I was recently asked to project manage a situation a group of surgeons had got themselves into.
It was, yet again, a case of so much money outstanding that the partners were really questioning was it all worth it? Repeatedly, the senior partner – an ENT consultant surgeon – had thrown his hands up in the air. Invoices, both from medical insurance companies and self funding patients, were unpaid. His reaction was to bang the table and demand the medical secretaries either telephone or write to all insurance companies who had outstanding invoices. They represented almost 80% of the total due to the medical practice. They should be chased and made to pay immediately.
It did not work.
Actually, it never would have worked because the consultant surgeon partner was issuing the wrong instruction. He was issuing the wrong instruction because he’d based his decision on the wrong premise. He knew and repeatedly shouted insurance companies wouldn’t pay until chased. Well, for the record actually they will – but only if the invoice is right.
The real question he should have been asking was:
Why aren’t the private medical insurance companies paying?
By listening to them or reading the contents of any of the remittance advices they were supplying for the small number of invoices that actually were being paid, he would have realised the vast majority of invoices produced for each private consultant surgeon who worked in the practice were incomplete or plain wrong. For example: an invoice stating the patients date of birth as 8/9/2053 was wrong (1953 was right) or an invoice for a “consultation £150” was incomplete because it did not state if the consultation was initial or a follow-up.
Instead each day for a number of months, he had ordered all the medical secretaries to contact an insurance company and chase down invoices. Each day they had to report to him precisely to whom they had spoken, what errors they had corrected and when therefore the medical practice would be paid. When that didn’t work as successfully as he intended – the number of unpaid invoices actually went up – he had formally and very vocally ripped into his practice manager whom he held responsible for the whole problem.
And thus a big clue to the cause of his inability to get paid was clear.
He did not enquire how the error had originated. Nor did he allow time to put the cause of the problem right before moving on to the next issue. Every one save himself was wrong. He refused outright to consider any other course of action. So the medical secretaries had been voting with their feet. Moral was on the floor and staff turnover increasing. That gave the first big right between the eyes clue as to real cause of the problem.
To quote the consultant surgeon concerned directly “if staff don’t perform they will be punished” and “if the practice manager makes mistakes he will be fined” Clearly as brilliant a consultant surgeon as he was, his people management skills were sadly lacking.
So he asked mhm to identify precisely when he was likely to get all these outstanding invoices paid.
The answer(s) were not what he expected:
To clear over two years worth of unpaid invoices anything between three and six months. By which point the private medical practice would need to start again on all the unpaid invoices generated between the last three and six months;
Until this climate of fear and the culture of the ultra aggressive management changed, it was extremely unlikely things would ever permanently change for the better.
A classic case of physician heal thyself.