Small Independent Medical Practice Financial Analysis and Reporting

How do you keep track of the financial health of your practice?

Providers in small private practices rely on a variety of information that makes them comfortable. Some providers will ask for all kinds of data ranging from total billing and charges per month, amount of money received every month or even weekly, total aging, collections by procedures and CPT codes, patient balances etc.

On the other hand there are providers that rely on their office managers and builders tremendously and as long as money is coming into the bank they don’t question too much.

In majority of the cases providers missed the mark entirely.

This is an age where we have data and information overload. Everything is digital, everything gets stored as discrete data and therefore everything can be reported on. Does that mean everything is useful? What information should we look at and what should we ignore?

Bits of data in isolation are irrelevant. Total charges per month and a graph of it over the year are irrelevant if not compared to the productivity and the total number of hours that a doctor puts in per day.

Absolute numbers don’t matter as much as looking at a trend over time. Keeping the total number of patients seen over time constant and the total number of hours that you put in on a daily basis as constant, if the trend indicates a downward slope on collections, that is what we should be worried about.

Similarly, ratios and percentages are more important than absolute numbers. Total revenue per patient, revenue per procedure, productivity per employee, and similar such ratios are perhaps more important than absolute numbers.

I understand that providers do not have the time to look into this in detail themselves. Most office managers are not equipped to think like business accountants. That is why you should look into experts and consultants who can help you analyze this data. If you are outsourcing your billing, many of them can provide this insight.


How do you know it’s time for a new EMR?

I read this blog from Seth Godin (New Times call for New Decisions) and it struck a chord.

Remember when you bought your first EMR? Perhaps you’re still on it, or you may have changed. Each has it’s reasons. Here is what Seth wrote:

New times call for new decisions
Those critical choices you made then, they were based on what you knew about the world as it was.

But now, you know more and the world is different.

So why spend so much time defending those choices?

We don’t re-decide very often, which means that most of our time is spent doing, not choosing. And if the world isn’t changing (if you’re not changing) that doing makes a lot of sense.

The pain comes from falling in love with your status quo and living in fear of making another choice, a choice that might not work.

You might have been right then, but now isn’t then, it’s now.

If the world isn’t different, no need to make a new decision.

The question is, “is the world different now?”

— Seth Godin

Nothing has changed more than Healthcare and in particular, Healthcare IT, EMR, EHR. We persist because Change is Fear!

In the world of EMR/EHR, implications are more than just fear. They have to do with real costs of change – cost of moving data from one system to another. 

Cost of Change

  • Cost of Training everyone
  • Cost of productivity – (it takes an average of 3 months before a practice become productive on one EMR/EHR system)
  • Cost of Transition – moving data from one system to another

Cost of No Change (Status Quo)

How do you determine if you need to change your EMR/EHR? Here are things that determine if you need to change your system:

  • Seeing less patients per day than you did before EMR/EHR
  • Drop in Revenue (not because of overall healthcare changes)
  • Unhappy staff. Listen to everyone, even if you are happy with the system
  • Inefficient workflow

How do you determine the cost of Status Quo

This may require some detailed financial analysis. Compare the cost of change and cost of no-change. If this cost is just incremental, do not change. Think of the analysis you do when you think of re-financing a house. Money saved per month versus cost of re-financing. 

But most important, do not remain stagnant.

How do you Buy an EMR/EHR System?

Most providers and practices buy EMR with Fear. Fear holding you back from asking the right questions. If you are a Physician, you know the fears – I don’t need to write an essay about that.

Here is what goes on in our minds when we think of EMR.

  • How should I select the EMR that is good for me and my practice?
  • How much should I pay? 
  • Aren’t all EMR the same?
  • How to get proper reimbursement? Will the EMR help?
  • How to maximize my time with patients?
  • Will I lose productivity?

Instead, step up and ask Why

  • Why get an EMR?
  • Why Bother with something that I fear?
  • Why should I be scared of CMS?

I urge all Providers to keep on asking WHY until you get to the core of the issue. What is the real fear? Where is the fear?

  • Am I afraid of computer technology?
  • Am I afraid that ‘big brother’ will watch the data and try to tell me how I should treat my patients?
  • Am I afraid of my ‘freedom’ and become a ‘data processor’?
  • Am I afraid Computer busywork will kill my practice?
  • Am I afraid I will be forced to choose between time with my patients and all the mandatory records we have to input into the computer?

We need to step up and ask the right questions. Buy EMR for the right reasons

EMR is NOT a Commodity and let’s stop asking the question – How much?

Instead, focus on what the system and the vendor can do for me and my practice. Will it allow me to grow my practice, and go home on time? Will it/they help me regain my life?

EMR Software Selection – Don’t go by the looks

I meet doctors and office managers that purchased EMR Software and now want to change. They always say – ‘it looked good, simple, easy to use’. Here is a typical response.

it is aesthetically pleasing but as we go deeper into the system, it is not working and doing what we need it to do.

Choosing EHR / EMR Vendor – Importance of Claims Processing Stability

I got an email this morning from someone that complained about an issue that never comes up during the EMR selection process.
Here’s what he wrote, ‘current practice management solution has switched who it uses for claims processing many times because of contract issues.

When you research your system, you generally don’t ask these questions. At the best, you (of your biller) may ask who is the Clearing house, just to make sure it is a good reputable company.

The EMR industry is under so much pressure that all kinds of things are happening. Vendors are cutting costs, cutting services and you will notice ‘shortcuts’ that can affect you. Here are some situations that can have prompted this –

  • A complete system is quite often built with partnerships. One such partnership is with a Clearinghouse to process your claims. Vendors strike deals and negotiate pricing. In doing so, sometimes promises are made that EMR companies cannot keep in terms of volume sales. When that happens, clearinghouse wants to raise prices, renegotiates contracts that can have direct repercussions on client pricing.
  • A worse case scenario is one where your vendors switch partners. If they bring in a less than desirable partner for claims processing, your cash flow can be severely affected. Just as there are ‘Free EMR’ companies, there are ‘Free Clearinghouses’. Even paid EMR vendors sometimes use Free Clearinghouses because of pricing pressures.

Two quick questions can resolve that.

  1. Who is the clearinghouse partner? Make sure it is someone like Gateway EDI, or similar company that is stable and has been around, and has a good reputation.
  2. How long has the EMR company been in partnership with them? Is this the only clearinghouse they use, or do they partner with others also? If so, who are the others?

In short, unfortunately, this is one more thing you must have on your list to ask your EMR vendor.