Choosing & Implementing the “Right” Management Style for Your Clinic

  Since the Affordable Care Act (ACA) was signed in 2010, time has ripened for wound centers to offer effective patient care and still manage to experience financial profit. With the shift of focus toward preventative care, savvy hospitals will emphasize outpatient services that offer controlled costs and efficient service. Wound centers are continuing to be practical options to reduce inpatient stays for nonhealing wounds.   Whether you’re revitalizing a facility or starting from the ground up, there are management options that should be considered to ensure that the effectiveness of your wound center is sustainable. This article will discuss different approaches to outpatient wound clinic management while addressing the respective pros and cons inherent with each. The authors will then break down the various operational components that should be included regardless of management approach.

Determining Management Style

  Changes in healthcare law have created an outpatient-focused landscape. Population health has displaced the focus from successfully treating symptoms to offering preventative care that results in fewer inpatient hospital stays and surgeries. In today’s environment, wound centers must find ways to maintain profit margins, offer effective care, and keep driving their goals in order to achieve clinical and financial success. Researching and committing to a specific management style is crucial to such success.   There are three predominant styles of management when it comes to providing wound care. The first option to consider has historically dominated the industry’s landscape: employing a comprehensive management company that charges a yearly fee to run the center. The second option operates as a services-based approach that manages various components of a wound center in areas such as auditing, staffing, marketing, technology, and education while leaving the overall operations in the hands of the wound center and/or hospital. With the third model, the center refrains from any outside management involvement, allowing complete control to rest in the hands of whichever entity owns the center (self-management). What follows is detailed information on each approach.   Comprehensive Management   In a comprehensive management model, an outside company is hired to direct day-to-day operations. A comprehensive management company will be paid a yearly fee to manage and maintain operative control of the center. With this model, a contractual agreement is reached to provide comprehensive management that begins with implementation and extends to financial support, staffing, technology, education, and marketing, etc. Oftentimes, a comprehensive management company requires little to no initial financial investment from the hospital, but will require a contract to protect the investment.   This management style can be a worthwhile option for an existing center. A reliable management company will conduct a thorough assessment of the clinic and slowly take control of managerial responsibilities. The company will monitor billing and coding, implement new policies and procedures (if necessary), provide staff training, and create a robust marketing program to ensure a strong referral and patient base. Much like a start-up, most management companies will require a long-term contract to manage the center.   Historically, hospitals partnered with management companies to direct smaller revenue sources such as wound centers. It was easier to place the center in someone else’s hands and rely upon them to keep it functional rather than deal with the challenges (eg, billing and coding, staffing, electronic health records) that came with the daily operations of running the clinic. With decades of experience in which to analyze this approach, several primary weaknesses have surfaced: The yearly management fee can severely cut into profits and in instances where a contract with the management company ends, the clinic stands to lose everything provided by the management company (including key personnel, policies and procedures, and equipment).   The comprehensive approach continues to work well when the wound center enters a flexible partnership with the management company. Reasonable fees should be offered so the center can achieve profitability. Should the clinic be ready to operate without a management company, agreements that allow the center to keep policies and procedures, equipment, key staff, etc. need to be in place. Instead of seeking complete control, a vibrant partnership should be desired where the management company seeks to pass down knowledge as well as provide management based on contractual obligations.   Services-Based Management   Similar to a comprehensive management approach, services-based management begins with an honest assessment of the center. Instead of contracting for a complete management takeover, this model allows the center to pick and choose areas that need outside management assistance. Typically, services offered include implementation, billing, auditing, marketing, technology support, staffing, and education. In this management style, the bulk of control still rests in the hands of the clinic director while a partnership is forged between the wound center and the management company that offers a collaborative and team-based approach.   Before entering into a service-based agreement, clinic administration should be knowledgeable of the state of its program (eg, finances and healing rates).   This may seem like an obvious component of the process, but oftentimes directors are simply unaware of potential weaknesses, especially in the areas of finances and patient care. Even if a management company provides an assessment, the director should be able to correctly evaluate his/her center independent of the initial assessment. The key to making this approach work is to protect all aspects of the facility from outside ownership. This includes policies and procedures, key staff, and equipment. If a services-based management company insists on owning the piece that it manages, the center becomes dependent on the management company to operate. One of the greatest benefits of this approach is flexibility. It allows the center to employ a management company and still maintain control of the clinic. As long as the management company is willing to assist without a long-term contract, the relationship will be mutually beneficial.   Self-Management   For some wound centers, when faced with the mire of management company choices, the possibilities of self-management become more attractive. Self-management allows a wound center to build itself from the ground up. This is by far the most difficult model in terms of risk assessment, as it puts the full weight of both management and financial responsibility upon the hospital. This includes implementation, staffing, billing and coding, policies and procedures, marketing, education, equipment, and technology. At the same time it may also be the most emotionally rewarding method when success is experienced.   In order to flourish, the self-management approach requires a team of committed professionals that is willing to learn and acquire the necessary skills to run a profitable wound center. Centers that desire self-management might benefit if this is the goal, not the starting line. If desirable, a wound center could build a strong partnership with a like-minded management company that can eventually assist the center in reaching a self-management model.

Overview of Core Clinic Components

  Regardless of which type of management style chosen, there are some common components that warrant consideration. Implementation, auditing, staffing, marketing, education, and technology are all important aspects that affect the operations of an effectual wound center.   Implementation   Implementation encompasses the overall development of the center, including geographical placement, equipment accrual, and initial setup. The management company will also assist in creating clear policies and procedures to serve as the foundation for the center. Clear implementation is necessary to ensure that a center begins appropriately from Day 1 and continues moving in the right direction.   Auditing   With the landscape of today’s healthcare reform, strong financial support may be the difference between success and failure for a wound center. Having a financial team in place to monitor charts and track changes in coding creates an extra layer of protection should the center face an audit and assists staff in staying current on new regulations and regulation changes. The proper auditing support ensures the center is being reimbursed for each provided service.   Staffing   Securing quality personnel is vital to clinical and financial success. A management company can assist the center in finding the best people and provide necessary training in specialized wound care. Rather than focusing on the specific position, a reliable management company will take the time to learn the company culture and seek passionate candidates who will take ownership of their position within the clinic. In this model, hiring from within the industry is often not the best approach as focus can be placed on intangible commodities such as personality and work ethic before seeking clinicians experienced in wound care. If a management company is doing its job well, it should be able to relay and transfer industry knowledge to the right candidate, regardless of specific medical expertise.   Marketing   A strong marketing partnership established with a management company can also be provided. This can assist with such needs as building a database of patient referrals, maintaining relationships with local doctors and hospitals making those referrals, and providing promotional and advertising materials as necessary. Even in this crucial component of the process, the goal should be on sustainable programs that increase revenue for centers. Effective marketing models must be customizable for your specific center, taking into consideration community demographics and company needs.   Education and Technology   The two final services that management companies can provide are the technology to manage and run an electronic medical record system and the educational pieces for both patients and clinical staff. The two often go hand in hand as patients become more technically savvy and require education that meets the demands of a digital world.   Another important component of educational resources is training on the current reimbursement guidelines of the Centers for Medicare & Medicaid Services. Hospital systems must be ready to implement ICD-10-CM codes by Oct. 1. The new coding system will use both numbers and letters, forcing system updates to ensure compatibility. There has also been a major shift in biologics as products have been divided into “high cost” and “low cost” options with varying reimbursement rates. If not closely monitored, clinics may be using expensive products and not recouping out-of-pocket expenses. A management company should provide these services to help the clinic stay focused on what it does best: healing patients.   Regardless of choosing an outside management company or conducting self-management, the clinic must possess and work toward a long-term vision. Know where you are with your center before partnering with a management company, if that’s the chosen route. Trisha Markowitz is a member of the TWC editorial board. Michael Comer is chief executive officer and Melissa Bailey is director of education at Wound Care Advantage, Sierra Madre, CA.