Robert Lowes

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For the busy physician, the office manager is indispensable to success and sanity. Yet it's easy to take a good office manager for granted. If insurers rarely deny claims, perhaps that's because the manager does dozens of things to send them out clean, such as regularly updating diagnostic and CPT codes in the billing software. Maybe the manager boosted the bottom line by trimming overhead expenses such as office and clinical supplies.  

However, the same manager who can make your practice can break your practice. A curt, imperious manager might make your billing ace quit. Someone with the mentality of "We've always done it this way" will hinder your efforts to convert from paper to electronic charts. The ultimate bad dream is the embezzler you trusted.  

In contrast, larger practices tend to employ a true manager. This individual typically delegates nuts-and-bolts duties to other employees and handles personnel matters like hiring and firing. In the largest, most sophisticated groups, he or she will be involved in major decisions like determining whether or not the group should offer a new ancillary service. Here, doctors must treat this employee not as a "Guy or Gal Friday," but as something close to a peer.  

That raises another key point. The more effectively you work with your second lieutenant, the more likely that person is to be able to help you prosper.  

What kind of manager does your practice need?

The number of doctors in a practice is a rough guide to its need for a manager.  

 In the smallest practices, you generally don't need a full-time, nonphysician manager. Instead you'll find one staffer in day-to-day operations-a billing clerk or a receptionist perhaps-who owns the manager title, but spends only about 20% of his or her time helping the doctors run the show, says practice management consultant Keith Borglum in Santa Rosa, CA. Even then, her responsibilities and authority are limited.  

"She might place an ad in the paper for a file clerk, but the doctor will do the hiring," says Borglum.  

There are exceptions. A full-time manager might make sense in a busy-and prosperous-solo surgical practice with a staff of six, for example. Or a part-timer may fill the bill. The manager for internists Jeff Kagan and Turgut Yetil in Newington, CT, logs 25 to 30 hours a week. 

 In midsized groups, a bona fide manager-sometimes called an administrator at this level-executes the policies set by his physician employers. He hires, fires, and supervises employees involved in daily operations, says Borglum.  

The value of having such a manager becomes apparent when evaluating contracts with third-party payers, says Bonnie Carlson, a veteran administrator with Denver Allergy and Asthma Associates. "In a solo practice, the person called the manager may never read the contract, but just hand it to the doctor for his signature. In a bigger practice, the manager will study it and make recommendations." 

Tip: Give your manager time to manage. Avoid having her substitute for absent employees or perform tasks that a less-skilled individual could do.  

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This key staff member could help improve your bottom line or throw a monkey wrench into your operations. Here's how to make the right choice.

Author | Robert Lowes

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MEDICAL ECONOMICS SPECIAL SECTION: Finding the right office manager