To make better marketing decisions, track fewer metrics

Most marketing agencies can bury you with metrics — website clicks, impressions, social media engagement, and on and on. They can then put those metrics into pretty, glossy reports with pie charts, line graphs, and other visuals. If you’ve received those reports, you might wonder what it’s telling you about your practice. You might also get confused, and you’re not alone. As noted in Principles of Marketing (via OpenStax), “the sheer amount of data the metrics can yield can be overwhelming.

Metrics tell us what is happening at any point in time without context as to why it is happening."

Marketing exists to drive growth of a practice. The marketing metrics that matter have to ladder directly back up to growth. So many of the metrics that are available, while interesting to some, either do not tie directly to growth or are repetitive of other metrics that are also reported. By focusing on metrics that tie directly to growth, practices get more clarity on how well their marketing is working, and inevitably, they track fewer metrics.

Start by simplifying your practice’s growth target

To illustrate how this works, let’s work with a simplified, fictitious example of a physician-owned practice with two physicians: Family Medicine, PLLC (FM). FM is a primary care practice that finished last year with $750,000 in treatment revenue. FM wants to grow by 10% this year ($75,000), and based on historical patterns, FM expects that 10% of their patient revenue will leave the practice ($75,000). Overall, FM needs $150,000 in new treatment revenue.

Keeping track of revenue can be abstract. An easier way to track growth is in patient visits. How many new patient visits will FM need? For the purpose of revenue planning, FM will use $250 for each new patient visit. That means FM will need 600 new patient visits this year, which equates to 50 new visits per month, or between 12 to 13 new visits per week. Tracking new patient visits per week (or per month or per day) is much easier to track than revenue.

FM knows that, in reality, the revenue per new patient visit will vary. FM also knows that some new patients will visit more than one time in a year. However, using one revenue figure, $250, and one event, a new patient visit, helps keep planning simple and still realistic.

FM tracks all new patients by where they come from. On FM’s new patient registration form they ask each patient to choose one from this list: referrals from friends and family, from other physicians, from online search, and other.

New patient leads drive new patient visits

New patient visits are a lagging indicator. FM tracks what indicates new patient visits: new patient leads. FM tracks lead volume using the same options on their new patient registration form: friends/family, another physician, online search, and other.

Visibility drives new patient leads

Prospective patients can’t choose FM if they can’t find FM. FM maintains a steady online presence on search and social media, sends a communication to local referral sources once each quarter, and makes sure to ask patients to give an online review to reinforce FM’s hard-earned reputation.

Keep tracking simple

Each month FM reviews the results of new patient registrations, the performance of each lead source, and online visibility. They built a simple dashboard in Excel. The most useful part of their dashboard is the historical data: They see the current year’s performance of each metric, by month. They can look for trends, and cause and effect of marketing activity to results. FM spends about 15 minutes each month reviewing performance. If results spark a question, they tackle it separately.

It took FM a few months to tailor their dashboard to suit them best. For example, when FM started tracking metrics, they measured all of Instagram’s available engagement data. They trimmed it down only to the few they felt not only told them about their visibility, but also didn’t overlap with other Instagram metrics. FM also decided to start looking at monthly revenue alongside patient visit volume so that they can refine their assumptions about average treatment revenue per visit and patient retention. Overall, though, they keep it simple. As reported in Medical Economics, “…tracking metrics — monthly revenue, new‑patient counts, retention rates, and average revenue per visit — practices can identify what works, replicate successes, and reduce inefficiencies."

Look for patterns

While FM is looking at performance, they’re watching for patterns of consistent over- or underperformance. For example, FM noticed that new patient registrations from physician referrals are higher in the month after they send a communication compared to other months. FM will experiment with increasing communications to every other month from quarterly.

If you offer multiple treatments

Late last year FM added sleep medicine as a new treatment for their patients. FM’s goals this year are to break even and fine tune the operations around it, which includes promoting it.

The measurement process will be the same, with a few tweaks. Their plan is to start by referring their own patients who are clinically appropriate for it, based on the result of an assessment they do in the office. FM will track the number of sleep medicine appointments booked compared to the number of assessments that indicate clinical appropriateness. Ideally, those are the same. If not, then FM can dig in, learn when and why patients drop out, and implement corrections. Once FM has worked out the kinks, they’ll start promoting to referral sources and to their local market. Their tracking will follow in kind. FM hasn’t decided yet if they’ll add sleep medicine to their current dashboard or start a new one. That decision can wait.

Fewer metrics, better decisions

Physician-owned practices do not need more dashboards or more complex reporting. They need metrics that tell them what they need to know while respecting the realities of running a medical practice, including limited time, tight margins, and increasing competition.

By starting with revenue goals, translating them into patient volume, and tracking only the metrics that meaningfully support those outcomes, practices can simplify marketing oversight and improve decision-making.

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Moving to integrated payments: A roadmap for health leaders

Every year, hospitals are unable to collect the majority of balances owed by patients with private insurance or Medicare Advantage. Research shows that before the COVID-19 era, repayment rates averaged 54%; more recently, they’ve sharply declined. When patient balances exceed $7,500, collection rates can fall as low as 17%. These unpaid balances, along with other inefficiencies in revenue cycle management, have contributed to more than $36 billion in uncompensated care each year for the past three fiscal years.

While fixing these challenges require system-level change, modernizing payment solutions to meet patient demand and industry best practices is a good place to start. Yet the decision to modernize isn’t as simple as it sounds. It requires organizations to weigh system compatibility, consumer preference, and scalability, and ensure compliance to security and privacy standards.

Why change is still hard in health care payments

Change in health care technology rarely happens quickly. Even as patient expectations evolve, many organizations remain tied to older systems and processes. For example, in 2022, around 73% of health care organizations were still operating on legacy information/operating systems that are no longer supported. Likewise, around 75% of providers still use manual collections processes, despite 77% of patients believe digital payments would be beneficial. This gap underscores why modernization isn’t just a convenience, it’s essential for meeting patient expectations and improving operational performance.

Staying with the status quo is always easier over the short term, but it comes with significant costs across the board. Outdated payment systems drive up administrative costs, delay collections sometimes indefinitely, and erode patient trust. In fact, 56% of patients would switch providers for a better payment experience and the number increases to 74% for patients under age 27. Health systems may believe that by avoiding modernization they’re minimizing their risks, but it may leave them less prepared for new demands.

Building a roadmap you can follow

Every journey requires a good map. Moving toward integrated payments is no exception. It’s essential to start with a candid assessment of your health system’s current situation: what systems are already in place, what integration gaps exist and where, and how much revenue is being lost to inefficient collections and write-offs.

From here, the early engagement of stakeholders, including treasury, revenue cycle management, IT, compliance teams, providers, and even the board, can help ensure alignment around high-level technical requirements, strategic goals, and end-user needs. Pairing all this with a partner that already possesses robust integration credentials and a track record of supporting scalable, secure implementations in health care delivers the kind of value that truly makes a difference.

Key considerations for successful integrated health care payments

When evaluating integrated payment options, health leaders must weigh several key considerations. Each one directly shapes patient experience, organizational performance, and system sustainability.

• Compatibility with existing EHRs. Payment solutions must work seamlessly with existing EHRs to ensure accuracy, efficiency, and a consistent user experience for both providers and their patients alike.
• Omnichannel payment options. Patients today need and expect payment flexibility. Mobile wallet payments overall have increased by more than 105% since 2019, showing that consumers want the ability to use a variety of digital payment platforms, like Venmo, PayPal, Apple Pay® and Google Pay™.
• Compliance and security. Health care providers must maintain PCI DSS compliance to protect cardholder data. Implementing technologies such as validated point to point encryption and tokenization is essential to secure payment information and reduce the overall PCI compliance burden. Choosing payment partners that are HITRUST certified demonstrates a clear commitment to data security and risk management. With cyber threats continuing to rise, health systems are on track with 85% stating that preparing for and mitigating cyberattacks is a high priority.
• Scalability and support. Expanding care locations and payment channels (for example, online, mobile, or kiosk) shouldn’t mean added complexity. A scalable, integrated payment solution within the existing EHR simplifies training needs and ensures consistent support from knowledgeable, responsive partners with expertise in both payments and health care workflows.
• Rising costs and expectations mean payment systems can’t be an afterthought. Integrated payments empower health care organizations to develop and maintain stronger revenue cycles, improve patient experiences, and reduce administrative costs across the board. While change requires effort, the roadmap to success is clear: evaluate carefully, involve stakeholders early and often, and select partners that understand the unique and pressing needs of health payments.

By prioritizing system and patient needs, organizations can build secure, sustainable payment solutions that support long-term growth.

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Keeping telehealth profitable

Telehealth can absolutely make money for a practice, but it usually stops being profitable when it’s treated like a convenient add-on instead of a real service line. The clinics that do well tend to be the ones that define what telehealth is for, build a repeatable workflow around it and stay on top of payer rules that keep changing. If you want a quick “are we doing this right?” gut check, this Physicians Practice piece is a helpful framing device: “Video visits versus virtual care”.

What does “profitable telehealth” actually mean?

In plain terms, you’re collecting more money than it costs to deliver the visit once you account for clinician time, staff support, platform fees, documentation, billing work and the follow-up tasks that can pile up after a virtual encounter. Practices often think the math is working because visit volume is strong, then discover their margin is being quietly eaten by extra “shadow work,” like tech troubleshooting, last-second conversions, and denials tied to small billing details. If that’s your reality, it’s usually worth revisiting the basics and making sure everyone in the practice is playing by the same rules. Physicians Practice has a useful refresher in “Untangling telehealth billing”, and for coding mechanics that come up in real workflows, “Coding for telemedicine visits” can help align staff and clinicians.

Which kinds of telehealth are usually easiest to sustain financially?

The visits that tend to work best are the ones that are predictable, protocol-friendly and clearly appropriate for virtual care. Think follow-ups, medication management, stable chronic care check-ins, and straightforward acute complaints where your clinicians feel confident that a virtual visit is safe and sufficient. Profitability also improves when practices stop treating telehealth as the default “overflow” and instead treat it as a planned option with guardrails.

It’s also worth remembering that some services adjacent to telehealth can support both access and revenue when handled carefully. Patient portal-based e-visits, for example, can be a meaningful part of the mix, but they only help if the documentation matches what you’re billing and the workflow is designed to keep it efficient. Physicians Practice gets into the practical “do this, not that” details in “How to correctly document and bill for patient e-visits”. Remote patient monitoring can be another revenue stream, but it’s also an area where compliance mistakes can erase gains quickly, which is why this Physicians Practice piece is worth keeping on your radar: “Remote patient monitoring under scrutiny: Top compliance mistakes to know”.

What Medicare rules should we watch right now?

If Medicare is a meaningful slice of your payer mix, it helps to keep a short list of “source of truth” pages bookmarked, because the fastest way to lose profitability is to bill confidently under an assumption that is no longer true. CMS maintains the Medicare List of Telehealth Services, which is a practical anchor when you’re trying to confirm whether something is actually considered a Medicare telehealth service. CMS also publishes an updated Telehealth FAQ (CY 2026) that addresses operational questions practices routinely run into. If you want the broader policy lens, CMS’ CY 2026 Physician Fee Schedule final rule fact sheet is a good high-level map of what’s changing and why. It can also help to keep an eye on HHS’ running resource page, Telehealth policy updates, especially when you’re trying to understand whether something is permanent, temporary or simply extended again.

Physicians Practice’s Medicare coverage can be useful context for how these rules evolved and why practices sometimes get tripped up by old habits. For example, “Meeting Medicare requirements to report telehealth services” is still a helpful operational explainer, and “Changes to Medicare telehealth services for CY 2024” can help teams understand how quickly the definitions and lists can shift.

Why do commercial payer rules make telehealth profitability feel unpredictable?

Because commercial coverage and payment policies vary across states, across insurers and even across different plans under the same insurer. That’s why a practice can run the same visit the same way and get paid differently depending on who the patient’s coverage is with. One of the most practical ways to control that chaos is to build and maintain a simple internal “telehealth payer grid” that spells out what each major payer expects in terms of eligible modalities, place-of-service rules, modifiers and any odd documentation requirements. The state-level view is well captured in the Center for Connected Health Policy’s scan, State Telehealth Laws and Reimbursement Policies Report (Fall 2025), and MGMA has also discussed the uncertainty practices have navigated as the so-called telehealth cliff has softened, including in “Bridging strategic uncertainty as the ‘telehealth cliff’ is replaced by firm ground”.

Where do practices usually lose money on telehealth?

Not always in the reimbursement rate itself. More often, the margin gets chewed up by friction. A telehealth program that looks fine on paper can become expensive when the process is inconsistent, when no-shows are high, when staff are constantly converting visits because patients can’t get connected, or when documentation and billing aren’t standardized. That’s why telehealth profitability is oddly tied to basic access operations. If your schedule is leaking appointments through cancellations and empty slots, it’s hard to make any visit type financially strong. Physicians Practice has a business-minded take on the revenue impact of cancellations in “Turning patient cancellations into revenue”, and a broader access angle in “Patient access myths specialty practices should ditch today”. Even older process stories can be useful as operational models; for example, “Atrius Health deploys home-based Covid-19 triage call center” is a reminder that tight triage rules and clean routing matter when you’re trying to protect both clinician time and revenue.

What compliance issue can blow up telehealth profitability the fastest?

Audit risk, repayments and enforcement actions. Telehealth has been a persistent area of interest for regulators, and the financial downside comes quickly when documentation doesn’t support what was billed or when a practice’s policies don’t match what payers and regulators expect. Physicians Practice has covered the post-pandemic landscape and fraud concerns in “Examining post-pandemic telehealth fraud risks”. Privacy and security also remain foundational; Physicians Practice walks through practical risk considerations in “Managing the risks of telemedicine”, while HHS offers the official baseline in HIPAA and Telehealth.

What if our clinicians prescribe controlled substances via telemedicine?

That’s an area where you want to be extra disciplined because federal policy has been evolving and extensions have been issued. A good habit is to keep an eye on primary sources as they’re released, such as this DEA press release and the associated Federal Register notice. For operations, the key is having a written internal policy that addresses identity verification, licensure, PDMP checks, documentation expectations and follow-up rules, then training staff and auditing your own work so you catch problems before someone else does.

What should we watch each month to know if telehealth is really paying off?

Keep the dashboard simple enough that it actually gets reviewed. Practices typically learn the most from tracking no-show rate for virtual visits, denial rate for telehealth claims, the lag between the visit and claim submission, net collection rate and how many staff “touches” it takes to get a telehealth visit from scheduling to a clean claim. If you want broader workflow thinking that ties into telehealth, Physicians Practice’s Physician Productivity hub can be a useful companion.

What’s the quickest way to improve telehealth margin without a giant project?

Look for one recurring point of friction and fix it quickly. Sometimes that’s tightening your visit types so telehealth isn’t the default dumping ground for anything “quick.” Sometimes it’s standardizing documentation so coding and billing are consistent. Sometimes it’s addressing cancellations and empty slots so the schedule stops leaking revenue. And sometimes it’s a compliance sweep of your platform, vendor contracts and policies so you’re not building growth on top of shaky risk assumptions.

Telehealth doesn’t have to be a margin killer. But it also can’t be treated like an informal convenience that lives inside your schedule. The practices that keep it profitable are the ones that make the work predictable, the billing repeatable and the risk manageable.

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Access before appointment: How response time affects patient engagement and practice outcomes

Patient perception of access has quietly become one of the most important signals in healthcare delivery. Long before patients walk into the clinic or engage in a clinical assessment, they form impressions based on ease of access, responsiveness, and clarity around next steps. For busy practices striving to balance patient flow, care quality, and operational efficiency, the first response moment has become a benchmark of organizational reliability.

When Communication Becomes Care Access

Despite the rise of online portals and digital forms, phone communication remains a dominant channel for scheduling appointments and initiating care in outpatient settings. Across medical offices, research consistently shows that most new and acute visits begin with a phone call.

When calls go unanswered, patients do not always retry the same office. Many simply seek the next provider who responds faster, delaying or abandoning care.

The Operational Toll of Missed Access

Missed appointments cost the U.S. healthcare system more than $150 billion annually in lost revenue and inefficiency, with individual providers reporting an average of around $200 in lost revenue per unused appointment slot. Missed calls are frequently the first failure point that leads to unused appointments, idle capacity, and last-minute scheduling pressure.

Wait Times and Patient Perceptions

Longer hold times and slower responses correlate with poorer patient perceptions of access and lower satisfaction. Patients who encounter repeated communication barriers during scheduling or early outreach are significantly more likely to disengage and seek care elsewhere.

Efficiency vs Perfection: Rebalancing Early Responses

Applying clinical standards of completeness to the first response moment often creates unintended delays. Early acknowledgment does not require full resolution. It signals attention, reduces uncertainty, and preserves the therapeutic relationship.

Scheduling Friction and Practice Stability

When patients cannot schedule appointments that fit their routines, they delay care or request last-minute accommodations, increasing lateness and no-shows. Practices that support routine-aligned scheduling see better adherence and smoother workflows.

A Quiet Standard Shift

The practices that thrive are not perfect in every response. They are consistently responsive. Fast and friendly is not a shortcut. In medical practice, it is now the baseline expectation for access.

References

National Institutes of Health. Missed appointments and healthcare system cost impact. PubMed Central.

Agency for Healthcare Research and Quality. Patient experience and access to care.

Griffith KN, et al. Call center performance and patient perceptions of access. The American Journal of Managed Care.

Guy R, et al. Effectiveness of short message service reminders in increasing clinic attendance. PLOS One.

Parikh A, et al. Reducing no-shows through targeted communication strategies. Journal of Medical Systems.


Heather Revens is Founder and Chief AI Officer at Aligned Practice Studio. Contact:
heather@alignedpracticestudio.ai | alignedpracticestudio.ai

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Health care’s invisible leaders: Group practice administrators, creating clarity in chaos

Turn on a medical drama, and the cast list is familiar: emergency room physicians, nurses, and other clinicians making split-second decisions. These are good, compelling stories to tell. Another real story rarely makes the screen: the practice administrators and managers who keep ambulatory care running, behind the scenes, with a similar sense of purpose.

The Medical Group Management Association (MGMA) celebrates National Medical Group Practice Week, which recognizes these teams and leaders who make care possible across thousands of medical group practices.

“Across the health care ecosystem, medical group practices help patients get the right care, in the right place, at the right time — often before a condition becomes an emergency,” shared Akash Madiah, acting CEO of MGMA. “Practice administrators are central to that mission, partnering with physicians and ensuring the systems behind care work the way patients need them to.”

The work can be hard to spot from the waiting room. It shows up in the steadiness of the day: schedules that stay on time, phones and messages that get answered, staff who feel supported, physicians who can focus on care delivery and patients who can move through their journey with fewer obstacles.

The mission in medical group practices

For many administrators, this isn’t “just operations.” It’s a call to service — often shaped by early exposure to the industry from family members, or entry-level roles that evolve into a career.

Dea Robinson, Ph.D., FACMPE, CPC, now a director of hospital medicine programs for CommonSpirit Health, remembers the moment when practice leadership stopped being an abstract concept and became lived reality in her earlier work starting a private practice with one physician.


“I didn’t have a nurse. I was the staff,” Robinson said. She handled billing, charting, chaperoning — the full stack of work that keeps a practice functional. The experience, Robinson said, “set the stage” for everything that followed in her career.

Andre Beach, MBA, chief operating officer of Denver Arthritis Clinic, describes the administrator’s job less like bureaucracy and more like stewardship. Health care is “a dynamic, ever-changing industry,” Beach said, and “my job is to create clarity amongst chaos” — aligning people, processes and priorities so the workplace is a place where teams can do great work together.

Forging a career in group practice

In practice life, leadership often emerges through what Beach calls “the chaos promotion.” Someone excels as a staff member, becomes the go-to fixer and gets elevated into management because competence is obvious. Overnight, the job changes. Technical mastery still matters, but it’s no longer sufficient. The new administrative leader must learn to lead people, build trust and shape the environment where others can succeed.

Tori Cordova, CPPM, CPC, COC, CHONC, senior manager, practice administration, Banner MD Anderson Cancer Center, describes a daily routine that builds confidence the old-fashioned way: showing up, listening and staying close to the work.


“The one constant thing is checking in [with] all my teams, all my providers, every day…making sure there’s visibility there,” Cordova said, “because visibility builds credibility.” Cordova added, “I love problem solving…it’s OK that no two days look the same.”

That shift — from performing tasks to developing people — is one of the most important transitions in practice leadership. Early on, success can look like personal achievement. Lasting success comes in personnel achievement: coaching, setting expectations, navigating conflict, reinforcing standards and helping others grow into their own roles.

Relational leadership

Beach described the evolution into practice leadership as being “less about control…and more about influence and the people and what I can do and how it can motivate others.”

That influence is built through relationships and consistency — and in many organizations, it’s strengthened through the administrative-clinical dyad. Robinson emphasized how much progress becomes possible when the partnership is intentional.

“I’m a big believer in the strength of a dyad relationship,” Robinson said. “I can’t really emphasize enough how much you can achieve when you have a strong dyad partnership.” Robinson described starting each day aligned with a physician partner — a small habit that prevents small issues from becoming large ones.

Continuous learning

The most effective administrators also share another trait: an “administrative CME” mindset. Regulations shift. Staffing models evolve. Patient expectations change. Technology disrupts workflows. Leaders who thrive treat continuous learning as a professional obligation rather than an optional hobby.

“Always ask questions, because learning never ends,” Cordova said. MGMA sees that appetite for learning across the profession, from formal credentials and leadership development to peer mentoring, practical toolkits and communities of practice that help leaders trade notes on what’s working right now.

Learning is also how leaders move through the internal tension many administrators might experience after rapid advancement. Beach doesn’t treat it as unusual.

“Work on managing your imposter syndrome, because it’s real,” Beach said. “It’s real to this day.” The pathway forward, Beach explained, is to pair opportunity with skill-building — saying “yes” to the work while also building the competence to do it well.

Building the future of group practices

As we celebrate NMGP Week 2026, there’s another reason this story matters: the “missing middle.” Postpandemic turnover and retirements have thinned the bench in many organizations. The next generation of practice leaders is emerging, but the pathway can’t be accidental. It needs structure: mentorship, time to learn, room to lead and leaders who make development a priority.

Robinson’s advice for sustaining a career in health care is the kind that also sustains the pipeline for future medical group practice leaders.

“Stay curious,” Robinson said. “And the other thing is…give back.” Giving back can mean volunteering, mentoring, teaching and creating opportunities for others to practice leadership before the next vacancy forces a rushed promotion.

NMGP Week is about recognition for many thousands across the industry, but it’s also an invitation: Notice the invisible work and invest in the leaders who do it. When practice administrators build clarity, credibility and culture, the entire care team benefits and patients feel the difference.

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One scheduling change sharply reduced after-hours EHR work in physician practices

A new study in JAMA Network Open takes a close look at a simple but increasingly popular idea in physician practices: setting aside protected time during the workday for electronic health record (EHR) tasks.

Instead of pushing inbox work into nights and weekends, one ambulatory network reserved a dedicated appointment slot each half day for activities such as patient messaging, prescription refills and prior authorizations. Researchers tracked what happened to productivity, after-hours work and message volume over nearly three years.

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The results suggest that small scheduling changes can have an outsized impact on physician workload. After-hours and weekend EHR time dropped quickly after protected time was introduced, while productivity took only a modest short-term dip and then stabilized.

A new study suggests that carving out protected time for electronic health record (EHR) work can sharply reduce after-hours charting and weekend inbox labor — with only a modest, short-term impact on physician productivity.

The findings come from a study published in JAMA Network Open on Dec. 2, 2025, that examined what happened after a large ambulatory network in the western United States began reserving one appointment slot per half-day for physicians to complete asynchronous EHR work.

The protected slots were used at physicians’ discretion for tasks such as patient messaging, prior authorizations and prescription refills.

Productivity dipped, then stabilized

Researchers analyzed data from 130 general internal medicine physicians working between November 2021 and June 2024. Eighty-nine physicians practiced in a control network, while 41 participated in the protected-time intervention.

After the new scheduling model launched in November 2022, the intervention group saw an immediate decline of about 13 relative value units (RVUs) per week compared with the control group. Over time, however, RVUs began trending upward again, suggesting the early productivity effect did not worsen.

The control group’s productivity remained largely stable throughout the study period.

Nights and weekends improved quickly

Time-stamped EHR log data showed immediate improvements in work-life boundary erosion:

• After-hours EHR use dropped by nearly 25 minutes per week.
• Non-workday EHR use dropped by nearly 29 minutes per week.

Those reductions persisted through the remainder of the study period.

Patient message volume rose briefly after the intervention began but then declined over time.

Burnout fell sharply at the intervention site

Although burnout was not measured across both networks, a pre- and post-intervention survey conducted at the protected-time practice found that physician burnout fell by 81% after implementation, according to the authors.

The study relied on observational methods and included differences in physician full-time equivalency and practice structure between sites, which may limit how broadly the findings apply.

The authors concluded that reserving dedicated time for asynchronous EHR work may reduce administrative burden without fundamentally undermining revenue — at least in fee-for-service, ambulatory settings similar to those studied.

For practice leaders, the study adds weight to a growing argument that EHR burden is not only a software issue, but also a scheduling and staffing issue. How inbox work is structured inside the clinic may matter just as much as which platform the practice runs.

Not all EHR systems support asynchronous workflows equally — and that gap becomes more visible as practices rethink inbox labor.

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Avoid these practice mergers traps

Any private practice physician understands the difficulty of starting a practice from scratch.The countless hours and sleepless nights one must endure to achieve a successful practice is what truly makes these physicians entrepreneurs. However, it is also necessary to accept the fact that keeping the business alive is just as difficult, if not more so. In most cases, crucial decisions should be made in order for the practice to move forward, including potential buyouts as part of a growth strategy or exit strategy.This is one case where mergers come in.

Mergers and acquisitions (M&A) is an umbrella term that covers quite a lot.For this article though, I am narrowing it down to just mergers; that is, two or more practices “joining together” as compared to a practice being “bought out entirely”. If you are a physician practice owner who is considering a merger at some point, it is vital to learn more about this process early in the game. As I have written about in previous articles, while a merger can prove vital for your practice, the business will definitely go through some changes in order to stay relevant and profitable. Mergers are a principle way for some practices to expand. If you do so, however, there are certain traps you must avoid.

Finding a good fit

Trap: Failing to reach a meeting of the minds

Each owner may have an initial idea of what he or she wants to accomplish with the merger, but together they may fail to flesh out the details to achieve their goals. For instance, one may be older and views the merger as an eventual exit strategy. That’s fine, but this can mean the older owner may have a conservative approach to the business and may not want to spend money on expansion. The younger owner may be more willing to take risks and may disagree on the direction of the practice in this situation. If both owners have failed to discuss their expectations candidly, they will probably become frustrated and unhappy after the deal has closed, which can undermine the success of the merged practices. Many physicians use consultants here early on to help facilitate these discussions and ensure the two practices are truly open about their desires and intentions.

Trap: The inability to mix company cultures

One practice may have very talented personnel; the other has more name recognition, which can translate into greater marketing success. Or one practice may bring capital to the table that the other needs for expansion. Even though on paper a merger may seem like a good idea, owners and employees of the two practices may not mix well. One team may be used to autonomy; the other may thrive under micromanaging. Make sure that your proposed marriage with another practice won’t suffer from incompatibility.

Control

Trap: Failing to clearly establish who gets what

Rarely is a merger a 50-50 proposition. Carefully allocate each owner’s percentage before committing to the merger. Give consideration to pre-merger accounts receivables as well as any promised/expected bonuses that have not yet been paid before a merger is completed.

Trap: The inability of one owner to cede the last word

One of the key issues for physician practice owners when two practices merge is who will call the shots. Until the merger, each owner has been supreme within his or her practice. Decide who will be in charge when the merger is completed. Make sure each owner knows which one has the final say. There are ways to have these decisions rotate for fairness and also ways to deal with tiebreakers. These are critical components of your governance documents.

Other issues to settle before the merger include:

• Practice name. Will one name survive? Will you create a new name?
• Positions on the governance board. Decide in advance how many representatives each former practice will have on the new board.
• Staff retention. When practices merge, there is duplication of functions and you need to avoid redundancies. Negotiate before closing the merger who will stay and who will have to leave.

The unknown

Trap: Failing to bring in professionals at the outset

Physician practice owners may shake hands on a deal before even talking with a consultant or their accountants and attorneys about the merger. This mistake can be critical.A seasoned consultant can help owners think through the structure of the deal as well as (and perhaps more importantly) the shape of the practice after the merger.

Trap: Incurring unanticipated liabilities

What you don’t know can hurt you in a merger. When deciding whether to merge with another practice, be sure to do your due diligence and check for any debts, judgments (or potential judgments), payroll and other taxes, contracts with suppliers, employment contracts with staff and other obligations you may incur. Again, here is where an experienced consultant is well worth the cost.Due diligence can be very time consuming.

If your practice has one type of retirement plan and the other has a different type of retirement plan, decide which plan will be used by the new company. This and other benefits will be uncovered and evaluated during due diligence by your consultant, and as previously mentioned there will need to be a plan put in place before the merger is consummated as to what these benefits will look like post-merger.

Final word

You don’t necessarily have to merge in order to grow your practice. You can gain many of the advantages that a merger offers while retaining your autonomy simply by deciding to work closely with another entity. You may be able to accomplish your goals via a joint venture with a hospital, for example. Of course, any arrangement outside of a merger can have some legal healthcare implications, so you should certainly talk with a healthcare attorney before proceeding down one of these avenues.

M&A is a powerful strategy that practices have been using for decades. As long as it is done correctly and with enough preparation, you’ll be able enjoy its benefits, in the long run, should you choose to do it. Use your outside professionals early on and the road to future success will be laid out much more clearly.

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