The times are a changin’
PPMCs
The times are a changin’
Especially if a PPMC just bought your practice
People are generally averse to change. As an administrator, even if you have fostered discussions between your practice and a physician practice management company, you probably are nervous now that the deal is done. Just how can you expect your role to change under the new regime?
We asked some people who know — PPMC executives and administrators who have been through the experience — to talk about it. Those who go in with an attitude that change will be bad won’t be disappointed, says Gerry Tresslar, president and chief executive officer of Stratum Med in Urbana, IL. "It becomes a self-fulfilling prophecy," says Tresslar, whose PPMC has 15 practices in four states. "But if you see it as an opportunity, you will do well."
Less focus on politics
He bases that statement on his own years as a practice administrator, his two years running Stratum, and what his administrator friends have told him. "As a practice administrator working for a partnership, you don’t have a lot of security," he explains. "The structure is highly political — with factions of old vs. young, highly compensated vs. less compensated. You will always be at odds with the major part of your bosses. That often frustrates your ability to make good strategic decisions. With a PPMC comes rationality. You can do what’s in the best interest of the group without fear of reprisals by some person or segment of the group who doesn’t like the decision. There is more of a focus on business, and less on politics."
There are other positive aspects for administrators, as well, says Dale Anderson, FACMPE, a partner at Anderson Rohr Consulting Group in Lake land, FL. He should know. He was an administrator for 28 years and presided over two PPMC takeovers: the Greely Clinic in Greely, CO, which was the fifth clinic to link with Nashville-based PhyCor, and most recently the Watson Clinic in Lakeland, a practice that also went to PhyCor.
"I viewed my new role as a primary care administrator at a practice," Anderson says. "I do what I can, but when I need to call on a specialist with more training in a narrower field, then I can. The PPMC is a resource."
Anderson isn’t the only one who describes PPMCs as a resource for help with issues like managed care contract negotiation or legal advice. Bill Sullivan, CMPE, is administrator at the Quincy (IL) Medical Group, a 75-physician multispecialty group that is part of Stratum Med. "When you talk to administrators, they say what they need most is a network of management experts, of ideas, and of innovation," he says. "If you have a PPMC, you have all of that. You have access to intellectual capital through joint discussions and brainstorming."
Ron Pierce, president and chief executive officer of the Houston-based specialty PPMC Integrated Orthopaedics, says one of the most positive changes for administrators is the increase in career opportunities. "There is a chance to grow, to create a real career path," he says. "If you start with a foundation practice and build a network, then you need higher-level people. Now there is a chance for cross-developmental skills. There is access to expertise in areas you didn’t have before. You gain in experience."
One other positive change you can expect, says Anderson, is for meetings to go more smoothly. "Whether you are small or large, when you get a bunch of physicians in a room with one administrator, you have a lot of temperamental material and focus on personal issues. You don’t follow an agenda. With a PPMC, from the first board meeting, because you have a corporate partner with a 50-50 vote between the docs and the corporate partners, the decision-making and discussion process take place in a much more businesslike environment."
Not all good
This isn’t to say the relationships bring only sweetness and light. A PPMC relationship sounds a death knell for some careers (see related story, above). And there are other irritations — such as more meetings and reports to write. Sometimes, Anderson says, your PPMC has a relationship with a vendor of a certain supply that forces you to end a long-standing relationship with your own vendor. "Of course, there are adjustments. You have to adjust to changing levels of control and to a national or regional rather than local agenda."
There is also a complexity to the new reporting relationships that takes getting used to, he says. "There is a bit of split loyalty. The phys icians think you are siding with the PPMC on issues, and the PPMC thinks you are favoring the docs. Rather than get caught up in that, though, you just have to practice good management skills."
Sometimes, administrators are casualties of PPMC transactions, says Pierce. "But usually it is the capabilities of the administrator that are the reason. Sometimes, the very reason they and the physicians sought out a PPMC is because there was a noticeable lack of management and administrative skills."
Anderson says the whole notion that PPMCs come in and let talented people go is far from the truth. In his experience with PhyCor, he has seen the organization grow from five or six administrators to 60. "What people are hearing are the five or six who complained loudly when the deals occurred. And those five or six complained loudly before the deal and complain loudly after they leave. That’s just the kind of people they are."
Here are five tips to help you through the changing times:
1. Know your strengths. Have faith in your ability and credibility, Anderson says. "Be confident, but not cocky."
2. Know the PPMC. Tresslar suggests that from the first contact with the PPMC, you should go to your peers in your market or contact the MGMA for information from people who have survived a PPMC purchase. "If Stratum Med were acquired by PhyCor, I would be calling people I know and trust at PhyCor practices and asking them what to expect," he says.
3. Know your limits. If things occur that you are not comfortable with, be prepared to make a decision about your future with the company, Tresslar advises. Don’t stay in a situation that makes you miserable.
4. Buy into the relationship. The physicians are the owners of the business, and if they have chosen for whatever reason to affiliate with a PPMC, Anderson says, you have to work with that. "You have to buy into it and support it or not be there."
5. Think positively. Begin the relationship with a positive attitude. "It won’t make your life or job easier," Anderson says. "It will be more challenging — more reports, more information preparation, more meeting time. The job becomes harder for that chief administrative person. But if you look at it as a resource for you, and you think of yourself as a generalist and the PPMC experts as the specialist, you can start the relationship from a more positive point."
In the final analysis, a lot of whether your new relationship goes well is determined by the attitude you bring. "If you look at it as an added value, that’s what you’ll get," says Sullivan.
And don’t worry about losing control, Pierce says. "The best PPMC relationships should provide freedom, not shackles — doctors concentrate on clinical issues, administrators and other management build a better business. The reality of the partnership should be that."
Sources
• Dale Anderson, FACMPE, Partner, Anderson Rohr Consulting Group, LLC, Lakeland, FL. Telephone: (941) 648-5744.
• Ron Pierce, President and Chief Executive Officer, Integrated Orthopaedics, Houston. Telephone: (713) 225-5464.
• Gerry Tresslar, President and Chief Executive Officer, Stratum Med, Urbana, IL. Telephone: (217) 337-3454.
• Bill Sullivan, CMPE, Administrator, Quincy (IL) Medical Group. Telephone: (217) 222-6550.
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