Amy Mowles, president and CEO of Mowles Medical Practice Management, who has developed dozens of pain management ambulatory surgery centers and worked with hundreds of practices and programs nationwide, identifies 10 steps taken by pain management programs to become top performers, both financially and clinically.
1. Develops a unique identity. The best pain programs define the objective of their practice in specific terms and create an image for the program that distinguishes them from other programs. "Clearly state the types of pain you are going to treat," Ms. Mowles says. "Are you multi-discipline or single specialty? What specific specialty? With what specific training? Do you provide ancillary/alternative services? Do you have an expertise in certain procedures? Speak a language of that community?
"Develop services that meet the needs and wants of your market," she says. "Be the best at providing the most advanced treatments and please establish reasonable prices."
2. Follows the three As. The three As are "availability, affability and ability." "Availability means you work out shared call systems, but are careful about 'who you get in bed with,'" she says. "For affability, remember you have many customers: patients, referral sources, hospital personnel, third-party payors. And ability means you stay up to date on everything that could impact your organization, its physicians and patients."
3. Creates awareness. It's important to have the unique identity discussed in quality #1, but that identity alone can only go so far in building a successful center. The best centers create awareness of their pain program through marketing. "And the best marketing is educating" Ms. Mowles says. "You get more 'bang for your buck' speaking to doctors than patients, but some speaking to patient groups can generate lots of good will. Give presentations to local groups, volunteer to answer questions on radio or television talk shows. Look for opportunities to constantly build external creditability through promotional activities and educational public relations."
4. Ensures strong payor mix. The leading programs place a significant importance on ensuring the best payor mix, Ms. Mowles says. "They describe the benefits to the payor of working with their center, the center's protocols, treatment options and then costs and reimbursement," she says. "They're always fair and honest with the payor. They use demand for types of services in their favor, and take steps to change the reimbursement percentages in a way that best serves both parties."
5. Reviews all contracts. A great payor mix is only as good as the contracts that a center signs with these payors, which is why top centers review all contracts closely before agreeing to any terms. "These center's perform a realistic case cost analysis," Ms. Mowles says. "They review the contracts and request carve outs, as applicable. And they keep contracts only when they can clearly explain to themselves and their physicians how the contract enhances the profitability of the practice."
6. Understands value of referrals. The long-term success of a pain program is heavily dictated by the quality and quantity of referrals, Ms. Mowles says. The leading centers understand that insurance companies are a strong referral source, and work to keep payors informed of the work of the center by performing continuous quality improvement studies and benchmarking and performing peer review through national clinical outcomes studies.
These centers also work closely with referring physicians, serving as a resource to these physicians for pain management advice or clinical assistance, she says. "The top centers discuss new techniques, recent successes and always serve as team players," she says. "They make referring physicians part of the treatment plan, keep these physicians informed and remember to thank them for the opportunity of being involved in their patients overall care."
7. Looks for appropriate expansion opportunities. The most successful programs look for effective ways to expand their patient base. "Consider expanding your practice into cancer pain and palliative medicine," Ms. Mowles says. "Recognize that this may significantly increase demands for availability. It can be very rewarding work, but you need to know your community resources: detox programs; inpatient pain programs —don't be afraid to refer the very difficult patient; and make sure you have access to a variety of excellent specialists and primary care doctors."
8. Bring on new physicians. Growth can come through expansion of services, but it can also come through recruiting new physicians. Top centers carefully seek out the best providers and then ensure these physicians are a good fit for the organization, Ms. Mowles says. "They obtain mandatory peer references, and use primary and secondary verification sources," she says. "They're not shy about looking over [the recruited] physicians work, watching for warning signs of poor care that include not returning calls or answering pages, frequent complaints and mishaps that could be avoided with precautions."
9. Set achievable goals. All organizations likely have goals they hope to achieve in a given day, week, month and year, but the best programs set goals for themselves that meet three criteria, Ms. Mowles says. "The goals are always specific, realistic and mutually determined," she says. "Violate these basic guidelines at your own risk."
10. Continually measuring efficiency. It's not enough to just think your program is a leader; top programs continually measure their efficiency to confirm this belief, Ms. Mowles says. "They are constantly reviewing how efficient they are in addressing a number of areas, including responding to telephone calls, limiting waiting time, responding to satisfaction surveys and comments left in suggestion boxes, complaints and complications," she says. "They pay careful attention to new patients and referrals, and always stay focused on their customers."
Learn more about Mowles Medical Practice Management.
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