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As 2008 draws to a close, the nation prepares to embark on a new year filled with equal parts anticipation and anxiety. What changes will a new presidential administration bring to the industry? What shape will healthcare reform take and what does that mean for practices and patients?

While no one knows the answer, Carol Hawkins, FACMPE, administrator for Pediatric Associates of Franklin, reminds us, "The one constant that we can depend on in healthcare today is change."

Although this isn't a new notion, it is a concept that can certainly cause administrators to experience some sleepless nights while trying to decide the best way to keep a practice viable in a constantly evolving healthcare environment.

"Learning to accept and embrace change is a critical skill in our positions," Hawkins pointed out. "Recognizing this enables us to be proactive in our planning."

During her 16 years as a healthcare executive, Hawkins said she has witnessed many remarkable changes … from the creation of Stark laws and implementation of HIPAA to the change from handwritten appointments to sophisticated practice management systems. She has also witnessed the evolution of managed care contracts, TennCare and now the trend toward retail medicine dispensed in a local grocery store or drugstore.

Hawkins said she'd leave the evaluation of whether these changes have been positive or negative to the healthcare consumer "since every change has always been promoted as being 'for the good of' the patient.' One thing for sure," she added, "is that we can continue to expect more changes in the future that I can't even begin to predict."

Staying at the ready and being prepared to accept new challenges, however, has defined Hawkins' career. After receiving her BS degree from George Peabody College of Vanderbilt University, Hawkins taught for eight years before spending the next two years in early childhood education under Lamar Alexander's gubernatorial administration.

"When Lamar left office, he – along with Bob Keeshan... better known as Captain Kangaroo – developed Corporate Child care, a corporation that developed employer-supported childcare programs across the country with hospitals and other major employers. I served as the regional director for the southeastern United States," she said, of the next five years.

For the past 16 years, however, she has focused her business acumen on the healthcare industry. In 1998, Hawkins became a Certified Medical Practice Executive from the American College of Medical Practice Executives. Four years later, she achieved fellow status from the same organization, making her one of only about 800 fellows in the country. She has been heavily involved in both the local and state MGMA organizations and has held a number of key committee positions. Hawkins has also been actively involved on the board of directors for both organizations including serving a term as president of NMGMA in 1998 and two presidential terms for TMGMA in 1993 and 1994. She has been awarded lifetime membership in both organizations.

Although always happy to work on behalf of the entire healthcare industry, her main focus is on the staff, clinicians, patients and families she serves at Pediatric Associates of Franklin. The practice, which began 31 years ago with two physicians, has grown to include seven board-certified pediatricians, a pediatric nurse practitioner and two child psychologists. The practice also actively participates in clinical research through Vanderbilt Children's Hospital with the physicians serving on the academic medical center's clinical faculty. In October of 2006, Pediatric Associates moved into a new, state-of-the-art facility in Cool Springs, which was designed by the physicians to best meet patients' needs.

NMN: What are some of your major concerns in the coming year?

The ability to maintain current levels of physician compensation in a declining reimbursement environment is a major concern for all administrators, especially in primary care practices, which includes pediatrics. Each year we have the challenge of determining what new programs or ancillary services can be implemented to help increase or at least maintain revenue (and) improve practice efficiency, while lowering overhead expenditures.

NMN Note: Although somewhat limited as to what can be offered, Hawkins said her practice has looked to appropriate ancillary services to increase their competitive edge. One of the most popular additions has been the in-house physician dispensing service. "That has been a wonderful value-added service for our patients," she noted. "Ninety percent of the time, you will be able to get the prescription right here." With prescriptions typically ready before patients arrive at the physician dispensing area, the convenience has proven to be extremely popular with parents. For those who prefer to get a prescription elsewhere, the practice also offers e-prescribing to area pharmacies or hard copies of the prescription. Hawkins also said parents have been very pleased to have two psychologists on staff and on site. Recently, the practice added PediaVision – new vision screening technology that can alert parents and clinicians to problems even before a patient's first birthday.

Hawkins said she is also concerned about rising operational costs coupled with declining reimbursements. "As administrators, we constantly strive to provide better healthcare, compensation, and benefits for our team members while balancing our practice budgets. Caring for the people who care for the patients is a serious responsibility that presents an ongoing challenge to any administrator." She added the costs associated with providing benefits and competitive wages should really be seen as an investment. "I feel really strongly about nurturing the team who nurture the patients."

With the current economy, Hawkins is also worried patients will put off seeking healthcare. "Studies have indicated that patients in consumer directed plans get less care in an effort to save money. My concern is that families may postpone preventive healthcare not only for themselves but for their children, as well."

In the current tight reimbursement landscape, what is your practice doing to ensure its financial health?

I have always worked hard to operate a fiscally responsible medical practice that plans for change and creates our own future by making consistently sound business decisions. We are continually identifying what our practice needs to succeed as we evaluate and monitor the financial health of our practice and make necessary adjustments. I believe the most successful medical practices share one thing in common... competent, quality healthcare providers, committed team members, and again, a patient-centered customer service environment. My focus has always been to increase revenue by growing the business as opposed to cutting resources.

How do you market your practice to maintain and grow your business and to differentiate yourself from other groups?

As you know, consumers' perception of quality healthcare is not necessarily medically based but is determined by many variables. Reputation in the community tends to be the driving force in many consumers' decision-making process. It certainly is the initial step to getting the patient through the door. At Pediatric Associates of Franklin, we realize that we never get a second chance to make a good first impression! Patients have choices in healthcare and whether we like it or not, many compare their healthcare visit to any other customer service experience. Patients expect that the physicians are clinically competent in their specialized field, but they also expect stellar performance and have high customer/patient service expectations from all other team members of a medical practice.

NMN Note: Hawkins added that she and her staff are always mindful that consumers have choices. "From the minute we answer the telephone to the minute they check out, every person they come into contact with has an impact on that patient experience."

From a more formal marketing standpoint, Hawkins said the practice looks at ways to reach potential patients and their parents by being visible where they live and play. Those efforts include having a presence in parenting magazines, grocery stores and county fairs, as well as sponsoring programs such as youth athletic teams and events where the practice logo will be seen.

Do you have a leadership philosophy?

My basic leadership philosophy is simple... treat people as I like to be treated. Hire the right, passionate, skilled people for the position who share common values and goals – implement extensive training programs and constructive feedback, provide them with the tools to be successful in their jobs, put solid operational systems in place by involving team members who actually perform the tasks, motivate and advocate for them, don't micromanage, and then allow them to bloom in their positions.

NMN Note: She added, "I never have apologized for having high expectations for the people I work with since I have them for myself. Healthcare is serious business that requires committed individuals who really want to care for others."

What's the best piece of advice anyone ever gave you?

"Timing is everything!" I have found this to be so true in numerous situations that I have encountered whether it is dealing with employee issues or having discussions with physicians. Learning to trust your instincts and understanding that it doesn't have to all happen on your timeline is a valuable lesson that I learned the hard way.

Looking ahead, what are some of your resolutions for 2009?

• Promote our group's strategic vision for quality healthcare while being fiscally responsible and implement necessary changes for our practice to thrive in today's healthcare environment while meeting the needs of our patients. Be the change agent when needed!


• Provide leadership to ensure that goals are met; provide support to team members and physicians and never lose sight of the basics of why we are in business.


• Think "service, service, service" and instill patient/customer service passion in all the team members.


• Research and utilize technology to enhance practice efficiency.


• Continue to educate myself through involvement with MGMA and other professional organizations.

Tags:

Carol T. Hawkins, Nashville Medical Group Management Association, Pediatric Associates of Franklin, Vanderbilt University

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