Dad and I—and how we've helped each other

The son saved his father's practice by computerizing it. In the process, the father taught his son about compassion.

By Thomas E. Moak, MD
Internist/Atlanta

It was time. After 50 years as general practitioners in a rural Southern town, my father and his partner, both 75, had decided to computerize their office. Even though they saw nearly twice as many patients as most city doctors do, their earnings were falling because their employees couldn't keep up with the complexity and volume of billing and filing claims by hand.

Trouble was, my father had never laid hands on a keyboard, and his office manager of 25 years announced she would have "nothing to do with computers." In fact, only one of Dad's employees was computer-literate.

Dad had always left the business side of his practice to his staffers. "I don't have time for that, with the number of patients I see every day," he'd grumble. And the concept of retooling the practice was equally foreign to him.

"Dad, simply installing a computer isn't going to save your practice if you don't also use it to make some major changes," I told him repeatedly.

My admiration and respect for my father are the reasons I followed him into medicine. When I was a kid, he was the only physician in the county, and he worked harder than any doctor I've ever met. He never took vacations and was on call every night. My sister and I would ride out into the country with him and wait in the car while he delivered babies. He helped get a hospital built in our little Mississippi town when the Hill-Burton Act was passed in 1947. In his prime, I doubt there were many physicians who could perform as many procedures competently. Dad deserved better than having to close his doors because the business side of his practice was overwhelming the clinical side.

I knew a lot about insurance and a little about computers, so I figured I could help. My plan was to connect my solo practice in Atlanta with his in Mississippi electronically via a wide-area network. That way, I could program the software, maintain his database, and provide technical support from 300 miles away. But after a month of watching his staff try unsuccessfully to convert paper tasks to the computer, I decided to run all his business functions—that is, do his billing, accounting, payroll, and e-claims—from my office. Dad's staff would merely have to enter patients' demographic information, such as address and insurance number, and each patient's procedure and diagnosis codes. Dad kicked in a portion of one employee's salary for the back-office work we did on his behalf.

To quell my father's wariness about computers, I tried to wow him with what my proposed system could do for him. "You always complain that your accountant's quarterly financial statements arrive a month after the quarter ends," I reminded him. "Now, with a click of the mouse, you can call up a profit-and-loss statement and see all the detail behind any number whenever you want!"

"Yeah, well, if computers are so smart," he'd counter, "why do they always send me mail with the wrong address or name?" I could see that this process wasn't going to be easy.

Dad realized, however, that nobody but me would be willing to choose the hardware, train his employees, revamp his practice, and assume responsibility for the computer functions that flummoxed his staff—at least not for free. He also knew that I was interested in developing a sideline business: setting up computer systems in other small practices so doctors wouldn't have to join large groups for want of sophisticated information systems and insurance expertise.

So my father, along with two solo internist friends of mine, agreed to let me practice being an "application service provider" in their offices. It took a year and a half and several hundred hours to fine-tune my system. The cost to outfit each office: $40,000.

Getting the computer system up and running in Dad's office was the simple part. Working with his employees was much harder than I anticipated. When my wife—who is an accountant—my insurance manager, and I went there for four days to train his staff, we first had to explain rudimentary things—literally saying, "This is a mouse." We also tried to impress on them that computerization was essential for the practice to survive. But they were having none of it. Instead of embracing an opportunity to enhance their career skills, they demanded a pay raise to learn the computer!

What's more, this crew had mushroomed to 10 full-time employees and six part-timers—far too many for two doctors. And they pretty much ran the office as they liked. They decided when bills would go out (not very often) and to whom. Frequently, they didn't bother to file insurance claims. Vendors—usually friends or family—were paid whatever they asked. The doctors' fees hadn't been raised in years. And with no accountability, employees worked only when they wanted to.

"You've turned my world upside down," Dad said apprehensively after he'd taken an earful from his angry staff about how we big-city invaders had no right to question every aspect of their work. He also didn't like hearing that the computer would eliminate some jobs, or that his employees' performance had been damaging the practice for some time.

Mercifully, two clerks quit soon after our visit, so Dad was spared having to fire anyone. And the office manager who'd vowed never to touch a computer agreed to become the doctors' transcriptionist instead. One of my own employees made several weeklong trips to Mississippi to work with Dad's staff on entering patient data. That and collecting copays were all we were asking them to do. But it was obvious the practice needed a real manager on site, since the employees continued to struggle with simple data entry.

"And where am I supposed to find someone with the qualifications you want in this small town?" my father asked. To my surprise and his, we found the ideal person within a week—a woman who'd run the admissions department at the local hospital and had managed a number of employees.

Given the attitude of Dad's staff, hers was a job I didn't envy. But she plunged in, making much-needed changes, like establishing personnel policies. Five more people quit within a few weeks and weren't replaced. Instead, the new manager cross-trained the remaining staffers so the office would run even more efficiently with fewer bodies. Working closely with my insurance manager, she has established a 98 percent accuracy rate in the information the staff enters into the computer. She is also evaluating all vendor relationships to get the best prices and services.

Although Dad has been furious with me at times for delivering bad news about the state of his practice, he's gained an appreciation of my business skills. With the computer system in place, better billing and collections, the right number of employees, and an efficient cost structure, the practice's profits are up 50 percent. Dad and his partner are even considering hiring a younger physician—something they couldn't have afforded a year earlier.

While I may be the better businessman, I've come to realize that Dad is by far the more compassionate human being. His concern for his underperforming employees touched me, and I'm proud of him and his partner for undertaking major changes in their practice. Our relationship has become stronger as a result of our partnering and withstanding difficult times. We now talk three or four times a week, but when he blames the computer for something, I gently remind him: "No Dad, the computer didn't do it. It's what you did to the computer."

Dad's practice was certainly not atypical in its inefficiency and disorder, and as such it offers lessons to all physicians. First, pay close attention to your business operation—you can't afford not to know what your staff is doing. The complexities of managed care require skilled employees, so be prepared to pay higher salaries to attract good people, then support them with appropriate computer systems. And as reimbursement continues to decline, we'll have to find ways to stay viable. One possibility is to share information technology platforms and skilled personnel between practices that are not financially integrated, as I've done with my dad and his partner. We are limited in finding solutions only by our own creativity and willingness to change.

 

Thomas Moak. Dad and I--and how we've helped each other. Medical Economics 2001;8:83.