One of the finer points of physician practice management is knowing when to use your practice's own resources to accomplish a goal and recognizing when those resources aren't adequate. If you have defined the scope of a practice project and decided that it's time to hire some help, this article will guide you in establishing a successful relationship with a consultant. A consultant myself, I'll review some guidelines for working with a practice management consultant that I generally provide to my physician clients.

Selecting a Consultant
Prepare a request for proposal (RFP) and/or meet with a prospective consultant to explain your needs. Understand what skills the consultant should possess for your particular project, such as:
• Unique technical skills;
• An understanding of practice operations;
• An awareness of the health-care market and delivery patterns;
• Specific optical training;
• Billing and coding knowledge;
• Clinical experience; and
• Financial analysis skills.

Let's say that you're considering opening a satellite office. You would want a consultant who knows the local community and is familiar with or has access to information about the surrounding health-care marketplace. Perhaps you would like to improve your office automation (add an electronic medical records system, purchase new practice management software), upgrade your telecommunications and have all of these systems interface with one another. You would seek out someone with an understanding of practice operations, knowledge of technology options and available practice management products. Alternatively, if you are interested in a chart audit, you would look for a consultant with billing and coding knowledge specific to ophthalmology.
Also, don't overlook personality; you should hire a consultant with whom you have a rapport and are comfortable. Interview the consultant, much in the same way you would interview a candidate for employment. Does she have the skills? What is her previous experience in similar engagements? Finally, be sure to check references.

Get On the Same Page
The physician(s), the office staff and the consultant all should understand the purpose of the project for which the consultant has been engaged and the deliverables she will produce. A mutually satisfying consulting engagement is characterized by:
• A clear understanding of the purpose and scope of the engagement.
• An understanding of the nature of the deliverables: Are you expecting a policies and procedural manual? A final presentation to the physician partners? Help in implementation?
• Realistic deadlines. If you're asking the consultant to assist you with an office expansion, don't wait until you have a month left on your lease to ex-plore moving the practice to a larger location.

The Agreement
After interviewing and selecting a consultant, expect her to prepare what's known as an engagement letter. This document addresses:
Scope of the project. The consultant outlines what she understands the goals of the project to be and how she plans to tackle it.
Responsibilities of both parties. The consultant may provide a list of information, data, etc., that she needs. For example, if the consultant is as-sessing your human resource overhead, she may ask for a staff listing in-cluding job titles and hours of work. If the consultant is assessing practice op-erations, she may ask for appointment templates, office manuals, etc.
Fees. The fee structure may be on an hourly or per-project basis. Typically, fees for consulting engagements like operational assessments, practice valuations and coding analyses are quoted on a per-project basis. Fees for ongoing support services, with less defined/recurrent time frames, may be quoted on an hourly basis. The consultant may require a retainer before services begin.
Billing. The consultant's proposal will address when you will be billed and when payment is expected (i.e., x% before the start of the project, with the remainder due on presentation of written report.) Out-of-pocket and travel expenses should be clearly ad-dressed.
Deliverables. The consultant will detail the nature of the final project: PowerPoint presentation with handouts, a written report and/or recommendations, policy and procedural manual, etc.
Time. States the availability of the consultant and length of time she estimates it will take her to complete the project.
Implementation. The role, if any, of the consultant in the implementation of the project.

Carefully review the engagement letter and ask yourself: Does it address your proposal needs and the project's implementation? Will the consultant's work plan fit with your practice? For instance, can she easily meet with those she will need to interview? Will she have access to the necessary records and materials? Does her plan seem appropriately directed? For example, does it make sense to talk with all of the support staff to do an assessment of billing practices?

Getting to the Final Product
Don't expect that you can hire a consultant and see her again six weeks later with a final report ready. The physician or the office manager must be accessible during the engagement. Your insights about the practice will help ensure a practical final product, one that is tailored to your practice and will work. It is not a bad idea to look at the proposal again during the consulting engagement.

To make the consultant's relationship with your staff smoother, you'll want to prepare them for the consultant's presence in the office and his or her questions. Your staff shouldn't feel undermined. Explaining the purpose of a consultant to your staff will ensure that she gets accurate information. You don't want staff resistance to impede any fact gathering or implementation.
Neither the practice nor the consultant wants the final product to end up on a shelf collecting dust. With clear direction, common goals and careful planning, the consulting engagement can provide the practice with much needed advice and guidance. 

Linda Cutler is a physician practice management consultant. She can be reached at (215) 568-3579, or by e-mail at