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Improving Clinical Operations

Episode 343

Recommended Book:

Four Agreements

Best Way to Contact Randall:

randy@medman.com

Company Website

MedMan

Improving Clinical Operations with Randall Evaro, Principal at MedMan | Convert audio-to-text with the best AI technology by Sonix.ai

Welcome to the outcomes rocket podcast where we inspire collaborative thinking, improved outcomes, and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.

Saul Marquez:
Welcome back to the outcomes rocket podcast and thank you for tuning in again. I have an amazing guest for you. His name is Randall Evaro. He’s a medical group administrator and principal at MedMan. He’s a strong leader successfully developing and directing highly skilled teams in support of achieving corporate objectives. Randall’s a seasoned health care professional with a demonstrated track record of leading and developing high performance teams and directing operations and fast paced complex medical environments. And our team by background that got into the administrative aspects of health care as a director and a CEO of a hospital. He’s got a wide array of experience from the frontline to the administrative c suite and so it’s going to be a really fun conversation today to dive through some of his thoughts and some of things that he and his team are up to at MedMan. So Randall, super super grateful that you joined us today.

Randall Evaro:
Grateful as well. Thank you for having me, I really appreciate it.

Saul Marquez:
Absolutely. Now that I leave anything out in the intro that you want to share with the listeners?

Randall Evaro:
I don’t think you left anything out. I was a medical group administrator for the last four and a half years recently transitioned into the new role as one of the principal partners for MedMan. So currently my role is the president of the Group of the company I should say and then I have three partners who have roles which comprise our corporate team and we work with our extended network to facilitate the operations of medical groups all over the northwest.

Saul Marquez:
That’s wonderful. And it’s not easy. Physicians get into the business to care for people and it’s hard to do all things you can’t wear all hats and so you guys fill a vital role. What would you say a hot topic that needs to be on every health leaders agenda today and how are you guys tackling it?

Randall Evaro:
Well for us as an organization I think the thing that we get talked to the most about or we’re discussing the most with is really this the issue going on here now in health care which is data physician ownership in for a lot of reasons physicians being out in that space where they are in this know which you certainly know is extraordinarily fractured health system, health care system that we have.

Saul Marquez:
Yes.

Randall Evaro:
It really really is driving physicians to places where they think are safe harbors and a lot of ways they are. They look at health systems payers that provide physicians a lot of financial security. But there’s a tradeoff to that physicians when they sell themselves or sell their practices they are they are winning something certainly at the expense of the things that they’re losing. So in terms of what physicians need to stay independent that’s an important discussion we’re having we think that patients are ultimately best served through physicians who are making decisions about their businesses and their medical groups in a way that ultimately serves the interests of the patients. But it’s a difficult thing to do in their current healthcare environment with the amount of regulation, mental uncertainty regarding reimbursements, regulations all the things that go into running a medical business it makes it hard for physicians and they really question exactly what is it they’re doing. They go to school for 12 years give up twelve years of their life and a lot of ways to become trained to be physicians that take great care of people. And in spite of all that sometimes they feel like it’s just not enough. And you know they look for situations that help them feel better about things so they can either with organizations like ours which help run the business side of their organization so they can practice medicine and do so competently that they’re going to get paid and their staff is going to get paid things like that. Or they move into a relationship and they’re owned which has its benefits again but also has a lot of drawbacks for physicians that we’ve seen time and time again over time.

Saul Marquez:
Yeah for sure. And so there’s no doubt the number of physicians that own their own practice is shrinking. The last stat I heard and maybe you could gut check this one is35% and then about 65% that are now part of large systems.

Randall Evaro:
Yeah. So that the pay and what you’re quoting or referencing I mean probably the last that we read coming out of MGMA management group medical associations about 60 percent of the nation’s employed physician basis and that number really accelerated in the early 2000s and this slowed somewhat but there’s still a lot of consolidation occurring.

Saul Marquez:
So 60 40.

Randall Evaro:
Yeah yeah.

Saul Marquez:
Yeah. So there’s still a good amount of you all there. You’re listening to this and you’re thinking Yeah. Last man standing or last woman standing. And it’s easy to feel like you’re on an island especially when things get tough. And so this is a timely discussion to dive into some of the things that you could be doing. I mean I just came back from a meeting in San Francisco where I met a couple of physicians that are actually doing the opposite. They’re going away from the system and they’re forming their own practice. And so the movements happening both ways. And and so I’d love to hear you Randall give us an example of the types of things you’re doing to create results for your customers.

Randall Evaro:
Well I was I was reading an article I think was an HBO recently and they nailed it right on the head in terms of the order of things that presidents are concerned about. The first thing being their confidence in the financial stability of their practice the outcome of that. What does that mean for them. Is it going to stay the same. Lots of questions about that because the revenue cycle doesn’t represent a black hole to most physicians in terms of their ability to understand the different pieces of that and nothing else really. So revenue cycle and the implications of that on a practice are a big, big deal to those independents out there who are making sure they’re staying on the path staying independent the management of the organization is also a big question for them something that they are very very concerned about and I think the quote was something over 51 percent of physicians so just over half are really concerned about whether they have the right management structure in place on the administrator side of things. Not so much their board or board of directors things like that and then the third thing really just kind of spoke to the complexity of payor contracting and credentialing. Those are the three big areas so for us as an organization we partner with physician groups in whatever form they they come to us and we really begin by taking a close look at the operations of the organization from the top to the bottom from the front office workflows to their care contracts and that helps to give us a pretty good indication of how the group is functioning where the blind spots are where the bright spots are and less has begun to kind of focus and priorities in those areas. You couple that with the planning session for the group that helps them to get on a path that they think is the right one for them. We facilitate that conversation but the end of the day it’s their decisions the place that they want to go and then we you know we help us military progress to that. So on the first two certainly the financial stability in the management side of things where we come in is given some horsepower depending on the situation sometimes that’s through us placing an administrator that works for us works for MadMan but as the permanent administrator for that clinic or it’s through doing some project work or some consulting as people would call it or if we’re just networking their administrator their practice manager to our network to give that person decades of experience from all of our other administrators so they’re not making some of the same decisions reinventing the wheel if you will over time over the same issues over and over again but they’re learning from this broad network of people that we have engaged ourselves with and in that way we services physicians in a way that meets their needs and their budgets and helps them to practice medicine while the rest of it gets handled by people who are experienced and engaged to do the rest.

Saul Marquez:
Now very impactful and in turn key seems like it’s it’s customizable. Tell us a time when a common mistake that you’ve seen or even a story about a program that you implemented that maybe didn’t work out and what you learned from that that the listeners could really gain from learnin.

Randall Evaro:
So to clarify we just specifically on as a business what’s worked when it hasn’t. With a specific situation when the client setting.

Saul Marquez:
Well yeah. You know it could be. Since we’re focused on on primary care or you know physicians that are in their own practices. Let’s focus in on on something that you see over and over again as an area of setbacks that that these practices typically have and some tips for them to avoid.

Randall Evaro:
Now very good. But set the stage to answer that question then. So as a company what historically has always been the case is when positions in their groups are most in crisis is when the phone reeks from it man and the company has a 40 year history of working with physician groups to help them meet their business goals medical goals or the case maybe. So when you look at 40 years of history where physicians have said hey I need help. Inevitably someone at some point has to ask the question why do they keep calling us when they’re in trouble. What is the common common factor here that all these groups are experiencing. So to answer your question in a roundabout way probably the single biggest mistake or rephrase that probably the biggest opportunity for physician leaders in their groups, owners, board of directors is whatever the case may be whatever the structure is is that it’s important for them to understand the things that will be a guideposts in understanding the health of their practice in different ways. And it’s pretty complicated. You know the you know everything from profits workflows to volume into the clinic to their documentation to their compliance programs, to their revenue cycle, their credentialing, their payor contracting, the H.R. elements – all these things that are typically pretty invisible or pretty in the background you know the business side the practice are things that positions so long as someone’s there to help them do what they need to do. While I’m not going to say it’s not poor to them but it certainly fades into the back a little bit.

Saul Marquez:
Yeah.

Randall Evaro:
So as a board they need to understand the things that they need to be seeing and why it’s important to them and to pay attention to those things. If you if you begin to defer decision making strategically or tactically in a practice or you take your eye off the will and you’re not paying attention to the things that help you understand your financial health of the organization your AR. How healthy is it things like that. Are we collecting or are we not? Are we building or coding correctly? What our curves look like? All these things then quickly you find yourself in trouble and underwater and having trouble paying the bills. So for us the thing that we see on a regular basis are folks who get distracted for whatever reason there’s a lot of reasons for that. Positions are every much a human being as the rest of us and things happen in their lives that take their eye off the ball. And for us it’s really kind of coming back to basics with them and finding why the fundamentals the basic blocking tackling isn’t working in the practice and getting it fixed.

Saul Marquez:
Yeah I think that’s a really good call out you know and I would even go as far as saying Randall that this happens to a lot of entrepreneurs. They could lose track and AR and not really have a dashboard to see the key metrics and for you know it you’re out of business.

Randall Evaro:
Yeah. I mean it’s no different than us as a company. So we’re now having bought the company recently from the founder of the company and all of us having a one point or another been in medical groups and running the business. We understand the importance of a good dashboard based on benchmarks that are relevant not matter. More importantly understanding those benchmarks and what they mean in the context of the business health is important. So for physicians and the folks who are running their businesses it really is no different at all. They have to understand the data and context of what it means for them in the space that they occupy.

Saul Marquez:
Yeah for sure makes a lot of sense. I’m glad you brought that up and we talked about some of the setbacks and the oh wow moments. How about one of the most proud experiences you’ve had doing what you do.

Randall Evaro:
Going to share that. Well of course. I don’t know that I could call out one and it’s not because we’re. That’s not to brag and just to say that you know I think it’s a company well we pride ourselves in is coming into a situation and having discussions with the shareholders board of directors whatever the case may be and understanding what their burning issue is from an operational standpoint a business standpoint and our ability to go in and partner with them and their teams whatever that might be and their setting to get to the heart of that issue. And then it begin to correct that. And then to see a physician or group of physicians looks like a very visual sigh of relief that OK this is gonna be OK. We can fix this. Practice after practice how we interact with. There is usually this one thing that was the trip wire to all the other things that happened in the practice and sometimes it takes a little bit of time to ask some questions seek some understanding and put some action plans in place. That really is by the most satisfying part of what we do is helping them realize that they can be successful and they will be if you need to stick to the path. So that’s probably where we where we draw most pride in our work is in being able to accomplish what we set out to do with them.

Saul Marquez:
I think that’s great. I mean and I just think about like a song from Chicago you know and there’s – you get the occasional real bad snow and I’ve been stuck in the snow. It just no matter what you do what you try, it seems that you can’t get out. And then here comes somebody to help you and you’re just like oh my gosh. Finally I got out and it’s that feeling of relief and thankfulness that I think you’re referring to and every situation is different.

Randall Evaro:
Now it certainly is different in every situation and we have we have some very similar situations we’re working through right now with different groups for different reasons different times and different things have gone off course a little bit and now we’ve been asked if we can help and we’re always up for the job but for the for the physician and what they’re looking for to work through that issue and sometimes it’s really just that difficult and uncomfortable and frank conversation about our priorities versus what they have been in. If they want to get from from A to B then these are things we got to do. Sometimes docs just want to have someone push back on them and make an argument and show some data as to why things are going to work the way that they should. And then they’re willing to let you try and show them that they could do it that we could do it with them and it’s very rewarding in that way.

Saul Marquez:
That’s awesome man. Tell us about an exciting project you’re focused on right there.

Randall Evaro:
Well you know the history of MadMen like you has always been that we’re a practice management company. But most physician groups are not going to seek out management if they don’t one have an issue have a crisis or has something that’s so broken they don’t know how to fix. So typically the type of partners we come across with the people who are just in a bad place, a little beaten down, on the brink if you will. And you know with fewer and fewer independent clinics out there particularly in different parts of the country the Northwest while is a very big geographic area it’s very sparsely populated relatively speaking. So the into the independent groups is pretty spread out very rural in the northwest in the states that we service primarily this point. So managing practices and placing an administrator is something of a premium these days. So I think for us as new owners the things that we think is a big opportunity in a slightly different take on how we approach the work is can we help prevent practices from getting to the place where they become in such a state that they need to be managed directly to pick some things ahead of time. So to do that you had to go out and find the places where the group where the groups are and typically those are going to be with IPAs, CINs, payor groups things like that where they have a lot of physicians a lot of independent physician groups all in one spot and then working with those networks those payers whatever the case may be to provide a service where you know the groups those groups those networks they know well in hand what the medical group they’re working with need help with my seat on the claims side certainly on the quality side and the data that they track and what they’re trying to do is trying to be creative in ways to provide that horsepower to physician groups to not only one better serve their policyholders through those networks but also to increase the quality of care the increase the efficacy of the care and decrease the expense. So if an organization like ours can be there out front with a network payer, network or a payer someone who wants to provide some service to an organization to a medical group if you will. That’s kind of a space that we want to sit in because when we have the real impact of being in a situation to prevent the fall just give someone a little bit of a tune up versus the spark causes the dumpster fire. Well then it’s really hard to fix but we can partner with payers, with CINs, with IPA s- in a way that allows them to provide the services that we would typically provide into a managed clients on a one to one basis on a broader scale to help positions in their groups tune things up here and there and stay above their status quo. And I think that’s a good opportunity for an organization like ours and one that we’re seeking out.

Saul Marquez:
That’s awesome. Now I think it’s a good call out in and a good opportunity to approach a little more proactive rather than reactive and in the way that the encounters happen. So getting close to the end here Randall and I want to go through this with you it’s a syllabus we’re going to create for the listeners a lightning round with five questions. The 101 with Mr. Randall. So I’ve got those questions ready for you. You ready?

Randall Evaro:
Sure. Let’s have it.

Saul Marquez:
All right what’s the best way to improve health care outcomes?

Randall Evaro:
Well that’s through people. I think the things that we see most is there is so much potential in room for improvement in the interactions that human beings have with each other whether that’s between the patients and for an office or an office in the back office whatever the case may be. The ability for us to raise the caliber of discussion and interaction between individuals in these settings where we work will really help to remove a lot of inefficiency and ineffectiveness. So I think helping people to get on the same page and understand and hear each other as opposed to make some assumptions about what they’re thinking someone else is one thing or things like that is a big, big head start on the status quo.

Saul Marquez:
What’s the biggest mistake or pitfall to avoid?

Randall Evaro:
Well generally speaking I think that the biggest mistake or pitfall to avoid in these settings is to not be making assumptions about what is or what isn’t happening and ask questions. So very much seeking to understand the situation before seeking to have yourself be understood. So seek some clarity before we start being directive about what needs to be fixed or what needs to happen.

Saul Marquez:
How do you stay relevant despite constant change?

Randall Evaro:
All that’s through conversation. It’s planting seeds. I work at the position here in town Great Physician leader a lot of experience and had learned some really painful lessons in his career. A lot of what you learned from thankfully and I had the pleasure of working to improve years and the one thing that he always talked about was planting a lot of seeds out there in the conversations that you have those things always bear fruit at some point. So to understand what’s changing you have to be out there talking with people who are also going to be impacted or are being impacted or that could impact things on the decisions that they make. So find ways to be involved in the conversation and to engage.

Saul Marquez:
What’s one area of focus that drives everything in your organization?

Randall Evaro:
Relationships. Probably the single most important thing that we as the owners and as a company are focusing on that above all those things is probably the most important thing that we need to protect and find ways to harness are the relationships that we have and the relationships that we’d like that.

Saul Marquez:
What’s your number one success habit?

Randall Evaro:
Number one success habit. For me it’s it’s doing a lot of reading and a lot of talking with folks who know a whole heck of a lot more than I do about a lot of different things. So increasing my understanding it’s spending some time thinking about those things and then trying to act on the things that makes sense for us as an organization.

Saul Marquez:
Love it. Randall what book would you recommend to the listeners?

Randall Evaro:
Oh well I think a book that I taught me a lot certainly as a as a younger man and as a general idiot at the time is probably the Four Agreements by Don Miguel Ruiz. A lot of wisdom there and it’s and I’ve a very very much taken advantage of and leveraged in my professional life from a young and dumb and experienced kid right out of school to a less dumb and less and experienced person I am now doing what I’m doing.

Saul Marquez:
The Four Agreements folks. So go to outcomesrocket.health and in the search bar type MedMan man or type in Randall and you’ll see the show notes pop up, a transcript, links to all the things that we’ve discussed. It’s all there nicely packaged for you. outcomesrocket.health. Randall, this has been a great conversation. I’d love if you could just leave us with a closing thought. And then the best place where the listeners could get in touch with or follow you.

Randall Evaro:
Yeah certainly. Thank you it’s been a wonderful conversation. And I very much enjoyed it. You can always get me at randy@medman.com. Probably the easiest way to do it. We’re always a first name and medman.com. So for me it’s Randy. I think I would leave people to think with is your gut has it right 90% of the time so relative to our work. Working with physicians who are very much function off the patterns of things that they learned in their know their gut instincts. If you feel it there’s something in your practice that just quiet isn’t the way that it should be or you just feel uncomfortable with don’t act on it. Whatever course I may be whether it’s talking to someone like us or a colleague who’s been through it or been there don’t delay because those things just compound on themselves. So that would probably be the thing that I would offer.

Saul Marquez:
Love it. Great great advice there from Randall. And so again folks appreciate you tuning in. Randall really shared some great tips here on really physicians running their own practice. Things that you could do, things to avoid. To learn more go to the website. Look up Randall and learn some more – the invitation’s there. So Randall just want to say big thanks to you and I’m looking forward to staying in touch.

Randall Evaro:
Absolutely, Saul. Thank you, I really appreciate it. Take care.

Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.

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