I really enjoyed teaching at this year’s SEAK conference on Non-clinical Careers for Physicians . I started Thursday September 23, teaching the consulting pre-course with Steve Babitsky and Jonathan Cargan.

Two days later, I spoke on Dealing with Disruptive Change: The Power of Transformation:

Transformation reflects a major change in form, function, or nature.  To me, transformation results from overcoming self-limiting beliefs and taking action on stretch goals at the same time.  Transformation is a way to deal with disruptive change proactively rather than feeling that change is done to us rather than by us.

Consulting

A consultant is a professional with specialized knowledge and expertise who assists clients to improve their situations by providing value-added advice.

Good consultants:

• Learn quickly
• Work well with others
• Are responsive to clients’ needs
• Diagnose even the problems that clients don’t tell them about
• Build consensus
• Provide simple, practical solutions

Dr. Lynn Helmer spoke about ways that consultants can add value by:

• Focusing on service and calling clients back within 24 hours
• Being pleasant and not making clients feel stupid with their answers to questions
• Underpromising and overdelivering
• Delivering a fair return on the client’s investment in consulting services, usually 5-10x, focusing on the metrics that matter

The best way to “make the magic happen” is by setting and delivering on SMART goals that are:

• Specific
• Measurable
• Achievable
• Realistic yet high
• Time delimited

How to excel in interviews

Dr. John Ferry encouraged participants to demonstrate performance by telling stories of situations that they have encountered that indicate managerial talent, especially in the areas of removing roadblocks, building trust, and holding people accountable. One way to diffuse tension at a group interview is to greet everyone around the table with a handshake at the beginning and end of the interview. The best way to demonstrate that you want the job is to express genuine enthusiasm.

 Networking

 Lillian Bjorseth defined networking as an active dynamic process that links people in mutually beneficial relationships. We network for advice, information, recommendations, referrals, and support. Rather than say, “I am a doctor,” she recommends describing what you do and the benefit that you provide to others.

 For example, when I am networking with hospital people, I tell them, “I work with disgruntled doctors and hospital leaders to improve clinical and financial performance.” It takes only 15 seconds and gives them more actionable information than my telling them that I am a general surgeon and MBA who writes books on healthcare collaboration.

It takes just 10 seconds for our brains to form a first impression.

Learning how to turn features into benefits is critical to effective networking.

Kenneth H. Cohn, MD, MBA, FACS

© 2011, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2012 thedoctorpreneur.com. All Rights Reserved.

The inspiration for today’s ezine came from a fellow physician at a combined medical staff and Board retreat  that I facilitated who asked me, “Whom do you turn to for mentoring assistance?”

Sam Horn  is a treasured mentor whom I met in 2005, when I attended the Maui Writers Retreat.  She taught the Non-Fiction Writing course, where I began writing my second book Collaborate for Success . She excels in teaching people how to communicate effectively.

Here is a summary from her blog posts on how to present with FLAIR, which stands for: 

•  Fun: fun is a sign of confidence. Not only do you command more favorable attention when you’re enjoying yourself, it shows you’re comfortable in your own skin and are comfortable wielding authority;
• Linking: Compare what you do to something with which people are familiar. The quickest way to help decision-makers connect with what you do is to compare it to something they already know and understand;
• Alliteration: Repeatability is crucial to memorability, and words like “Dirt Devil” are easier to remember than “vacuum cleaner,” for most people; 
• Inflection: Do what TV broadcasters are taught to do their first day on the job. End your sentences with downward inflection to project authority;
• Rhythm and Rhyme: When you put things in a beat; you make them easy to repeat. 

Concluding thoughts 

I remember when a strong part of my clinical clerkship grade stemmed from how well attending physicians felt that I presented patients to them.  I hope that reading Sam Horn’s material helps you to be more confident and successful in your ongoing journeys.  For those of you who are planning to attend the 2011 SEAK Conference on Non-Clinical Careers , please introduce yourselves to me. I will be teaching at the Consulting Course  September 22 and mentoring at the main conference September 23.

Kenneth H. Cohn, MD, MBA, FACS

© 2011, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2012 thedoctorpreneur.com. All Rights Reserved.

• In Masks,”she was fighting the angel of death…. No one would die that night.  She had looked feral.”
• In Achilles Heel, “Who could argue with perfectionism in a surgeon? …. The OR was indeed stressful for everyone, and most surgeons managed to keep their cool.  There was a clear line that delineated the appropriate response to that stress.  Alix crossed that line, time and time again.”
• In The Notebook, “The thing is I just don’t care anymore.  And that’s really bad.  I’m thinking of getting out of surgery altogether.  I could write poetry, maybe even go back to school.”
  “She was increasingly pulled in three directions…. She spent 50% of her time taking care of patients, 50% of her time teaching and writing, and 50% of her time in meetings- and yes, that added up to more than 100%. There had to be an easier way to make a living.”
• In Passing Storm, “… I was committed to give a talk to a group of high school kids in one of those innumerable small towns that dotted the area.  A female role model.  I had never felt less like one.  Female failure, more like it.”

There are some wonderful pearls passed on, for example:

• In Passing Storm, “I … sat down on the foot of Janice’s bed…. It puts you on the same level as your patients…. It makes you more human…. Besides, it saves your feet.”
• In Clinic Day, ‘”Is there anything I haven’t asked about that you think might be related?’ Silly question, most people probably thought.  But once in a while, you hit pay dirt.”
• In Who Will Catch Me When I Fall,”She could hear the tension in her own voice and willed herself to relax.  Tension in the small resuscitation room was already high.  Adrenalin made people move faster, made them more alert.  Too much, and they made mistakes.  She had to set the tone.”
  “The law says that clothes for children must be flame-proof, but there isn’t any requirement for clothes for adults.  So little old ladies set themselves on fire when they reach over to get the teapot off the gas stove.  Make sure your grandma has an electric stove, and tell her not to wear her shawl, or anything with trailing sleeves, when she goes near it.”

 I especially liked the last chapter, The Making of a Surgeon:
“Surgeons need to be able to make decisions under conditions of incomplete information, and most surgeons crave the immediate gratification of success or failure.  Most surgeons are distinguished by a buoyant optimism and high energy level…. You need to be well organized and to have a lot of energy and a sympathetic spouse”

I hope that you make this book part of your summer must-reads.

Kenneth H. Cohn, MD, MBA, FACS

© 2011, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2012 thedoctorpreneur.com. All Rights Reserved.

I can only imagine what you must be thinking: “I have enough to do; why do I need to learn selling?”  My point is that you are already doing selling in its most basic form any time you ask a patient to sign an informed consent form or ask a nurse to do a task for a patient.  Selling basically is persuasion, and good salespeople are good listeners (p.15), regardless of how stereotypical salespeople abuse the privilege.  One cannot understand what people want unless one learns to listen.  Unlike hearing, listening is an active process that involves:

• Concentrating on the speaker, maintaining comfortable eye contact
• Listening with one’s eyes as well as ears to be mindful of body language
• Opening one’s stance to convey receptivity
• Suspending judgment to maintain objectivity
• Empathizing, trying to put oneself in the speaker’s frame of reference, using summary questions, such as, “Do I understand you to say….,”

How to Sell Anything to Anyone Anytime by Dan Kahle is a great introduction to the selling process.  He clarifies misconceptions and then writes, “Selling is the science of helping people get what they want” (p.21-2).  Asking questions helps people make decisions that result in their exchanging something that they have for something that you offer.  His Five-Step Selling Process involves (p. 25-7):

• Engage the right people, ie those who recognize that they have a problem, are accessible, have resources to invest, want to resolve their problem now, and are people with whom you enjoy working.  We are not talking about being on call, where one has a duty to see and treat patients.
• Make them comfortable with you, understanding that the other party defines comfort and risk, not you.  The greater his or her perception of the risk, the greater must be the relationship to enable someone to take that risk (p.71).  As with elective surgery, patients must feel that you understand and appreciate their concerns in order to lay their lives on the line.
• Find out what they want and appeal to that need.  Succcessful salespeople probe to discover what issues are important, what problems people want to solve, and what they are looking for in a sales experience rather than force products or services on others.
• Craft your presentation to show them how what you are offering gives them what they want.  If you are not successful initially, analyze whether you are offering the wrong solution or talking to the wrong people
• Gain agreement on the next step.  Every interaction has a next step, extending from gaining  prospects’ attention to setting up a conversation to learn more about their needs to crafting a presentation to solve their problems to getting them to commit to action, ie closing the sale.  A “no” is preferable to a “maybe,” so that you can focus your attention on prospects who truly value what you do rather than on people who are stringing you along.

When you feel great about what you do, selling becomes service, leveraging your talents to benefit others  and being paid for your knowledge and experience.  It is an iterative journey which, like learning judgment and technique, is something that any motivated healthcare professional can master.

Please let me know what you think about edgy posts that address the elephant in the room and what you desire to learn in the future.  May all your transitions be learning journeys.

Kenneth H. Cohn, MD, MBA, FACS

© 2011, all rights reserved

Disclosure:

I have a material connection because I received a review copy that I can keep for consideration in preparing to write this content.

©2012 thedoctorpreneur.com. All Rights Reserved.

I returned with my wife to the Canyon Ranch Spa in Lenox, MA, where last year, I learned how to cook fish at high temperature  fearlessly, among other skills.

Zumba Class

This year, I noted that I was the only male in Zumba class and decided to go the front row just behind the instructor, who is shown graciously giving me after-class merengue instruction. 

It was only the second time that I had attended Zumba class, but I felt relaxed and in the moment.  I like to think of it as action being the hack saw that breaks the prison bars of fear, as I discussed in my last blog post, Building a Culture of Ownership.

I think that part of vacation (in addition to getting exercise and eating great food) is doing something new and being fearless.  Leonard Bernstein reputedly said, “If you are going to fall off a ladder, it might as well be the top rung.”

After the fall

Three days later, I slipped on the ice in front of my house, taking the garbage cans from the street.  I sprained my ankle and fractured my wrist.  All I remember is hearing a dog bark across the street as my legs went out from under me.

It is humbling to reflect on how a second can change one’s life.  At the same time, I am proud of all that I have learned to do with my left hand in less than a week, from eating and toothbrushing to starting my car.

Some times, we do not know what we are capable of until we are challenged in the moment.  These experiences have an unexpected way of reminding us of what we have and keep us from complacency.  As I allow more time in the morning to shower and dress, I think of the sacrifices of our veterans who do not have the use of limbs and how they and their families cope.  It makes me grateful for what I have and (most of the time) keeps me in the present instead of reliving the experience and wondering “What if …” or worrying about the implications of wrist stiffness on my ability to provide locum tenens surgical coverage.

It helped me a day after my accident to be able to help a fellow physician in transition to a new post clarify his new boss’s expectations and focus on the top three priorities.  After we hung up, I thought to myself, “At least I can do telementoring.”  Perhaps at times when we are feeling down on ourselves, we should smile and complete the “At least I can …” sentence.

Kenneth H. Cohn, MD, MBA, FACS

© 2011, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2012 thedoctorpreneur.com. All Rights Reserved.

Once you get past the premise, this is a great book. I especially liked the insights regarding fear (89-91):

• Fear is a reaction; courage is a decision
• Cliques and silos indicate a fear-filled workplace
• Action is the hacksaw that cuts through the prison bars of fear
• Make fear your ally by letting it catalyze you to action instead of allowing it to paralyze you into inaction

He called attention to our limiting beliefs with, “A journey of 1,000 miles begins with a long, inward gaze.”

He quoted Daniel Pink that engagement requires the following three conditions to be present (104)

• Autonomy
• Mastery
• Purpose

He quotes Drucker that leaders should treat their workers as volunteers, because they are. It may seem unsettling, but our top talent walks out the door every day. What makes them want to return? He closes with the insight that people cannot be empowered, that the only genuine empowerment is self-empowerment, which he summarizes as “Proceed till apprehended.” He describes empowerment as a state of mind, not a job description.

This book reminded me of a scene in which a hospital CEO asked “How many people own a car?” followed by “How many of you have taken the car to a car wash?”

Then he asked, “How many of you have rented a car,” and “How many of you have taken the car to a car wash?” It took months before physicians came to the realization described in Collaborate for Success (page 5) that :

It has become abundantly clear that we have lost touch with each other. Forces are being brought to bear which many of us have ignored or dismissed because we have felt powerless to influence them. Our professional, ethical charge is to provide our services in the manner that is most beneficial to the welfare of our patients. We are now reminded that the hospital has the same responsibility. Our task is to work together to find solutions that will benefit all three- patient, physician, and hospital- and in so doing, gain strength from one another.”

At a meeting of his senior team, the CEO in All Hands on Deck said (114):

… the accountability pendulum has swung too far to the left brain. We’ve become so obsessed with counting beans that we forgot our future success depends upon planting beans. What had been a culture that encouraged entrepreneurial thinking gradually morphed into one which people were more concerned with covering their tracks than with blazing new trails….

They outlined 4 essential characteristics for building a culture of ownership:

• Commitment to values, vision, and the mission, as summarized by,“If you don’t stand for something, you’ll fall for anything.”
• Engagement with customers, co-workers, and the work itself, as summarized by,“There are no menial jobs, only menial attitudes.”
• Passion: Enthusiasm for the work and fellowship in the workplace, as summarized by, “Making sure that people are having fun is the ultimate retention strategy.”
• Pride in the organization, the job, and themselves, as summarized by, “The best way to make sure people are proud of their work is to assure competence and motivation through training, recommitting to have the best-trained people in the industry.”

What do you think?

As always, I welcome your input to improve collaboration in our workplaces.

Kenneth H. Cohn

© 2011, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2012 thedoctorpreneur.com. All Rights Reserved.

If you want to learn how this practice was able to optimize its operations and earn more money without working more hours, please read on.

Case Presentation

A physician who dreamed of delivering care to a rural NC community started his urgent-care business in 2006. He was open 7 days a week and with the help of one midlevel provider, delivered compassionate care to his local community. It was such a struggle to make payroll, he ultimately took on an external part time job when his own resources were spent. He contacted us in January 2009 uncertain of the future of his business.

He was desperate for ways to increase overall collections. Their payor mix had a large number of self-paying patients due to their urgent care hours. However, located in a rural small town of less than 15,000 residents, Medicare, Medicaid and third party payor reimbursement financed a majority of claims. Upon review of their collections and billing process, we found that they were losing money from denied claims, unpaid patient balances, and increasing accounts receivable. They had no experience with analysis of reports or internal research. They were relying on one staff member who preferred to work from home and they used a clearinghouse that did not send regular statements for collection of patient balances. In addition, their biller was not generating any monthly report data for review.

We focused on three basic areas: report generation, reconciliation of third party payor claims and collections, and patient collections. The intention was to improve overall collections through more efficient processes.

Methodology

The Model for Improvement Method was employed, using fundamental analysis and the Plan-Do-Study-Act (PDSA) cycle to make incremental changes within his practice.

The PDSA cycle tests change in the workplace. First a change is planned, then initiated and tried, then the results are observed. Permanent changes are implemented after learning what was successful. By testing small changes and evaluating the success of each test, results can be refined and broader changes may be implemented across a larger spectrum.

We designed several PDSA cycles to initiate change. First, we established a routine of running reports at defined times. We needed clearer information regarding patient balances and posted payments from third party payors, and we needed a system to view this information to accomplish an improved rate of collection within 60 days.

Next, we selected three items to track monthly within the report system:

1. CLAIMS POSTING – Many claims took an excess of 14 days to post to patient accounts. We decreased this delay time to no more than 3 business days.

2. DENIED CLAIMS – New procedures and updated clearinghouse software ensured that denied claims would be followed up within one workweek.

3. PATIENT BALANCES – Old patient balances lingered from 2007. We employed a collection agency and changed the front desk process such that patient balances are satisfied in full or a payment plan implemented before further services are rendered.

Results

Within one 30 day cycle, we improved total collections by 76.4% and over the 60-day target we improved collections by 47% overall. We achieved significant gains initially by collecting on patient accounts receivable within the last 30 days and refilling all denied claims within the last 60 days. The average collection ratio rose from 48 to 65.7% within that timeframe. The physician saw an average increase of $3000 per month and over the course of six months collected 16% more than the previous year. Average daily patient volume increased from 12-15 daily to 18-22.

For the first time, the physician understood payor mix, bad debt, and claims processing.

The physician initiated the transition from urgent to primary care and with this transition, negotiated improved reimbursement rates from third party payors. His staff met with state Medicaid officials to clarify billing processes, resubmitted Medicaid claims, and recovered nearly $2000 in claims outstanding.

The practice now utilizes a running calendar to follow with ongoing data report generation and claims analysis and a collection agency to settle bad debts. Unpaid claims from third party payors are reworked and refiled in a more timely fashion. Patient balances are reconciled and balances due are collected at the point of service. Now, if there is an issue with declining reimbursement, the practice can act more quickly to minimize impact on monthly cash flow.

Further review of their collections revealed that their overall collection rate was between 60% and 70% most months. This is significantly higher than average family practice rates of 50% and further reinforced that when they followed proper procedures, they achieved a measurable, sustainable improvement in cash flow.

The physician now has a framework that he applies to future data measurement to ensure improved collections. He is steadfast in his dream to deliver quality healthcare and now feels that he has a better chance of success as a result of improved measurement and more efficient processes.

Reference: http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/

Lisa P. Shock is the President/CEO of Utilization Solutions in Healthcare, Inc., a consulting firm specializing in teaching physicians how to get paid for the services that they provide and how to utilize PAs to their fullest potential. Please visit her website at www.pushpa.biz or contact her directly at lisa@pushpa.biz.

Kenneth H. Cohn, MD, MBA, FACS

© 2011, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2012 thedoctorpreneur.com. All Rights Reserved.

The next term I remember hearing was the “bogey,” where someone floats an innocent sounding question beginning with, “Just suppose…,” which I remember being used on me during a job interview after fellowship.  I listened with interest, thinking, “No wonder nobody wants us to know about this stuff!”  I recognized how many times before my ignorance was that of a lamb being led to slaughter.

When I was in business school, I took an elective on negotiation, where I learned about win-win negotiation, a major step up in the win-lose and lose-lose negotiations in which I had participated previously.  It was with no expectations that I opened up Steve Babitsky’s and Jim Mangraviti’s new book, Never Lose Again: Become a Top Negotiator by Asking the Right Questions.

First, I need to expand on the disclaimer below.  I teach at the SEAK Non-Clinical Careers for Physicians Seminar.  I have known Steve and Jim for 7 years, since I began taking SEAK courses as a student.  I have the utmost respect for them as teachers and entrepreneurs of integrity. 

Putting aside conflicts of interest , this is a great book.  Reading it is pure, painless growth.  I loved the way each chapter began with a field-tested, practical question that one can use in a negotiation, followed by dialogue on the question to the point of sale.  The ending is equally clever, with suggestions on what to do when the roles reverse and you are asked the question.  My favorite 5 (of 50) questions were:

• So, how did you hear about us; a great way to probe for information at the beginning of a negotiation
• What is your time frame for wrapping up this negotiation; allows one to find out about time pressures
• Can you shoot me an e-mail before our meeting with your issues, goals, and concerns, so that I can prepare
• How about we try it for a while; what do we have to lose
• Will you give us a best-price guarantee

I think that every physician should read this book.  I just wish that medical schools and residency program directors would make it required reading.

Kenneth H. Cohn, MD, MBA, FACS

© 2011, all rights reserved

 Disclosure:

I have a material connection because I received a review copy that I can keep for consideration in preparing to write this content.

©2012 thedoctorpreneur.com. All Rights Reserved.

Spencer Baron wrote in his recent book, Secrets of the Game, “A superstar athlete’s most powerful tool is his mind.” (p.49)

I had second thoughts about reviewing this book until I reached Chapter 4 “A Mind is a Terrible Thing to Waste.” It began with a quote from Jason Taylor, defensive end of the Miami Dolphins and Defensive Player of the Year in 2006:

“Pressure does one of two things to people. It either crushes you or turns you into a diamond.”

Dr. Baron makes the case that athletes become superstars because they believe that they are capable of greatness (p.46). Once people control their minds, they control their physical and psychologic pain.

Mental toughness, which results from the practice of reframing negative experiences as learning and growth, leads to consistent performance, irrespective of time, place, or circumstance (p.50).

As I mentioned in Collaborative Resilience, resilience derives from focusing on the present and future rather than whining about the past. Resilient athletes emerge from challenges feeling productive, empowered, and inspired. Dr. Baron uses the metaphor of palm trees that sway in a hurricane, in contrast to more rigid oak trees whose branches are broken in windstorms.

Dr. Baron concludes the chapter with, “If you want to see a superstar, go find a losing team and see who keeps pushing himself and his team beyond their horizons and the seductive courtship offered by depression and disappointment.Now there’s your winner!”

He describes mental secrets of superstar athletes in Chapter 5 (p. 55-71), who:

•Change their vocabulary to eliminate exaggeration, overgeneralization, and despair

•Demonstrate strong personal presence; I believe that physician presence derives from choosing to exist at a higher, more positive outlook and energy state; after we watch a scary movie, we realize that the human mind-body axis does not know the difference between screen visualization (fantasy) and what we refer to as reality; we can influence our reality by the thoughts and visualizations that we send to our brain

•Choose to associate with people who make them want to evolve into a better person and avoid negative people and the gossip that they promote

•Use music to stimulate positive mental outlook, ranging from Mozart, Vivaldi, Beethoven, and Bach to the theme song from Rocky

•Develop positive routines that make them feel safe, secure, and in the moment

•Visualize every step of success, adding as many of the other senses as possible

•Choose role models with unshakeable faith, such as Rev. Martin Luther King Jr., Mahatma Gandhi, and John F. Kennedy, to overcome obstacles

•Bring onto their team coaches or mentors who help them see beyond their blind spots

He concludes by encouraging us to evolve to having jobs that allow us to be happy every day, where our tasks are aligned with our life purpose, vision for the future, and personal values:

Maybe you should be the superstar of your life. Take an inventory of your victories, especially those where you have succeeded against all odds. If you can’t find them, ask your friends, significant others, and mentors. If you were watching you, what would excite you? After all, if you are not your own biggest champion, why would you expect anyone else to be?

I recommend this 153-page entertaining book to all aspiring physician entrepreneurs who want to elevate their thinking and consequently elevate their performance. The biggest obstacle to transitioning is making the mental leap.

Here is some additional reading that can help you feel more comfortable in your career transition:

•Transitioning from Clinical Medicine

•White Paper Mastery: How to Get Interviewers to Want to Speak with You

•Overcoming Frustration: Keys to Leadership.

•Business Plan Writing for Physicians.

Kenneth H. Cohn, MD, MBA, FACS

© 2010, all rights reserved

Disclosure:

I have a material connection because I received a review copy that I can keep for consideration in preparing to write this content.

©2012 thedoctorpreneur.com. All Rights Reserved.

We discussed a range of consulting experiences, including:

• Strategy for bringing new products and services to market
• Billing, coding, information technology, and back-office operations
• Risk management, expert witness, compliance, insurance, contracting
• Finance, marketing, business planning, entrepreneurial activities

 An interactive session that I enjoyed involved helping participants find their niche, about which I have written previously.  What we emphasized is to focus on one area based on their expertise, unmet needs of the people or organization they want to serve, and their network of contacts.

Getting one’s first job(s) establishes a track record; several people in the audience learned at their day job, for example an internist who had been part of a successful electronic health record system launch.  Another physician spoke to small audiences at little or no charge until she built up a following.  Writing, especially in blogs, ezines, and white-papers also helps physicians build their brand.  A white paper is an authoritative report that points out a solution to a problem.

I hope that this blog post piques the curiosity of physicians who find that the marginal value of seeing one more patient or doing one more operation starts to decrease and who are looking for ways to do meaningful work with great colleagues and receive positive feedback.  If this is a subject that interests you, start now to connect the dots by brainstorming with other people your areas of expertise, your passion, the unmet needs, and your contacts who might give you that all-important start.

©2012 thedoctorpreneur.com. All Rights Reserved.