On measurable and compensable items such as these, the practice's medical director works with a statistician to review each physician. "Part of the problem before was that the docs would say, 'I've been doing this but I've never recorded it.' It was just a given that it was done," Smith says. "But now with electronic health records, it is easy to see if it has been done. We compare internally doc to doc and do a national comparison, and we determine what an insurance company is looking for as a minimum acceptable level."
It's imperative that analyses and critiques come from a fellow physician—rather than, for example, a practice manager—because peer-to-peer admonishments are harder to brush aside.
"The problem I have is they say, 'Jeff, you are not a doctor,'" Smith notes. "So you need that physician on your side to go into that individual practice to say, 'Doc, you have to be doing this. This is the way the practice is going to be doing this. If you don't agree with it, you need to look for another job.'"
Smith warns that not all physicians are cut out for the work.
"A lot of docs, because they are seeing their compensation fall or static, look at [the] medical director [role] and they think. 'Oh boy, I can do that and make some additional money,'" he says. "But most docs don't have that personality. They are going to want to do this but there is only going to be a select few who are successful."