Multiple-Location Practices: 7 Ways to Leverage Them

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• Multiple-Location Practices 7 Ways to Leverage
  Them
• New technologies make it easier than ever for
  offices that are far apart to share resources,
  records, and information. But owning and running
• a multiple-location practice also compounds the
  administrative, financial,
• and regulatory challenges that practices of all
  sizes are now facing.
• Whether your eye care practice is just opening
  location number two, or struggling with location
  number ten, weve found seven major ways to make
  your operations more effective, efficient, and
  profitable.
• Forge Connections
• Multiple-location practices used to wrestle with
  getting the right health records to the right
  location at the right time. Patients dont
  always go to the same offices, so in the old
  days, they would pull the charts the day before
  and the doctors would actually carry the charts
  with them to the other office, remembers Barbara
  J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC,
  CPCO, AAPC Fellow, vice president of Stark
  Coding Consulting in New Jersey. But now, if
  you have good EHR and PM systems, you can
  securely access all patient records wherever you
  are.
• With physicians and staff bouncing from location
  to location, and patients sometimes visiting more
  than one location, you must ensure that your EHR
  and PM software is securely accessible from
  anywhere. Many experts now recommend a
  cloud-based system over an on-site server.
  Physical servers wont always have the IT
  support or technology to connect everybody in
  remotely, Cobuzzi warns, and they arent always
  adequately protected against cybersecurity
  threats.
• Staff Smartly
• Staffing is always the biggest challenge for a
  busy practice, no matter how many locations it
  has. Many practices struggle to find reliable,
  self-sufficient employees in the first place
  retaining them when their skills are in such
  high demand is even harder. Multiply those
  staffing needs by more than one location, and
  its easy to feel overwhelmed (and understaffed).
• The clearest way that multiple-location practices
  can solve staffing problems is to train and
  promote candidates from within. Forget about the
  time-consuming work of finding the right outside
  professional to fill a
• mid-level position. Simply step your current
  staff up a ladder of experience

inside your practice. That way, whenever a job
opens up at one of your
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locations, an internal employee will be available
to fill it. As long as you keep your entry-level
positions filled with solid candidates (we know
thats a challenge all its own), and as long as
you invest in employee education and development,
youll build your own pipeline. If you have an
employee in your front office who is hungry,
wants to excel further in their career, and is
reliable, promote them, train them, and encourage
them! says Tina Allen, operations manager at Eye
Surgeons of Indiana, a multi-location eye care
practice in Indianapolis. These employees
already know your business and there is less of a
learning curve. This system is also a great way
to retain your most talented staffers Employees
need to feel like there is opportunity for growth
within your organization, Allen says. Otherwise,
youll always be struggling to keep your existing
employees and recruit new ones. 3. Create a
Central Plan Most practices assume that every
outpost of a multiple-location practice must look
and operate exactly the same. Newsflash they
dont! For example, one location might have fewer
hours or patients than another, depending on the
needs of its community. This variety can offer an
important economy of scale for your
multiple-location practice centralizing certain
operations. Priority 1 Coding and
Billing Youll have someone who can enter
charges at each checkout desk, says Cobuzzi,
but its unrealistic and wasteful to have a
coding and billing operation at each office.
Usually the practice has one centralized office.
It might be in the main office or, as some
practices are doing now, they rent cheaper space
for their coding and billing office, because
physician space is very expensive. Youll save
money by hiring fewer coding and billing
specialists, and youll also get the added
benefit of implementing more consistent
processes. Each location doesnt need to make up
its own separate system from whole cloth
instead, all charges are submitted in exactly the
way the main billing office decides is best.
Office administrators can concentrate on
cultivating a top-notch patient experience, not
on learning the complicated nuances of coding and
billing ops. Priority 2 Phone Ops One
candidate for centralizing you might not have
considered fielding
phone calls. Front desk personnel may assume that
answering calls is an
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absolutely essential part of what they do, but it
actually takes away from face-to-face interaction
with patients. Instead of having the calls come
into the front desk, interrupting what its
doing, try having the calls come into a
centralized operator phone bank, Cobuzzi
recommends. She knows of one Detroit practice
where they have a small room with four
operators, and they just handle phone calls and
make appointments and forward the prescription
renewals instead of bothering the front desk.
Its on site in the main office at this
particular practice, but it doesnt have to
be. An added benefit? Front desk staff is often
thought of as entry-level, but thats not always
the case. They need plenty of training and
experience to provide the best in-person
experience for patients. In contrast, just about
anyone can learn to answer telephones. So
operators are usually entry- level, much easier
to find, and much less expensive to train and
pay. Also, if streams of phone calls arent
distracting your front desk staff, theyre less
likely to make mistakes that frustrate patients
or put PHI in jeopardy.

• Set High Standards
• You probably already know that you can save time
  and money at your practice by setting up standard
  operating procedures for every task you perform.
  But this system is especially useful at a
  multiple-location practice. With so much more to
  manage, including staff members possibly rotating
  among locations, standardization makes quality
  control and seamless operations possible.
• The receptionist will be more successful if all
  of the front desks are set up the same way and
  the check-in processes are identical among
  offices, says Holloway. Having a uniform
  operations strategy also allows staff members to
  reduce errors, especially when the office gets
  hectic. Compliance in particular gets easier
  when standardized. Instead of worrying that the
  added complexity will let important compliance
  matters fall through the cracks, you can be
  confident that every location is following regs
  correctly if theyre all doing things the same
  way.
• Master Complex Scheduling
• A multiple-location practice can give you a real
  competitive advantage in todays market, but that
  doesnt mean it doesnt face real challenges too.
  It can be much harder to schedule doctors, techs
  and opticians and ensure your staffing levels are
  correct, especially if staff members travel among

locations on a daily basis.
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One doctor may be at location one on Mondays and
Wednesdays, and location two on Tuesday mornings,
and location three on Tuesday afternoons.
Depending on how the doctors are staffed, it can
be hard for them to manage their days, notes
Cobuzzi. It gets harder when a patient wants a
specific location and doctor. That doctor may not
be at that location at the time they want to come
in. Its hard enough getting patients the
appointments they want anyway, but having
multiple locations makes that harder, she
elaborates. Untangle the Maze of
Schedules Start with each physicians support
staffing needs, advises Holloway. Some
practices elect to have a dedicated team for each
physician, and that team then travels to
different locations with their doctor, she
explains. Other practices choose to have all of
the staff trained to work with all of the
physicians, allowing staff to be more
interchangeable between physicians and offices,
she continues. Ultimately, staffing for each
location needs to be aligned with the number of
physicians and patient volume for each
location. Cross-training is critical to having
an agile workforce. When the team is
knowledgeable and can work in more than one
position in the office, we have better options to
cover vacations and unplanned absences.Elizabeth
Holloway, BSM Consulting The more flexible and
consistent your support staff is, the easier it
is for your physicians to jump between locations.
Investigate where you can consolidate or share
personnel, or train staff to move effectively
between locations and functions, suggests
Holloway. I am also an advocate of training
staff such that they can work with more than one
physician, she says. 6. Facilitate
Communication Communication is one of the
biggest challenges that multi-location practices
face. How do you keep everyone on the same page
when they work many miles apart? Communication
between offices, physician partners, management,
and staff must be frequent and consistent,
Holloway recommends. If youre having an
all-staff meeting, you should actually invite all
of your staff! Not possible or practical to
assemble everybody in one location? Make sure to
set up a videoconferencing service so that that
everyone feels included.
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In-person meetings are great, but they arent
always an option. For everyday communication
needs, practices with many locations depend on
electronic communications. Every Monday,
management sends out a weekly communication
email that includes information about who is out
of the office, upcoming training sessions, MIPS
reminders, tips on how to improve our patient
experience, and new projects on the horizon,
says Allen. If all of your locations are
receiving regular electronic updatesand asked to
contribute when appropriateits more likely
those locations will feel like a part of the
whole, even if theyre physically distanced from
the main office. 7. Maintain Continuity Most
multi-location practices have a hub office
usually, their original location that contains
their central administration. This office likely
has more staff, longer hours, and more and better
equipment. This can present a challenge to
patients who are accustomed to a satellite
location but need a service that is only offered
at the main location. You could have a visual
field test at the south side location, but your
IOL Master is on the north side. If youre going
to do cataract surgery, you need that IOL Master,
so the patient would have to drive, Holt
explains. Trying to explain that to patients can
be difficult at times. Eventually, you want to
try to outfit all locations just like your main
location, because not every patient can afford to
travel. Tailor Products to Each
Location Conversely, having different equipment
and products at different locations isnt always
a bad thing. You see it all the time with
multi-location practices, Holt offers. One
optical shop may have the higher-end eyewear
brands. Another will have the more affordable
brands. They can each tailor their inventory to
the locations primary demographic. Your business
district location and your working-class
neighborhood location shouldnt stock all the
same options, for example. Different customer
bases have different affordability issues. Ive
seen some practices that have both high end and
low end, because they only have one location,
says Holt. Ive seen patients struggle when you
have, say, a Prada frame and a Calvin Klein
frame, because the price points are very
different. If they really like the Prada frame,
how are they going to be able to afford it? This
can lead to lower patient satisfaction. Patients
may leave your practice feeling disappointedeven
though your practice did nothing wrong. By
molding your offerings to each locations
demographics, you can use your multi-location
practice to better serve your patients.
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