Women in Healthcare: Jill Arena on Elevating Financial Literacy Among Physicians
Download MP3Everyone, and welcome to the latest edition of Women in Healthcare podcast hosted with MGMA. I am Adrienne Lloyd, and I'm excited to be here today with Jill Arena and really just excited to share. Jill is the CEO of Healthy Practices and leads its operations. She's a nationally recognized expert in medical practice, finance and operations, as well as revenue cycle management and leadership development. She's a serial entrepreneur, which I love, and has co founded several different entities and as a frequent speaker and convener in the medical community.
Adrienne Lloyd:And if you've been to a, MGMA conference in the last few years, you've probably seen her on the stage or seen her at, in one of the exhibitor booths, but just has a wealth of knowledge. She has, is also the author of Physician Heal Thy Financial Cell, which was written for physicians who want to master the finances of their practices. And she produces a weekly podcast for physicians and administrators called Medical Money Matters, which is just so important. And she also given her passion for the leadership development, also co founded the Physician Leadership Project in 2020, which is a year long program for high potential physician leaders and really helping just continue to help them develop into those formal leadership roles. And Jill, we're just so excited to have you and I love so much of what you're doing and having worked with so many physicians over the years and leadership roles are just regular roles.
Adrienne Lloyd:As we all know, there's such a gap between what people are taught in medical school and what they actually need to know in order to be successful participants and then potentially leaders or owners in their practices. And I just love that you're helping helping them. So thank you so much for taking time to be here with us today.
Jill Arena:Thank you. Thanks for inviting me. I'm excited about the conversation.
Adrienne Lloyd:Me too. Me too. And tell us too. I think you're tell us where you're based, and what's one thing that you love to do for fun?
Jill Arena:Oh, well
Adrienne Lloyd:Not doing all of these entrepreneurial adventure.
Jill Arena:Based in the beautiful Portland, Oregon. And, one thing I love to do for fun, I love to visit the Oregon Coast. And so now I'm gonna out the Oregon Coast. It's beautiful. It's a little colder than the California coast, but, equally beautiful.
Jill Arena:And my daughter and her crazy labradoodle like to go and run on the beach.
Adrienne Lloyd:Oh, I love that. I love that. So kind of diving in first question, many physicians do lack the formal financial training. How have you found or created effective ways to communicate the complex financial concepts to leaders and practice owners? And I know for many of us who've been on the administrator side, really being able to speak the language in a way that connects with them and, how have you found the ability to do that?
Adrienne Lloyd:And what are some suggestions you might have for either side as they're trying to have those conversations?
Jill Arena:Well, I trained in accounting and finance. So before I came into healthcare thirty three years ago, I actually worked as an auditor for one of the large public accounting firms. So finance and numbers is sort of my comfort zone, right? That's where I go back to. When I have any kind of question or I wanna analyze a purchase or a strategic decision, I go to the numbers.
Jill Arena:I have found literally in about the last four or five years in getting started with the physician leadership project, where as you mentioned in the introduction, we get these high potential physician leaders in. We spend a year with them really honing those skills. And as you can imagine, out of 11 sessions across the year, two of those we dedicate to finance. At the beginning of the first one, we close the door and we say, okay, it's Vegas in here. So what's said it here stays here.
Jill Arena:And let's now make a list of all the finance topics that you've heard and that you'd like to find. Like, you don't understand what they need. And then my job is to hold a straight face while they make a really big list, of things. So that's really been my learning in the last five years is, for the prior, you know, whatever that is, twenty eight years of my career, I was wandering around as a finance and and operations professional, spouting off all kinds of things in board meetings about return on investment calculations and budget to actual variances. Just assuming that all these intelligent, well educated people sitting with me understood everything I was saying.
Jill Arena:And there was a lot of nodding and smiling. And I imagine our listeners probably get a lot of that in their board meetings. And what I've learned coming through the physician leadership project work is that we don't teach accounting and finance in medical school. That is not a the medical school curriculum today. That's probably a project for my retirement, right, is to go and infiltrate the medical education system.
Adrienne Lloyd:Let me know if I can help. That sounds
Jill Arena:great. Absolutely. I'd I'd have a lot of competitors I think. Really do a disservice to our physicians, right? We put them through all this amazing clinical training and we give them all these great tools for diagnostics and pharmaceuticals.
Jill Arena:And we teach them nothing about loss statements or analyzing any kind of big strategic purchase or any of that. So understanding that now this, you know, sort of at this stage in my career, it's one of these moments. Oh, I've been running around and spouting up all kinds of things that hasn't really been helpful. The other piece of that to share with your audience is what I've learned in having deeper conversations with physicians about this is that the medical schools by and large have what I call a knowledge shame culture. And that means, you know, as the physician or the physician in training, you're expected to have the knowledge.
Jill Arena:And you if you don't, you just keep your head down and you pretend, or you just hope that they don't call on you, because the attending is gonna, you know, be all over you if you don't have the answers. So that coming through that and learning how to function in that kind of an environment, doesn't lend itself really well to having the confidence to stop and say, hey, can you explain what you mean by budget variance? Right? Just it they they don't come out of medical school with that knowledge or the skill set really Right. To communicate.
Jill Arena:And it requires some courage. Right? Put your hand up in the air and say, I don't know.
Adrienne Lloyd:Well, and it's a lot of I mean, I know I've interviewed and hired a lot of physicians over the years and then talking to them, especially if they're new out of fellowship or residency and, you know, they're trying to compare an offer maybe that they already have with one that we're giving them. And they're giving me I'm like, well, you know, tell me about tell me as much as you're willing to share. And they're saying like, well, I'm gonna get x percent after overhead. And I'm like, well, did they talk about what's in the overhead? And it's like, no.
Adrienne Lloyd:And I'm like, I can hide a lot in overhead. You know? Sure can. So just, you know, here's some questions whether you choose a job with, you know, us or you choose a job with someone else. Like, you might wanna ask, like, to really kind of dive into what does that look like and what would you have the ability to influence and, you know, control at an individual provider level.
Adrienne Lloyd:And then obviously, you know, I work with a lot of physician owners of smaller big groups too, it's similar, you know, and they hire managers and administrators. And I truly believe, you know, eighty, ninety, 90 five, 90 nine percent of us are in it for the right reasons, trying to do the right thing. But if you don't have the answers to these questions, you can end up in situations that none of us want to be in. I'm sure you've had that experience too. The
Jill Arena:embezzlement statistics are staggering in those practices. And I think that MDMA's current statistic is eighty three percent of medical groups. So I like to say, you know, if you're a physician and you're out to you know, for drinks with four friends, know, only one of you has not been invested at some point. You know? It's just crazy.
Jill Arena:And those are, you know, 83%, those are the ones we know about. The really talented ones do it and move on and you never know. And I
Adrienne Lloyd:think there's the culture, which is so shocking. And then there's there's a culture, and and I completely understand this. When you're building your practice and you're starting small, you know, you wanna hire people that you you feel like you can trust. You can kinda build this, you know, family for better or for worse environment, but, at least you become close to them and then you wanna trust them. And if you don't have the answers to those questions or know what to look at or trends to dive into, it can be a slippery slope.
Adrienne Lloyd:One of the things you mentioned too, led me one of the things that came to mind is having been in leadership roles and having to say no to provider requests on something like extra staff or new capital equipment or those kinds of things can always, you know, be tricky. And so, you know, talk a little bit about the importance of financial transparency within healthcare organizations and some specific examples that you've, how you've implemented this and the impact of TAG. Cause I know that's something that, yeah, I've kind of wrestled with how much and do you share and when and all of those things?
Jill Arena:Absolutely. Well, I tend to be a fan of a % transparency amongst the owners at a minimum. Right? So the partners in the practice. And anytime we go into a practice and there's not that transparency, at least with the owners, I start having lots of questions and sort of hearkening back to our, you know, our entitlement conversation.
Jill Arena:Like, is there something odd going on here? You know, why why aren't you willing as the finance person or the managing partner? You know, why aren't you willing to share? So I much prefer those environments where it's open. I've even been a proponent of sharing the financials at a high level with everyone in the practice.
Jill Arena:And that's spending some time educating everybody about, you know, how this looks. If you look at any practice, mostly, you know, private practice specifically and primary care specifically, the margins are so thin in those practices, meaning there's so little money left over Yeah. That that really can help you as a leader from my perspective when everyone understands, you know, how little money is left over at the end of the month or the end of the year. Yeah. Puts us where I like to be with financial discussions, especially when there's, you know, there's not going to be enough for all of the assets perhaps that the physicians wanna purchase.
Jill Arena:You know, somebody wants a sparkling new C arm or something, and these are Yeah.
Adrienne Lloyd:The toys. And I,
Jill Arena:I try hard I try hard not to say no because, you know, that's uncomfortable. But it really kinda helped just lead them to the answer. Like, you know and it with anything, when you have a fixed pie, right, there's just just a choice. It's like, well, you can have the hundred and $20,000 c arm, and that means all 10 partners need to take a $12,000 pay cut. Are you ready?
Jill Arena:Right. And that's you know, and maybe not quite that bluntly, but you can help them get there. And then they're in a space of choice rather than you as the finance or administrator having to say no. Yeah. And I like to remember with, you know, private practices, it's their money.
Jill Arena:They can spend it however they like. And I really try to, you know, provide guidance and without a lot of judgment. Mhmm. And that's that's a that's a leadership skill. Right?
Jill Arena:That's a ghost. Right. Let me let me show you what this means financially. And if you ask me for my opinion, I'm happy to give it to you. And at the end of the day, it's it's your decision.
Adrienne Lloyd:Yeah. Yeah. And I found those conversations. And, obviously, you know, sometimes there are incremental items that are to enhance the practice or perhaps one provider is interested in this new device, and it seems more like a nice to have versus a have to have. And sometimes there's real decisions around we have critical items that are breaking and there's just not enough to go around what we're gonna do.
Adrienne Lloyd:But one of the things I found helpful with those kind of nice to haves or expansions of practice and service lines is to have those conversations, as you said, with here's what it costs, here's what it would take for us to break even. Do you feel like you can see that many patients? Do you feel like that's reasonable? How quickly do you think you could get there? I need your commitment to helping work to that.
Adrienne Lloyd:Obviously, you can't always build that into any kind of contract per se or anything. But, you know, really just having that transparent conversation I think is really, really helpful for the conversation. I
Jill Arena:love that. Yeah. We like to give scenarios too. So we'll we'll run the good, the bad, and the ugly. Right?
Jill Arena:It's like, let's you know, if if we really do hit it out of the park, here's what this new service line or this new piece of equipment may generate for the practice. And if growth is a little slower than expected, then here's, you know, here's the cost that we're gonna have to bear. And if you really don't, have the volume that you expect, then here's the expense you're gonna have.
Adrienne Lloyd:Looking upstream and downstream of, you know, x number x percentage of patients tend to have this procedure, but, you know, new patients versus returns. Are you gonna add new patients to your practice to actually bring those those volumes in or, you know, those kinds of things I think are really, really helpful too.
Jill Arena:You see physicians sometimes wanting to look at things that are a little bit more, you know, they may or may not have a positive return on investment, which is fine. But I always want physicians armed with that information. Like if you go ahead and provide this service, it really just amounts to convenience for your patients. And that might be enough for you to say yes. We'll incur the expense.
Jill Arena:So I love having those conversations and try to really get everybody as much information as possible so that they can make a really informed choice.
Adrienne Lloyd:Right. And I think too anchoring into the why and translating it both from the administrator side, the finance side to the physicians of how this is going to help benefit the patients, the practice, the team, whatever the case may be is really, really key.
Jill Arena:I love seeing like a prioritized asset purchase list, capital asset list that the whole ownership group gets to weigh in on. And however they govern themselves, you know, if it's a simple democracy, everybody gets to vote on, you know, where does this live on the list? And then we can look and see with, you know, funds that are remaining for investment. How you know, how do we
Adrienne Lloyd:Yeah. Which those can be tricky discussions, especially if you have multi specialty groups that are fighting for cardiology or GI this and so forth. But, yes, very important. One of the things I know that you've talked about in some of your money matters, as I've watched on LinkedIn and other places, if you're looking for Jill, is the concept of all patients are created equal, but all payers are not. And how can healthcare leaders really take this to help improve the financial understanding and management of their practices and kind of their physician partners?
Jill Arena:The, I I probably need to get that statement printed on a T shirt, don't I? And it actually resonates with the physicians when I say that out loud. And then it opens us up to having a conversation about payer mix. What I'll say to physicians and what I generally coach administrators to say to physicians very simply is, again, patients are all equal, payers are not. And when we talk about your saleable unit, that relative value unit, when we get the physicians clear that that really is their unit of value.
Jill Arena:And when we say very simply, that unit of value with a Medicare patient is worth $33 and some change this year. Medicaid, depending on the state is probably paying you somewhere in the mid to high twenties for that same unit of And your commercial payers is where you balance it out. So you're maybe depending on your market $50 to $60 depending on the size of your group, it might be a little higher. And I usually just really break it down to those basic levels. And then we have an important part of the conversation, which is your cost to generate an RVU in the practice.
Jill Arena:Most practices probably somewhere in the forties. So as soon as we say those things, then you can kinda see the light bulb coming on and physicians get like, oh, why not? Oh, no. And so then you can have a cogent conversation about why we need to manage payer mix in a private practice. And, that, you know, you if you're if you're losing money on every sale, you can't make that up in volume.
Jill Arena:You know? Just take it that way. The physics don't work. So we have to have, you know, the right amount. And it sort of puts each individual clinic or medical group in the space of having to kind of balance their own portfolio, if you will.
Jill Arena:Yeah. Yeah. That usually helps. Just laying out those very simple facts usually helps drive a discussion about why we need systems up front, why we need scheduling templates, why we need to be certain that we have, you know, the right number of commercial patients coming through the door to be able to afford the things that we want. And I've had to have that conversation with full staff because sometimes well, sure you see it with your practice too.
Jill Arena:You get a lot of pushback from folks at the front desk. You know, why would I give you know, they they get can get very indignant and very righteous. You know? Why would I give priority to a commercially insured patient over a Medicaid patient? You know?
Jill Arena:Why should I pay it differently? And it's like, you're not treating the human differently. You're treating the payer differently. Right. They treat the practice very differently Okay.
Jill Arena:Monetarily. So yeah. That's a that's a really interesting conversation. I recall having that with a group of orthopedists about twelve years ago
Adrienne Lloyd:and Yeah.
Jill Arena:At a 7AM meeting. And with the I could just sort of see their eyes getting bigger and bigger. And they had asked me why their revenue, had been falling over the last eighteen months. And when I went and looked at their, financial reports, it was a ten year trend on an eighteen month trend. And it was really their zip code.
Jill Arena:Their zip code was becoming far heavier Medicaid. And so when I explained that, I said, well, you you have a real increase in Medicaid in the ZIP code, and they kind of looked at me blankly. So I did the basic building blocks, and then I see the eyes get really big. And so this is a 7AM meeting, and at about ten, one of them popped into the office that I was sitting in, and he looked a little pale and drawn. And I said, what's up, Jeff?
Jill Arena:And he says, I've just seen three Medicare patients in a row. And he was all He's like, oh, no. I said, okay. Good. Let's get back out there and see some commercial ones.
Jill Arena:Quite sure what to tell you. But
Adrienne Lloyd:Well, I think it's I think it's very key, I, you know, I do a lot of process improvement change management, both, you know, coaching and, you know, operational consulting. And I think that's usually one of the first, you know, kind of where are we and part of where are we today and where we versus where do we need to go is that financial component, both as an organization, what we're doing. And I know one of the groups, as I was working with, gastroenterology back in the day, you know, we were having for our Medicare patients, we actually had a significant loss in our commercial patients. There was margin there, but not as much as we needed, but it was actually just really a stimulant to the conversation of like, why do we need to shift? Why do we need to be more efficient?
Adrienne Lloyd:Why do we need to look at the process? And having that conversation with the frontline staff and the providers was very important and eye opening I think for them too. Because I was in a system at the time that presumably had all the resources in all the world, why do we need to worry about it? But being able to say like, actually for every patient we take care of, here's what it's costing. Here's what we're getting reimbursed.
Adrienne Lloyd:This is why we need to make our processes as streamlined and sufficient for every patients, but also to really appeal to those commercial contract patients. We get great reviews and they continue to come and see us and support what we're doing. So
Jill Arena:yeah. Commercially insured patients, think, are probably the first ones to consider health care a bit more of a commodity. And they really are looking, I know I behave this way as a patient, I'm looking for the practices that make it easy for me to interact with And scheduling is easy, paying my bill is easy. I want everything on my You know, I don't I don't wanna have to deal with a piece of paper that comes in the mail. I'd love to give a credit card on file and just leave it there.
Jill Arena:Please use that for me when we're done. Let me know how much it was, but so yeah. And I I realized I'm not every consumer. I'm not always the typical consumer, but I really feel like practices today using technology and really looking at it from the patient experience on are the ones where, to your point, you're streamlining all the operations.
Adrienne Lloyd:Agree.
Jill Arena:Making it attractive for those kind of actions that we all need.
Adrienne Lloyd:Well, to that, like, the overall education of physicians, what strategies you know, again, I think we've all heard the fake it till you make it and all of those things. But what strategies have you which I have mixed perceptions on. I think, you know, that sometimes makes us feel way more stressed than we need to versus feeling like we can ask questions. But what strategies have you found successful to help physicians recognize when they maybe are faking their understanding of the financial concepts? And how do you approach those conversations either through your programs or otherwise?
Adrienne Lloyd:What would you advise kind of for the administrators to help them maybe feel more comfortable in opening up with positions?
Jill Arena:Yeah. Our physician leadership project, program, which is a Pacific Northwest thing, is a year long program for high potential physician leaders, and we have two out of 11 sessions devoted to finance. That's the level of import that we assign And we routinely, you know, we'll ask the physicians a lot of questions, about what they do and don't understand. And, I I find there is a lot of variation in understanding of finances. So when I'm presenting financials at a physician board meeting, I usually aim really low in terms of just understanding and I start with basics.
Jill Arena:And I'll never forget one I was sitting in where they really hadn't had financials presented to them for several years in their trading, which I was kind of trying to, you know, close my mouth when they said that's me. Really? Okay. Let's do it. And so I brought them, and I recall having a two page profit and loss, and I handed those out at the board meetings.
Jill Arena:And, I said, okay. When I read a profit and loss, I usually start with the bottom line, and I flip over the page. And I could see every other person in the room flipped over their page, and I and I look all the way down to the bottom line. If there's a positive or negative variance. So just literally talking through at that level.
Jill Arena:And I will sometimes just open a conversation by saying my experience with physician groups is there's always a variety of levels of understanding. I'm going to start with the basics. And if this is too basic for all of you, please let me know that and I'll step it up. We'll go from 25 miles an hour to 60 miles an hour and see how that pace works for you. And I have not yet had a group of physicians say to me, yeah, yeah, we got this go higher.
Jill Arena:It's always when we start at that basic level of understanding, we're really explaining the mechanics of you know, your profit and loss. And this is a month's worth of information about what came in and what went out and literally talking about it at that level, is, generally welcomed by groups. Occasionally, I run into a group where there's been a, you know, administrative leader or a finance leader who has done the basics. That's always refreshing. Yeah.
Jill Arena:Well, I was keynoting a conference about a year ago that was really around physician real estate purchases. And one of the speakers prior to me said that you know, he said one or two of the physicians in your group actually understand the real estate component. The rest are just faking it. And I I followed on his statement beautifully. I said, I think he nailed it.
Jill Arena:And I would double down on that statement and say one or two of your physicians really understand the finance. Rest are probably faking it. That's, I think really for just administrators and finance folks to have that understanding that Yeah. Probably you've been like me. You've been talking at a level for a lot of years that they really don't like.
Adrienne Lloyd:Yeah. And I think it could be a great opportunity for administrators, especially if you're new kind of to the practice or maybe you're going through some change or finances aren't looking as beautiful, positive as you would like them as to I don't know. You can what are some suggestions that you might have? I could think off the hand maybe doing, like, a brown bag session, like ask me anything, you know, kind of open book.
Jill Arena:We love those. And with this technology because, I mean, Zoom is great. Yeah. And so we'll offer a brown bag. We will record it on Zoom, and then we post that in wherever's the, you know, the SharePoint for the clinic so that physicians can go and watch it anonymously if they want to.
Jill Arena:And I find that one's super helpful. So a lot of people don't wanna cop to the fact that they've been faking it in the board meeting, you know, six years. But, that one's good. Sometimes we will, aside, you know, we'll add like a half hour to the front of the board meeting and we'll just say, this is gonna be open forum on the finances. So if you have questions,
Adrienne Lloyd:if I'm really
Jill Arena:Hopefully, leaders are handing out their financial statements a few days in advance of the board. Yeah. I do find there are some physicians that really need that processing time. So getting out information, especially if there's detailed financial information you're gonna be reviewing, sharing it ahead of time really helps. And that also follows by subspecialty too.
Jill Arena:There's some that are very information hungry and they take it all in and process it. So at least a couple two, three days in advance. And then yeah, offering thirty minutes ahead of time that you're just there for Q and A. It's also nice if you can you know, enroll some of your more senior physicians who do understand a bit more about the finance, to either act as financial mentors or their younger colleagues or to be a plant for you in the brown bag or in the half hour before the board meeting. So if you sit and ask what sort of appears as a dumb question.
Jill Arena:Right? So they'll Mhmm. But you can say, hey. If nobody asks this, would you please ask it for me? And any other topics, you know, you can kinda line up what you wanna cover if there aren't any questions.
Adrienne Lloyd:Yeah. Yeah. One of the, having worked, like, consulting now, I do all work with all kinds of practices, but the, kinda most of my career was more in the academic large health system. I mean, we would have some slides from time to time that was like, where does the money come from? Where does it go?
Adrienne Lloyd:And so anything from a mix of, like, what types of services are we offering? What are those kind of trailing and leading into the revenue, to the payer discussions, to the revenue cycle? And then, you know, where does it go? That always, I think, as administrators can be a little nerve racking when you start getting the pointed questions of like, well, how many staff do we need all the staff that we have? Or maybe we need more staff or why can't we pay the staff more?
Adrienne Lloyd:You know, whatever those expense categories are, I think being able to share like here's what here's what's paying for what at a high level and then accompanying that with and I'm you know, don't know if you do some of this too, but like the benchmark of you know, we do benchmark with whatever association makes the most sense for you, on staff, on productivity, and those things so that you have those can help you navigate some of those more pointed questions with physicians if you
Jill Arena:The great things. I love the highly performing practices dataset. That one is fun to point to and to talk a little bit about, you know, when we talk about staffing ratios where I, you know, traditionally we've sort of been in this three to one world and then we look at the highly performing practices and they're more like five to one or six to one. Right? And having the conversation with the physicians about the why that and really talking about working, practicing at the top of your license and really delegating and pushing down all of the work that doesn't make you a physician.
Jill Arena:And as I like to say to them, you should spend it, Same is true for executives too. Right? As you move through your career, you should spend most of your day talking and signing your name. And that's pretty much all you should do. You know?
Jill Arena:And, obviously, if you're seeing patients, you might be doing, you know, of the number of procedures, but always, always being at the top of your licensure.
Adrienne Lloyd:Yeah. Agreed. Agreed. If you've looked across physician groups, obviously, there's variation in every every area of practice as there is in all of health care and is there isn't all of business, really. There's but how have you found ways to kinda use the data and to drive the, you know, productive discussions with providers or just practices at the high level?
Jill Arena:I one of the things I learned early in my career is physicians, by and large, are a competitive bunch. And so that is beautiful
Adrienne Lloyd:over Yeah. That
Jill Arena:is beautiful fuel for your leadership when we're you're wanting to change in a group, if you can just harness the the competitive nature of the physicians, that is that is gold right there.
Adrienne Lloyd:Vidyapist's leader is probably the same, I guess, we That
Jill Arena:know your friend about you. Same is true. Same is true for, yeah, high performing executives too. But you wanna win. Yeah.
Jill Arena:I have many times, and and this is a bit of, you know, culture development within the group. But I many times, I have just posted or shared amongst all the physicians, performance on any metric, you know, by physician. And in in those who are not accustomed to that kind of data sharing, we might start by blinding them, you know, doctor a, doctor b, doctor c, and just letting them know which one they are. That will spark, you know, the the competitive nature. I much prefer, you know, moving groups through that part of their cultural development into a space where there's a % transparency, and it is doctor Smith performed this way.
Jill Arena:Doctor Jones performed this way. And, really, that makes your job as a leader so much easier because you don't have to talk much. You just share the data, and you wait.
Adrienne Lloyd:And then you can ask questions like, how do we make this better? Why do we think there's differences? But yeah.
Jill Arena:And if we look at one you know, first, just to get clarity on what the data means. And if it is giving a clear message that one physician is performing more optimally than another or than group, what can we learn from that individual? And maybe allowing them to provide some training. I've seen this work really powerfully with coding training, having physicians teach other physicians, Here is how I do this. Here's how I set up my visits.
Jill Arena:We had a rear foot and ankle surgery group years ago. And one of the physicians, his per visit value was one and a half times his colleagues. And so we would literally just put him on stage for most of the meetings where we're talking about coding. Talk about it. He was great at accessorizing his visits.
Jill Arena:That's what I called it. It was, you know, if and and again, thinking about are you a commercially insured patient? Alright. Here we go. And, I actually went to see him as a patient, and, it was great.
Jill Arena:He was kinda like, we should probably talk about some orthotics for you. And I kinda nodded. He said, would you like to get casted for those today? And I kinda nodded. And It was wonderful because it was like this intersection of appropriate clinical, but also convenience for me as the patients.
Jill Arena:So I love sparking those kinds of conversations within the physicians so that they as they're understanding more about how the business actually works, they also can get that their own personal habits of how they conduct visits and how they code have a huge impact as well.
Adrienne Lloyd:Well, and I love the intersection of that. I think that's where, there have been many jobs where the finances really need needed improvement. And it's like you can't fix finances if operations either aren't or, you know, are broken or just truly aren't, you know, to the level they need to be. And that's a nice intersection of saying, like, sometimes it's a if we can conclude, maybe not completely conclude, but really serve the the patient and getting as much of the visit done and getting those extra procedures ordered or even having testing prior to the visit so you can actually give them an answer and a treatment plan, You know, thinking through those pieces versus I think depending on the specialty sometimes or maybe depending on the practice, there's that tendency to like, oh, we're just gonna do the and there's some coding, you know, and regulatory issues we have to navigate through, obviously. But, you know, we're just gonna do this piece and then we'll have them come back and we'll have them come back.
Adrienne Lloyd:And ultimately, there's a lot of situations where that's not serving the patients. Again, we may have to from a billing perspective depending on what it is. But, you know, having those discussions, I think really can be helpful. And I love the blinded approach. I've seen that work very well, both at provider staff level on time starts to length of stays, to quality results for procedures, you know, those kinds of things too.
Adrienne Lloyd:I think that's a great place to start if you're not ready to go to the full transparency, level. But I I see it move pretty quickly from the blinded to the full transparency. It usually doesn't take as long as you think it might. So
Jill Arena:Oh, no.
Adrienne Lloyd:That is great.
Jill Arena:We've it drive groups where you think about, you know, the the distribution, and I'm not a statistical expert, but when you can, you know, graph the distribution of the group and, if you can help the group both, you know, sort of narrow the bell curve and make it taller. Yeah. Part of this, you know, can we reduce variation and can we improve performance? So we're shifting performance to the right if that's the way we want it to go, and we're making that bell curve tighter and taller. That that for me is the fun, right, of leadership.
Jill Arena:Having those conversations to say, can we learn from the folks that we can identify are performing really optimally? Yeah. But what can the rest of us learn from them? Hey. That's beautiful.
Jill Arena:And it it really does make the leadership job a lot easier in this book. Lot less. It does. You sort of put the data up there, you sit back and wait. Yeah.
Adrienne Lloyd:I think data in anything. Anything you're trying to do in change management, just gaining momentum, engagement, the more that you can break it down. So, like, again, this is where we are. Here's where we'd like to be. Help me understand how to get there and kind of showing them information along the way, the easier it's gonna be for whether you're a physician leader, administrative leader, clinical leader, any of those
Jill Arena:those things. You have when you have alignment and you show up as a leader with the intention of having the medical group and the individual owners and physicians really thrive. Right. When you always come from that place, I think the physicians get it, and they get that you're motivated to be there. A lot a lot less resistance and a lot more trust.
Adrienne Lloyd:Well, Joe, we could talk all day, but, last question. What advice would you give to health care leaders, whether physicians or administrators, to really improve the financial IQ of their teams and organizations? I know many of them listening today may have been like, oh, I'd love to go through the programs, but obviously, they're not all gonna be able to do that. What do you feel like would be kind of the best place for as a phys individual physician or overall as leaders that they could do to help their teams kinda raise that financial bar?
Jill Arena:I would just encourage, openness and curiosity. And I love that. Probably also trying to come at it if you're a leader, trying to come at it with zero assumptions about what the physicians do and don't know. And even saying to them, well, I heard a podcast or I read a book and it seems like perhaps, sometimes we talk about these things at a level that physicians don't get. What I'd love to say is it's akin to you as a physician handing me an EKG and asking me to read it.
Jill Arena:I've gotten that. Yes. And here I am handing you a profit and loss and asking you to read that, and you've had no training how to do that. So, I think that kind of, you know, reciprocation and also listening for them and creating an environment where it is safe for them to say, don't know or I don't understand what you're talking about. That requires some leadership in terms of creating that space, and that requires some courage on their part to be vulnerable with you because that is not how they've been trained.
Jill Arena:Now they've been trained to know. And, when they don't know that those behaviors come out in all kinds of sort of odd ways. So Right. Reducing the pressure and really making it an open space to ask questions as we said earlier with those kind of brown bags or open forums or setting up a senior leader to really, you know, start asking questions and model that behavior so they know it's okay to ask questions. Yeah.
Jill Arena:That it's, you know, this is a space of curiosity.
Adrienne Lloyd:No, I love that. I think it's such a The finances, such a core part of vision alignment so that you can move the needle in whatever way you need, whatever the individual physician or administrator role is really it's so important. So again, thank you for all the work that you're doing, and thank you for taking your time to be here with us today. And we will have the information, below with the podcast for you to find Jill, but you can also look for Medical Money Matters, podcast that Jill does. And she kinda gives, you know, again, small focus tidbits around, different areas or questions that have come forward from physicians and practice leaders.
Adrienne Lloyd:So, Jill, thank you so much for being with us today, and, hopefully, we may see you again. Who knows?
Jill Arena:For having me.
Adrienne Lloyd:Absolutely. Thank you.
