"Help, my partner won't perform!" It's a cry I hear over and over again here at the Verden Group. Not only can it be a source of frustration and limiting to the growth of the practice, but these days payer contracts are becoming increasingly based on performance. If you have certain metrics and goals in place that need to be reached in order to receive maximum compensation, having a partner who simply won't comply can really hamper your practice.
So what do you do when your partner just won't act like one? First, get to the source of the problem — there is no single path to this. Some physicians are just slower than others and simply do not/cannot see the same volume of patients as others. Others seem to shirk their share of the non-patient workload. However, in many cases what I find is that the term "partner" has never been properly defined, and if not quantified, how can expectations be met? So start there.
Does your partnership agreement spell out what it means to behave like a partner? Most agreements address only the financial and operational aspects of the relationship, and that does little to help you ensure that your partnership can work successfully. In these cases, we help practices create what I call a "partner charter." This involves sitting your partner down and discussing what it means to be a "partner." This can be quite cathartic, often revealing, and is designed to result in a document that identifies what the group — collectively — can agree to.
Defining your mission
For example, you might start with your mission statement, if you have one (if you don't, go to http://bit.ly/practice-statement) and discuss what it means to achieve that mission on a daily basis. Let's break one down to see how it works. Here's part of a mission from one of our clients:
Through open communication, compassion and collaboration, we strive to fulfill our goals by remaining progressive in our commitment to our practice.
This could be used to start the conversation by focusing on the word "collaboration." Define it. Talk about how collaboration is achieved (or not) and why that is important to the functioning of your group. Build on the conversation from there.
The next step is to really qualify what the most important issues are for the practice. Using the above mission statement example, communication, compassion, collaboration, progression, and commitment are the key areas of importance to this group. Define each word, ask each partner to discuss how each term can be met on a daily basis, and then write it down in the form of a charter. This document becomes the set of standards you all agree to, based on the practice's values. Once it's written, have each partner sign off on it so it acts as a commitment by each to uphold those standards. When issues come up, this becomes your "go to" document to pull out and point to and say "we all agreed to this, this is what is expected of you as partner."
Crunching the data
So you have your mission defined, your charter written and signed, and there are still problems. What then? It's time to turn to your data. Quantifying, and comparing performance can actually be inspiring. If you have a good electronic health record (EHR), chances are that you can do some basic reporting that allows you to analyze metrics by partner, such as number of visits, revenues, coding patterns and the like. That may be enough to create some baseline data but if you are participating in pay-for-performance programs, you'll need something more robust that allows you to drill down into specific compliance with those measures. Being able to bring up data that shows exactly where a physician failed to meet a metric (say, prescribing generics for certain diagnoses) is a powerful tool for pinpointing where behavior needs to be modified. Often, once identified, it is simply a matter of measuring, communicating, and improving. There are a handful of (affordable) programs that have the capability to get to this level of detail working with the data from your EHR, one of which (that I like) is Clinigence.
However, I have seen cases where a physician has produced high revenue but created havoc every day by consistently running behind. If a physician simply cannot pick up the pace (assuming that is important to you) then discuss scheduling fewer patients and reducing their salary or bonus. Often quality of life is more important to these physicians than earning maximum compensation.
Which brings me to my next point, which is setting compensation based on productivity (go to Physicians Practice's RVU Topic Resource Center for more information). If you are simply splitting the profits equally, then there is no incentive for your partners to do more. Some doctors are hard-wired to be competitive and achieve, others have a more laid-back approach. Which is OK, but not when the laid-back partner is getting compensated as much as the high achiever. There should always be opportunity to get paid more for doing more.
By defining what it means to be a partner, getting buy-in to the most important aspects of performance, and holding partners accountable for productivity, you can improve how your partners perform. However, at the end of the day, some of your partners may never perform the way you might like them to, but you can avoid resentment by compensating everyone fairly based on effort.
Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She can be reached at email@example.com or by visiting www.theverdengroup.com