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Practice Board Meeting: What's on the Agenda? What's Not?

John Commins, for HealthLeaders Media, March 12, 2010

Depending upon how well they are organized, board meetings can provide vital monthly or quarterly face-to-face time among the decision-makers to keep your physician practice running smoothly.

Or, they can devolve into a cat rodeo; a huge waste of time and energy, where very well educated, very opinionated, highly trained professionals find themselves arguing over the everyday and trivial issues that should be solved on the middle-management level.

At Radiological Associates of Sacramento (RAS), the monthly practice board meeting is a model of efficiency. It is no small feat to get the 64 physician-owners of the practice to sit down for some two to four-and-a-half hours every month to review critical governance issues. But the efficiencies built into the meetings, which might seem effortless to the casual observer, are actually the result of constant streamlining and review, says Fred Gaschen, executive vice president at RAS.

"I'm proud of the way they have organized this," Gaschen says. "I've been here more than 13 years and I inherited a good structure. But I'd like to think that in that time we have streamlined and improved the structure."

RAS has been around since 1917, and Gaschen says the physicians in the practice know enough to let the business people they've hired to run the business, run the business. The business side takes care of the minutia, and helps the physicians organize the subcommittee and board meetings.

"We support the decision-making process by the physicians at the board level through our infrastructure," Gaschen says.

This all seems perfectly logical and simple. Don't waste everybody's time squabbling for hours about lower-level management issues that prolong meetings, force you to skim through more important issues, and leave practice partners irritated by the sense that important issues are not being addressed. But it's surprising how many physician practices run their meetings exactly that way, says Ken Hertz, principal, MGMA HealthCare Consulting Group, based in Monroe, LA.

What's on the agenda?

"I don't think you want to spend a half-hour at a board meeting deciding what kind of chairs you are going to put in the reception area. I don't think you want to spend a half hour at the board meeting or partner meeting deciding whether Dr. Jones' nurse Mary should get a bigger raise than the other nurses, because she has been here longer and, after all, she does three times the work everybody else does," Hertz says.

Instead, he says, the board should focus on governance. "We are talking about strategic issues—mergers, acquisitions, integration, recruitment, strategic decisions to develop a marketing plan," Hertz says. "Sitting at the board meeting is not where you read the copy for the ads and Dr. Jones says 'I don't like the way that paragraph is written.' It is your right to question, but there are certain things you need to entrust to a manager or a subcommittee."

To run an efficient meeting, Gaschen says, what is not on the agenda is almost as important as what is on the agenda.

"Small operational issues are not discussed at the board level. The board is responsible for overseeing corporation setting policy and directions. That is their role," he says. "The day-to-day operations are handled by the respective administrative staff hired in the divisions and each division."

For example, RAS has several subcommittees that meet weekly to vet and prepare issues for the larger board to act upon.

"It is at the divisional level they will look at new offices, new equipment, new services, or new medical ways of doing things, and there will be a lot more debate at the division level and the sub-groupings that happen between the monthly board meetings," Gaschen says.

"So the division will arrive at a consensus within its membership and that division will take it forward to the executive committee for informational purposes and the board of directors for final approval. By the time it gets to the board of directors, it has been vetted in multiple stages along the way. Rarely do we bring something up to the board level and there is a big brouhaha."

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