Practice Overhaul Contest: The winner is...

On the surface, High Ridge Family Practice looks enviable. It's located in the upscale community of Stamford, CT; consists of four family physicians, two pediatricians, several medical assistants, and an RN; and has some 6,000 active patients. Additionally, it's been "paper light" for several years, and the doctors and other clinicians are in the process of moving to more spacious quarters.

Beneath the surface, though, are a litany of problems that are all too common in small practices-too much front office turnover, stagnant income, and head-butting battles with insurers that have failed to yield higher reimbursements. For High Ridge Family Practice, though, help is on the way: Its managing partner, FP Alan T. Falkoff, was named the winner of Medical Economics' first Practice Overhaul contest. The prize: a full-day, in-office consult with two top practice management consultants-Michael P. Brady, president of Healthcare Business Consultants in Asheville, NC, and Michael D. Brown, president of Health Care Economics in Indianapolis.

When things go "clunk" in the night-and day

That was a challenge, because so many entries met those criteria. Several doctors punctuated their vignettes with the word "help!" and one opened with a plaintive "desperately seeking sanity." Respondents mentioned long workdays, inadequate financial rewards, and problems with personnel, billing, coding, patient flow, rising overhead, declining reimbursements, and EHR implementation. Some examples:

There were also comments about wasted space, unmanageable clutter, inefficient handling of patient phone calls, dishonest employees, and frustrated attempts at modernization. As one respondent wrote, "I have Space Age dreams on a Stone Age budget."

"Despite working harder, we're treading water"

Alan Falkoff, who started High Ridge Family Practice in 1988, now runs the practice with the help of his partners, FP Joshua B. Herbert and pediatrician David M. Berkun. In addition to a large clinical staff, they employ a full complement of front- and back-office workers, including three reception people, a full-time and two part-time billers, a medical records scanner, and a cleaning woman.

As Falkoff notes, "Our office is highly computerized, and utilizing many tools that should make things better, but we never seem to be where we should be." Among the vexing problems he mentions: inability to get staff to understand carefully explained office policies, intraoffice bickering, stagnant income, and inability to negotiate fee schedule increases with insurers. Practice income, he says, covers overhead, but just barely-something that hasn't changed in several years. "We're working harder, but for the last eight years we've been treading water."