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Getting Paid Below Medicare

This week several of us went to Capitol Hill to speak for the O&P Clinical Profession. If you were there, thank you.  If not, you can still make a valuable contribution.  We spoke with our elected representatives to encourage them to support a bill that has high-powered bipartisan support.  While it may feel futile to try to get the US Congress to do anything meaningful, this bill seems to have a good chance of going through.  But it NEEDS YOUR support.  Membership in AOPA is not necessary to support this.  They are coordinating the effort, but they are not working in a vacuum.  All of the O&P national organizations support this effort as well as the national organizations of other healthcare professionals. In an O&P legislation rarity, there are no serious objections to the requests we are making.

For over two decades, people in this profession have complained about how unfairly Medicare treats them. And for the life of me, I do not understand how the private payers get away with “below Medicare” reimbursement for O&P services.  Maybe our profession is so disrespected because unless you have inside knowledge, people fundamentally do not understand that O&P is not DME…At least not from a real-life standpoint.  Unfortunately, when the Social Security Act was written, the omission of a couple of key words has cursed us into equal coexistence with sellers of diabetic test strips. This proposed legislation will make it crystal clear that the provision of orthotic or prosthetic Clinical Care is not the same as the provision of traditional DME.

Senators Mark Warner (D-VA), Steve Daines (R-MT), Tammy Duckworth (D-IL), Chuck Grassley (R-IA), John Cornyn (R-TX), Bill Cassidy (R-LA), John Thune (R-SD) C0-Authored the Senate bill, which has identical wording to the house bill.  Today, we are on the hill to encourage more cosponsors of these two bills, known as the “Medicare Orthotic and Prosthetic Patient-Centered Care Act.”

Picture of the US Capitol

Referencing the document linked above and provided by AOPA, there are four key goals of this legislation:

  • Differentiate O&P Clinical Care from Durable Medical Equipment: The legislation would statutorily differentiate the clinical, service-oriented nature in which O&P care is provided from durable medical equipment (DME). DME is totally different than O&P care and should be treated separately in statute and regulations. O&P clinical care would no longer be viewed through a DME lens, permitting more appropriate regulation.

 

  • Refine Competitive Bidding of Off-the-Shelf Orthotics: the legislation revises the interpretation of “off-the-shelf” (OTS) orthotics for purposes of competitive bidding by clarifying that the Centers for Medicare and Medicaid Services may only competitively bid orthoses that require “minimal self-adjustment” by patients themselves, restoring congressional intent and ensuring that patients in need of custom fit orthoses will continue to have the clinical care necessary to achieve proper orthotic fit and function.

 

  • Exempt appropriately credentialed clinicians from Competitive Bidding: This bill would exempt certified and/or licensed orthotists and prosthetists from the requirement to have a competitive bidding contract to provide OTS orthoses to their patients, much like the law treats therapists and physicians. These orthoses would be subject to the competitive bidding rate so this provision would increase patient convenience without increasing Medicare outlays.

 

  • Prohibit “Drop Shipping” of Custom Fit and Fabricated O&P: The bill would reduce waste, fraud, and abuse by prohibiting “drop shipping” of all prosthetic limbs and orthotic braces that are not truly OTS (i.e., subject to minimal self–adjustment by the patient). This would save Medicare outlays and ensure the provision of clinical O&P care.

 

While these four goals may seem small, they are the crucial groundwork for further legislative action. Getting these measures codified will ensure orthotic and prosthetic (“O&P”) patients have access to quality care and will reduce fraud and abuse in the Medicare O&P benefit. Specifically, this legislation will fundamentally ensure that patients are receiving the best quality care by licensed, credentialed, and trained professionals, guarantee that patient care is easily accessible, and reduce fraud and abuse that carries both a patient care and financial cost.

To move this legislation forward, we need to garner as much support as possible for it. Please write to your Representative and urge them to support this important legislation – simply enter your information on the platform, personalize the letter as you see fit – it’s important to tell YOUR story – and click send. The process will take you just a few minutes; however, educating Congress on the issues surrounding the O&P profession is vital to businesses and more importantly patients – if we don’t advocate for our needs and the needs of patients, no one will.

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Size Matters

I am excited to be working on a new report that we will be sending to all OPIE Plus customers who have the OPIE Business Intelligence tools available to them.  As these reports take shape, there is a lot of discovery that has to take place.  Our goal is to create something that helps business owners ask the right questions and see where there may be opportunities to improve profitability, efficiency, or overall business health.  We have a decade of work behind our framework with knowledge gained from over a hundred different O&P practices working on the same challenges to arrive at an optimal “best practice solution.”

We learned early on that size matters.  The systems, processes, and resources available can be radically different among O&P practices. We have analyzed millions of data points from OPIE customers to identify groups of companies with similar profiles that we could group together to provide meaningful comparisons of operational data. Through this process we were able to create five distinct peer groups that we now use for benchmarking.

As we think about company health, one indicator is how effective we are at attracting new patients. But in order to answer that question you have to know what is reasonable.  What’s realistic? What can we do to influence the number? Should we spend more time trying to increase the number of new patients that come into the practice, or would we be better off focusing on a different aspect of our business?  I do not think there is one thing that you have to get right.  I think there are many things that have to work well, and like the “spinning plate” analogy, you have to keep everything in balance.  You know what matters to you based on your organizational goals.  If, for instance, business growth is a goal, then you may want to see your new patient count getting bigger each month.  But maybe you are happy with your patient volume.  You need a steady state to maintain your book of business so you might want your new patients to be consistent over time.  Not too many, not too few.  Or what if you are trying to emphasize your prosthetic business…then you may want growth in the number of new prosthetic patients and a steady sate or even a decreasing number of new orthotic patients.

If your OPIE system is hosted by OPIE Software, you are considered an “OPIE Plus” customer.  You have a dedicated Customer Success Manager who is here to help you navigate the data and the BI tools.  You can reach them here. They will make sure you are set up for data and eligible to get this new report.

In addition to the new patient information, we will be looking at a new metric called the “Clean WIP Score.”  This score will allow you to dig into the biggest challenges to moving a patient through your system from intake to delivery and highlight opportunities to improve your patient flow.

I look forward to getting this report into production and out to you!

Checking your Progress

Here we are, starting another month… and just like that, we are a third of the way through 2022!  It’s time for an assessment. How are you doing?  When you look back at your goals for this year, how have you done?  (How’s that diet plan working out?) Even if you didn’t create business goals for 2022, it’s not too late — the second half of the year is fast approaching–sit down with your team and make a plan for what you want to accomplish.

I talk about the importance of accountability, the need to align the job descriptions to the company mission, and the need to hire people who believe in the mission. When setting goals, they should be designed to support your mission.  Let’s say your mission is along the lines of providing the best practical O&P care to the people in your community. How would you define the “best practical care?” I imagine we would think about timeliness of care, we would certainly have to think about affordability and profitability. After all, if the patients can’t afford it and you can’t make money on it, then you won’t be helping anyone!

So let’s look at some numbers.  The WIP: Aim for Success tool is designed to help you visualize and strategically manage your patient load. This tool has many uses, but for this, let’s look at two ways we can monitor your progress. Let’s say the goal this year is to bill $2million in services.  I can look at this image and see that I have about $102k scheduled for delivery in the next 30 days.  To reach my goal, I need to be billing at least another $65k every 30 days. Knowing that I have about $406k in potential deliveries (see the red zone), I can reach out to the admin team and have them work to identify and schedule deliveries for those who have been seen and had codes selected.  This requires coordination with and cooperation from the clinical and technical teams, as well as patient coordination.  The goal would be to keep the “bucket” filled with enough work to keep the lights on.

Another way we can look at this is volume.  Perhaps you elect not to share the dollar amounts with the staff. This same tool is available without financial information. We can see that there are 5 deliveries scheduled in the next thirty days. Maybe our goal is to have at least 12 scheduled deliveries every 30 days.  Now I rephrase my question to the team.  I would ask them to identify 7 or 8 patients in our WIP that we can get scheduled for delivery in the next 30 days.

This tool, and this approach, allow our company to strategically manage the patient load to help us meet our corporate financial goals. It has the bonus of perhaps providing care to our patients in a more timely fashion, which should lead to better physical outcomes and increased patient satisfaction.  Both of which will help your reputation in the community and should help attract more patients.  Learn more about our Business Intelligence here.

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Uncertainty: Revisited

A year and a half ago, I wrote about uncertainty and the need to embrace it to drive your business forward. I introduced you to the World Uncertainty Index and I thought it would be interesting to see where the index is today as we emerge from the pandemic and enter this new phase of global unrest and hostility. While doing my research, I investigated why this matters to the O&P profession. 

Nicolas Bloom is an economist at Stanford and is a developer of the “World Uncertainty Index,” which was created for the International Monetary Fund (IMF). Compared to the last time I wrote about it, the degree of uncertainty has diminished significantly. Up through the 4th quarter of 2021, the data was showing a fairly steady decrease in uncertainty. New data shows that there was a significant uptick in the index during the first quarter of 2022. It is not as high as it was in October 2021 when I wrote about it, but, there was interesting data in the movement of the numbers. 

The National Bureau of Economic Research says that “innovations” in the Index “foreshadow significant declines in output” (Ahir, 2022). What this means is that given the rapid increase in uncertainty documented in the index in Q1 2022, we can expect economic activity to decrease. And what that means is that supplies will be further limited, supply chain problems will continue to arise or even be exacerbated, costs will continue to rise, and the economic recovery will be further delayed. 

In our profession, we seem to be constantly dealing with change. The good news is that at least we have a good idea of what the next big change is…more of the same! This means your business strategy is more important than ever. Things are going to get tougher before they get better. Here at OPIE, we know that data-informed decision-making

is critically important to your business’ success. We do it all the time with our patients, but we trust our guts regarding the operation of our business. Please don’t rely solely on this! Watch your data, look for trends, and make your decisions based on what your data shows! 

But also, don’t fall into the trap of thinking that with just a little more information or just a little more time, you can make a more informed decision; that just leads to paralysis. The line to tow is thin, but that’s what we’re here for at OPIE. If you want to learn more about how to do this, join us for our educational events! Look at our Events Calendar here. 

Keep in mind that your business is always facing uncertainty. You are paid to have a long-term view and think strategically. Assume the worst and have a plan. If nothing bad happens, then you are that much better off. But if something does happen, you have a contingency in place and will be able to respond to it because you have already thought about how the constant force of change might impact your business. 

Don’t hide from the uncertainty monster. Embrace it and drive your business forward through it. 

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Don’t Fleece Your Staff

If you are a boss or a leader, guess what? According to the American Psychological Association, about a third of your staff do not think you are always honest and truthful with them. About one in four does not trust you.  We have been told that the solution is transparency. Transparency builds trust.  It increases employee engagement and boosts morale.  But what does transparency really mean, and can we achieve it in an O&P business? 

According to Slack, “82% of knowledge workers say it is important that their organization is transparent. But only 19% consider their company to be ‘very transparent’.” I think a key reason that staff does not trust leadership is that leadership often gives lip service to transparency.  Everyone knows it is important, and many say they are transparent, but studies continue to show that there is a real lack of trust in the ranks.  Presumably, you do not hire dummies. So, are they on to something? 

Fast Company says that a “transparent workplace moves beyond the hierarchical companies of the past that thrived on departmental silos and need-to-know, reactive information sharing. Leading with transparency, managers eliminate murky processes and vague expectations that lead to disconnected, ineffective employees.” And as awesome as this sounds, few companies are able to open themselves up to true transparency.  Transparency is bi-directional and requires mutual accountability. Most leaders are not willing to go that far.  So, they talk about transparency, but they really are pushing “visibility.” Committing to transparency over visibility requires a high degree of leadership vulnerability.  

But all is not lost! At OPIE Choice, we have come to know John Spence pretty well, and he has come to know O&P pretty well. He teaches business excellence and one of his topics is “high-performing teams.” Do not get me wrong…trust is key. And transparency is desirable. But transparency without an alignment is not sufficient. So, I go back to my oft-mentioned need for authentic Vision, Mission, and Value Statements for the company. It is crucial that those depict the true desire for what the company will do. Create objective statements and tie job descriptions to achieving them. That creates your transparency. Your Value Statement lays down the guardrails. Hire the right people; people who not only understand your Vision, Mission, and Value statements — but who are motivated by them and who embody the values you profess. With those people on board, there should be no doubt in your mind that they are solidly on your team and therefore you will know that success is only possible when they have all the information possible to accomplish their objectives. 

As a leader, your biggest challenge will be to get out of their way once they have the tools they need! 

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Transitioning To Leadership In O&P

As a clinician or an administrative worker in an O&P practice, your primary focus is on doing the work that comes across your desk or your table. You went to school or at least took classes to learn the basics of the job and you have perfected your skills over time. As good as you may be in your role, the transition to management or leadership requires a totally different skill set. But I think the transition can be less intimidating and stressful for all involved with a few simple ideas.   

Vinod K. Sahney, Ph.D., a Senior Fellow at the Institute for Healthcare Improvement, compares becoming a leader to buying a house. He says “When you buy a house, you do an assessment or walk-through. You have to do the same when you become a leader. You have to figure out the most important issues to tackle, and what new training, technology, and facilities are needed.” I don’t have his credentials, but for me, I like to think of the practice as a patient. You conduct an assessment using both subjective and objective criteria to document the current condition. You then determine the goals for the “patient.” In your practice, those goals are documented through your Mission Statement. Once you have all that information, you create a “plan of care” or your business execution strategy. The tricky part in patient care is executing the plan. 

 

Clinicians had to learn clinical expertise to provide competent O&P care. It only makes sense that you would have to learn leadership skills to provide competent leadership. One of the biggest challenges people face when assuming a leadership position is the appropriate delegation of responsibility. So much of the work you did in the “worker” role is your own. Now you need to motivate others to be your helping hands. It can be very hard to let go of those things that you have always done. But if you do not let them go, if you do not delegate, you are not leading and you are not helping others in the organization to grow professionally.  

If you read back through my blogs, you will see a consistent theme of competencies needed to effectively lead. Among them is emotional intelligence. It is the awareness of your own and other peoples’ emotions and the skill to effectively align the company’s goals with the emotional drivers of the people you work with. It is crucial to successful leadership. Having a strong self-awareness is another critical success factor in leadership. An understanding of your own strengths and weaknesses can help leaders avoid blind spots and find the appropriate people to assist them. It is also important for a leader to understand how others see them, so they can adjust, as necessary. 

Along with those skills comes the need to influence people. To move others along in new directions, and to get others to carry out your decisions, leaders sometimes need to use influence rather than direct power. In order to cultivate influence, leaders need to understand that people represent different areas, interests, and opinions. They also need to be able to work through that complexity to reach a goal. 

The last thing that can help O&P leaders succeed is a strong network to help throughout the transition and beyond. Just as clinicians seek consultations from specialists, they benefit from consulting other “subspecialties of management” to help them carry out their goals and be the best leader they can be. That is where your participation in the OPIE Choice program pays you incredible dividends. Reach out to me to learn more about how Choice can help you and your practice thrive. 

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You Have To Suffer To Be Beautiful

Such a simple statement, uttered a little sarcastically, became a rallying cry for a championship team. A friend of mine was teaching a Bible class this past Sunday. He is a Marine and was an accomplished wrestler. There was a sign hung by his coach, Jare Klein, in the Olivet College wrestling team gym where he trained. On it was the phrase, ‘you have to suffer to be beautiful.’  

The coach, he said, defined beauty as winning. Trophies, matches, personal goals, whatever you are striving for, winning is doing what you set out to do. And to realize your beauty, you must suffer. You need to put in time, effort, and discipline to overcome the challenges and the opposing forces to make it so. Later in life, as my friend was talking to his former coach, he learned where those words of wisdom originated. One day, the coach’s wife was having one of those days where getting ready for work was an ordeal. Everything she was doing seemed to not have its desired effect; hairdryer, curling iron, straightening iron, mousse and all the trimmings were actively working against her. As she was finally finishing her routine, she quipped to him, “See, you have to suffer to be beautiful!” 

On the surface, it is funny — but with just a little thought, you can see how those words can have a profound meaning. Virtually nothing worth having comes easily. Why should we expect to get something for nothing? Maybe beauty is watching a patient perform a task after your intervention. Or it is the flawless execution of the workflow that keeps the patients progressing toward their own goals. Patients do not just walk on their own. Heads do not reshape on their own, nor do curved spines straighten on their own. We do not regrow limbs. Your hard work and sacrifices gave you the ability to create the beauty of your patient care. Their suffering, hard work, and dedication allow them to achieve their goals. Overcoming the challenges is ultimately a team effort where each person suffers to reveal their beauty. 

The same is true in managing your practice. The team often suffers through the process of creating beauty. But we push through, we know that there is something we are creating that motivates us to overcome the challenges in pursuit of the beautiful outcome we are seeking. It is critical to know that the suffering can be significant. Real pain manifesting in hurt feelings, personnel changes, anger, frustration, and more can arise. This is why a clearly articulated definition of beauty is so important to success. We have to understand why we are suffering, and we have to see the beauty ourselves. Your missions, vision, and values statements work together to paint the definition of beauty in your practice. If the staff cannot see it, they will not be able to endure the suffering and the beauty will not be realized.  

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Sustaining Your Growth

You started out with a single location.  You were driven, determined, and focused on providing quality patient care. 

You got busier, you hired an office manager to help organize some of your processes and billing. 

Now you have hired techs, assistants, more practitioners and expanded into more locations. You have come a long way since you first opened your doors! But the bigger you get, the more critical it is to be efficient, to have repeatable processes with defined and understood intended outcomes.  There are three key components to a health organization. All must work in harmony to achieve your objective.  They are your people, your processes, and your tools. You can’t realize your full potential without all three of those working together.   

Your people are critical. We have spent a great deal of time talking about the need to have your team aligned and we have numerous resources available to Choice Network members to help with the intricacies of staff management and development. They must have the freedom and authority to do their jobs well, and those jobs have to be strongly aligned with the company’s mission. That way, when the environment changes, they know what they need to do to adapt to change and keep moving the company forward. 

Your processes matter too! They are created in combination with your people and your tools. The processes your team develop allow your entire organization to scale and adapt to growth, contractions, environmental changes, and other things that we can’t always anticipate. Processes are not intended to be static. They must be adaptable. But there needs to be a system in place to manage process changes. You do not want them to be too flexible or too rigid. We have spent hundreds of hours with your peers examining processes and understanding how they impact business operations. This has allowed us to identify some critical best practices that facilitate practice stability. 

The tool you use to manage your practice is every bit as important as your people and your processes. It is as essential as electricity to keep your doors open. How you use it matters too. Just hiring a person does not make them a great employee. Just writing a policy doesn’t make it so, and just having software won’t help you if you don’t use it the way it is designed. When it comes to owning a healthcare business, you need to work smart. That means having the right tech to optimize your business growth. If you think of your software as a documentation and scheduling tool, you are not thinking like a strategic business owner. 

Use your system to show you things that matter. How is your staff spending their time? How satisfied are your patients with their service? Are you meeting their physical goals? How much revenue, on average, does each patient visit generate for your practice?  How can you improve on that? How much does it cost you to deliver a device?  How long does it take you to get paid? How long does the admin team wait on clinician notes before they can obtain insurance authorization? How much will the patient owe? Have we notified them? Collected their balance? 

How confident are you that everything you need for a scheduled patient visit is ready for that visit? It is the combination of many little things multiplied by the volume of your business that can sink your vision. Death by a thousand cuts. With the peer-based experience-sharing opportunities we provide through Choice, you can set your practice up to thrive! 

Colleagues planning a business strategy in an office.

Business Strategy

Last week I talked about the historic outcomes of business strategy during previous economic downturns. The jury is still out on whether we will officially enter a recession, but facts are facts. We are experiencing significant inflation, which means the cost of existence is increasing. The rates of inflation vary across markets, and even without a supply shortage, the cost of transporting those goods to the end-user is increasing with no good solution in sight. 

So, I stand by my statement that the business decisions you make in the near term can have a serious outsized impact on your future. The good news is that your OPIE System, which is so much more than a patient record system, is the most powerful tool available to O&P practices as you seek to strategically manage your practice. 

The “best practices” identified and vetted by your peers have informed the business intelligence tools and the Choice Acuity Reports that give you unprecedented and unparalleled insight into your operations and the opportunities for improvement that can most impact your business. As times get harder, your best chance of success is to focus on your output. This means to take a fresh look at your mission, your purpose, and determine how you can fulfill that despite the fresh challenges. 

While your first reaction is to minimize losses and protect what you have, that approach is the one that is most likely to lead to your downfall. Roughly 4 of 5 companies that take this approach underperform their peers coming out of a recession, according to the Harvard Business Review. The course of action most likely to lead to success is one where you strategically invest in your people, processes, and tools to reduce your operating costs by increasing efficiency and productivity. This allows you to avoid staff reductions and other painful actions. Your goal should be to eliminate wasteful spending and make the most of the resources available to you.  

How are your people spending their time? How much does it really cost you to deliver an AFO? A TT prosthesis? How many visits does it take your practitioners to “get it right?”  How many follow-ups, on average does each practitioner have? Could their time be better spent on Evals and Deliveries? How much time does your CPO spend fabricating? 

How long does it take you to bill for the services you provide? How many days, on average, does it take from when the clinician sends the codes to admin until we deliver? Or send the bill to the payer? Are there things you can do in your practice to speed this up? A dollar today is worth more than a dollar tomorrow, so how do you shorten the time it takes to collect those dollars? 

OPIE Business Intelligence makes it easy to find opportunities to improve. If we can help you save or find just 48 minutes per day in “wasted” activity, that equals about an extra month in the year. How much more revenue could you achieve with one more month? Do you think that could give you a competitive advantage? 

At OPIE, our team is committed to your success. Let us help you make the most out of your practice. 

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Practice Management Response to Recession

As an O&P practice owner, the decisions you make in the next couple of weeks may determine whether or not your business survives the next year or two. It is no secret that the United States is experiencing record inflation. Inflation in and of itself is not necessarily a bad thing and The Federal Government has mechanisms to keep inflation in check. But the levers require a deft touch. Most economists are predicting that the United States will experience a recession and some are arguing that we are in the beginning phases now. The next actions to be taken by The Federal Reserve (the Fed) will be critical to successfully managing the risk. But now we have another shock to our system with the war in Ukraine. According to an Economic Report from Market Watch, as well as observations we can make on our own, prices are increasing at the same time as our economic growth is slowing.  This combination can create a very difficult scenario called ‘stagflation,’ which the United States has not experienced for nearly 50 years. Let’s hope we do not get there!  

On March 14, 2022, the Wall Street Journal’s Dion Rabouin warned us that Fed policies could send us into a recession. A recession is a significant decline in economic activity that lasts for months or years. It is declared when a nation’s economy experiences negative gross domestic product (GDP), rising levels of unemployment, falling retail sales, and contracting measures of income and manufacturing for an extended period. It is too early to have the actual GDP numbers for the current period, but leading indicators are strongly pointing toward recession. Without decisive action by the Fed, the likelihood of course correction seems slim. So, what can you do? 

There is little research that has been done on strategies to help companies survive a recession.  The most common advice is to get ahead during the good times so you have the resources to weather the storm. According to the Harvard Business Review, “historically 17% of companies will go out of business during a recession.  And only nine percent were operating at or above their pre-recession levels three years after the recession ended.” HBR goes on to say that “firms that cut costs faster and deeper than rivals do not necessarily flourish, have the lowest probability—21%—of pulling ahead of the competition when times get better.” Conversely, those that invested boldly only had a 26% chance of emerging victoriously. And about 85% of the leaders going into a recession were toppled during the tough times.  

Do Not Panic! 

HBR’s researchers classified three types of responses to a recession: 

  • Prevention-focused companies: those which make primarily defensive moves and are more concerned than their rivals with avoiding losses and minimizing downside risks. 
  • Promotion-focused companies: those which invest in more offensive moves that provide upside benefits than their peers do. 
  • Pragmatic companies: those which combine defensive and offensive moves. 

There is a great deal of discussion we could have about each of those responses and as you might expect, each of these approaches has some merit. I have listed them in order by how likely each of those responses is to produce a winning outcome (outperforming their rivals by 10%), post-recession: 21%, 26%, and 29% respectively. 

There is a fourth approach that has a 37% chance of outperforming your rivals and that is what the HBR researchers called “progressive companies.”  These companies deploy the optimal combination of defense and offense. The companies most likely to outperform their competitors after a recession have an “attitude of looking away from first things, principles, categories, supposed necessities; and of looking toward last things, fruits, consequences, facts.”  These companies understand that it is necessary to cut costs in order to survive a recession, but that investment is just as important to spur growth.  These companies know that they must manage both at the same time if their companies are to emerge as post-recession leaders. They primarily slash costs by improving operational efficiency rather than cutting employees.  Many of my blogs talk about identifying opportunities to improve your operational efficiency. 

These companies invest in their future in part by looking for new business opportunities.  By focusing on the output, they develop creative ways to deliver that output (think quality patient care) in new, less costly ways. Using the data you have in your patient management software to understand your business objectively is a great start to strategic planning what you should be doing right now.  Your OPIE Business Intelligence Dashboards and your Choice Acuity Reports are great places to start.