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Most administrators find it difficult enough to keep up with the demands of managing one practice … Charlene Pershke, market manager for HCA Physician Services, spends her days overseeing 11 busy practices.

"I have been managing multiple practices most of my healthcare career so it feels normal to me," she said. "The only way I can do multiple locations is with great physicians, great managers and the great staff I get to work with," she added.

A self-described "farm girl" growing up, Pershke graduated from North Dakota State University with a business degree. She moved to Nashville in 1985 to be close to two of her brothers who had relocated to the area. Not only did she fall in love with Middle Tennessee, but she also found the weather to be "incredible!" Pershke laughingly recalled on the January day she left Minneapolis to move to Nashville, it was 22 degrees below zero. Although Nashville was experiencing one of the coldest winters on record that year, Pershke said it felt so comparatively balmy that she never even wore a coat.

The move to Nashville two decades ago also signaled the start of her healthcare career. She began working with Medical Practice Management, a medical consulting firm that manages smaller physician offices. "It was an incredible training ground for me … incredible," she said. In her role with the company, Pershke was called upon to do everything from preparing payroll to submitting insurance claims to researching pension plans to answering phones in the office.

In 1999, Pershke joined HCA. She started by managing Family Practice Associates of Southern Hills, a single practice with two locations. In addition to that practice, she now also oversees Southern Hills Family Medicine of Nolensville, Southern Hills Family Medicine of Brentwood, Southern Hills Surgical Consultants, Southern Hills Orthopaedic Consultants, Gastroenterology of Middle Tennessee, Internal Medical Associates of Southern Hills, StoneCrest Family Practice, StoneCrest Internal Medicine, StoneCrest Gateway Primary Care and Mid State Family Medicine and Urgent Care.

Pershke maintains an office in each of the locations and has 11 onsite managers dedicated to each of the practices. Still, the ultimate health of the practice falls on her shoulders. "I try to get to each office and spend one-on-one time with each physician to know how they are feeling about the office … staff … anything. I am fortunate to have physicians that keep me focused on 'patient care first and foremost' … I believe the rest will take care of itself," she said.


NMN) How has the practice manager's role changed or evolved since the beginning of your career?
I started in healthcare in Nashville 23 years ago. Life was simpler with more solo physician offices. Computers were just starting to be a size and price physicians could consider. I filled out insurance forms by hand; HMO's were just getting started in the area. I remember being taught how to balance a pegboard. I am not sure how many of us there are left that remember standing at a copier with ledger cards and getting statements out by hand.

NMN Note: The pegboard, Pershke explained, was a manual way of keeping up with charges, payments and adjustments. She added that in so many ways technology has clearly made the business office more efficient … but that it has also created new issues. She is a proponent of administrative simplification but is quick to say she doesn't hold the solution. Pershke is adamant, however, that the greatest amount of concern and energy should be focused on the patient … not the paperwork. "I certainly think we've got to figure out how we get some of these layers between the patients and physicians streamlined," she noted.


What is the most important piece of technology on which you rely and why?
My cell phone and e-mail. I encourage everyone who needs me … or thinks they need me … to call me. They are all very respectful of my time, but I would much rather deal with issues right away than wait and have them maybe become a potential crisis.


Along those lines ... with so many practices to manage, how do you juggle everything and make it work?
I manage 11 different practices consisting of 18 primary care (physicians), six specialists that are general surgeons, ortho surgeons and gastroenterologists. We have also added three extenders over the last year. Most of my practices are on the Southern Hills Medical Center campus and the StoneCrest campus with a few in Brentwood, east Brentwood and north Murfreesboro. I have 11 managers that directly report to me and around 115 staff. All my providers together add up to about 500 patients per day in the offices –– not counting procedures and surgeries. As you can tell from the volume, it takes everyone working together to make it all happen.

The biggest challenge is making time in my day for everyone and still get what I need to get done. All my managers work very well together, supporting each other and being a team. My physicians have taught me to "do today's work today" … there are no more hours in the day tomorrow.

NMN Note: The other motto to which Pershke, her management team, staff and physicians adhere is "treat the patients, not the insurance." She explained that the providers often have to make very quick decisions when it comes to patient care. For the administrative team, Pershke's rule is to worry about what's best for the patient, not the financial ramifications … paperwork can always be sorted out later. "I will never believe if we put the patients first, we will make a wrong decision."


What's the best advice anyone ever gave you?
My brother told me when I moved here and was looking for my first job to "hire my boss." (Later, in 1999) I came to work for Dr. Holmes and his group with HCA because of what I had heard of his reputation, work ethic and values. I have never been disappointed with that, and what I also found was a wonderful extended family in the people I get to work with at HCA. I would say 'go to work with the kind of people you would like to be.'


What advice do you pass along to others?
I think the best advice for anyone starting out or wanting to get into this business is to remember that behind it all is the patient. To me, we bring everything down to the patient level and build from there. I think that as an administrator, you can sometimes get removed from patients. Never forget behind every number is a real patient with real issues.

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