitudes, performance standards, management controls, marketing strategies, service offerings and fees, clinical documentation, business contracts, staff compensation, and operational finance. It involves building profit into the practice rather than trying ever-harder to squeeze it out.


It’s a story that predictably begins with the gathering of help for a job too big to do alone and reliably ends with new possibilities and reward. ...”Welcome home”.


At least half of practices today are struggling against progressive financial erosion resulting from the relentless waves of increasing competition and costs amidst declining reimbursement – then there are matters of regulatory compliance, staff that expect and often deserve more, and operating systems that are part of the problem and not part of the solution. Many owners/managers privately acknowledge that, “work’s no fun anymore” and that they are, “at their wits end and need help”.


We all acknowledge the incredible rate of change that is happening in the world around us. But, we often don’t connect the dots to understand and anticipate what it likely means for our families, professions, and practices. We become comfortable and complacent inside the familiar walls and routines of our practices and fail to fully appreciate the implications and certainties that follow trends.


As in matters ranging from auto repair to obesity and global warming there are tendencies to delay, defer, and deny. With each passing day, practices and careers become either more obsolete or more relevant. It all depends on the decisions management makes and the actions it takes.


Consider a few technology changes over the past 25 years – Internet, laptop computers, Google, plasma TV, HDTV and now 3D TV, cell phones, airbags, GPS, CDs and DVDs, email and voice mail, digital cameras, ATMs, and space shuttles already being sent to museums rather than the moon. Then there is medical technology!


The current economy is a grim reminder for governments, companies, and individuals that the traveling companions of change are obsolescence and risk.


Futurists tell us that most jobs that will be performed 20 years from now have not yet been created and most have not even been imagined! Rohit Talwar, a London based futurist, suggests such jobs might include:


“Body Part Maker - Due to the huge advances being made in bio-tissues, robotics and plastics, the creation of body parts - from organs to limbs - will soon be possible, requiring body part makers, body part stores and body part repair shops.


Nano-Medic - Advances in nanotechnology offer the potential for a range of sub-atomic 'nanoscale' devices, inserts and procedures that could transform personal healthcare. A new range of nano-medicine specialists will be required to administer these treatments.
nano-medic,


Pharmer of Genetically Engineered Crops and Livestock - New-age farmers will raise crops and livestock that have been genetically engineered to improve yields and produce therapeutic proteins. Works in progress include a vaccine-carrying tomato and therapeutic milk from cows, sheep and goats.


Old Age Wellness Manager / Consultant Specialists - Drawing on a range of medical, pharmaceutical, prosthetic, psychiatric, natural and fitness solutions to help manage the various health and personal needs of the aging population. Memory Augmentation Surgeon - Surgeons that add extra memory to people who want to increase their memory capacity and to help those who have been over exposed to information in the course of their life and simply can no longer take on any more information - thus leading to sensory shutdown.”


Then of course there is the New Science Ethicist, Climate Change Reversal Specialist, Virtual Clutter Specialist, Waste Data Handler, and... Well, you get the picture.


As Dorothy said in the Wizard of Oz, “Toto, I've a feeling we're not in Kansas anymore.”


To be continued....


All The Best!


Bob

© Copyright 2010 Performance Builders

Game Changers - Compensation

We've discussed certain Game Changers that are testing the economic foundations of traditional health services practice models. Change begets change. With change comes uncertainty and risk - but its where the reward is. Change is required of those who are committed to stay in the game and remain competitive.


Here's what I'm telling the leading practices that I'm working with...


The first responsibility of a leader is to define reality.

Our emerging practice realities are economically driven... cost per unit of service needs to be improved, revenue sources need to expand and diversify, and risk needs to be shared. These are the same realities that have faced the automotive industry in recent years - enough said. Interestingly, a related reality is that most health services owners/managers come into the game with little economic training or passion.

In matters of economics it's aways a good discipline to begin with the big rocks. In the health services sector there is no bigger rock than compensation. Consider these realities...

1. Few practices establish adequately informed or disciplined compensation practices

2. Persistent labor shortages drive compensation packages steadily upward

3. Compensation progression is commonly tenure based rather than contribution driven

4. Staff have been conditioned to expect annual compensation adjustments - only upward

5. The value of escalating labor benefit expense goes under appreciated

6. A culture of "entitlement"has taken deep root in the industry

7. Salaried compensation models establish fixed rather than variable expense limiting management options

8. PT productivity is one of the lowest in the health services industry

9. Accountability for financial contribution and return on investment is weak

10. Practices are held hostage by fears of resignation and staff turnover

11. Financial compensation is framed by matters of experience and self-defined quality rather than financial contribution

12. Excessive labor costs threaten job security and even survival of many practices

The time for a well considered and systematic migration to variable compensation has arrived. Such a migration will produce winners and losers - both categories will be self defined. Are there risks in doing so? Certainly, but the status quo has its own risks. Is it easy to do so? No, but neither is keeping existing compensation models working!

Practices who successfully establish a sustainable variable compensation model with benchmarked performance will enjoy a decisive competitive advantage in the market as measured by clinical, operational and financial outcomes.

Professionals who step up and graduate to variable compensation will also improve their personal competitive advantage while enhancing earning capacity and earning job security. Variable compensation is all about accountability and risk sharing - its the future. Its a big rock that's worth moving.

Variable compensation based on financial contribution can be a huge Game Changer. Is everyone in that game? No, only the leaders...

The next Game Changers post will consider Start-ups, Start-overs, Turn-arounds, and Right Sizing.

All The Best!

Bob

(C) Copyright 2010

Performance Builders