Practice Leaders, Unfiltered

A Q&A with a Practice Leader at a TWH Partner Practice

From the Administrator's perspective, these are the biggest questions I hear from other administrators.

Will we be able to retain our current staff, Practice Leader included? Is the Practice Leader position in jeopardy after partnership?

One of the things I've appreciated about TWH is that they commit to the current staff going forward, Practice Leader included. TWH has never asked us to make changes to our current personnel. They've always said their goal is to keep a strong leadership team in place after partnership, because that team is what attracted them to the practice in the first place. If I've heard it once, I've heard it a hundred times: TWH doesn't want to partner with a struggling practice. They are growth partners, so they want to keep the things in place that made that practice valuable.

That doesn't mean they won't make suggestions about how the practice runs day to day. They've recommended changes to the types of roles that work better in today's private practice, like an RN versus a Medical Assistant, but it's always with the Practice Leader's and Partner Physicians' input.

How much input do the partners and Practice Leader have on staffing levels and salaries?

The Partner Physicians and Practice Leaders are always involved in staffing decisions. It's called a partnership between the practice and TWH for a reason.

Some of the biggest daily headaches of running an independent practice – billing, IT, and recruiting – are taken on by TWH, which makes my days significantly easier.

How do benefits change for employees? Do they offer better benefits, or offset where they can't match current benefits?

Every practice is different before partnership when it comes to benefits. The goal is to offer consistent benefits across TWH partner practices.

Depending on where you're starting, some benefits may get better and some may not look quite as strong as what you had before. One thing TWH did when we partnered was work to keep the overall value of our employees' benefits comparable.

In our case, where employees would have paid more for the same or a lesser benefit, TWH compensated them through an immediate payroll adjustment to help make up the difference.

The goal is to offer better benefits where they can, but we all know the world of benefits is an ever-changing thing.

There are also some benefits TWH offers that were a great addition for our employees. Two great examples are Short Term Disability and six to eight weeks of paid Maternity Leave, both paid for by TWH.

Will I lose my current PTO time or accrual rate?

No. TWH allows current employees to keep the same accrual rate and years of service they had before partnership. Keep in mind, all new employees hired after partnership fall under the standard TWH PTO benefits and accrual.

It's worth noting that at the time of our partnership, all employees received a one-time payout for accrued PTO over 40 hours. We chose to let all employees roll forward up to 40 hours so they didn't have to start fresh accruing new time off, even though they'd continue to accrue at their pre-partnership rate.

How has TWH impacted overhead? Have they brought savings to the table?

It impacted our overhead greatly. The sheer purchasing power TWH has over an individual practice lowered our overhead for medical supplies and devices on day one. Every year we're seeing additional national purchasing contracts added for equipment and services as well, like Samsung ultrasounds and IUDs. That purchasing power is something an individual practice just doesn’t have on its own.

Is there a bonus structure in place for the Practice Leader or other positions, both at partnership and annually going forward?

Yes. Practice leaders are also eligible for an annual bonus, and it's included as part of the employment contract for those individuals.

What headaches have they taken off you? And on the flip side, what headaches have they added?

I can honestly say that some of the daily headaches of an independent practice, like RCM (billing and collections), IT, and recruiting both physicians and employees, are taken on by TWH, and it greatly makes my days easier. It's nice to know I've got a team of people for those purposes just a phone call away, and I'm not having to monitor and address it daily.

TWH has done a phenomenal job of recruiting physicians far in advance, which seemed to be where we were missing it. We were always late to the game making contacts and building relationships with possible physician candidates. On the employee side, TWH does the tedious work of screening new candidates and provides the ones we need to consider. As a practice, we still make the decision of who to hire or not hire. They just make the screening part much easier. Once a hire is made, they take care of the employment documents and onboarding, and we can focus on training and welcoming them to the practice.

On the flip side, being totally honest, the number of meetings could be overwhelming in the beginning. It has gotten a ton better since we partnered almost four years ago, and I think we have settled into only having the meetings that matter now. Maybe that was just a part of becoming a partner that was unexpected.

What will they require us to change after partnership? EMR, phones, IT, malpractice carrier?

This is usually the first question I'm asked. TWH will definitely ask practices to change to Athena as the EMR and to fall under their malpractice carrier. Seeing how the partnership works now, this is a good thing. The level of expertise we rely on at TWH regarding how Athena functions is amazing. I've seen practices go through this transition on their own, and it was a disaster. TWH's team are truly experts when it comes to setup, training, and ongoing education. Having all the practices on the same EMR, and being able to compare how it's used, is a huge benefit. As for the malpractice carrier, it only makes sense to be on the same one, because that's where you get your savings.

Does TWH assume the recruiting role for new providers?

Absolutely. The focus they put on growing every practice and market footprint is amazing. We were having a hard time recruiting providers before partnership. Since partnership, we've brought on five new providers, both Physicians and NPs, with more signed to join next year.

Are providers locked in to a period of time to keep working? What happens if a provider wants to cut back hours or days?

Those are pre-partnership discussions specific to each practice. I do know there's an expectation for partnering physicians, owners specifically, to commit to a certain period, but that doesn't mean there isn't flexibility. Any discussion of a physician adding or dropping days is at the discretion of the physician and TWH. Partnership should come with a level of commitment, but we all understand that life happens and sometimes we need to make adjustments. TWH has been great to talk through this with our physicians so everyone understands what any changes mean. At the end of the day, the goal is a happy and productive partnership for all parties.

How does TWH evaluate purchasing new equipment, like ultrasounds or mammography? Who pays for it?

This is on a case-by-case basis. It always involves developing a business plan to make sure it's a good, sound decision, and TWH is intimately involved in running the numbers and making recommendations. The beauty of a partnership with TWH is that when it's a financially good decision, capital to fund new equipment purchases is never an issue. The same applies to investments beyond equipment, like leasehold improvements.

The purchasing power TWH brings is something an individual practice simply doesn’t have on its own, and we saw the impact on overhead from day one.

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