The practice was one of three located in a large metropolitan area providing services such as counselling, consultations and pelvic floor chair and alternative therapies. The practice bulk billed all patients. Their commitment is ‘to work alongside and support women of all ages, backgrounds and cultures in a respectful, friendly and effective way’.

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BHC was engaged to review and provide a financial and staff analysis to the board of directors.

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Some of the concerns raised included:

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• practitioners paid at an hourly rate (compared to the more common practice of percentage payments for service / management fees);

• number of patients seen per hour (quite minimal);

• staffing numbers and remuneration;

• fee for service.

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Initially the project involved meeting with the board, then practitioners and finally staff on an individual basis to obtain feedback. It became apparent very quickly that the organisation was in danger of failing should changes not be implemented rapidly.

 

A review of financial reports identified:

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1. Debtors showing as $1.1mil in unreconciled income;

2. Some invalid item numbers still being used;

3. Incentives for some item numbers not being used;

4. Pay structure of all doctors was not viable (doctors were classed as employees not contractors). This in itself presented significant complications;

5. Doctors receiving income from non-income generating activities e.g. meetings with reps, paperwork;

6. Approximately 23% of patients entitled to be bulk billed therefore leaving over 70% who could potentially be privately charged resulting in a significant increase in practice income;

7. Significant unnecessary expenditure;

8. Clinic running at a loss overall.

 

Additional issues that were identified included:

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• Staff numbers were significantly higher than was needed;

• Staff were being paid extremely well (well over award) for duties performed;

• Potential medico-legal issues.

• Unable to extract useful data from management program, for example:1.The number of specific EPC items billed in a time period;

• The percentage of HCC / pensioners v private (no concession)Poor succession planning.

 

BHC provided a comprehensive set of prioritised recommendations that included:

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• Reconciliation of all income received;

• Pay structure of doctors to be reviewed (employee to contractor status);

• Management software support be contacted to enable extraction of useful reports for review;

• Review of item number usage

 

Project Outcome:

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All recommendations were agreed to and adopted by the board.  Over time those recommendations have been implemented through a structured consultation process involving all parties. The consultative process has ensured all recommended changes, while substantial, had minimal impact on the operation of the clinic and its staff.

The clinic is now sitting in a much better financial position overall with the services provided being offered in a more efficient and profitable way.