Medical Professional Publications

Learning the Business Side of Medicine —“On the Fly”

(From the September 2017 Issue of MedStat)

Jennifer Miller, MD, FAAPBy Jennifer Miller, MD, FAAP

Dr. Miller has been practicing medicine at Pediatric Associates of Lancaster for the past eight years. She received her medical degree from Indiana University School of Medicine and completed her residency at Nationwide Children's Hospital.

One of the things I wished I had learned more about through my medical training is the business side of medicine. I have had to learn a lot of it along the way through trial and error since joining a private practice. There are many questions to answer about how to best run a practice and what transfers to the bottom line. When I feel insecure making business decisions, I have learned to follow these “mantras”:

Plans fail for lack of counsel, but with many advisers they succeed.


No margin, no mission.”

First I’ll elaborate on the first quote. “Plans fail for lack of counsel, but with many advisers they succeed.” Just like when we need a consult with a specialist for a complicated medical case, we often need advice from others regarding how to best run our business. We can seek wise counsel from many different sources.

1.       Mentors — I found some great mentors in the doctors I worked with during my outpatient primary care months (PECS) in residency, and in the owners of the practice I joined after residency.

2.       Local practices— Our community is unique in that 3 different pediatric practices help cover the newborns at the hospital and get together monthly for meetings. We discuss and learn best practices from each other. I also learn a lot from other practices in the PFK network during webinar calls and discussions.

3.       Pediatricians from around the country — AAP’s SOAPM (Section Of Administration and Practice Management) is a great resource. You can join the listerv and glean information from the questions and answers posted by others. I have also posted questions specific for our practice and was relieved to get advice from well-respected colleagues, often within minutes.

4.       Conferences —Our EHR vendor’s annual conference this year focused on the topic of practice productivity and profitability. Sessions concentrated on using the EHR to improve your bottom line and streamline systems, while improving the quality of care for your patients. We learned so much that we can easily make up for our costs of the conference just by implementing a few of the things we learned.

5.       Lectures — If you don’t want the expense, or to sacrifice days away from family, attend a locally sponsored talk like the Practice Fitness series at Nationwide Children’s or the annual CPP coding seminar by Richard Tuck.

6.       Books or other publications — We all know continuing education is foundational to being a doctor. In addition to CME to keep up with the clinical advances, we should broaden our learning with business books like E-Myth Physician and magazines like Medical Economics.

7.       The Internet — I learned valuable coding lessons from E/M University Online. The AAP member website also has great resources and webinars about managing different aspects of practice.  

8.       Reports — I love how our EHR now offers a dashboard service that helps to compile and break down many benchmarks related to practice finances. Look at these!

9.       Accountant — Our account meets with us monthly to review overhead, charges, and write offs. We compare our numbers to the same month the prior year. She is very patient in helping answer questions about our financial statements and evaluating changes that might affect our bottom line.

The second mantra I like to keep in mind is “No margin, no mission.” We can’t run our practice if we don’t have some profit. Those margins allow you to keep your doors open, provide jobs, and continue to offer quality care. Creating a profitable margin in your practice can be one of the most challenging things about the business of medicine. Here are some ways we have found to maintain as much margin as possible by not missing out on key opportunities.

1.      Adjust prices regularly — We try to adjust our prices annually and/or whenever the cost of the product or service changes. Vaccine companies are notorious for increasing prices periodically. Whenever vaccine price goes up, you need to increase your charges accordingly. This is not a guarantee that an insurance company will pay you more, but at least you won’t be surprised three years down the road when you finally realize that insurance companies are paying you less than your costs, causing a net loss.

2.      Comply with meaningful use— We adopted our EHR in 2010. Understanding and staying on top of those rules has earned us incentive money each year to help offset the costs of our EHR and new computerized systems. We have reaped the added benefits of better quality care for our patients as well and more legible notes among providers.

3.      Join an ACO (accountable care organization) — Partner for Kids is likely the most relevant organization for pediatricians to join in Ohio, but there are others involve private payers. ACOs can track performance through coding and billing. If you meet desired quality metrics, you get a check for a portion of the shared savings from the ACO. When you have good vaccination rates, well child compliance, and generic prescribing habits, insurance companies save money, patients stay healthier, and you get an extra check every quarter. Providing quality care for your patients is a win-win in this case.

10.  Become a PCMH certified practice — In some states becoming a certified Patient Centered Medical Home allows you to get better contracted payment rates from insurance companies. In other states it doesn’t matter as much, and you won’t see an extra dime from insurance companies. Geography aside, the PCMH practice requirements make you more likely to be compliant with Meaningful Use criteria and ACO quality metrics which will yield your practice extra payments. In general, PCMH practices can be better at recalling patients, reducing ER utilization, and providing quality care. All of these things are great for the bottom line of the practice.

Learning to run a business can be an adventure to say the least. I think the rewards for your practice and your patients though are well worth the effort.

The articles in this ongoing series will feature news and items of interest to pediatric primary care providers. If you would like to contribute, email

The opinions and policies expressed in MedStat are those of its contributors, and are not necessarily the opinions or policies of Nationwide Children’s Hospital. Nationwide Children's Hospital does not endorse or recommend any specific opinions, policies, tests, physicians, products, procedures, or other information that may be mentioned in MedStat. The content made available on MedStat, such as text, graphics, images, and other material contained on the website are for general educational and informational purposes only and do not constitute medical advice; the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Reliance on any content provided by MedStat is solely at your own risk. 

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