April 2003 Bulletin

Things you never learned in medical school

Survey shows orthopaedists need more practice management training

By Diane Thome

You learned to saw. You learned to pin. But did you learn how to run a practice? Face it. In addition to being an MD, you are also a CEO… or at least a first vice president.

The Academy recognizes that its educational mandate is not limited to helping Fellows maintain their orthopaedic skills. In September, the AAOS conducted a survey of its Fellows to determine practice management issues that most need attention. Previous Academy research suggested that orthopaedists who practice in an academic setting have practice management information needs that differ from orthopaedists in private practice. The Academy also sought to determine if there was a current common ground of practice management information that orthopaedists practicing in either setting would find useful.

Methodology

On September 6, 2002, the Academy mailed questionnaires to the 990 Fellows who indicated in the Academy’s 2000 Census that they have an academic practice, and to 2,000 randomly selected Fellows who did not identify themselves as having an academic practice on the Census questionnaire.

By the September 30 cut-off date, 724 respondents had either mailed or faxed back completed questionnaires for a 24 percent response rate. Generalizing their responses to a total of 14,834 Fellows, the maximum error range is +3.6 percentage points at the 95 percent confidence interval.

Demographics

Only 8 percent of respondents practiced exclusively in an academic setting (academicians), while 35 percent practiced in both academic and clinical settings. More than half (56 percent) were in private practice (clinicians).

The demographic characteristics of the respondent population varied significantly from the general population of Fellows in certain areas. Orthopaedic specialists were over-represented in the respondent group (52 percent) in comparison with their proportion among all Academy Fellows (31 percent). Conversely, the proportions of generalists (22 percent) and generalists with a specialty interest (27 percent) among respondents were significantly lower than their proportions among all Fellows (30 percent and 38 percent, respectively).

Respondents also differed from the general population of Fellows by practice type. Solo practitioners comprised 18 percent of survey respondents but 28 percent of all Fellows. Approximately one in five respondents (21 percent) were members of a multi-specialty group but only 13 percent of all Fellows work in this type of practice. However, the difference in the proportions of Fellows (59 percent) and respondents (62 percent) in orthopaedic groups was not statistically significant.

Who’s minding the practice?

Approximately half the respondents had either daily, hands-on involvement in the management of their practices (25 percent) or little to no involvement (24 percent). Overall, the mean rating of respondent involvement in management was 3.41 on a 5-point scale. 1 (See Figure 1.) Solo practitioners were the most involved (mean = 4.33), while members of multi-specialty groups were least involved (3.01). Similarly, generalists (3.65) and generalists with a specialty interest (3.67) were more involved in the running of their practices than were specialists (3.23).

Respondents, even those with a high degree of involvement in practice management, relied heavily on practice administrators. In 79 percent of respondent practice settings, a practice administrator had primary (21 percent) or shared (58 percent) responsibility for practice management. This finding suggests practice administrators play a key role in influencing the future business direction of these practices.

Business 101

Although 73 percent of all respondents reported medium to very high involvement 2 in the management of their practices, only 16 percent of this group had attended an educational program focusing on practice management (primarily coding/billing/reimbursement issues) in the past two years. Still, 75 percent agreed that the need for practice management information would escalate in the future.


The survey measured respondent interest in a one-day Academy-sponsored practice management course. Among respondents with medium to high involvement in their practices, 44 percent indicated they were likely (29 percent) or extremely likely (15 percent) to attend, with a mean rating of 3.24 on a 5-point scale.3 However, the proportion of Fellows likely to attend may be underestimated by this respondent group. As Figure 1 illustrates, those likely to attend also had significant involvement in the management of their practices (mean = 4.12). Yet, the respondents included a disproportionate sample of specialists and orthopaedists in multi-specialty groups, Fellows less likely to be involved in practice management issues.

The most preferred venues for practice management courses among respondents with any likelihood of attending were Friday/Saturday (42 percent) or Saturday/ Sunday (26 percent) at the Orthopaedic Learning Center in Rosemont, Ill.

What’s "hot"?

The greatest need for information remains on issues that affect the "bottom line." Among Fellows with medium to high involvement in the management of their practices, likelihood of attending a practice management course was highest if the topics included reimbursement (69 percent) and business operations (47 percent). Second-tier topics of interest included strategic positioning and marketing (39 percent), regulatory and compliance issues (36 percent), contracting (35 percent) and personnel (31 percent). Broad topics of less interest were facilities (29 percent), patient relations (27 percent), practice evolution (26 percent) and funding (24 percent).

Table 1

Practice Management Course Topics
Mean Likelihood of Attending*

Total

Clinician

Academician

Both Settings

Reimbursement

3.83

3.92**

3.38

3.77

Business Operations

3.27

3.28

2.88

3.34

Strategic Positioning and Marketing

3.04

3.14

2.66

2.99

Regulatory and Compliance Issues

2.99

3.12

2.62

2.88

Contracting

2.91

3.00

2.88

2.76

Personnel

2.87

2.82

3.06

2.91

Patient Relations

2.75

2.80

2.61

2.67

Facilities

2.72

2.69

2.72

2.81

Practice Evolution

2.60

2.77

2.32

2.32

Funding

2.49

2.13

2.90

3.17

N = 489-500

N = 291-299

N = 29-32

N = 145-149

*Means based on a 5-point scale where "5" means "extremely likely" and "1" means "not at all likely."

**Shaded statistics are significantly different from bolded statistics across categories.

Likelihood of attendance, however, varied by practice setting. Table 1 arrays the mean ratings of likely attendance by broad topic area among clinicians, academicians and respondents who practiced in both settings.

Reimbursement was clearly a "hot" issue among all orthopaedists, regardless of practice setting. However, Fellows practicing in both the academic and private practice arenas were significantly more likely to attend a practice management course that includes the topic business operations than orthopaedists solely in academic practice. Not surprisingly, orthopaedists with an academic orientation were significantly more likely to attend a course that included funding as a topic than orthopaedists in the private practice setting.

Common ground

Fellows who expressed any likelihood of attending a practice management course that included one of the broad topics then indicated their interest in specific subtopics. Of the 64 subtopics tested, Table 2 highlights those in which respondents reported a high level of interest.4 Shaded areas indicate topics of high interest to Fellows in all three practice settings.

Within the two broad topics of major interest to survey participants, reimbursement and business operations, four specific areas of high interest emerged across practice settings. Virtually all respondents likely to attend a practice management course that included reimbursement as a topic also expressed high interest in strategies for increasing third-party reimbursement (99 percent) and strategies for timely third-party reimbursement (97 percent). Likewise, cost control (93 percent) and ICD-9/CPT coding (89 percent) surfaced as subtopics of high interest among those likely to attend a course that included the topic business operations.

Although respondents expressed interest in specific subtopics, it is likely that the person attending a course in these areas may not be an orthopaedist. Approximately four in 10 Fellows (38 percent) would attend themselves. However, just under half (46 percent) indicated the person likely to attend would be a practice administrator (27 percent) or a business office manager (19 percent).

Overall, the findings suggest academicians and orthopaedists in private practice share a common struggle to increase reimbursement and control costs. Information addressing these needs could form the basis of a course that would appeal to orthopaedists in both sectors. Further, the role of the practice administrator should not be underestimated and must be considered in future practice management course offerings.

Table 2

Practice Management Course
Areas of Specific Interest

Clinician

Academician

Both Settings

Strategies for increasing Third party reimbursement

Y

Y

Y

Strategies for timely Third party reimbursement

Y

Y

Y

Business Operations

Cost control

Y

Y

Y

ICD-9/CPT coding

Y

Y

Y

Information technology to manage business ops.

Y

Y

Medical records management

Y

Information technology to manage clinical ops.

Y

Budgeting

Y

Strategic Positioning and Marketing

Developing a marketing plan

Y

Regulatory and Compliance Issues

HIPAA

Y

Y

Y

Accreditation

Y

Contracting

Managing payor agreements

Y

Y

Y

Personnel

Conflict resolution

Y

Staff performance evaluation

Y

Laws affecting employment

Y

Employee policies

Y

Patient Relations

Patient satisfaction

Y

Y

Y

Staff/patient communication

Y

Y

Y

Physician/patient communication

Y

Y

Outcomes data collection

Y

Facilities

Facility organization and management

Y

Y

Acquiring information technology equip. /software

Y

Y

Practice Evolution

Practice expansion

Y

Funding

Obtaining funds for teaching activities (clinical)

Y

Y

Obtaining research funds

Y

Obtaining philanthropic funds

Y

Footnotes

  1. Based on a 5-point scale where "1" means "no involvement in practice management decisions" and "5" means "daily, hands-on involvement."
  2. "Medium to very high involvement" is defined as ratings of "3," "4," or "5" on the 5-point scale previously discussed. All findings noted from this point forward refer to respondents who indicated a medium to very high involvement in the management of their practices.
  3. Based on a 5-point scale where "1" means "not at all likely" and "5" means "extremely likely."
  4. High interest is defined as 88 percent or above for "yes" responses.


Home Previous Page