today's practice: changing the business of medicine

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EDITION

HAVE WE LOST IT?

REPUTATIONYOUR

HOW DO YOUR PATIENTS PERCEIVE YOU?

MARKETING ADVISORY SERIES:

TECHNOLOGY ADVISORY SERIES:

THEHUMANTOUCH

SPECIAL FEATURE:PRACTICE CULTUREDEVELOPMENT SERIES

FINANCIAL ADVISORY SERIES

ESSENTIAL CONSIDERATIONSIN CHOOSING A SECURE TEXTMESSAGING SERVICE

ESTATE PLANNING FOR RETIREMENT ACCOUNTS: UNDERSTAND AND BENEFIT FROM TODAY’S LANDSCAPE.

2 5 0 G S T. • P. O . B O X 1 2 0 • B L A I N E , WA 9 8 2 3 1 - 0 1 2 0

www.ScenarPT.com

3 6 0 . 3 3 2 . 8 1 6 7 • I N F O @ S C E N A R P T. C OM

Many of your clients experience chronic pain that results in abuse of narcotic pain relievers. Breaking the addiction cycle with chronic pain patients has been an ongoing challenge. The solution has arrived.

Scenar PT is a Drug Free chronic pain treatment delivered through a hand-held medical device. Non invasive, non narcotic, computer modulated, and therapeutic electro-stimulation is delivered onto and through the skin.

Less pain and more function for your patients means less dependence on narcotics. Scenar PT provides a powerful solution for drug free chronic pain treatment.

FDA-cleared for pain relief, muscle re-education and stress reduction, Scenar is a a biofeedback device that aids the body in the self-healing process.

Scenar Therapy has been proven to be highly effective and longer lasting than other pain control methods. In fact, a randomized study done at the Macquarie University in Sydney, Australia, compared traditional TENS (Transcutaneous Electrical Nerve Stimulation) to Scenar Therapy. Patients treated with the Scenar showed dramatic and sustained results with chronic pain reduction, functional improvements and general health restoration. Scenar prompts the body’s own adaptive processes by reducing stress and inflammation. It facilitates the return to homeostatic function, effectively changing the symptoms of pain and dysfunction. Decrease relapse rates, improve your clinical outcomes, and free your patients from pain and narcotic dependence.

DISCOVER MORE BY VISITING

2 5 0 G S T. • P. O . B O X 1 2 0 • B L A I N E , WA 9 8 2 3 1 - 0 1 2 0

www.ScenarPT.com

3 6 0 . 3 3 2 . 8 1 6 7 • I N F O @ S C E N A R P T. C OM

Many of your clients experience chronic pain that results in abuse of narcotic pain relievers. Breaking the addiction cycle with chronic pain patients has been an ongoing challenge. The solution has arrived.

Scenar PT is a Drug Free chronic pain treatment delivered through a hand-held medical device. Non invasive, non narcotic, computer modulated, and therapeutic electro-stimulation is delivered onto and through the skin.

Less pain and more function for your patients means less dependence on narcotics. Scenar PT provides a powerful solution for drug free chronic pain treatment.

FDA-cleared for pain relief, muscle re-education and stress reduction, Scenar is a a biofeedback device that aids the body in the self-healing process.

Scenar Therapy has been proven to be highly effective and longer lasting than other pain control methods. In fact, a randomized study done at the Macquarie University in Sydney, Australia, compared traditional TENS (Transcutaneous Electrical Nerve Stimulation) to Scenar Therapy. Patients treated with the Scenar showed dramatic and sustained results with chronic pain reduction, functional improvements and general health restoration. Scenar prompts the body’s own adaptive processes by reducing stress and inflammation. It facilitates the return to homeostatic function, effectively changing the symptoms of pain and dysfunction. Decrease relapse rates, improve your clinical outcomes, and free your patients from pain and narcotic dependence.

DISCOVER MORE BY VISITING

COLORADO EDITIONCONTRIBUTORS

PUBLISHERCharles Tramont

ct ramont@todayspract ice.com

MARKETING EDITORNathan Purcell

npurce l l@todayspract ice.com

PRACTICE MANAGEMENT EDITORCandy Caverley

ccaver ley@todayspract ice.com

LEGAL EDITORNeil Thomson Esq.

nthomson@todayspract ice.com

TECHNOLOGY EDITORBob Smith

bsmi th@todayspract ice.com

FINANCE EDITORChris Hynes, JD, CFP

chynes@todayspract ice.com

EDITORIAL ASSISTANTNancy Smoot

nsmoot@todayspract ice.com

BUSINESS MANAGERKathy Schauer

kschauer@todayspract ice.com

Becky RudolfHeal thcare Management Par tners, LLC

[email protected]

Randall C. SchauerFox Rothschi ld LLP

rschauer@foxrothsch i ld.com

Doreen JaressMySuccess Inc.

d [email protected]

Bob SmithMySuccess Inc.

bsmi [email protected]

Alan BrandfonPr ior i ty Payment Systems At lant ic

abrandfon@ppsat lant ic.com

Richard Wagner, JDql iqSof t

r ichard@ql iqsof t .com

Allan W. GermanSolar is Imaging

agerman@solar is imaging.com

Christopher Hynes, JD, CFPHynes F inanc ia l

chr is@hynesfinancia l .com

Brendan J. King, EsquireEstate Preser vat ion Law Offices

bk ing@estatepreser vat ion law.com

Philip C. Gallant, CLTCThe Opt imus Group, LLC

phi l@theopt imusgroupl lc.com

Alan FinstonWhatcom Phys ica l Therapy

a [email protected]

Ron MerittOn Adver t is ing

rmer i t t@on-adver t is ing.com

Keith ClarkAbode Systems

[email protected]

R. Scott LiffLi f f Laborator ies

COLORADO EDITIONCONTRIBUTORS

PUBLISHERCharles Tramont

ct ramont@todayspract ice.com

MARKETING EDITORNathan Purcell

npurce l l@todayspract ice.com

PRACTICE MANAGEMENT EDITORCandy Caverley

ccaver ley@todayspract ice.com

LEGAL EDITORNeil Thomson Esq.

nthomson@todayspract ice.com

TECHNOLOGY EDITORBob Smith

bsmi th@todayspract ice.com

FINANCE EDITORChris Hynes, JD, CFP

chynes@todayspract ice.com

EDITORIAL ASSISTANTNancy Smoot

nsmoot@todayspract ice.com

BUSINESS MANAGERKathy Schauer

kschauer@todayspract ice.com

Becky RudolfHeal thcare Management Par tners, LLC

[email protected]

Randall C. SchauerFox Rothschi ld LLP

rschauer@foxrothsch i ld.com

Doreen JaressMySuccess Inc.

d [email protected]

Bob SmithMySuccess Inc.

bsmi [email protected]

Alan BrandfonPr ior i ty Payment Systems At lant ic

abrandfon@ppsat lant ic.com

Richard Wagner, JDql iqSof t

r ichard@ql iqsof t .com

Allan W. GermanSolar is Imaging

agerman@solar is imaging.com

Christopher Hynes, JD, CFPHynes F inanc ia l

chr is@hynesfinancia l .com

Brendan J. King, EsquireEstate Preser vat ion Law Offices

bk ing@estatepreser vat ion law.com

Philip C. Gallant, CLTCThe Opt imus Group, LLC

phi l@theopt imusgroupl lc.com

Alan FinstonWhatcom Phys ica l Therapy

a [email protected]

Ron MerittOn Adver t is ing

rmer i t t@on-adver t is ing.com

[email protected]

R. Scott LiffLi f f Laborator ies

IN SYNCManaging the business & cultural

aspects of a practice merger

THE LATEST BLISTERINGPHRASE IN HIRING

STRESSAddressing the elephant in the corridors,

the exam rooms, and in the mirror.

THE PERFECT COMPLIMENTUpgrade your human resource function to

better support your strategic mission, whilemore effectively administering the basics.

ARTICLE DIRECTORY

PRACTICE MANAGEMENT

ESCAPE FROM THE TAX TRAPCan you become a Financial McGyver?

DEFINING YOURINVESTMENT PHILOSOPHY

FINANCE

YOUR REPUTATIONProtecting & using it to your advantage.

LOCAL SEARCH ENGINE OPTIMIZATIONThe importance to your practice.

MARKETING

5 ESSENTIAL CONSIDERATIONSIN CHOOSING A SECURE TEXTMESSAGING SERVICE

IS YOUR PRACTICE READY FOR EMV?

KEY BENEFITS OF MEDICALRECORD SCANNING

TECHNOLOGY

BUILD A STRONGER FOUNDATIONUpgrade your human resource function tobetter support your strategic mission, whilemore effectively administering the basics.

ESTATE PLANNING FORRETIREMENT ACCOUNTSUnderstand and benefit from today’s landscape.

SPECIAL FEATURE: PRACTICE CULTURE DEVELOPMENT SERIES

5 TODAY’S PRACTICE: CHANGING THE BUSINESS OF MEDICINE Ju ly/August 2014 Ju ly/August 2014 TODAY’S PRACTICE: CHANGING THE BUSINESS OF MEDICINE 6

IN SYNCManaging the business & cultural

aspects of a practice merger

THE LATEST BLISTERINGPHRASE IN HIRING

STRESSAddressing the elephant in the corridors,

the exam rooms, and in the mirror.

THE PERFECT COMPLIMENTUpgrade your human resource function to

better support your strategic mission, whilemore effectively administering the basics.

ARTICLE DIRECTORY

PRACTICE MANAGEMENT

ESCAPE FROM THE TAX TRAPCan you become a Financial McGyver?

DEFINING YOURINVESTMENT PHILOSOPHY

FINANCE

YOUR REPUTATIONProtecting & using it to your advantage.

LOCAL SEARCH ENGINE OPTIMIZATIONThe importance to your practice.

MARKETING

5 ESSENTIAL CONSIDERATIONSIN CHOOSING A SECURE TEXTMESSAGING SERVICE

IS YOUR PRACTICE READY FOR EMV?

KEY BENEFITS OF MEDICALRECORD SCANNING

TECHNOLOGY

BUILD A STRONGER FOUNDATIONUpgrade your human resource function tobetter support your strategic mission, whilemore effectively administering the basics.

ESTATE PLANNING FORRETIREMENT ACCOUNTSUnderstand and benefit from today’s landscape.

SPECIAL FEATURE: PRACTICE CULTURE DEVELOPMENT SERIES

SPECIAL FEATURE:Practice Culture Development Series

HIPAA COMPLIANT MESSAGING FOR ALL.qliqSOFT provides a real-time, secure, HIPAA and HITECH

compliant healthcare communication platform that connects

doctors, nurses, and other members of the healthcare team

to facilitate patient care.

HIPAACOMPLIANT

PEER-TO-PEER ENCRYPTION REDUCES RISK OF PHI BREACH

SECURE MOBILE MESSAGING

DESIGNED FOR HEALTHCARE PROFESSIONALS

from any location

RECEIVE DELIVERY CONFIRMATION

SECURELY SHARE DOCUMENTS, IMAGES,

AUDIO AND VIDEO FILES

SEND MESSAGES TO ENTIRE GROUPS OR

SELECTED USERS

free qliqCONNECT Secure Messaging

(866) 295-0451

qliqCONNECT SECURE MESSAGING FOR HEALTHCARE PROFESSIONALS

July/August 2014 TODAY’S PRACTICE: CHANGING THE BUSINESS OF MEDICINE 8

SPECIAL FEATURE:Practice Culture Development Series

HIPAA COMPLIANT MESSAGING FOR ALL.qliqSOFT provides a real-time, secure, HIPAA and HITECH

compliant healthcare communication platform that connects

doctors, nurses, and other members of the healthcare team

to facilitate patient care.

HIPAACOMPLIANT

PEER-TO-PEER ENCRYPTION REDUCES RISK OF PHI BREACH

SECURE MOBILE MESSAGING

DESIGNED FOR HEALTHCARE PROFESSIONALS

from any location

RECEIVE DELIVERY CONFIRMATION

SECURELY SHARE DOCUMENTS, IMAGES,

AUDIO AND VIDEO FILES

SEND MESSAGES TO ENTIRE GROUPS OR

SELECTED USERS

free qliqCONNECT Secure Messaging

(866) 295-0451

qliqCONNECT SECURE MESSAGING FOR HEALTHCARE PROFESSIONALS

managing the business & culturalaspects of a practice merger

In Sync.special feature: practice culture development series

featuring becky rudolph, MShealthcare management partners, l.l.c.

EDITOR’S NOTE: Becky Rudolph is the founding partner of Healthcare Management Partners, LLC in Denver. In this article she will touch upon the business and cultural aspects of a practice merger. With a background in psychology she has been focused on the business and people aspects of health care for the past 30 years. �e emphasis on physician practice management, operational e�ciency, organizational development and mergers has evolved over the last 15 years. Becky is called upon for the nuts and bolts of how to blend everything into one functional business model a�er the attorneys and CPAs are �nished. She turns several business cultures and systems into one seamless entity; dealing with everything from �nance to business process to cultural aspects.

INTERVIEWER: Among physicians, there’s a growing perception that there’s a bene�t to larger practices. From the non-physician side, what are the actual bene�ts you have seen with practice mergers?

BECKY RUDOLPH: Having been involved with practice mergers predominantly for the past 15 years, I would say the economies of scale are there, but the knowledge of how to get to those economies is a mystery to most organizations. Many of the mergers I’ve been involved with have started with exorbitant overhead, and by work-ing through streamlining business and management systems, they’ve been able to cut their overhead from 70% to 80% down to 50% to 55%. �is of course takes time and expense may actually rise for a brief period while new systems emerge.

PRACTICE MANAGEMENT

managing the business & culturalaspects of a practice merger

In Sync.special feature: practice culture development series

featuring becky rudolph, MShealthcare management partners, l.l.c.

EDITOR’S NOTE: Becky Rudolph is the founding partner of Healthcare Management Partners, LLC in Denver. In this article she will touch upon the business and cultural aspects of a practice merger. With a background in psychology she has been focused on the business and people aspects of health care for the past 30 years. �e emphasis on physician practice management, operational e�ciency, organizational development and mergers has evolved over the last 15 years. Becky is called upon for the nuts and bolts of how to blend everything into one functional business model a�er the attorneys and CPAs are �nished. She turns several business cultures and systems into one seamless entity; dealing with everything from �nance to business process to cultural aspects.

INTERVIEWER: Among physicians, there’s a growing perception that there’s a bene�t to larger practices. From the non-physician side, what are the actual bene�ts you have seen with practice mergers?

BECKY RUDOLPH: Having been involved with practice mergers predominantly for the past 15 years, I would say the economies of scale are there, but the knowledge of how to get to those economies is a mystery to most organizations. Many of the mergers I’ve been involved with have started with exorbitant overhead, and by work-ing through streamlining business and management systems, they’ve been able to cut their overhead from 70% to 80% down to 50% to 55%. �is of course takes time and expense may actually rise for a brief period while new systems emerge.

PRACTICE MANAGEMENT

In Sync... (continued) Becky Rudolph, MS

INTERVIEWER: �e legal and �nancial issues have been worked out; now it is time to call you to help us with the nuts and bolts. What do we do next?

BECKY RUDOLPH: When I consult on a merger, the initial step is an organizational analysis of each entity to deter-mine the operational strengths and weaknesses. Each practice is going to have its own culture and manage-ment style. I think it’s important to look at any poten-tially con�icting management and practice styles because dealing with hot topics early on can lead to relatively easy negotiation of the issues. When con�ict happens, people are on edge; they have formed an opin-ion and there is much more to deal with as everyone thinks they’re right. Potential partners will be willing to manage things more openly and positively if we can talk about each of the practices’ styles—what is relevant, what is not, and what the group agrees to adopt as the business culture. Make no mistake—when change happens, chaos will follow, and mergers create massive change for the inside of each business. Fear and doubt rule and the sta� member thoughts are: “Am I going to have a job?” or “We don’t do it that way” or “Our o�ce is better than yours.” �e physicians are caught in the middle, trying to navigate these issues and practice medi-cine at the same time. If you do not address the issues with management and sta�, fear and doubt can and will undermine the most positive intent.

�e model I use in dealing with change I like to call the Change-Chaos Model; it is characterized by the acknowledge that change creates chaos, and chaos has to be managed by systems, protocols, and uniform imple-mentation. Con�ict has to be addressed, decisions made and implemented; then with solid directives from the stakeholders and the business will settle down to a

day-to-day process that will run smoothly. �is kind of transition takes 18 to 24 months. �ere’s no easy way out—it takes a lot of hard work and communication. But the new culture blending all parties emerges in to one new entity where the mentality of all goes from “I” to “we.”

INTERVIEWER: So is it good to start with a hybrid model of the care centers and eventually ends up with the fully integrated? Or stay with the care center? Or does it depend on the situation?

BECKY RUDOLPH: I think it’s all about nuance. �ere are certain things within the operational structure that immediately need to be part of a complete merger. Busi-ness systems—billing, �nancial systems, management styles, and front-o�ce operation— need attention and consistency from the beginning. Other processes can wait until the group is more comfortable in moving forward together. Because sta� is the biggest culture killer behind the scenes in any practice, the most impor-tant factors are giving thought and attention to consist-ency of knowledge and training. When working with physicians, it is important to get them to realize that they all practice in the same fashion about 85% of the time. �ey all have an excellent standard of care, and thus subscribe to similar standards of practice. About 15% of what they do in clinic is physician preference, so sta� must be trained consistently to accommodate these physician preferences. When sta� can be trained to cover a multitude of situations instead of being able to work for only 1 or 2 physicians, coverage becomes much more consistent and patients can be accommodated. �at’s one of the e�ciencies you gain, as it keeps physi-cians in production day to day. So I agree with a blended model to start with full integration as the ultimate goal. It is best to look at processes from the beginning of the merger and streamline sensibly. It is so important that decisions about the business make sense to all partners.

INTERVIEWER: Are there factors that can predict whether a merger’s likely to be successful?

PRACTICE MANAGEMENT

BECKY RUDOLPH: If the physicians do not like each other, you’ve got challenges to overcome that need close atten-tion and mediation to �nd positive resolution to the con�ict. If there is a huge disparity in production and it is not addressed up front, it will tank the merger as feelings will arise concerning fairness. If there is one controlling group and you don’t set up an executive com-mittee model that represents the needs of the entire partnership, it’s going to scuttle the merger. �ese are the business/social/cultural issues that are the hardest to get your hands around unless you spend time with each physician. As the Consultant on a merger I �nd out each physicians preferences and what they think works so the issues can be mediated. It is a sure formula for con�ict if thoughts and feelings are not dealt with from behind the scenes.

INTERVIEWER: What about practices’ inequities and inequalities with productivity? Does that play into whether a merger’s successful or not? How do you deal with that?

BECKY RUDOLPH: �e shaky ground regarding this issue is the willingness for people to have an open and honest conversation about inequities or perceived inequities. I �nd Physicians as a group are usually very con�ict-avoid-ant. �ey want in no way to hurt anyone’s feelings, espe-cially someone as valued as a partner. So they’ll tend to talk about inequities through the back door and not address them in the open air so people can come up with creative solutions about how to deal with them. Once they are to the point where a trusting conversation can ensue, they can come up with some pretty creative solutions.

INTERVIEWER: Is there a management style you would recommend?

BECKY RUDOLPH: �e management style I �nd most e�ective is one that is highly collaborative and focuses on communication at all levels. In many cases, management is pretty unprepared for dealing with the scope of the

merger. So people become very territorial and the man-agement sta� can split the physicians and ramp the chaos, even at the partnership level. �e conversations have to be highly collaborative from the beginning, and I think that a high-level Consultant is the key to bringing something like this together. A consultant is a neutral party to help unify the physicians and managers until things calm back down and people feel they’re on solid ground. �e Consultant can help all parties select best practices for running the business that are a blend of the former organizational preferences. When the new processes make sense to people at every level of the organization and a new identity has emerged, it is very possible that current management can rise to the occa-sion and run the new business model. I think it’s really signi�cant to address culture, deal with change, bring the partners together into a uni�ed voice, and ensure management knows the direction in which they are headed. If these items are dealt with early, the potential for con�ict lessens and all parties can focus on the change and chaos management necessary to make the new organization work.

about the author:

Becky Rudolph, MSFounding Partner, ConsultantHealthcare Management PartnersDenver, Colorado

Thirty-years of accomplished health care management, effective, result-oriented leadership with a rare acumen for organizational and business development. Over the coarse of her career Becky has built and sold two businesses; over the past fifteen years Becky has focused on physician practice management where she has demon-strated proven excellence in working with medical professionals to attain thier goals. Her expertise includes: practice merger and acquisi-tions; innoovation and change management techniques; medical practice turnaround; billing and coding services; practice start-ups; physician recruitment; succession strategies, planning and implemen-tation; ancillary business lines for physician practice and surgery center build out. Extensive experience in executive management and leadership in all phases of operations, expense control, budgeting, risk management, human resources, business development, marketing, strategic planning and organizational development.

“Each practice is going to have its own culture and

management style.”

10 MAY/JUNE 2013 MAY/JUNE 2013 11

WWW.TODAYSPRACTICE.COM WWW.TODAYSPRACTICE.COM11 TODAY’S PRACTICE: CHANGING THE BUSINESS OF MEDICINE Ju ly/August 2014 Ju ly/August 2014 TODAY’S PRACTICE: CHANGING THE BUSINESS OF MEDICINE 12

INTERVIEWER: �e legal and �nancial issues have been worked out; now it is time to call you to help us with the nuts and bolts. What do we do next?

BECKY RUDOLPH: When I consult on a merger, the initial step is an organizational analysis of each entity to deter-mine the operational strengths and weaknesses. Each practice is going to have its own culture and manage-ment style. I think it’s important to look at any poten-tially con�icting management and practice styles because dealing with hot topics early on can lead to relatively easy negotiation of the issues. When con�ict happens, people are on edge; they have formed an opin-ion and there is much more to deal with as everyone thinks they’re right. Potential partners will be willing to manage things more openly and positively if we can talk about each of the practices’ styles—what is relevant, what is not, and what the group agrees to adopt as the business culture. Make no mistake—when change happens, chaos will follow, and mergers create massive change for the inside of each business. Fear and doubt rule and the sta� member thoughts are: “Am I going to have a job?” or “We don’t do it that way” or “Our o�ce is better than yours.” �e physicians are caught in the middle, trying to navigate these issues and practice medi-cine at the same time. If you do not address the issues with management and sta�, fear and doubt can and will undermine the most positive intent.

�e model I use in dealing with change I like to call the Change-Chaos Model; it is characterized by the acknowledge that change creates chaos, and chaos has to be managed by systems, protocols, and uniform imple-mentation. Con�ict has to be addressed, decisions made and implemented; then with solid directives from the stakeholders and the business will settle down to a

day-to-day process that will run smoothly. �is kind of transition takes 18 to 24 months. �ere’s no easy way out—it takes a lot of hard work and communication. But the new culture blending all parties emerges in to one new entity where the mentality of all goes from “I” to “we.”

INTERVIEWER: So is it good to start with a hybrid model of the care centers and eventually ends up with the fully integrated? Or stay with the care center? Or does it depend on the situation?

BECKY RUDOLPH: I think it’s all about nuance. �ere are certain things within the operational structure that immediately need to be part of a complete merger. Busi-ness systems—billing, �nancial systems, management styles, and front-o�ce operation— need attention and consistency from the beginning. Other processes can wait until the group is more comfortable in moving forward together. Because sta� is the biggest culture killer behind the scenes in any practice, the most impor-tant factors are giving thought and attention to consist-ency of knowledge and training. When working with physicians, it is important to get them to realize that they all practice in the same fashion about 85% of the time. �ey all have an excellent standard of care, and thus subscribe to similar standards of practice. About 15% of what they do in clinic is physician preference, so sta� must be trained consistently to accommodate these physician preferences. When sta� can be trained to cover a multitude of situations instead of being able to work for only 1 or 2 physicians, coverage becomes much more consistent and patients can be accommodated. �at’s one of the e�ciencies you gain, as it keeps physi-cians in production day to day. So I agree with a blended model to start with full integration as the ultimate goal. It is best to look at processes from the beginning of the merger and streamline sensibly. It is so important that decisions about the business make sense to all partners.

INTERVIEWER: Are there factors that can predict whether a merger’s likely to be successful?

PRACTICE MANAGEMENT

BECKY RUDOLPH: If the physicians do not like each other, you’ve got challenges to overcome that need close atten-tion and mediation to �nd positive resolution to the con�ict. If there is a huge disparity in production and it is not addressed up front, it will tank the merger as feelings will arise concerning fairness. If there is one controlling group and you don’t set up an executive com-mittee model that represents the needs of the entire partnership, it’s going to scuttle the merger. �ese are the business/social/cultural issues that are the hardest to get your hands around unless you spend time with each physician. As the Consultant on a merger I �nd out each physicians preferences and what they think works so the issues can be mediated. It is a sure formula for con�ict if thoughts and feelings are not dealt with from behind the scenes.

INTERVIEWER: What about practices’ inequities and inequalities with productivity? Does that play into whether a merger’s successful or not? How do you deal with that?

BECKY RUDOLPH: �e shaky ground regarding this issue is the willingness for people to have an open and honest conversation about inequities or perceived inequities. I �nd Physicians as a group are usually very con�ict-avoid-ant. �ey want in no way to hurt anyone’s feelings, espe-cially someone as valued as a partner. So they’ll tend to talk about inequities through the back door and not address them in the open air so people can come up with creative solutions about how to deal with them. Once they are to the point where a trusting conversation can ensue, they can come up with some pretty creative solutions.

INTERVIEWER: Is there a management style you would recommend?

BECKY RUDOLPH: �e management style I �nd most e�ective is one that is highly collaborative and focuses on communication at all levels. In many cases, management is pretty unprepared for dealing with the scope of the

merger. So people become very territorial and the man-agement sta� can split the physicians and ramp the chaos, even at the partnership level. �e conversations have to be highly collaborative from the beginning, and I think that a high-level Consultant is the key to bringing something like this together. A consultant is a neutral party to help unify the physicians and managers until things calm back down and people feel they’re on solid ground. �e Consultant can help all parties select best practices for running the business that are a blend of the former organizational preferences. When the new processes make sense to people at every level of the organization and a new identity has emerged, it is very possible that current management can rise to the occa-sion and run the new business model. I think it’s really signi�cant to address culture, deal with change, bring the partners together into a uni�ed voice, and ensure management knows the direction in which they are headed. If these items are dealt with early, the potential for con�ict lessens and all parties can focus on the change and chaos management necessary to make the new organization work.

about the author:

Becky Rudolph, MSFounding Partner, ConsultantHealthcare Management PartnersDenver, Colorado

Thirty-years of accomplished health care management, effective, result-oriented leadership with a rare acumen for organizational and business development. Over the coarse of her career Becky has built and sold two businesses; over the past fifteen years Becky has focused on physician practice management where she has demon-strated proven excellence in working with medical professionals to attain thier goals. Her expertise includes: practice merger and acquisi-tions; innoovation and change management techniques; medical practice turnaround; billing and coding services; practice start-ups; physician recruitment; succession strategies, planning and implemen-tation; ancillary business lines for physician practice and surgery center build out. Extensive experience in executive management and leadership in all phases of operations, expense control, budgeting, risk management, human resources, business development, marketing, strategic planning and organizational development.

“Each practice is going to have its own culture and

management style.”

WWW.TODAYSPRACTICE.COM WWW.TODAYSPRACTICE.COM

MAKE YOUR MARK.

C R E AT I V E & W E B D E S I G N M A R K E T I N G A N D B R A N D D E V E L O P M E N T M E D I A P L A N N I N G & B U Y I N G

T H E R A W R A G E N C Y. C O M

MAKE YOUR MARK.

C R E AT I V E & W E B D E S I G N M A R K E T I N G A N D B R A N D D E V E L O P M E N T M E D I A P L A N N I N G & B U Y I N G

T H E R A W R A G E N C Y. C O M

upgrade your human resource function tobetter support your strategic mission, whilemore effectively administering the basics.

Foundationbuilding a strongerspecial feature: practice culture development series

featuring randall c. schauerfox rothschild llp

One of the challenges facing many medical practices is how to e�ectively and uniformly administer the human resources (“HR”) function across a number of o�ces, o�entimes with a diversity of cultures and historic practices. �is article is not going to focus on HR issues unique to a medical workplace, but rather the HR issues unique to multi-location operations and the unique HR opportunities and challenges those pose. As the administrative work historically associated with a large part of the HR function are capable of being performed by computers or entry-level individuals, and the legal mandates in the workplace become greater and more complex, many organizations are wrestling with how to both gear up the strategic and compliance capabilities, while pushing other administrative items down to the appropri-ate level, or even outsourcing. As employment law advisor to many medical practices, I have seen many examples of what does and does not work in this industry.

upgrade your human resource function tobetter support your strategic mission, whilemore effectively administering the basics.

Foundationbuilding a strongerspecial feature: practice culture development series

featuring randall c. schauerfox rothschild llp

One of the challenges facing many medical practices is how to e�ectively and uniformly administer the human resources (“HR”) function across a number of o�ces, o�entimes with a diversity of cultures and historic practices. �is article is not going to focus on HR issues unique to a medical workplace, but rather the HR issues unique to multi-location operations and the unique HR opportunities and challenges those pose. As the administrative work historically associated with a large part of the HR function are capable of being performed by computers or entry-level individuals, and the legal mandates in the workplace become greater and more complex, many organizations are wrestling with how to both gear up the strategic and compliance capabilities, while pushing other administrative items down to the appropri-ate level, or even outsourcing. As employment law advisor to many medical practices, I have seen many examples of what does and does not work in this industry.

Building a Stronger... (continued) Randall C. Schauer

�ere are several bene�ts to e�ectively implementing what is sometimes referred to as “shared HR services.” It allows a “total solution” and “total approach” to prob-lems by centralizing the HR function, rather than having it administered in whatever number of o�ces may be involved in your Practice. On the conceptual level, this approach allows the hiring of a high-level HR profes-sional who has the capacity, and also the work and educational capability, to provide strategic advice at the highest levels of the organization in the administration of the HR function, broadly including recruiting, train-ing, compliance, bene�ts, and productivity. �is person can interface with legal counsel and the Board of Direc-tors of the organization in the strategic function, helping the business to successfully execute strategy. Another component of the centralized o�ce are administrative experts who can improve organizational e�ciency by making sure that the HR function and other work processes, including bene�ts administration and track-ing legal compliance item such as use of FMLA leave by employees across the organization, are consistent with the needs of the speci�c organization and its employees. A third skill set that is required in the multi-o�ce environment are the individuals that interface with the o�ce managers and sta� to assure consistent enforce-ment and administration of HR initiatives and policies among all o�ces. �is position would be responsible for providing or initiating training; being available for daily consultation as workplace issues present themselves to the o�ce managers; and periodic visitation to o�ces for feedback and understanding. �ese individuals would be critical to implementing best practices in the HR world, and assuring that sta� morale does not diminish through feelings of alienation or distance. With the bene�ts above, there should be improved career develop-ment for all sta� development and training, while obtaining e�ciencies in the professional provision of HR services.

Critical to the success of a centralized HR function is that the o�ce managers understand the critical need for uniform administration of consistent policies across the

organization, by referring HR issues to the appropriate HR professional, rather than handling it themselves (and freeing the O�ce Manager for other tasks). In any organization, it is lack of consistency that most o�en turns workplace decisions into claims that will need to be addressed either in settlement or in litigation, as there is disparate treatment of individuals by managers who may not have known what others were doing and have treated individuals in di�erent classi�cations di�erently, even if there is no di�erence in the demographics of the individuals involved. Hopefully the organization can obtain better management information by consistently gathering information across an organization, rather than the practice management only hearing about HR issues a�er they have become a problem.

On the other side of the coin, issues that need to be addressed which can undercut a centralized HR function in a multi-o�ce environment is the loss of face-to-face contact; employee involvement with the HR manage-ment sta�; a lack of ownership of Human Resource prob-lems at the o�ce level; and possible IT problems with an extended network.

Management should also be aware that a smooth trans-formation to provision of centralized HR services is critical in assuring that the e�ciencies and enhanced bene�ts of a centralized model are not lost. In that regard, management needs to de�ne and achieve business goal as early as possible. �e centralized HR group must be extremely diligent initially so as to be taken seriously be other management, particularly o�ce managers. It is important that o�ce managers understand what the

process will look like. Initially also, there should be a high visibility of the central HR sta� in the o�ces to help with buy-in and con�dence around the new model.

In summary, management needs to consider strategic issues as to why an enhanced, upgraded central HR function is useful; consider how it will a�ect the busi-ness strategy, understand the relationship between the HR professionals, o�ce managers and line managers, and how it will provide both day-to-day administra-tive support while providing the strategic input at the corporate level. Management will need to be very attentive to managing the change process from the current system, o�entimes one of a laissez-faire man-agement with o�ce managers being relatively empow-ered versus centralized management. Operational issues will need to be considered with regard to loca-tion and access. Finally, there needs to be understand-ing of what changes and goals are reasonably expected from the process to avoid failure of implementation. And while this model may not work for all, it is one that can provide signi�cant improvement in recruit-ment, compliance, risk avoidance, and e�cient provi-sion of bene�ts and other employee programs. With a commensurate improvement to the bottom line.

about the author:

Randy C. SchauerPartner, Fox Rothschild LLP

Randy's practice focuses on all aspects of labor relations and employment law. He handles the full spectrum of the employment relationship from pre-hire procedures to post-termination closure, including unem-ployment compensation and statutory compliance issues such as Title VII, ADA, FLSA, FMLA and OSHA compliance. Randy negotiates, drafts, and enforces contracts protecting client's rights in all aspects of the employment relationship, including employ-ment and separation, confidentiality and non-competition, intellectual property protection, and independent contractor arrangements.

“Critical to the success of a centralized HR function is that the office managers understand the critical need for uniform administration of consistent policies across the organization”

�ere are several bene�ts to e�ectively implementing what is sometimes referred to as “shared HR services.” It allows a “total solution” and “total approach” to prob-lems by centralizing the HR function, rather than having it administered in whatever number of o�ces may be involved in your Practice. On the conceptual level, this approach allows the hiring of a high-level HR profes-sional who has the capacity, and also the work and educational capability, to provide strategic advice at the highest levels of the organization in the administration of the HR function, broadly including recruiting, train-ing, compliance, bene�ts, and productivity. �is person can interface with legal counsel and the Board of Direc-tors of the organization in the strategic function, helping the business to successfully execute strategy. Another component of the centralized o�ce are administrative experts who can improve organizational e�ciency by making sure that the HR function and other work processes, including bene�ts administration and track-ing legal compliance item such as use of FMLA leave by employees across the organization, are consistent with the needs of the speci�c organization and its employees. A third skill set that is required in the multi-o�ce environment are the individuals that interface with the o�ce managers and sta� to assure consistent enforce-ment and administration of HR initiatives and policies among all o�ces. �is position would be responsible for providing or initiating training; being available for daily consultation as workplace issues present themselves to the o�ce managers; and periodic visitation to o�ces for feedback and understanding. �ese individuals would be critical to implementing best practices in the HR world, and assuring that sta� morale does not diminish through feelings of alienation or distance. With the bene�ts above, there should be improved career develop-ment for all sta� development and training, while obtaining e�ciencies in the professional provision of HR services.

Critical to the success of a centralized HR function is that the o�ce managers understand the critical need for uniform administration of consistent policies across the

organization, by referring HR issues to the appropriate HR professional, rather than handling it themselves (and freeing the O�ce Manager for other tasks). In any organization, it is lack of consistency that most o�en turns workplace decisions into claims that will need to be addressed either in settlement or in litigation, as there is disparate treatment of individuals by managers who may not have known what others were doing and have treated individuals in di�erent classi�cations di�erently, even if there is no di�erence in the demographics of the individuals involved. Hopefully the organization can obtain better management information by consistently gathering information across an organization, rather than the practice management only hearing about HR issues a�er they have become a problem.

On the other side of the coin, issues that need to be addressed which can undercut a centralized HR function in a multi-o�ce environment is the loss of face-to-face contact; employee involvement with the HR manage-ment sta�; a lack of ownership of Human Resource prob-lems at the o�ce level; and possible IT problems with an extended network.

Management should also be aware that a smooth trans-formation to provision of centralized HR services is critical in assuring that the e�ciencies and enhanced bene�ts of a centralized model are not lost. In that regard, management needs to de�ne and achieve business goal as early as possible. �e centralized HR group must be extremely diligent initially so as to be taken seriously be other management, particularly o�ce managers. It is important that o�ce managers understand what the

process will look like. Initially also, there should be a high visibility of the central HR sta� in the o�ces to help with buy-in and con�dence around the new model.

In summary, management needs to consider strategic issues as to why an enhanced, upgraded central HR function is useful; consider how it will a�ect the busi-ness strategy, understand the relationship between the HR professionals, o�ce managers and line managers, and how it will provide both day-to-day administra-tive support while providing the strategic input at the corporate level. Management will need to be very attentive to managing the change process from the current system, o�entimes one of a laissez-faire man-agement with o�ce managers being relatively empow-ered versus centralized management. Operational issues will need to be considered with regard to loca-tion and access. Finally, there needs to be understand-ing of what changes and goals are reasonably expected from the process to avoid failure of implementation. And while this model may not work for all, it is one that can provide signi�cant improvement in recruit-ment, compliance, risk avoidance, and e�cient provi-sion of bene�ts and other employee programs. With a commensurate improvement to the bottom line.

about the author:

Randy C. SchauerPartner, Fox Rothschild LLP

Randy's practice focuses on all aspects of labor relations and employment law. He handles the full spectrum of the employment relationship from pre-hire procedures to post-termination closure, including unem-ployment compensation and statutory compliance issues such as Title VII, ADA, FLSA, FMLA and OSHA compliance. Randy negotiates, drafts, and enforces contracts protecting client's rights in all aspects of the employment relationship, including employ-ment and separation, confidentiality and non-competition, intellectual property protection, and independent contractor arrangements.

“Critical to the success of a centralized HR function is that the office managers understand the critical need for uniform administration of consistent policies across the organization”

the latestblisteringphrase

�ere is a phrase that is bouncing around in both the Technology and Medical �elds; “Hire Slow – Fire Fast”. Nice intention – but it misses the mark com-pletely. If you are competing for the best talent you can get, then you can’t waste time. In some markets there are 4 jobs for every candidate. If you are the only company in your space that is growing and the market around you is staying still and no competitors are looming, then take your time. (Of course I am being sarcastic). No business facing the potential of growth is alone in its quest.

PRACTICE MANAGEMENT

special feature: practice culture development series

by bob smithMySuccess Staffing Solutions

15 SEPTEMBER/OCTOBER 2012 SEPTEMBER/OCTOBER 2012 1718 NOVEMBER/DECEMBER 2012 NOVEMBER/DECEMBER 2012 19

the latestblisteringphrase

�ere is a phrase that is bouncing around in both the Technology and Medical �elds; “Hire Slow – Fire Fast”. Nice intention – but it misses the mark com-pletely. If you are competing for the best talent you can get, then you can’t waste time. In some markets there are 4 jobs for every candidate. If you are the only company in your space that is growing and the market around you is staying still and no competitors are looming, then take your time. (Of course I am being sarcastic). No business facing the potential of growth is alone in its quest.

PRACTICE MANAGEMENT

special feature: practice culture development series

by bob smithMySuccess Staffing Solutions

15 SEPTEMBER/OCTOBER 2012 SEPTEMBER/OCTOBER 2012 1718 NOVEMBER/DECEMBER 2012 NOVEMBER/DECEMBER 2012 19

The Latest... (continued) Bob Smith

We suggest that you “Hire E�ectively and Fire E�cient-ly” and this phrase is not even close. On this basis, you want to have a very clear understand-ing of the direction and strategy of your business, be aware of how the position you are �lling will a�ect that strategy and understand the results that you want the person in that role to generate. Also, you want to under-stand what Skills, Knowledge, Experience, Attitudes and Beliefs that the ideal candidate brings so that you can more easily recognize a winning combination. Be prepared to act in your hiring process, but utilize all your resources (an interviewing team, key associates, Executives from other areas, Mentors or Advisors), they can help you get additional perspective on the upside and concerns that go with every candidate.

As for Fire E�ciently, it’s important to make the release of someone be a necessary next step – not your �rst step (unless it is for “cause”). Informal (versus formal) Perfor-mance Improvement plans let someone know that they are not meeting needs and expectations. It also lets them know that a signi�cant change has to happen quickly. Very o�en, people will take themselves out of the game, because they don’t want to be someplace where they can’t really �t. �e process you use to determine if someone is a �t a�er they are hired, is as important as the hiring process. It tells everyone in the a�ected area, what the standards for performance are and how the company’s culture is repre-sented in the process. It tells people what you really stand for as a company and what you can be counted on, relative to fair treatment.

Have a well-formed and clear hiring process and e�cient shared model for performance evaluation and accounta-bility. It can save the company a fortune and people a lot of grief. One additional point that can really make a di�erence occurs during the hiring process. You can let people know that you are not just �lling a role, but you are building culture that has to be a great �t all the way around. You might specify a time frame to review “the �t” (1 or 3 or 6 months) and then spell out what happens if there doesn’t seem to be a �t. For example, “It is our custom to make sure that we as a company are a good �t for everyone that works here and we want to be a �t for each person working. We check-in to make sure things still make sense for us to be together. If either of us decides that a change out of the company is best, then we provide 1 day severance for every 2 months someone is employed. (or whatever your compliance and labor laws allow). If a separation is the next step, we will do it with respect and appreciation. �at is what you can count on from us and that is what we want to be able to count on from you.” As you can see, it is a very mature approach to working relationships, managing performance and value. Of course, make sure your legal resources concur that you are in compliance with how your State Labor Laws impact your workplace.

PRACTICE MANAGEMENT

about the author:

Bob SmithFounder/Senior PartnerMySuccess Staffing SolutionsLas Vegas, NV

As Founder of Mysuccess, Inc., Bob has applied studies from program work at MIT Systems Thinking Lab, along with Organization and Growth Strategy and beyond with MAP (mental Aptitude Pattern-ing) Relationship and Communication tools. Bob now works with key individuals and teams within companies that want to boost perfor-mance through Relationship, and has provided corporate and execu-tive strategy for industry leaders such as Marriot Corporation, Sears, Northwest Airlines, Children’s Hospital, Pulte Homes, Staples Inc., GAP Inc. and numerous startups and fast growth companies.

“We suggest that you ‘Hire Effectively and Fire Efficiently’... and this phrase isn’t even close. “

“Boulder Valley IPA has been great to work with all these years. Whenever we need help getting our claims paid with a contracted insurance, BVIPA is more then willing to contact the insurance company on our behalf to help resolve the issues.“

“Any questions we have had regarding our contracts, reimbursement or just general questions have been answered by BVIPA very professionally and promptly-often the same day. “

“...when BVIPA helps me analyze the contractual offers, I am in a much better position to accept or place a counter offers due the assistance of a

I would not want to go alone in this market.”

- BVIPA Member

Boulder Valley IPA is run by individuals with old school values: honesty, integrity and hard work for the dollars earned. They are a 1st class organization.

- BVIPA Affiliate Member

What BVIPA Members are saying:

6676 Gunpark Drive, Suite B, Boulder, CO 80301 303 530-3405 www.BVIPA.com [email protected]

Boulder Valley IPA’s purpose is to coordinate the delivery of high-quality, affordable health care services through a physician-directed, market responsive, and accountable system. This system is designed to provide physicians the tools to enhance the viability of, and satisfaction in, independent medical practice.

CENTRALIZED REFERRAL/PRE-CERTIFICATION PROCESSING

PHYSICIAN COMPENSATION PLAN DESIGN/REDESIGN

PHYSICIAN BUY IN/OUT FORMULAS AND AGREEMENTS

STAFFING

BOOKKEEPING

PRACTICE ASSESSMENTS

OUR INDIVIDUAL SERVICES INCLUDE:

21 TODAY’S PRACTICE: CHANGING THE BUSINESS OF MEDICINE Ju ly/August 2014

The Latest... (continued) Bob Smith

We suggest that you “Hire E�ectively and Fire E�cient-ly” and this phrase is not even close. On this basis, you want to have a very clear understand-ing of the direction and strategy of your business, be aware of how the position you are �lling will a�ect that strategy and understand the results that you want the person in that role to generate. Also, you want to under-stand what Skills, Knowledge, Experience, Attitudes and Beliefs that the ideal candidate brings so that you can more easily recognize a winning combination. Be prepared to act in your hiring process, but utilize all your resources (an interviewing team, key associates, Executives from other areas, Mentors or Advisors), they can help you get additional perspective on the upside and concerns that go with every candidate.

As for Fire E�ciently, it’s important to make the release of someone be a necessary next step – not your �rst step (unless it is for “cause”). Informal (versus formal) Perfor-mance Improvement plans let someone know that they are not meeting needs and expectations. It also lets them know that a signi�cant change has to happen quickly. Very o�en, people will take themselves out of the game, because they don’t want to be someplace where they can’t really �t. �e process you use to determine if someone is a �t a�er they are hired, is as important as the hiring process. It tells everyone in the a�ected area, what the standards for performance are and how the company’s culture is repre-sented in the process. It tells people what you really stand for as a company and what you can be counted on, relative to fair treatment.

Have a well-formed and clear hiring process and e�cient shared model for performance evaluation and accounta-bility. It can save the company a fortune and people a lot of grief. One additional point that can really make a di�erence occurs during the hiring process. You can let people know that you are not just �lling a role, but you are building culture that has to be a great �t all the way around. You might specify a time frame to review “the �t” (1 or 3 or 6 months) and then spell out what happens if there doesn’t seem to be a �t. For example, “It is our custom to make sure that we as a company are a good �t for everyone that works here and we want to be a �t for each person working. We check-in to make sure things still make sense for us to be together. If either of us decides that a change out of the company is best, then we provide 1 day severance for every 2 months someone is employed. (or whatever your compliance and labor laws allow). If a separation is the next step, we will do it with respect and appreciation. �at is what you can count on from us and that is what we want to be able to count on from you.” As you can see, it is a very mature approach to working relationships, managing performance and value. Of course, make sure your legal resources concur that you are in compliance with how your State Labor Laws impact your workplace.

PRACTICE MANAGEMENT

about the author:

Bob SmithFounder/Senior PartnerMySuccess Staffing SolutionsLas Vegas, NV

As Founder of Mysuccess, Inc., Bob has applied studies from program work at MIT Systems Thinking Lab, along with Organization and Growth Strategy and beyond with MAP (mental Aptitude Pattern-ing) Relationship and Communication tools. Bob now works with key individuals and teams within companies that want to boost perfor-mance through Relationship, and has provided corporate and execu-tive strategy for industry leaders such as Marriot Corporation, Sears, Northwest Airlines, Children’s Hospital, Pulte Homes, Staples Inc., GAP Inc. and numerous startups and fast growth companies.

“We suggest that you ‘Hire Effectively and Fire Efficiently’... and this phrase isn’t even close. “

“Boulder Valley IPA has been great to work with all these years. Whenever we need help getting our claims paid with a contracted insurance, BVIPA is more then willing to contact the insurance company on our behalf to help resolve the issues.“

“Any questions we have had regarding our contracts, reimbursement or just general questions have been answered by BVIPA very professionally and promptly-often the same day. “

“...when BVIPA helps me analyze the contractual offers, I am in a much better position to accept or place a counter offers due the assistance of a

I would not want to go alone in this market.”

- BVIPA Member

Boulder Valley IPA is run by individuals with old school values: honesty, integrity and hard work for the dollars earned. They are a 1st class organization.

- BVIPA Affiliate Member

What BVIPA Members are saying:

6676 Gunpark Drive, Suite B, Boulder, CO 80301 303 530-3405 www.BVIPA.com [email protected]

Boulder Valley IPA’s purpose is to coordinate the delivery of high-quality, affordable health care services through a physician-directed, market responsive, and accountable system. This system is designed to provide physicians the tools to enhance the viability of, and satisfaction in, independent medical practice.

CENTRALIZED REFERRAL/PRE-CERTIFICATION PROCESSING

PHYSICIAN COMPENSATION PLAN DESIGN/REDESIGN

PHYSICIAN BUY IN/OUT FORMULAS AND AGREEMENTS

STAFFING

BOOKKEEPING

PRACTICE ASSESSMENTS

OUR INDIVIDUAL SERVICES INCLUDE:

featuring cynthia ackrill, mdpresident of wellspark

As physicians we are no strangers to stress- learning to perform under pressure is part of the package. But in “perfecting” this skill, could we be losing sight of the real impact of stress in our lives and in the lives of our patients? �e changes in healthcare are about to make our patients mental well-being more critical to our revenue. And if we don’t make our own mental well-being more of a priority we cannot reverse the alarming numbers (40%!) of physicians who would choose to leave practice if they could!

Early in my career I was always fascinated by the fact that patients with essentially the same clinical picture could be experiencing their diseases in such a wide range of ways—from profound misery to cheerful acceptance to even apparent vitality of spirit in the face of death. What made one person focus on the su�ering and another on hope, possibility or gratitude? Clearly, those who were not handling the stress of life well were less resilient in the face of medical challenges. (I was also bemused by the arbitrary separation of physi-cal and mental health—as if putting the diagnoses in separate books and under separate insurance codes teased apart the intricacies of human experience?!)

PRACTICE MANAGEMENT

Stress.addressing the elephant in

the corridors, the exam rooms, and in the mirror.

featuring cynthia ackrill, mdpresident of wellspark

As physicians we are no strangers to stress- learning to perform under pressure is part of the package. But in “perfecting” this skill, could we be losing sight of the real impact of stress in our lives and in the lives of our patients? �e changes in healthcare are about to make our patients mental well-being more critical to our revenue. And if we don’t make our own mental well-being more of a priority we cannot reverse the alarming numbers (40%!) of physicians who would choose to leave practice if they could!

Early in my career I was always fascinated by the fact that patients with essentially the same clinical picture could be experiencing their diseases in such a wide range of ways—from profound misery to cheerful acceptance to even apparent vitality of spirit in the face of death. What made one person focus on the su�ering and another on hope, possibility or gratitude? Clearly, those who were not handling the stress of life well were less resilient in the face of medical challenges. (I was also bemused by the arbitrary separation of physi-cal and mental health—as if putting the diagnoses in separate books and under separate insurance codes teased apart the intricacies of human experience?!)

PRACTICE MANAGEMENT

Stress.addressing the elephant in

the corridors, the exam rooms, and in the mirror.

Stress... (continued) Cynthia Ackrill, MD

Equally apparent were the varied reactions of fellow clini-cians under the strain of ridiculous hours and whopping mental and physical demands. �e very mechanism of the stress reaction reduces blood supply to the frontal lobe, that part of the brain responsible for self-awareness. (�us explaining the “What was I thinking” phenomenon!)

To make matters worse, many high achievers train them-selves to further ignore the signals and alarms of the stress reaction. Sadly this leads to higher risk for costly mistakes, career or personal dissatisfaction, burnout, relationship and health problems. We have all witnessed the burnout of far too many excellent, caring doctors. When coaching physicians, I o�en �nd we need to work on down-regulating the stress, before we can e�ectively address leadership or career strategies.

I spent 10 years studying brain mapping (qEEG), various forms of biofeedback, and the mechanics of behavior. I had the opportunity to see �rst-hand how simply chang-ing thoughts minute to minute radically alters our physi-ology and our brain activity. I found that patients with high perceived stress scores had a much harder time learning new patterns of behavior, or �ghting the depres-sion or health decline of extended cortisol overload.

Stress—our reaction to the perception that our homeo-stasis or safety has been threatened, or that we do not have the skills or energy to meet the challenge—has been estimated to be somehow involved with 70-90% of all doctors visits! Yet we barely have time to review labs and adjust meds, much less ask questions that might open a can of worms about dealing with the complicating factors of real life. We were not taught to empower our patients to handle stress—we weren’t taught healthy ways to handle it ourselves!

To be e�ective in addressing the role of stress we need a better model to develop the language to help our patients and ourselves. (Our brains love models!) �e term “stress” is so overused and misunderstood that many myths have taken root.

�e job of our brains is to �lter out the billions of bits of information it receives moment to moment searching for anything that might be a threat to us. �at identi�ca-tion process (mostly amygdala based) is dependent on our perception—our genetics, stories, experiences, and current psycho-physiological state.

Once the alarm is sounded the mostly sympathetic reaction involves some 1400 chemical reactions—a very energy intensive process! �is is a one-sized-�ts-all reaction designed to protect early man from chasing wildebeests. But there has been no so�ware upgrade to help us deal with constant onslaught of annoying emails, EMR challenges, technology breakdowns, or interrupt-ed sleep. �e chronic ringing of the alarm bell depletes the energy balance of every physiological and psycholog-ical system.

We know this—the research is overwhelming and our experience lives it—but we need to �nd ways to clearly and succinctly discuss this with our patients and proac-tively step up our own stress management.

PRACTICE MANAGEMENT

In this model there are 3 entry points to change the balance:

I �nd this way of looking at stress empowers patients and professionals to see they have choices that will increase their energy, their con�dence, and their personal accountability to take an active role in their health, performance, and overall well-being. By choosing to balance the energy we spend with thoughts, behaviors, and practices that renew our energy, we can make the subtle shi�s that take the bite out of stress.

What small change can you make today that will �nd you more energy, more ease? How can you help your patients take a more active role in their stress manage-ment and well-being?

about the author:

Cynthia Ackrill, MDHuman Performance ConsultantPresident of WellSpark

Dr. Ackrill is a Human Performance Consultant, Coach, and Speaker President of WellSpark.

Dr. Ackrill works with professional leaders and teams to expand perfor-mance capacities and resilience. With the latest science and research, she provides innovative ways to optimize energy, creativity, focus, and access to brilliance for enhanced, sustainable performance. Her work includes the systematic management of stress, addressing specific lifestyle/health risk challenges, facilitating behavior change, and creating collaborative cultures to support excellence. She coaches individual leaders, their teams, consults on wellness programming, organizational effectiveness, and cultural shifts, and speaks at off-sites and conferences.

Cynthia L. Ackrill, MD brings a unique and thorough background to the subject of health as a business strategy and the power of mission and values based leadership. She combines her knowledge as a primary care physician with her extensive experience in neuro-psycho-physio-logic approaches to behavior, performance, and health, and her training in coaching. She is a graduate of Duke University and the University of Maryland School of Medicine, a Fellow of the American Institute of Stress, a charter member of HeartMath, and a former board member of the International Society of Neurofeedback and Research. A certified Wellcoach® and Well People coach, and certified Professional/Executive coach, Dr. Ackrill has also completed training in positive psychology, intrinsic motivation, and peak perfor-mance coaching. She enjoys the “diagnosis” of systemic issues and facilitating groups toward mutuality of purpose and is a certified Team Advantage leader.

Stress—our reaction to the perception that our homeostasis or safety has been threatened, or that we do not have the skills or energy to meet the challenge—has been estimated to be some-how involved with 70-90% of all doctors visits!

Proactively reducing the exposure to internal and external stressors (seeing this as proactive choosing how to spend our precious time and energy.)

Reframing our perspective to sound the alarm less often—acceptance,mindfulness, attitude work.

Raising our resilience by increasingthe habits that support our fitness- physically, mentally, emotionally, and spiritually.