The Medical Practice Playbook
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tices. I relied on advice from those colleagues as to how to survive when practice consolidation began to become the norm. I was approached by several larger practices to join them, but I felt that the loss of autonomy would not be my preference even though a larger practice had multiple safety nets which could protect me. Advantages of a larger practice included the ability to more easily negotiate contracts with insurance companies and having partners to share call with. With support from organizations like GLMS, negotiations with insurers were able to be handled more effectively, although there were times that we had to ask our legislators to intervene on our behalf when insurers were not clear in their responses. This is one of the reasons that I became involved with advocacy early in my career and still am involved to this day.
The practice has evolved over nearly 30 years by constantly investing in new technology to accurately diagnose diseases such as glaucoma and macular degeneration and performing new procedures such as LASIK and laser-assisted cataract surgery. All the while, I have had constant emphasis on hiring dedicated staff members who pride themselves on providing excellent care to our patients. We now have only the Middletown office location after closing the Dixie Highway office and after having satellite offices in Brooks and Shepherdsville, Kentucky. We felt that we could provide more comprehensive, better care from one location.
We have staff members who have been with the practice for over 20 years. They remain committed to setting an example to the rest of our employees in providing care and concern for our patient’ s well-being. We emphasize to our staff the importance of remaining updated on the latest developments in our field so that we can provide an always current experience to our patients. We support the staff in becoming certified and we encourage them to keep their certifications active by supporting their continuing education needs. Our philosophy remains focused on providing patient satisfaction and excellent outcomes above anything else.
The success of our team starts with having an excellent administrator. Nicki Greenwell, our current administrator, has been with the practice for over 20 years and fits that description perfectly. She started in the early days of the practice and has worked in the front office, as a technician, in the billing department and, ultimately, took the position of administrator in 2011. She has helped lead the practice through multiple challenging situations including assembling and keeping a successful team, transitioning the practice through the adoption of electronic medical records, dealing with the financial aspects of the practice and making sure that the practice is in compliance with the regulatory mandates of Medicare. We invest in her ability to stay on top of the latest changes in reimbursement and the administration of our practice by sending her to the annual meeting of the American Society of Ophthalmic Administrators. Our practice would not be in the strong and successful position it is currently in without her leadership over the last 10 + years.
More recently, our practice endured the struggles all of our practices faced during the COVID-19 pandemic. We faced numerous challenges getting our practice back to being fully functional. Following several weeks of total shut down and restarting with a reduced schedule, we were booked out a year for comprehensive exams. Fortunately, during this time frame, I received a call from a colleague who had hired Dr. David Strickland, a younger physician finishing up his Navy commitment and moving back to Louisville to settle down. Dr. Strickland was supposed to start with his practice full-time on July 1, 2020. Because of the shutdown, my colleague had been forced to close a majority of his offices and said that he would be unable to offer Dr. Strickland a full-time position at that time. He asked if I would be able to offer him a part-time position. Because of my schedule backlog, I responded that I absolutely could offer him a position and again the practice evolved from solo to group.
‘ The Future’ by David Strickland, MD
We all have an idea of where we want to end up after training. I graduated from medical school at the University of Louisville in 2012 and went off to do all of my training and serve as an active duty officer in the Navy. I trained in San Diego, California at Balboa and afterwards worked at Camp Lejune, a large Marine Corps base in North Carolina. Being of service to our country was a great experience, but I always wanted to come back and raise a family here in Louisville.
Academic medicine never really called to me, and I knew that I wanted to be in a larger private group offering full scope of my specialty. As all things in life are subject to change, joining Dr. Burns in his solo practice turned out to be exactly the right fit for me. Although this was not where I thought I would be, it was where I belonged.
The ability to evolve and to take chances in life are things that have always worked out for the best for me. I never thought being in a small group would be for me, but I enjoy the small group of employees we have. We have low turnover of staff, are able to offer great benefits and can have a positive atmosphere that’ s palpable to patients. If you’ re happy and make others around you happy, it translates to a positive experience for patients.
With an evolving reimbursement climate and the many regulatory hurdles we all face, being on top of the business aspects is also much simpler in a smaller setting. Medicare is set to cut cataract reimbursement dramatically in 2026, and, more recently, we have payors that are flat out denying reimbursement for claims submitted. I’ m sure most of our specialties are seeing cuts and denials. Declining reimbursement in
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