Practice Management Improvement Strategies

Five advisors every surgeon needs

Having a solid team of advisors brings peace of mind so surgeons can focus on patient care.

Wise individuals know their area of expertise and know when they need expert advice. For surgeons, building a team of trusted advisors is as important to their personal and professional success as building a team of top-notch employees is to the success of their practice.

Engage these five important advisors who can guide you throughout your career.

Health care attorney

Amy Boyer
Amy Boyer

Many surgeons starting out in practice will join a hospital or group as an employed physician. The employment agreement you will be offered is a legal document that sets the stage for your income potential and practice growth. Reviewing it is not the time for do-it-yourself or to ask a favor of your brother-in-law’s lawyer friend who practices family law. You will likely review an employment agreement fewer than five times in your career; hospitals and large medical groups have a team of people who do it daily. This is not the time to skimp. Hire a health care attorney to review the agreement and advise you on negotiations.

A good health care attorney can help you in other areas, too. For example, if you receive a request from a special investigations unit of an insurance company, especially if they are asking for a statement or a personal meeting, call your health care lawyer immediately. According to health care attorney Thomas O’Carroll of Hinshaw & Culbertson LLP, often physicians wait until it’s too late to consult with an attorney, because they are used to cooperating with an insurer.

“Many times, physicians do not expect these meetings to be confrontational only to find that they feel more like a deposition,” O’Carroll said. “Often, physicians will find that the follow-up of that meeting will be a demand letter where statements made are quoted out of context and used to justify requests for reimbursement for a figure that is well beyond the physician’s ability to pay.”

Contact an attorney as soon as you receive a request from a payer questioning billing or coding practices.

Patricia Hofstra is a health care attorney at Duane Morris LLP and helps physicians navigate regulatory minefields like Stark, HIPAA and anti-kickback prohibitions — areas that go beyond the expertise of a general law practitioner. She said, “If your attorney doesn’t understand your business and the complicated regulatory environment, you are at significant financial and legal risk.”

Work with a health care attorney to manage your risk and ensure you maintain compliance.

Accountant

Many employed surgeons feel that being employed eliminates any financial and practice management concerns that come from being in private practice. However, according to orthopedic spine surgeon Michael Marks, MD, MBA, president of Marks Healthcare Consulting and senior consultant at KarenZupko & Associates, if you are employed it is even more important to have your own team looking out for you, as the hospital system is unlikely to have your individual goals high on its priority list.

“You need to make sure that an accountant will be your advocate,” Marks said. “He or she can help you look at productivity reports and help with planning yearly financial goals.”

Taxes are confusing and it only gets increasingly complex when, in addition to W-2 and 1099-MISC forms, you have income from interest, dividends and capital gains, some of which are sheltered through multiple types of tax-deferred accounts, such as 401(k), IRA, 529 plan or health savings accounts. Add to that any real estate investments and small businesses, and professional help is needed.

Select an accountant with substantial experience working with orthopedic surgeons.

“We help physicians maximize their income by assisting them with tax minimization,” Brad Barrick, CPA, CHBC, principal, Medical-Dental Consultants Inc., said. “In order to properly perform our role, we need to understand the business and the industry. Our expertise lies in maximizing income and reducing expenses.”

Look for an accountant with whom you want to work and who you trust to advise you on personal and business finances. It should be a collaborative process.

“My experience has been physicians who listen, provide feedback and work with us regularly have a bright future and will accomplish financial goals,” Barrick said.

Financial advisor

According to the Association of American Medical Colleges, the median level of medical school debt for the class of 2015 was $183,000. How do you manage that debt, buy a house and start saving for your retirement and your children’s educational costs?

Financial planners work with physicians to understand their short-term and long-term financial needs and design a financial plan. They take a comprehensive look at all related financial needs, including tax planning, asset protection, debt management, retirement planning, college planning, investment management and risk management and insurance, as well as real estate purchases.

Remember to involve your spouse in financial planning and decision-making. Discuss your shared vision and goals with your spouse, and create a plan.

Work with the financial advisor to fully understand your investments. A good advisor speaks in terms you understand and educates you to make informed decisions about your financial future. The right financial advisor will explain details of investment options and not make you feel dumb for asking questions. It’s your money and you need to be in charge of it.

Insurance agent

Choose an experienced insurance agent for risk management planning. Protect your and your family’s future by putting in place the appropriate insurance coverage. Life, health and disability insurance are a must. Experts recommend buying 10 to 12 times your income in life insurance coverage to ensure your family can live comfortably and maintain their lifestyle in the event something happens to you.

Remember to purchase coverage for your spouse. Even a stay-at-home parent needs life insurance. Consider the economic value he or she brings to the home. If something happens, you would have to hire someone to care for the children and manage your household so that you can continue earning an income.

Be sure the disability insurance policy you choose contains a definition of disability called “own specialty.” This means you are eligible to receive benefits if you are unable to perform the duties of your own medical specialty — not just any job that is in the medical profession.

If you own a practice, you will also need business property and liability coverage, workers’ compensation insurance for employees and commercial auto insurance. Check with the American Academy of Orthopaedic Surgeons and AMA for discounts available to members.

Mentor

The first few years of practice can be tough both clinically and professionally. Stay in touch with your residency or fellowship mentor who can assist you with hard cases as you begin practice. Also, find a mentor at your place of employment to help you navigate the politics of the organization and start your career on the right step.

“Focus on building your practice and avoid outside distractions,” Marks said. “After becoming board certified, get involved with your state, specialty society and the AAOS. Building your relationships with your colleagues, locally and nationally, is important.”

Begin your search for advisors by asking for referrals from trusted colleagues. Spend time interviewing professionals and select advisors who are good fit with your values and personal philosophy. Putting in place a solid team of expert advisors to guide you and advocate for you provides the kind of peace of mind that allows you to focus on what you do best — take care of patients.

Disclosure: Boyer reports she is a consultant with KarenZupko & Associates Inc., which develops and delivers CPT Coding and Practice Management workshops presented by the American Academy of Orthopaedic Surgeons in conjunction with KarenZupko & Associates Inc.

Wise individuals know their area of expertise and know when they need expert advice. For surgeons, building a team of trusted advisors is as important to their personal and professional success as building a team of top-notch employees is to the success of their practice.

Engage these five important advisors who can guide you throughout your career.

Health care attorney

Amy Boyer
Amy Boyer

Many surgeons starting out in practice will join a hospital or group as an employed physician. The employment agreement you will be offered is a legal document that sets the stage for your income potential and practice growth. Reviewing it is not the time for do-it-yourself or to ask a favor of your brother-in-law’s lawyer friend who practices family law. You will likely review an employment agreement fewer than five times in your career; hospitals and large medical groups have a team of people who do it daily. This is not the time to skimp. Hire a health care attorney to review the agreement and advise you on negotiations.

A good health care attorney can help you in other areas, too. For example, if you receive a request from a special investigations unit of an insurance company, especially if they are asking for a statement or a personal meeting, call your health care lawyer immediately. According to health care attorney Thomas O’Carroll of Hinshaw & Culbertson LLP, often physicians wait until it’s too late to consult with an attorney, because they are used to cooperating with an insurer.

“Many times, physicians do not expect these meetings to be confrontational only to find that they feel more like a deposition,” O’Carroll said. “Often, physicians will find that the follow-up of that meeting will be a demand letter where statements made are quoted out of context and used to justify requests for reimbursement for a figure that is well beyond the physician’s ability to pay.”

Contact an attorney as soon as you receive a request from a payer questioning billing or coding practices.

Patricia Hofstra is a health care attorney at Duane Morris LLP and helps physicians navigate regulatory minefields like Stark, HIPAA and anti-kickback prohibitions — areas that go beyond the expertise of a general law practitioner. She said, “If your attorney doesn’t understand your business and the complicated regulatory environment, you are at significant financial and legal risk.”

Work with a health care attorney to manage your risk and ensure you maintain compliance.

PAGE BREAK

Accountant

Many employed surgeons feel that being employed eliminates any financial and practice management concerns that come from being in private practice. However, according to orthopedic spine surgeon Michael Marks, MD, MBA, president of Marks Healthcare Consulting and senior consultant at KarenZupko & Associates, if you are employed it is even more important to have your own team looking out for you, as the hospital system is unlikely to have your individual goals high on its priority list.

“You need to make sure that an accountant will be your advocate,” Marks said. “He or she can help you look at productivity reports and help with planning yearly financial goals.”

Taxes are confusing and it only gets increasingly complex when, in addition to W-2 and 1099-MISC forms, you have income from interest, dividends and capital gains, some of which are sheltered through multiple types of tax-deferred accounts, such as 401(k), IRA, 529 plan or health savings accounts. Add to that any real estate investments and small businesses, and professional help is needed.

Select an accountant with substantial experience working with orthopedic surgeons.

“We help physicians maximize their income by assisting them with tax minimization,” Brad Barrick, CPA, CHBC, principal, Medical-Dental Consultants Inc., said. “In order to properly perform our role, we need to understand the business and the industry. Our expertise lies in maximizing income and reducing expenses.”

Look for an accountant with whom you want to work and who you trust to advise you on personal and business finances. It should be a collaborative process.

“My experience has been physicians who listen, provide feedback and work with us regularly have a bright future and will accomplish financial goals,” Barrick said.

Financial advisor

According to the Association of American Medical Colleges, the median level of medical school debt for the class of 2015 was $183,000. How do you manage that debt, buy a house and start saving for your retirement and your children’s educational costs?

Financial planners work with physicians to understand their short-term and long-term financial needs and design a financial plan. They take a comprehensive look at all related financial needs, including tax planning, asset protection, debt management, retirement planning, college planning, investment management and risk management and insurance, as well as real estate purchases.

Remember to involve your spouse in financial planning and decision-making. Discuss your shared vision and goals with your spouse, and create a plan.

Work with the financial advisor to fully understand your investments. A good advisor speaks in terms you understand and educates you to make informed decisions about your financial future. The right financial advisor will explain details of investment options and not make you feel dumb for asking questions. It’s your money and you need to be in charge of it.

PAGE BREAK

Insurance agent

Choose an experienced insurance agent for risk management planning. Protect your and your family’s future by putting in place the appropriate insurance coverage. Life, health and disability insurance are a must. Experts recommend buying 10 to 12 times your income in life insurance coverage to ensure your family can live comfortably and maintain their lifestyle in the event something happens to you.

Remember to purchase coverage for your spouse. Even a stay-at-home parent needs life insurance. Consider the economic value he or she brings to the home. If something happens, you would have to hire someone to care for the children and manage your household so that you can continue earning an income.

Be sure the disability insurance policy you choose contains a definition of disability called “own specialty.” This means you are eligible to receive benefits if you are unable to perform the duties of your own medical specialty — not just any job that is in the medical profession.

If you own a practice, you will also need business property and liability coverage, workers’ compensation insurance for employees and commercial auto insurance. Check with the American Academy of Orthopaedic Surgeons and AMA for discounts available to members.

Mentor

The first few years of practice can be tough both clinically and professionally. Stay in touch with your residency or fellowship mentor who can assist you with hard cases as you begin practice. Also, find a mentor at your place of employment to help you navigate the politics of the organization and start your career on the right step.

“Focus on building your practice and avoid outside distractions,” Marks said. “After becoming board certified, get involved with your state, specialty society and the AAOS. Building your relationships with your colleagues, locally and nationally, is important.”

Begin your search for advisors by asking for referrals from trusted colleagues. Spend time interviewing professionals and select advisors who are good fit with your values and personal philosophy. Putting in place a solid team of expert advisors to guide you and advocate for you provides the kind of peace of mind that allows you to focus on what you do best — take care of patients.

Disclosure: Boyer reports she is a consultant with KarenZupko & Associates Inc., which develops and delivers CPT Coding and Practice Management workshops presented by the American Academy of Orthopaedic Surgeons in conjunction with KarenZupko & Associates Inc.