Medical Colleagues of Texas (MCT) in Katy, Texas, has taken pride in its practice culture for many years, and Ethan Bing, MBA, CMPE, practice administrator, believes the COVID-19 pandemic bolstered an already healthy culture at the MGMA Better Performer practice.
“I think we came out stronger than we went in, and a big part of that is we have a very strong employee-first attitude,” maintains Bing. “At the end of the day, we found that if you take care of your team, they’ll take care of your patients.”
A legacy of care in southeastern Texas
Medical Colleagues of Texas’ roots in southeastern Texas date back more than a century, starting with Dr. R.E. Bing. After graduating from medical school at the University of Tennessee in 1909, Bing headed back to his home state of Texas, where he practiced in Monaville and Oakwood until 1956.
“There are stories about Dr. Bing delivering babies on people’s kitchen tables, going over in a horse and buggy. So there’s a lot of history there,” says Ethan Bing of his great-grandfather, who was described as a “‘good old-fashioned doctor’ who would come in any weather, at any time, to help anyone who needed a doctor.’”1
R.E. Bing’s eldest son, Lyndon Bing, MD, began practicing in Katy in 1951, and served the community for decades. He was followed by his son Mark, who started what would become Medical Colleagues of Texas in 1982. The practice added William Currie, MD, in 1985, then Paul Bing, MD, and Kelly McCullagh, MD, in 1996. In 2005, Medical Colleagues of Texas moved to its current location.
MGMA Better Performer: Medical Colleagues of Texas, LLP, Katy, Texas
- Founded in 1982 by Mark Bing, MD; current location opened in 2005
- 12 FTE providers (11 physicians, 1 nurse practitioner) and 33 full-time and seven part-time staff in one clinic
- MGMA Better Performer in Profitability
For MCT, this starts during the recruitment process by targeting sharp employees with positive attitudes. Throughout the interview process, Bing emphasizes the practice’s values. If a candidate is selected for a second-round interview, they tour the practice, which gives them a feel for the team they’ll be working with, as well as the overall work environment, including where they will be working.
According to Bing, this is where MCT’s culture shines through, as candidates are introduced to staff and some providers. “It is impossible to fake a jovial, upbeat work environment,” says Bing. “Candidates are always commenting on how happy everyone seems around our office after the tour. I believe it is a big hook.”
Candidates also meet with their team lead, who gives them insight into the job duties, expectations, and working relationship with their prospective direct supervisor. “We do this second-round interview … to ensure candidates have the information they need to be confident in making a decision on whether they would like to accept the position if it is offered,” notes Bing.
He also stresses the importance of mutual fit. For example, MCT has passed on excellent candidates because the position may not have made sense in terms of their career progression. However, the right candidate often zeroes in on the practice’s culture. “When you do find a candidate who is a good fit, they can tell you actually care about your team — that you care about each individual,” states Bing. “The smart ones pick up on it and are excited to work with us.”
Once a candidate is hired, Bing says that the practice can teach them the rest by providing them resources, tools and training to succeed. “Ultimately, I see myself as a macro manager in the sense that we give everybody guidelines and policies, but we allow them to find ways to better do their job,” relates Bing about building positions around employee strengths.
By adding individuals with different strengths, Bing says that the team is more well-rounded and performs better. “It doesn’t matter how much experience they have,” observes Bing.
This is where retention starts, and it’s reinforced by how MCT’s leaders treat every member of the practice, which reflects a valuable principle Bing learned from his father early in life about how to serve and support his team. “I do not have 40 employees; I have 40 bosses,” he says. “This mentality goes a long way, even in the recruitment cycle.”
Bing notes that all MCT’s physicians are equal owners, whether they’ve been with the practice for a year or 30 years. “It keeps them very hard working and … very engaged with our practice and with our staff,” says Bing. “There’s a very strong connection and relationship with our physicians and staff, where we don’t have a bureaucracy or crazy hierarchy.”
He adds that the practice culture is one in which staff feel comfortable approaching physicians; in turn, physicians are open and kind to staff. “We have an environment where everybody works well together,” states Bing. “Nobody’s looking over their shoulder, and if they make a mistake, that’s OK. We learn from it and move on.”
This egalitarian culture and concern for the well-being of the individual is fundamental in staff and provider retention, including with challenging positions such as medical assistants (MAs). “We’ve actually been very fortunate; we have MAs that have been with us for 15, 20-plus years,” says Bing. “Even with our rapid growth over the past decade, our average MA tenure is around six to eight years.”
By the numbers
A physician-owned multispecialty practice, Medical Colleagues of Texas focuses on primary care, sports medicine, pulmonary medicine, gastroenterology and women’s health at one clinic, which is separated into three connected suites — an administrative suite, an OB/GYN suite and a primary care/internal medicine subspecialty suite. As Bing notes, patient demographics closely reflect the community’s demographics:
- 40% are 41 to 64 years old
- 35% are 65 and older
- 23% are 21 to 40 years old
- 2% are 16 to 20 years old.
In terms of payer mix, the breakdown is as follows:
- 66% commercial
- 16% Medicare
- 17% Medicare Advantage
- 1% self-pay.
Benchmarking has also played a key role in helping MCT retain employees, with data as an integral part in helping the practice establish staffing strategies. MCT looks beyond the local market in determining pay rates, which has helped reduce turnover and increase productivity. “I think your employee who’s paid the least is actually the one who costs the most,” Bing says. “That comes down to just making sure that you have people who are absolutely effective and competent.”
One example that illustrates MCT’s culture of care took place at the beginning of the pandemic and during recent natural disasters, including Winter Storm Uri in February 2021 and Hurricane Harvey in August 2017. Bing says that even though staff and providers weren’t working for several days, the practice was able to pay them 100% of their salary/pay rate.
The few individuals who have left the practice in recent years often realize that the grass is not always greener. We’ve found that “getting an extra dollar per hour down the street wasn’t worth the extra headache or the culture that the other company offered,” notes Bing. “It is a humbling experience when former employees rejoin our group with a renewed appreciation for our mission and organization.”
Bing notes that because the practice stays slightly overstaffed, MCT does not pay a significant amount over market value. “I find that having a very efficient operation takes care of that and keeps people happy to where they’re not overworked and overburdened,” says Bing.
He adds that there’s been a significant amount of market consolidation since the pandemic shuttered some clinics and/or revealed other clinics’ weaknesses. “I think the big shuffle in the employment market has brought some really strong people out into the labor field that we haven’t seen before,” says Bing. “We’ve been able to attract some good people and keep them happy.”
Profitability*
As an MGMA Better Performer in Profitability, Medical Colleagues of Texas surpassed MGMA’s criteria in the following areas:
- Less than the median for total operating cost per work RVU (MCT: $29.88; MSP**: $89.33).
- Less than the median for total cost per total RVU (MCT: $35.05; MSP: $71.93).
- Less than the median for total operating cost as a percent of total medical revenue (MCT: 31.11%; MSP: 61.50%).
- Greater than the median for total medical revenue after operating cost per FTE physician (MCT: $556,108; MSP: $549,914).
*Data from 2022 MGMA DataDive Cost and Revenue, based on 2021 data.
** multispecialty practice
Embracing technology
MCT has made concerted efforts to embrace new technology as it grew in the past decade, especially after the passage of the HITECH Act in 2009. “We started to realize that to really provide excellent care, we had to invest in resources [such as] EHRs and really sharp billing practices,” notes Bing.
Amid the surge in telehealth usage during the pandemic, Bing says MCT is continuing to invest in its growth. “We have a lot of telemedicine visits; we expect telemedicine to be an important and strong service line going forward,” says Bing. “We’re going to be inventive or creative about how we maximize our space and exam room utilization, with physician schedules and telemedicine.”
Telehealth has also been a key patient access initiative, providing opportunities for more timely care. “When our physicians are on call over the weekend, they weren’t conducting appointments,” says Bing. “But now if a patient calls, they’ll typically offer a telemedicine visit, which gives more comprehensive care, rather than holding you over till Monday to see your doctor.”
It’s also helped reduce wait times. “Say there’s a situation where we get behind in clinic due to a really complicated case,” offers Bing. “Telemedicine patients are typically content with their appointments starting a little bit later, so you don’t have people physically waiting in the office as long.”
Telehealth accounts for around 25% of MCT’s total visits; specialties such as OB/GYN might average one or two visits a month, whereas gastroenterology and primary care have about 35% of all visits done virtually. With anticipated growth in telehealth appointments, the practice is assessing its current facility.
“The next couple years we’re potentially moving to a new clinic or redesigning the clinic for a new age of medicine,” notes Bing, adding that this involves determining whether they will move from pods, with an exam room for each specialty — including a physician desk and an MA desk — to more centralized exam rooms.
MCT also adopted VoIP technology in 2022 — a game changer, Bing says, in that it included analytical tools to help the practice better staff its phones. Before the switch, “we were answering about 56% of our inbound calls, but in the most recent month, we answered 90% of inbound calls,” says Bing, noting that he first targeted the scheduling department, which now answers 97% to 98% of calls.
The analytical tools helped MCT determine that most scheduling calls were made during the beginning and end of the week. To address this issue, the practice hired seven part-time workers to answer phones during these times. As a result, provider utilization has increased significantly. “Our gross revenue just due to that went up nearly $30,000 a month by optimizing our scheduling,” says Bing.
In addition, VoIP has allowed the practice’s part-time and hybrid employees to work from home, which saves space. It also provides MCT the opportunity to serve its patients when the office closes for inclement weather. “We were able to close our clinic and still contact patients and conduct a bunch of telehealth visits from home, which patients were really appreciative of,” says Bing of when the clinic closed in February. “We were still able to take care of people who really needed to talk with docs.”
Patient access initiatives
Providing better access to care is a priority for MCT. At the start of the pandemic, the practice began offering patients the ability to fill out electronic forms prior to their visit. “It has been really helpful because we’ve been able to streamline administrative work and get consents filled out beforehand,” notes Bing.
Getting new patients to fill out paperwork ahead of time and having them registered has not only reduced wait times significantly, Bing asserts, it has also helped the practice schedule physicians more accurately.
The practice also recently added an online bill pay solution, which enables patients to conveniently pay their bills and set up payment plans. Moreover, MCT offers estimates on levels of service along with reviewing anticipated procedure costs with patients during the informed consent process. Bing notes this is especially useful for higher-complexity care, such as OB/GYNs discussing gynecologic surgeries or GIs explaining colonoscopy and upper GI endoscopy (EGD).
Bing points out that MCT does not currently have a system in place to allow for copay collection prior to a visit. That said, the practice is considering a platform that can automatically collect the patients’ portion of their deductible after a telehealth visit, which would eliminate the need to obtain that information over the phone.
MCT is also moving toward a remote patient monitoring (RPM) service line to help address chronic care management. “We don’t know the best practices, and setting up a program like that is pretty difficult to do if you’ve never done it because of the requirements and how unique it is integrating it into your current operations,” Bing says of their RPM program, which is set to launch in October via an outsourced vendor, with the intent to bring some of it back in house eventually.
Keeping costs down during inflation
MCT is currently focusing on two main areas to help reduce costs:
- Staffing — According to Bing, the practice has been able to stretch its office space by incorporating a variable staffing model, which centers on hiring part-time remote support staff. “We’ve always tried to stay slightly overstaffed so that we are able to operate effectively” in the event of employee sick days, vacations or emergencies, says Bing. “Having hybrid and part-time employees has allowed us to reduce our overall staffing capacity while still being able to pull on it by asking part-time employees to come in an extra day or two that week when they weren’t on schedule.”
- Telehealth — Bing notes that the practice’s clinic supply costs have dropped 25% to 30% due to an increase in telehealth appointments. “Everything from less paper to less table paper sanitizer — it’s small stuff, but it adds up,” says Bing. Telehealth has also helped the providers see more patients while reducing staffing levels for the triage team.
Although Bing maintains that most of the practice’s expenses have been managed well, one that they plan to address soon is the Consumer Price Index (CPI) adjustment in their lease. “We’re definitely not happy about it, as it’s our biggest expense behind staffing and the one that’s completely out of our control,” notes Bing.
During the past couple years, MCT has grown stronger as an organization because providers and staff have supported each other, treating employees as peers and championing their work. Bing takes pride in the fact that employees are continually reminded that “they are Medical Colleagues of Texas and without them our patients really would not get the quality care that we celebrate.”
Note:
- The Brookshire Times, Dec. 27, 1956.
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