Case Study: Reiter, Hill, Johnson & Nevin
Innovating for the Future of Women’s Health
In existence for more than 40 years, Reiter, Hill, Johnson & Nevin (RHJN) is currently the largest privately owned OB/GYN practice in the Washington, D.C. metropolitan area with a team consisting of 24 providers. The practice has had a longstanding affiliation with Sibley Memorial Hospital, a part of Johns Hopkins Medicine, where RHJN practitioners attend more than 40% of all deliveries.
In a world of rapid consolidation and intense competitive and cost pressures that is squeezing medical practices nationwide, RHJN has maintained its independence through a successful model build on a collaborative culture, a family atmosphere, an integrated approach that brings together doctors, physician assistance and nurse practitioners on a unified patient care team, and an aggressive, practice-wide commitment to innovation and quality assurance. As a result, the practice works hard to avoid falling into ‘This is the way we’ve always done it’ assumptions and everyone remains focused on pursuing new ideas and emerging models that can improve patient outcomes.
Three years ago, the practice’s partners hired Jason Miller to serve as practice administrator. Jason came to RHJN with prior experience as a healthcare consultant at Booz Allen Hamilton and for the U.S. Department of Veteran’s affairs, and he holds both an MBA and the Certified Medical Practice Executive (CMPE) certification. Upon joining the practice, Miller become involved in many of the practice’s core innovations, including its commitment to expanding patient access to in-office procedures; enhancing patient ease-of-access to the right care; and carefully monitoring risk management indicators and priorities.
Despite its innovative culture and successful track record of growth, Reiter, Hill, Johnson & Nevin still faces many of the challenges endemic to the healthcare industry. One is the process of renegotiating and enhancing annual contracts, both with providers and with payors, to ensure that the practice is operating efficiently and effectively. Another priority is to ensure that every provider stays focused on accurate use of the practice’s Electronic Medical Records (EMR) system, both in terms of recording and managing patient care information, and also in regard to billing, coding and protecting the practice’s ability to properly charge insurers.
One of the areas in which Miller identified significant opportunities to improve operations was in accounting, which had been managed previously through a combination of a heavily manual in-house process and some support from an outside accounting provider, overseen by Miller’s predecessor who had been with RHJN for 17 years.
In addition to being enormously time-consuming, the process was also not designed to support internal assessments and reviews to identify errors or increase accuracy. In short, the process itself was so cumbersome that just maintaining the day-to-day workflow became an overriding priority.
Recognizing these issues, Miller began investigating options for re-engineering the accounting process at RHJN. The practice’s employment law counsel recommended LTBD as a firm worthy of serious consideration. Miller and the RHJN leadership interviewed LTBD as well as four other firms. “LTBD came to the table not only with a range of services they could provide, but also with common-sense recommendations for how to make major improvements,” Miller says. Among LTBD’s recommendations: separate accounting operations and tax accounting so that they are managed by two independent firms; improve transparency and accountability by ensuring that processes are clearly documented; and configure workflows so that accounting activities provide the right data to support high-value reporting.
At first, Miller was hesitant because the changes LTBD proposed were significant, but in the end it all worked out and it has become a huge success. “Ultimately, we chose LTBD due to the overall model that they offer, where Tim Hawkins or another CFO-level expert is involved — but that person is also not the only resource a client will be partnering with,” adds Miller. “LTBD takes a team approach, and in doing that they’ve create a truly symbiotic and aligned working partnership with us.”
As a result of partnering with LTBD, the practice has experienced dramatic results on many levels. First, the core daily, weekly and monthly accounting processes are being managed with greater precision, accuracy, efficiency and productivity. Second, the process improvements have led to the development of new and enhanced reports that provide Miller and practice leaders with the data they need to identify trends and make strategic decisions. Third, RHJN’s shareholders have been empowered with more accurate, in-depth and informational reports and quarterly briefing presentations. And fourth, Miller’s own time has been significantly freed up, allowing him to evaluate and pursue new strategies to improve the practice overall. In addition to these enormous benefits, the new model involving LTBD actually costs the practice less than the prior inefficient, hybrid model.
“LTBD is not a conventional, cookie-cutter accounting firm,” adds Miller. “They very, very much think outside the box, they really look at the whole picture and ask, ‘Do you really want to do things this way…instead of doing it better that way?’ The configuration and setup of the new model took some time, but now we can ask a question and receive an answer in a matter of minutes, because they are so well organized. They really do look at the whole picture — they look at everything before making a suggestion or offering a solution. As a result, they really do come up with innovative ideas to deal with processes or provide better reports. I would highly recommend LTBD to others, without any reservation.”