Evolving requirements for managers

Increased competition, decreased reimbursement, and the pressure to do more for and with less are changing the way ophthalmic practices do business. You probably have multiple payer contracts, and a varied set of rules under which they expect you to practice. You may have multiple offices. You probably have at least three staff employees for each physician, and if you run multiple offices with dispensaries, your staff numbers are certainly higher. You have likely considered a merger, affiliation, or expansion, and in most cases, you have recruited and/or retired at least one physician in the practice.
Have you considered whether your current practice manager is up to the task of administering a large, complex, sophisticated practice with multiple demands in this changing marketplace? What skills should your manager possess? Recognizing you are talking about one person, what are reasonable performance expectations? Certainly, the manager must be able to motivate and manage your practice employees, clearly communicate instructions, maintain discipline, and hire, and fire staff. Commonly medical practices do not hire human resource personnel until they are managing 100-plus employees, so this role of staying current with and implementing the regulations usually falls to your manager.
Computer competency is a must. You likely have agreements from payor to physician contracts that your manager handles, and implements. So a strong ability to manage information, write, and even have basic spreadsheet ability is a must. Your manager should share your vision for your office and see where it is headed. This requires strong communication skills with the top layer(s) of management, as the physician players involved in management oversight may change more frequently than the manager, and each person may have their own goals for the practice. To help your practice succeed, your ophthalmic practice manager should also able to: • function well as a project manager, multi-tasking a number of concurrent projects;
• analyze complex data sets and make projections;
• develop, implement, monitor, and adjust business plans and marketing strategies; and • compete aggressively for strategic relationships.
Why? Because the physicians in the practice may not have the time, the inclination, or the ability to take a broad perspective of the practice, and be able to lead while still seeing patients and operating.

Increasing responsibility

Consider a one- or two-doctor ophthalmic practice. The manager oversees (or does) the payables, runs the front desk, manages the employees, conducts the marketing efforts of the practice, and attempts to keep the practice physicians busy.
In addition to the physicians, this person may oversee four to eight employees -depending on physician productivity—with responsibility to supervise and manage. Usually this person reports directly to the physician(s), who issue orders and instructions.
Consider a three- to six-doctor practice. The demands are generally the same, but the manager must now control the activities of perhaps 15-25 non-physician employees, again dependent on physician style and patient throughput. The employment rules have become more burdensome with the number of overall employees. Likely, there is a main office and at least one satellite office and by now, at least one or more of the physician practices in a subspecialty area and has special needs for staff and equipment to be managed.
This manager no longer has the time to oversee or pitch in on a routine basis. At this point, the manager should really just manage. Depending on practice size and marketing efforts, the manager may also oversee a marketing director or back-office supervisor, as well as one or more site supervisors at the satellite office(s).
Consider a seven-plus- doctor practice. This manager manages directors, seeks out managed care contracts, instructs the staff, implements practice income division, influences corporate structure, devises a marketing plan and a business plan, prepares for expansion and/or merger, and ultimately is responsible for being sure that everyone is fulfilling his or her employment responsibilities.

What expectations are fair?

First, know your practice needs, and evaluate your options. How involved do you (or the managing partner) intend to be and how much time is likely to be required of the manager. Of course, if your manager cannot perform the complex functions central to running a multi-million dollar corporation (which is what most one-plus physician ophthalmology practices are now), then you should reevaluate your options. Second, if your manager is able and wants to rise to the next level of management be sure that you provide the requisite tools to do so.
You must be willing to invest in your manager’s continuing education, as you do your own. Help your manager acquire the tools needed to improve competencies. Formal and informal programs provide both novice and even experienced managers with the intensive educational background that provides the foundation for business success. Your manager should be attending the national society meetings at least every other year, and preferably annually in addition to other training.
Many practices subsidize—or pay outright—for the manager’s continuing education, including the examinations necessary to become certified in the specialty. After all, most practices pay to have their certified ophthalmic technicians and certified ophthalmic assistants become certified. Managers deserve at least the same investment.
You need someone who has experience with multi-million-dollar, high overhead, capital-intensive practices. If you cannot find an ophthalmic practice manager, consider an orthopedic or cardiology practice manager. The only problem is that their compensation is likely higher (largely because the practices tend to be larger) and it may take the new manager a few months to adjust to the nuances of ophthalmic practices.

Summary

Think about the investments you have made in your practice: your office staff and equipment, your own continuing education, and the time you spent learning new skills. Those investments enable you to be more efficient and more profitable. You must invest in your human resources. Your personnel costs are likely the highest single overhead item, and your manager your single highest paid administrative position. Invest in your management—just as you invest in yourself and your practice—to maintain and improve your performance.
If your manager is not certified, consider encouraging her to become so. Just as fellowship is a mark of credibility for physicians, so, too is certification a mark of validity for your manager. This will offer confidence that the manager is staying current in the field.
ABOUT THE AUTHOR

Sandra E. D. McGraw, J.D., M.B.A., is a principal consultant with The Health Care Group Inc., and a principal attorney with Health Care Law Associates P.C., both based in Plymouth Meeting, Penn. She can be contacted at 800-473-0032.