When’s the last time you cleaned out your garage? Chances are it’s been a while, and chances are you’ve put it off, which will make tackling the job more difficult. Thus, it’s time to roll up your sleeves.

If you’re a physician with your own practice, Dr. David Zahaluk says the same rules apply if your practice needs an overhaul: Don’t procrastinate, just do it.

“It’s the same thing with your practice. By not deliberately ignoring it or just taking on even one small part of it, there is a great sense of ownership and a great pleasure in knowing that you can effectively direct yourself, become more successful, have the kind of relationships that you want with patients and staff, and really feel like you’re making a difference. But it only comes from, in my opinion, taking accountability and ownership,” said Zahaluk, a Dallas primary-care physician whose sideline is “Maximum Income for Physicians,” a training and coaching business to help doctors extract more money and more satisfaction from their job (www.ultimatepracticebuilder.com). In fact, he offers a money-back guarantee if physicians who implement his system don’t earn an extra $30,000 the first year.

“Early on in my practice, I struggled, and the first practice that I started up did really badly because I didn’t understand the ins and outs of building a practice. Necessity got me into this more than anything else,” said Zahaluk, explaining his reason for launching his consulting venture. He has advice both for physicians who are struggling to build a patient base and for those who have scads of patients and feel like they’ve lost control. His top three tips are:

1. Increase revenue per patient encounter.
2. Increase the flow of quality patients.
3. Build a sense of teamwork within the practice.

Increase revenue per patient

“It’s a very useful thing to somebody who is struggling with their revenue or perhaps just starting out to get in the habit of capturing all the revenue available per encounter. I’m a big fan of increasing the revenue per encounter first, and then building up the volume of patients second,” Zahaluk said.

To maximize reimbursements per patient, Zahaluk recommends developing a set of standing orders, “an actual document and teach and train everyone in the office to follow,” he said.

As an example, he said one of his clients, a physician in solo practice, owns an echocardiography machine, but it’s not used nearly as much as it should be. That’s lost revenue. After talking with several cardiologists about which patients should receive an echocardiogram and how often, the physician issued a standing order. Now revenue is up.

“It’s good for patient care because they’re following the standardized care, but it also ensures more uniform implementation of services that patients need and physicians can earn revenue by doing,” Zahaluk said. He added that a senior nurse could be responsible for ensuring that standing orders are followed and the charges captured. “The physician doesn’t really need to trigger that. It’s already triggered as a standing order,” he said.

More quality patients

The top 20 percent of patients in any practice generate 80 percent of the revenue. It’s similar for payers: The top 20 percent generate a majority of the practice’s revenue. That’s why physicians should review their payer mix and gradually decrease dependence on — and eventually close the practice to — the worst contracts, Zahaluk recommends.

“Part of that means referring some patients out of your practice, and many physicians are a little bit hesitant on that, because intuitively it seems like it’s not good for business,” he said. “But it ends up being very good for business.”

A sense of teamwork

Zahaluk said his third recommendation, building camaraderie within a practice, “arguably trumps the first two. … Beyond just taking care of patients and earning income, it’s so important to be around people who really, really support each and who will buy into the ideas that the practice owner and physicians are trying to make happen. They say a chain is as strong as its weakest link,” he said.
One effective way to build that team is to listen to staff members when they have suggestions for improvement. “Not everything they say is going to be a gem, but often because their viewpoint within the clinic is so different and closer to the patient, they have outstanding insights. Just listening, recognizing and acknowledging them is valuable and does so much for a staff member,” he said.

Retention and referrals

Zahaluk said the cornerstone of his system is to help physicians retain their existing patients and encourage those patients to refer others. “Research shows that it costs six times more money to get a new patient than it costs to retain an existing one,” he said. “Doubling your retention rate is just as good as doubling your acquisition rate of new patients. In fact, it’s actually better.”

Consumer behavior is the same whether the person is buying tires or buying healthcare services, he said. Fifty percent of the time, consumers return to where they’ve been before, and 30 to 35 percent of the time, they buy based on recommendations from others. Thus, Zahaluk recommends that physicians spend their marketing dollars building relationships with the patients they have “because that’s where the best return is.”

In his own practice, Zahaluk publishes a patient newsletter, and patient flow bumps up 20 percent after it’s distributed. “It strengthens the bond between existing patients, and it also increases their chance to make referrals,” he said. “You become more a part of their circle of trust.”



July 2007

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