Enhancing Your Practice's Revenue - California Orthopaedic ...

may restrict the practice’s financial operations. Makingthe correct lease vs. buy decision may be key to a businessventure’s long-term success. Once a decision has been madein this regard, investors need to review the terms of thelease or purchase in detail to be sure they understand thefinancial and operational consequences. See # 8 below.6. Human Resources ManagementHuman resources (HR) is something that operates “behindthe scenes” and physicians may not think much about.Establishing a full-fledged HR function at the outset,however, is critical to the success of any new or existingbusiness. This includes (a) employment (recruitment,selection and retention); (b) compensation and payroll,(c) benefits (medical, dental, life and disability insurance,pension, vacation); (d) training and development; (e)performance management; (f) policies and procedures(including clinical policies and procedures); (g) anemployee manual; and (h) legal compliance and federalreporting.7. Don’t Rob Peter to Pay . . . PeterReference to this was made by several chapter authors butit bears repeating. When a group of potential investorsassesses the profitability of a business venture, they mustconsider what the impact of that venture may be onexisting operations. For example, if a practice wants toopen another office, it will be necessary to develop a proforma that sets forth anticipated revenue and costs. It islikely however, that some patients that otherwise wouldhave gone to the first office will no longer do so, so thismust be taken into account. By the same token, it mayalso be the case that economies of scale may limit certainexpense increases.8. Seek Counsel from Appropriate OutsideAdvisors at the Appropriate TimeNot infrequently, potential investors in a business areloath to seek counsel from outside experts because thiscan increase the initial cost of the investment. They maysimply do some reading on a subject such as Stark, HIPAAor Anti-kickback or ask for information from a sourcewho will give them feedback at no charge. This is never agood idea. Anyone who desires to grow his or her currentbusiness, or create a new one, must consult appropriateadvisors – recognizing that not all advisors can provide allkinds of advice. For example, an accountant may be ableto assist with calculating profits and losses of an existingbusiness but may not wish to involve him or herself inprojecting a future investment return (see # 2 above). Anattorney may know all about the law but may or may notfeel equipped to weigh in on whether the business modelmakes sense. Investors must decide which advisors theyneed as part of their initial plan. See # 9 below.9. Planning the PlanOne or two Primer authors made reference to the valueof the concept of project planning. Planning is perhapsthe key element in the success of any enterprise (all “todo’s” identified, responsibilities assigned, and deadlinesestablished). The more detailed the plan, the greater thelikelihood of success. Planning, however, is a tedious,detail-oriented process that many people want to dispensewith or think about only in broad terms. Orthopaediststend to be “take charge doers” but many have limitedpatience with the seemingly-never-ending meetings, emailexchanges, negotiations and compromises that are requiredto develop any comprehensive plan. They must learn a newset of skills if they are to contribute meaningfully to theplan’s development. [Note: one element of every successfulplan involves planning for the unexpected. While it is neverpossible to account for everything, it’s useful to think atleast about the “known unknowns” even if it is not possibleto take into account the “unknown unknowns.”]10. AAOS Practice Management ResourcesFinally, Academy members who are considering embarkingon any new business venture are well-advised to look to theAAOS to determine if information is available regardingthat venture. The AAOS Practice Management Group, inconjunction with the Practice Management Committeehas a wide array of resources to help Fellows improve theirpractices’ efficiency and effectiveness. For example:• The on-line Practice Management Center (www.aaos.org/pracman) contains hundreds of articles, white papersand spreadsheets on a wide array subjects including optionsfor practice growth.• Every year, AAOS sponsors two educational courses:a one day course at the Annual Meeting and a 2.5 daycourse in the fall.In addition to the on-line Practice Management Centerand courses, Practice Management Group staff offeradvice and counsel over the phone and via the Internet.This advice and counsel is provided free of charge as amembership benefit. AAOS is one of the few nationalmedical specialty societies that employ former orthopaedicpractice managers and practice management consultants inits practice management area. These individuals have notonly “talked the talk;” they have “walked the walk,” andmembers should avail themselves of their expertise.Contact: Steven Fisher, MBA: sfisher@aaos.org© 2011 American Academy of Orthopaedic Surgeons45