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For more than two decades, Brenda Plunkett has efficiently and effectively overseen the controlled chaos that marks a busy pediatric practice. As administrator for Old Harding Pediatric Associates (OHPA), Plunkett relies on flexibility, technology and her master’s degree in counseling … a skill set that has served her well in her 30 years of working young patients, worried parents, providers and staff.

In addition to her daily duties, Plunkett is a member of the national Medical Group Management Association and its state and local affiliates. A past president of Nashville MGMA, Plunkett also serves on the Health Information and Management Systems Society (HIMSS) Davies Award of Excellence Committee, honoring practices that best implement health information technology to the benefit of their patients. OHPA was an award recipient in 2004. Plunkett is also a member of the Nashville Medical Group Executives … a gathering of administrators from the area’s largest practices who meet to discuss issues impacting the management and delivery of healthcare.

Her main focus, however, is to continue to build upon OHPA’s nearly 80-year history of providing outstanding care to children in Nashville. Founded in the 1930s by James C. Overall, MD, the modern practice includes 11 board-certified pediatricians and approximately 75 support staff at three locations. Plunkett said the practice accommodates approximately 80,000 visits annually and fields between 800 and 1,000 calls daily.



How is running a pediatric practice different than that of another specialty?

Managing a pediatric practice is managing chaos. Each day is different, and we have to have systems in place that allow us to be flexible and adapt to what children need each day. Most of these systems revolve around personnel –– do you have enough, do you have too many? You have to be prepared for seeing same-day appointments, and you do not know the volume until the phone begins ringing at 7 a.m. In pediatrics, you have to be available. Children are not always conveniently sick 9-5 Monday through Friday. Therefore, we are open seven days per week and five nights per week. We staff two shifts everyday. One of the best parts of managing a pediatric practice is NO Medicare. All my colleagues can understand the advantages of that.



Even without the Medicare reimbursement issues, are you negatively impacted by the current tightening economy?

Healthcare has seen an economic recession for several years as reimbursement has decreased or remained flat while expenses continue to increase. Health insurance premiums have skyrocketed, and the only way employers can continue to offer this as a benefit is to change plan design to higher deductibles … and many times no well child coverage.

For decades patients have been accustomed to insurance companies paying their medical bills. Now with the high deductibles and less coverage, patients are ill prepared for this new budget issue. Currently with the woes of the economy that is affecting every household, collections will be harder to obtain. How to lessen the impact? I believe all practices are looking for new services to bring to the practice that might generate more revenue. Even though I feel we are efficient in our practice, we have to manage more closely each expense.

NMN Note: Plunkett said she is particularly concerned about the impact fewer well child visits could have on long term health. She noted that within the OHPA practice, parents without coverage tend to still make well child appointments during the first year of life and at the five-year mark as children prepare to enter school. During the toddler years and after children have started school, however, uninsured parents often let those visits slip. “When your child is healthy, and you don’t see anything wrong, you don’t come,” Plunkett said of parents who must pay for such visits out of their own pocket. She was particularly excited when the Tennessee Board of Education mandated all incoming seventh- and ninth-grade athletes must have a complete physical beginning this coming school year and encouraged parents to have the physicals performed at their medical home. Plunkett said the more intense exam and lab work should help identify potential problems that might be missed in the abbreviated sports physical that has been required in the past. Additionally, she said the appointment gives providers a golden opportunity to talk to teens about sex, drugs, nutrition and other topics that could impact their lifelong health.



What is the most difficult part of managing a practice with multiple physicians and locations, and what steps do you take to make the office run more smoothly?

Communication! It is important to make sure multiple locations act as one. It is necessary to create the same culture and philosophy so patients can receive the same service in all locations.

The electronic health record (EHR) was a major step in assuring all clinical care was accessible at any office. Physicians and staff members can be in any office and have access to the medical record. They can assist the patient in obtaining information or allowing the physician to have the complete medical history to see the patient. We also built an intraoffice message center that allows physicians, management, and staff to communicate. We post information from the most trivial announcements to policy changes and committee minutes. It allows for quick distribution of information so we can adjust quickly if we need.

NMN Note: Plunkett referred to the EHR, which the practice has used since 2002, as “the most significant and best change in my career.” She added, “It has made managing a practice more manageable. It has increased the quality and continuity of care for our patients. It created more efficiency in all areas of practice –– from the front staff check-in to triage to the nurse to the physician to billing.” Prior to implementing the technology, Plunkett said every patient in the Bellevue office had a “shadow chart” at the Old Harding Road practice (the Ashland City office opened after the advent of EHRs). Everyday, every record was faxed to the main office, which was the only one open for night and weekend appointments. “We couldn’t afford not to have the information we needed,” she said, adding that EHRs have saved a lot of money, office supplies, man-hours and hassles.  



Besides the EHR, what other technology is essential to managing a practice?

You cannot live without a practice management system. This provides the appointment scheduling and billing. We also have a new digital phone system that allows us to manage incoming calls in real time. We can manage the phones by assigning staff to the higher volume areas –– triage and appointments, mainly. Through its reporting system, we receive valuable statistics that help us use our resources to better meet the patient demands.

Our Web site is a very important part of our office for both convenience and information. It provides education, news on community and health updates, and most importantly … it provides an interactive, secure portal for our patients to communicate with us. I believe that having a Web site of this caliber is both expected by our growing population of savvy computer users, as well as an efficient way for our patients to use our services. It allows us to meet their needs without clogging the phone lines and spreading out staff. Our Web site has become a highly used communication tool with several thousand unique users and over 12,000 exchanges between our office and our patients in the first six months of this year.



What advice do you like to pass along to young practice managers?

Nothing stays the same in healthcare so be prepared to lead change. I tell my managers to be open to learning something new everyday and to be open to changing systems to make us better. You can do this best through networking, and MGMA is a fabulous resource. 



August 2008

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