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The practice manager: A change agent for healthcare practices

This discussion paper has been developed in partnership by Avant and the Australian Association of Practice Management (AAPM). It aims to stimulate discussion and action on the role of the practice manager in the transformation of healthcare practice in Australia.

Executive summary

Private healthcare practice in Australia has evolved considerably over recent decades and the pace of change is continually increasing. External forces and changes in practitioner preferences are resulting in a shift away from smaller practitioner owned practices to larger corporately run practices. An increasing number of these practices include multidisciplinary care models, with doctors working in a team alongside nurses, allied health professionals, and pharmacists.

This transformation of the healthcare practice has necessitated the need for the role of the practice manager to evolve. The new breed of practice managers are now running large multidisciplinary practices and responsible for a range of activities including scheduling and billing, practice accreditation and compliance, financial and technology management, human resource and risk management. They are able to take responsibility for the administration of the practice, allowing the healthcare professionals to focus on the clinical aspects. Ultimately, this results in improved patients care and health outcomes.

A significant driver of change has been government reform and given the government’s future agenda we are likely to see an acceleration of change for practices. These reforms and the pressures they are likely to create will test the viability and resilience of many practices. In light of these changes, our question to practice managers and the industry more generally is “How is your practice going to manage these changes?” and “Who within your practice is taking responsibility for driving the changes necessary to navigate this successfully?”

We believe professional practice managers are ideally placed to be positive change agents within practices and an important government interface. We urge practice managers, individually and collectively, to equip themselves for the changes ahead so that they and their practices, are ready to successfully navigate the impact of the change to come.

Drivers of change

There are currently several drivers of change in healthcare practice in Australia which impact practice management. These drivers centre around three factors – increasing complexity, changing demand for services and cost pressures.

They include:

  • An ageing population with a corresponding rise in chronic diseases – the leading cause of illness, disability and death in Australia1. These demographic and epidemiological changes are driving increased demand for healthcare services in the context of finite and constrained health budgets, and limitations on the supply of practitioners. More healthcare needs to be delivered within available resources, necessitating new models of care.
  • Rapid technological change including increased use of telehealth2
  • Greater emphasis on quality assurance, accreditation and clinical governance3
  • Greater emphasis on education, professional development and research
  • Greater demand for health data collection, analysis, management and sharing to improve health outcomes, reduce duplication of medical testing and improve health monitoring
  • Growing consumer expectations including a demand for patient-centred care, and access to preventive care services
  • An increasing appetite of new doctors to be employed rather than run their own practices
  • Higher expectations of the next generation of practice principals
  • Changing business structures, including increasing corporatisation of practice
  • Increasing complexity of services provided
  • Rising costs
  • A move away from the fee-for-service business model towards revenue based on patient outcomes from sources as diverse as government grants and health programs, and private stakeholders such as the private health insurance industry
  • An increased requirement for consultation with other health providers and organisations, and for stakeholder management.

Each of these drivers have varying degrees of impact on the way healthcare practices operate and their profitability, but all need effective management processes to ensure that healthcare practices are sustainable and clinicians are able to focus on healthcare. Furthermore, the government has and continues to implement a significant change agenda to respond to these drivers of change.

The following case studies highlight areas where the changes underway are affecting healthcare practices and illustrate the challenges to be faced by many practices.

The Health Care Home

From July 2017, about 200 general practices throughout Australia will begin a trial of the Health Care Home (HCH) for patients with chronic and complex health conditions. The practices, including Aboriginal Medical Services, will be the home base for up to 65,000 patients who voluntarily enrol in HCH. Practices will coordinate a comprehensive care plan for each patient, including identifying the best local providers to meet each patient’s needs, coordinating care with these providers, and developing strategies to better manage patients’ health conditions and improve their quality of life.

The HCH will take patients with chronic and complex conditions out of the MBS fee-for-service system and pay eligible practices regular periodic payments to meet the patient’s care needs. According to the government, “This will enable Health Care Homes to be flexible and innovative in how they deliver care to enrolled patients”4.

Practices will need to implement and manage the HCH approach and transform to facilitate the flexibility and innovation needed to coordinate the patient’s care. Particularly, practices will need to ensure the GP leading the care plan has access to all necessary data.

Simultaneously, other patients with acute health problems will continue to present to the practice under fee-for-service arrangements. A clear management plan will be essential to handle these parallel systems.

MBS review

The size and complexity of the Medicare Benefits Schedule (MBS), as well as regular changes and adjustments, mean many doctors and practices struggle to keep up with item numbers and definitions.

The Federal Government has commissioned a review of the MBS and the Review Taskforce has released its interim report to the Minister for Health5. The Taskforce has described one of its key objectives as “to eliminate the funding of low-value or inappropriate health services — that is, treatments, procedures and tests which are of little or no clinical benefit, through overuse or misuse, and which in some cases might actually cause harm”.

This report highlights several priority areas for reform, including addressing administrative General Practitioner (GP) consultations such as writing sickness certificates and repeat prescriptions, and unnecessary diagnostic imaging.

The implementation of the Taskforce’s recommendations is likely to result in significant changes to the MBS. Healthcare practices will need to be ready and well equipped to respond by incorporating changes to MBS items, managing the impact on the practice’s business model, and making the necessary adaptations to optimise business income whilst delivering quality care.

Private health insurance

The private health insurance (PHI) industry, which is also subject to government review6, is seeking to improve its relationship with primary care and specialist healthcare practices. hirmaa7, which represents Australia’s memberowned, not-for-profit and community-based private health insurers, believes current legal, regulatory and technological issues act as barriers to more effective care of patients with chronic and complex conditions at the primary care level. This body suggests the PHI industry can assist general practices to help patients access chronic disease management resources by increasing awareness of services covered by insurance and gap payments patients can face when referred to specialist and allied health services.

The PHI industry is increasingly looking to engage with primary care and specialist practices to introduce initiatives designed to improve patient outcomes and reduce the cost of care.

While it is still too early to determine how this might be achieved, it will likely, at the very least, require practices to coordinate patient care with yet another external party, either the private health insurer or one of its service providers. This further complicates the administration of a patient’s care and the practice managing this plan.

My Health Record

Mobile and digital technology will fundamentally change how people are diagnosed and give them the opportunity to monitor their own health in conjunction with their healthcare team. It will impact on many aspects of the interaction between patients and health professionals, including bookings, script renewals, referrals and information updates.

The electronic patient record, My Health Record, is seen by many as the foundation of Australia’s digital health reform and an essential tool to maintain high quality health care and ensure it is sustainable.

To date, patients and healthcare practitioners have been reluctant to embrace an e-health record, but trials are underway of an opt-out system of participation in My Health Record8. If adopted, the opt-out system is expected to accelerate uptake of My Health Record9.

Government incentives associated with the adoption of My Health Records will play an important part in the financial performance of many practices. Therefore practices will need to stay abreast of developments in e-health and ensure that all practice staff are informed and educated on any relevant developments. Practices will also need to implement practice systems that support the uptake and effective use of My Health Record, and mobile and digital technologies in general.

Accreditation

The need for healthcare practices to be accredited is increasing, with many healthcare professional bodies and medical colleges or government initiatives either incentivising or mandating accreditation of practices and other healthcare facilities.

Furthermore, refinements to existing standards continue to set higher expectations of practice which must be met should practices wish to continue operating, or continue to receive government incentives.

The evolving role of the practice manager

The complexity of running a private healthcare practice has increased over time. Consequently, the role of the practice manager has become multifaceted and increasingly sophisticated since the position was officially recognised more than 30 years ago.

Practice manager’s tasks today are wide ranging, depending on the type and size of the healthcare practice. They generally include the review and implementation of processes within the practice to increase efficiency and contribute to the goal of ‘excellence in health care’. There is also an increasing emphasis on strategic and business planning.

A recent practice manager salary survey10 shows a growing trend towards practice managers possessing higher qualifications, as well as shouldering more responsibilities and working in larger practices. Practice manager qualifications include professional practice management programs offered by institutions such as UNE Partnerships11, as well as a move towards graduate and postgraduate qualifications12.

Highest level of education 2009 2015
Secondary school (year 12 or below) 26.2% 14.6%
Certificate or diploma 46.9% 52.6%
Bachelor degree 13.8% 16.9%
Postgraduate or higher qualifications 10.2% 15.8%

Source: 2015 Australian Practice Management Salary Survey

Large and complex practices are becoming increasingly more reliant on dedicated management expertise. The increased complexity and number of stakeholders a practice must manage, including interactions with external parties like Primary Health Networks, means most practitioners are no longer able to run their practice in their spare time.

The current and future changes to healthcare will only increase the challenges of running a healthcare practice. However this brings further opportunities for the practice management profession and practice managers individually, to rise to these challenges.

Successful management of change processes requires skilled operational and strategic management, and the practice management profession has much to contribute. The challenge for both the practice management industry and practice managers, is how to ensure they are, through collaboration with practice owners, healthcare practitioners and other practice staff , able to take a leading role to implement and take advantage of the changes ahead. This will not only benefit their practice but patients and the healthcare sector.

Practice managers are in an ideal position to work with practice owners and the clinical team, to achieve the required changes and to drive innovative change and improve processes.

The practice manager as a change agent

It’s time for action.

Significant changes affecting healthcare practice in Australia are underway and the pace of change will only increase. The ability of practices to anticipate and adapt to change will become increasingly important with more changes on the horizon for healthcare practices.

Many practice managers are already driving change in their practices via changes to systems, processes, risk management, staff culture and training to ensure the practice runs efficiently and effectively, and to deliver high quality care to patients.

If practice managers are to take a leading role and act as change agents, they will need to make a conscious effort to fulfil this role and be ready, willing, and well equipped for the changes to come.

Practice manager

This will require practice managers and the profession as a whole to implement a change agenda across a number of stakeholder groups, including the practice manager profession itself, practice owners, clinicians and government.

The profession

Education and training

There currently exists a significant variation in the education and capability of practice managers. The profession as a whole will benefit from greater recognition of excellence in practice management and an investment in the development of those who are less experienced and educated. This includes ongoing professional development, particularly in areas such as leadership, change management, project management, e-health and technical competencies.

Many practices, like most small businesses, have historically underinvested in staff training; however we believe greater promotion of excellence in practice management and selfdirected education amongst practice managers will build greater awareness and appreciation of the capabilities of a professional practice manager. This in turn, should result in greater empowerment of practice managers and further investment in education and training of practice staff.

Key areas of education to enable practice managers to drive and lead successful change include technical and operational areas such as practice and business operations, supporting patient needs, risk and compliance management as well as more leadership related competencies such as people management and strategic planning.

Practice managers need to be not only competent, but confident, to take on strategic roles within the business of healthcare practice. This may require leadership training, mentoring, or other forms of support, but ultimately it also requires a readiness from each practice manager to reach their full potential.

In recognition of this, the AAPM has introduced the Certified Practice Manager and Fellowship qualifications for practice managers to recognise their qualifications, experience and ongoing commitment to professional development.

Collaboration

The profession as a whole needs to be geared towards a high level of collaboration and innovation, to help drive positive changes for the profession itself and ultimately for the healthcare system in Australia.

This could involve anything from creating forums to building greater awareness of impending change and its likely impact, opportunities to celebrate and share innovation and success of practice managers, to lobbying government for high impact change.

The change agent within a practice

Many practices continue to react defensively to the change around them, with limited capacity to contemplate or plan for the future. A key part of being a change agent is about anticipating and planning for change.

This involves understanding the factors which are driving change and the potential impact on the practice’s business model, and developing a strategic response to this change.

Professional and well informed practice managers are well placed to support practice owners through this process and help them develop and execute a strategy best placed to navigate the change ahead.

Practice owners and clinicians

Employing or developing a professional practice manager has the potential to enhance a practice at many levels. The challenge for the profession is to be able to demonstrate this value to practice owners.

Government

As a profession and individually, practice managers need to find ways to engage with, influence (for the better), and facilitate the delivery of initiatives being undertaken by government, including Primary Health Network initiatives, e-health and Health Care Homes – just to mention a few. This will further drive the government agenda to contain healthcare costs through increasing the efficiency of healthcare practices with professional management systems, while allowing healthcare professionals to focus on improving patient outcomes.

There have been pockets of recognition, with AAPM representatives being invited to participate in advisory committees for various government and professional bodies. However increased practice manager engagement and positive contribution will not only drive positive change, it is also likely to build greater awareness and recognition of the capability of practice managers, both within government and the practice itself.

Similar to practices, this recognition has the potential to drive further government investment in access to quality education and training and professional development, and to ensure the profession is well informed and educated about new government initiatives that affect healthcare practice.

Developing greater awareness and recognition of practice managers’ capabilities

There currently exists a significant variation in the education and capability of practice managers. The profession as a whole will benefit from greater recognition of excellence in practice management and an investment in the development of those who are less experienced and educated. This includes ongoing professional development, particularly in areas such as leadership, change management, project management, e-health and technical competencies.

Many practices, like most small businesses, have historically underinvested in staff training; however we believe greater promotion of excellence in practice management and self-directed education amongst practice managers will build greater awareness and appreciation of the capabilities of a professional practice manager. This in turn, should result in greater empowerment of practice managers and further investment in education and training of practice staff.

Key areas of education to enable practice managers to drive and lead successful change include technical and operational areas such as practice and business operations, supporting patient needs, risk and compliance management as well as more leadership related competencies such as people management and strategic planning.

Practice managers need to be not only competent, but confident, to take on strategic roles within the business of healthcare practice. This may require leadership training, mentoring, or other forms of support, but ultimately it also requires a readiness from each practice manager to reach their full potential.

In recognition of this, the AAPM has introduced the Certified Practice Manager and Fellowship qualifications for practice managers to recognise their qualifications, experience and ongoing commitment to professional development.

Conclusion

The healthcare industry faces an increasing number of economic, technological and clinical challenges.

The practices that can be expected to adapt well to the changing dynamics of the healthcare industry will be characterised by a focus on:

  • strategic and business planning
  • highly efficient business and financial systems which are adaptable to new funding models
  • a commitment to quality and risk management
  • an openness to new and innovative models of practice by readily adopting and utilising digital health technology.

Furthermore, these practices will be engaging a range of different stakeholders in various ways, including, governments, Primary Health Networks, peak bodies, insurers, and more.

While practice managers are well placed to act as change agents to drive positive change while enabling clinicians to focus on patient care, this will require practice managers and the profession as a whole to mobilise and engage a number of stakeholder groups, including, practice owners, clinicians, and government.

Acknowledgements

AAPM:

Danny Haydon, President
Gillian Leach, CEO
Gary Smith, Board member
Tracey Johnson, member
Colleen Sullivan, founding member and UNE Partnerships presenter

Avant:

Dr Walid Jammal, Medical Advisor and GP practice owner
Adam Golabek, Head of Partnerships
Marianna Kelly, Senior Risk Manager
Martin Edwards, General Manager of Strategy and Diversification

RACGP:

Dr Nathan Pinskier, Chair of Expert Committee – eHealth and Practice Systems, and practice owner

hirmaa:

Peter Aroney, CEO of Doctors’ Health Fund

Primary Health Networks:

Ian Corless, Director, Integrated Care and Commissioning, WentWest, Sydney

UNE Partnerships:

Anne Davis, academic director and independent management consultant

Practice manager:

Kim Weeks, Practice manager and practice owner, Marima
Medical Clinic, Goulburn

References

  1. AIHW: Key indicators of progress for chronic disease and associated determinants: data report (June 2011)
  2. Department of Human Services: MBS and telehealth
  3. National Safety and Quality Health Service Standards
  4. Department of Health: Health Care Homes: Reform of the Primary Care System, August 2016
  5. MBS Review Taskforce – Interim report to the Minister for Health
  6. Department of Health: Private Health Insurance consultations 2015-2016
  7. hirmaa response to the Primary Health Care Advisory Group, September 2015
  8. My Health Record for Northern Queensland and Nepean Blue Mountains area
  9. Nabhealth: Health in Focus: Health Sector Insights
  10. The Practice manager, Issue 1, 2015: Longitudinal analysis of Practice manager salary survey 2005-2013, p. 10
  11. UNE Partnerships Professional: Medical Practice Management
  12. 2015 Australian Practice Management Salary Survey 6th Edition