John Bogacz says it’s rare that one finds a good doctor who is also an accomplished businessperson or polished accountant.
And he wasn’t talking about the Boston-area physician who left his patient on the operating table recently, with an open incision, to run out and deposit a paycheck.
He was referring to physicians who practice in a broad range of specialties, men and women who devoted a dozen years of their lives to learning about the human body and how to care for it — and not on how to run a business.
“It’s hard to be a good doctor and a good businessperson at the same time … there’s not enough hours in a day,” said Bogacz, whose company, Healthcare Management Inc. (HCM), helps practices of all sizes run more efficiently — and therefore profitably.
The company, which has been in operation in various forms and locations for 25 years, provides assistance with everything from billing and bookkeeping to setting up a practice and finding new staff and physicians.
The company is one of many in the area that provide medical business services, but is somewhat unique in its broad scope of services and wide coverage area, said Bogacz, who now runs the company with his son, Thomas.
HCM’s services have been in growing demand in recent years, said Thomas Bogacz, as reimbursement rates have plummeted, making it increasingly difficult for physicians’ offices to operate effectively, while the paperwork, most of it from insurance companies, has increased exponentially.
“These days, it’s not whether a doctor provides a particular service,” said John Bogacz, “but whether they put it on the right line, with the right code, with the right modifier, and all the other small details that can add up to big problems.”
This crush of paperwork and bureaucracy has led to development of new software programs designed to help practices keep track of — and in some cases eliminate — the paper trail. To that end, HCM has created a second company, Advanced Medical Records Inc. (AMI), which has become the vendor of a new product called Impact.MD, a program that can reduce the cost, and also the frustration and anxiety, of handling medical records.
Impact.MD is a cutting-edge product in the growing and evolving field of medical records management, which represents a new way of doing business for many physicians and practices, he said.
“People have been doing things one way for so long, it’s often hard to sell them on a change,” he said, “but this is another way we can help make doctors’ lives easier.”
Making a Prognosis
John Bogacz told The Healthcare News that in over a quarter-century in business he has conducted hardly any marketing to speak of. He maintains a one-line ad in the Yellow Pages that has generated one or two clients, he said, and years ago undertook a mailer that wound up being a huge waste of time of money.
He’s concluded from his years of experience that this is a tough business to sell — many doctors don’t fully understand what companies such as HCM can do, and staff members, or “guardians,” as Bogacz calls them, are often fearful that their jobs might be lost if the firm is retained and thus don’t allow easy access — and, in actuality, doesn’t need to be sold.
“When my phone rings, it’s because someone’s in trouble,” he explained. “People don’t call me to tell me how well they’re doing and that everything’s running smoothly.”
That trouble that Bogacz referred to comes in a number of forms. It could be poor cash flow or a revolving-door staff that makes it difficult to maintain any form of continuity. Other challenges include recruiting new doctors, finding the right staff people, and getting a practice off the ground. “Often, it’s a combination of things … there could be too much staff, they may not be collecting enough, not billing properly, it could be anything,” he said.
After the initial phone call or introduction — almost all the company’s clients come via referral — HCM will conduct a review of the practice, an undertaking not unlike a checkup that a doctor gives a patient.
“We’ll go in and find out what’s wrong,” said Tom Bogacz. “A lot of the practices that think they’re running smoothly could, in many cases, run more smoothly. We can find areas where things aren’t going right. You never know what you’re going to find.”
HCM has been finding and solving problems for practices across Western Mass. and also in the eastern part of the state as well as Connecticut, Vermont, and New York. It works with doctors across a number of specialties, but has a large number of orthopedists, podiatrists, and neurosurgeons on its client list.
The company currently employs about 15 people and recently relocated into new offices on Myron Street in West Springfield. HCM has invested heavily in new technology — including high-speed scanners that can scan 90 pages a minute — which has become a key weapon in the fight to control and reduce paperwork and help practices run efficiently.
And while the services provided by the company vary, the common denominator is helping doctors who are — or should be — too consumed with their patients’ needs to run a more efficient business.
“A lot of doctors think they can do things on their own,” said John Bogacz. “What we try to show them is that things can usually be done better.”
He said a common problem for practices is not realizing enough revenues to accommodate all the doctors doing business at a specific location. Sometimes, fee structures need adjusting or the practice needs to provide different types of care to gain more revenues, he explained.
“Over the years, doctors will think that service A is worth more than service B,” he said. “In reality, the insurance company is going to pay more for B than A, so they lose both ways.”
In other instances, doctors will run what Bogacz calls a “cheap show,” but in the process use an inefficient billing system that winds up costing the practice money.
And in some cases, the problem isn’t with revenues but with unnecessary overhead, too much staff, or ineffective staff — all symptoms that can be identified when HCM conducts a check-up of a practice. “The problem isn’t always where the doctor thinks it is,” said John Bogacz. “In fact, it usually isn’t.”
The only selling the company has to do comes in the form of convincing doctors that the amount they’ll gain in savings or additional revenue will far exceed the fees paid to HCM. “And that’s not hard to do,” he said, adding that the company has several clients who were with HCM, left, and came back “because they realized that this is harder than it looks.”
Indeed, one goal for the company is to try to convince practices to enlist its services before the problems become acute. Such a proactive approach is often a hard sell, said Tom Bogacz.
“Many people don’t start paying attention until the cash flow is down,” he said. “Then they turn around and say, ‘what went wrong?’ If you have someone paying attention all the time, there will be far fewer headaches.”
Dollars and Sense
While John Bogacz described his as a “slow growth” business, one area which could take off is medical records management, which has always been a problem for physicians but has become more so in this era of managed care and ever-increasing regulation.
Citing the measures contained within the Health Insurance Portability and Accountability Act (HIPAA) as just one example, Bogacz said physicians are being swamped with new rules and regulations regarding privacy and security.
Which is why programs such as Impact.MD should grow in popularity over the next several years, he said.
Using only a few keystrokes, Bogacz showed how the program easily allows physicians to store patient records electronically, chart a specific patient’s history and recent progress, and catalog all important documents.
“At a lot of practices, the file room looks like the town dump,” he explained. “With this program, doctors can move their file room to their desktop and have easy access to any chart at any time.”
To date, only a few practices have purchased the Impact. MD system, said Tom Bogacz, noting that old habits die hard and many physicians are simply wedded to paper — as clumsy as it is.
He expects that as more physicians see the program in operation and come to understand its value as a time-and-cost saver, it will become very popular.
“It tracks every piece of paper in the office — and it eliminates it,” he said. “It makes doctors’ lives much easier.”
And this is the broad goal for all of the company’s services, said John Bogacz.
“It’s all about allowing doctors to spend more time focusing on their patients and less time on the business aspects of their practice,” he said. “If they can do that, then problems like cash flow will take care of themselves.”