#189 The Boring Work Is the Work

Show notes 

A physician built a solid, growing independent practice over six years, then got bored with the pace and chased three new ideas at once. None launched. The original practice still lost an estimated $180,000 in revenue degradation over twelve months, not from a bad decision, but from the boring work quietly going undone. This episode is the framework for staying in the room with it. 

The compounding cost of distraction.  

The revenue cycle does not tolerate divided attention. When leadership focus drifts, performance does not collapse, it leaks. A $350K-a-month practice that drifts for six months can lose $84,000 in net collections that never gets recovered. The shiny idea did not cost the money. The distraction did. 

The patience advantage.  

A boring denial-rate fix that recovers $8,000 to $12,000 a month compounds every month forward. A new service line that might add $5,000 a month creates complexity with no compounding. Patient money picks the boring fix every time. 

The boredom threshold.  

James Clear calls boredom the greatest threat to success. When the practice is working, the work stops feeling like progress and starts feeling like maintenance. The reframe: the boring work is not maintenance, it is compounding. 

The Five Shiny Objects That Cost Practices the Most 

The Shiny Object   

• Adding a second location before ops are solid 
• Switching EMR mid-growth 
• Launching a new service line 
• Hiring aggressively before systems exist 
• Chasing a new payer vertical 

What It Feels Like 

• Growth and scale 
• Modernizing and streamlining 
• Diversification and new revenue 
• Team building and capacity 
• Revenue diversification 

What It Actually Costs 

• 2x overhead, fragmented leadership, billing gaps at both sites 
• 6 to 12 months of workflow disruption, revenue dip during transition 
• Core service attention drops, existing margin erodes 
• Payroll grows faster than revenue, management overwhelm follows 
• Credentialing lag, cash flow gap, billing team stretched thin 

Three actions this week 

• Name the hard problem you have been avoiding, and write it down. 
• Calculate what one boring fix is worth over twelve months (a 3% net collection lift on $300K a month is $108,000 a year). 
• Schedule the boring meeting that keeps getting skipped: weekly, named owner, standing agenda. 

Resources 

30-Day Revenue Recovery Plan (primary): 

eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan 

Book a call with Heather: 

calendly.com/heather-natrevmd 

Payment Posting Audit Checklist (supporting): 

eligibility.natrevmd.com/payment-posting-checklist 

Referenced: Atomic Habits by James Clear.

Transcript

SPEAKER_00 0:01

When you finally get your business down, you're excited, you're obsessed almost with the day in and day out details you can. But then the years go by, the business is growing, but the issues of a business distract you from what once felt joy. So you get the idea of maybe I can just start a new business or a new service line because it it almost feels easier. Welcome to Nat RevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency so you can have the business of your dreams. I'm your host, Dr. Heather Signorelli, founder of Nat RevMD. Let's get started. So today we're going to talk about the importance of the boring work in your current business without getting distracted by the shiny new object, a new business or a new idea that feels easier, but in reality, it's just that you've hit a growth period with your current business or you have an issue that you just don't know how to solve. And sometimes it feels like, well, I can just start something new because that feels easier than dealing with the current issues that you have at hand. So today we're going to talk about the strategies to help businesses fight through that painful moment of continuing to scale, dealing with those issues and growing, even if it feels like you're walking through glass. So many independent practice owners that I talk to have felt the same way. Gosh, we've even felt the same way in our own business. You build something that works. And then the thing that made it work, the repetition, the consistency, the grinding refinement, the 1% better each day with the same systems over and over again. It starts to feel like a ceiling instead of a foundation. And it's something, you know, starting something new starts to feel like a real opportunity, right? It's exciting. It's the thing that's going to spark your interest again. And Alex Hermozi, who you guys know I enjoy listening to, has spent years studying why intelligent, capable entrepreneurs actually fail to build the business that they're capable of building. So he basically says shiny object syndrome isn't a lack of focus, it's a lack of fortitude. We come to some hard problem we don't know how to solve. And rather than confronting the problem, we try to go back to problems we know how to solve with a new business or a new service line or a new idea. And that is doomed to repeat until we learn to embrace the hardship of figuring out the problem. He's basically saying this isn't a focus problem. It's a fortitude problem. And the shiny new thing is not more exciting than what you have. It's just easier. It does not have the specific hard problem that you're stuck avoiding. It is a return to the beginning where everything else felt possible and nothing has failed yet. And so you will build it until you have that same hard problem, whether that's operations, whether that's culture, whether that's staffing, and then something else is going to start looking exciting. And we work with practice owners and when we're sitting down and going over those top challenges or feelings of frustrations, whether that's staffing or billing workflows or how to manage expenses, there's that moment where they want to switch it up, right? Instead, they want to bring on the new location or the new service line or try new technology or switch EMRs. And so today I want to share the strategies that have helped both us stay focused in our own business as well as other practices that we work with. And as you guys experience every day, um, you know, being a medical practice owner, that hard problem almost is always kind of the same several things. And we'll talk about a few of those today, right? It's the billing workflow that you know is not quite right, but it has been broken badly enough and you don't know how to fix it. Or it's the office manager at a certain location who's fine, but just not excellent, or it's a denial pattern or eligibility issues at the front desk that just won't go away and would take a real sprint or a different approach in order to fix these. And of course, these are not the interesting problems, right? They're repetitive, they're operational, they're unglamorous, but they compound in the wrong direction every month that you don't address them. And so I'm going to start with the cost of distraction. The reason I advocate for staying focused and being patient. And then we'll talk a little bit about shiny object syndrome that can get the best of us. And if you feel like you're always starting the next cool thing, but unable to finish the boring repetitive issues that you know need your attention, then today's episode is for you. So, all right, let's talk about the compounding cost of distraction. So the reason the shiny object syndrome is so expensive in a medical practice is that the operations and especially billing metrics that you don't that that you get distracted from, that you start to ignore because you don't know how to fix them, right? There's they're sticky problems that aren't easy to fix. And it's easier to move on to something that is, you know, something you feel more comfortable with, right? Like you know how to hire the new physician because you've done that a million times. You know how to open the new location because you've opened one in the past. Uh, you know how to switch a technology because you've done that in the past. So that's easier to try and distract yourself from those versus dealing with the denial issue or the eligibility issue that you just don't really either know how to do or want to do that boring work, uh, or you don't have the right staff or team to be able to manage it on your behalf. And so that doesn't mean that you can't hire and delegate, but you need to make sure that you know your workflows, you have the right metrics, you hold your team accountable, that you have the right process in place before you move your attention away from those fundamentals and try and go and start something new. So here's what it could look like in a practice, right? Practice owner has built the successful practice, it's growing, patients are increasing, but not all the operational workflows, workflows are settled. So you may still have uncollected patient AR, you don't have a collection agency set up, denials are piling up, you're not sure how to fix eligibility issues, and they remain week after week. Again, that could be six figures of revenue on an annual basis, depending on your size, but it's stuff that you don't feel confident in how to fix and you or you don't enjoy fixing. You don't enjoy working through those workflows. Um, you don't enjoy holding your front office staff accountable. So instead, you spend three months diving down and do a new service line. And during those three months, the owner is maybe avoiding the denials or the workflow issues. You don't have somebody to delegate it to. So you just ignore it altogether. And those are the compounding issues that, if not addressed, your revenue is going to get impacted, your profits gonna be impacted. And so maybe that new service line is researched and maybe you start it, maybe you don't. But either way, this is the distraction away from what the real work needs to be in your practice in order to get the results that you that you want and also the results that you deserve. So today I want to remind you to list those hard things out that are going on in your practice, the things that must be done to improve your metrics or your operations or your revenue or your profit in order for you to get the results in your practice that you, that you want. And in a way, it's taking on those challenges that feel sticky, that feel hard, that you don't have the easy answer to, that really need your attention versus the shiny new project that maybe you know how to get started, right? You like those shiny new projects, but in reality, you're missing out on the easy wins that compound from a revenue perspective over the years. And so I want to talk about how to be patient, right? Because, and I say this as much to you as I say it to myself all the time, because it's really important to be able to stay patient. And Warren Buffett, whether you love him or hate him, has built more wealth through patience than almost anybody in the history of business. And it hasn't been through all of aggressive deals or this constant pivot. It wasn't through chasing the sexy new thing that was going on in the market. It was through finding something worth owning and then holding it for years after years over a long enough period of time. And he actually said the stock market is basically a device for transferring money from the inpatient to the patient. And medical practice or most businesses work the same way. Independent practices that stay focused on the operational excellence, that do the hard, uncomfortable things, or find the right people who can help solve those problems over and over again are the ones that are going to be here in 10 years. And they're going to be bigger than they were years before. They keep their denial rates low. They hold those weekly staff huddles, they keep their AR clean, they they have patient AR that's collected by the front desk. They're dealing with their eligibility issues. They look at those boring metrics over and over and over again and fix the same recurring problems over and over again. But it's those boring things that compound the performance every year in ways that are going to be invisible to you in month one or even month six, but are undeniable in year five. And so it's the practices that chase every new vertical or every new technology or every new service line, miss out on the compounding success if you were to fix the sticky issues that you're avoiding. And so I want to encourage you, if you feel defeated over not understanding your billing workflows or your metrics, or how to fix your no-show rate that's there, or how to get your eligibility issues addressed with your front staff, front desk staff, pick one issue at a time, workshop it, have a weekly meeting set up to where you're identifying your current stage of addressing that issue that you're holding your teen accountable and then moving on to the next one before moving on to a shiny new object or shiny new service line or a new location. Like fix the operational and the culture issues or the staffing issues before you move on to the next. And I tell you, these fixes are boring. It's the same metric meeting, it's the same darn staff huddle and it's not sexy, it's not always fun, but it's the necessary work that someone has to do. And again, you can delegate that and hire somebody to be that second person in command, but they also then have to have the authority and the ownership over those decisions, or you need to be able to stay as involved in order to be able to make those decisions. And there's different ways to set that up. But if you don't have that right team helping you fix your staffing problem or those frameworks, um, then those hard problems are still going to exist, even if you go get distracted with the new idea that you've got on your mind. And, you know, Buffett also says that someone is sitting in the shade today because someone planted a tree from a long time ago. And so that clean workflow you build this quarter is the shade that you will sit in for the next five years. And the shiny idea that you chased is instead the tree you never planted. And let's talk a little bit about boredom because I think I've been there, I've seen practices that we work with go there. And a book that I really like is Atomic Habits. So James Clear is the author of that book. And he provides a very practical framework for understanding why people abandon things that are working. And so in his book, Atomic Habits, he identified what he calls the greatest threat of long-term success. And it's not failure, it's not competition, it's not the wrong strategy. He says that the greatest threat to success is not failure but boredom. When we get bored with habits because they stop delighting us, the outcome becomes expected. And as our habits become ordinary, we start derailing our progress to seek novelty. And basically he's just saying the outcome becomes expected. That is the moment most practice owners or business owners even have shiny objects that start to appear. The practice is working, collections are predictable, the tree, the team is trained, the systems are running, and because everything's working, the work stops feeling like progress and starts feeling like maintenance, maintenance. So the novelty's gone and the novelty goes where energy goes. He also says the difference between a professional and an amateur is the professional still shows up when the work is boring. The amateur lets life get in the way. The amateur finds something more interesting. The amateur is in a medical, you know, context, starts exploring a second location when the first one has a denial rate problem or a staffing problem that nobody has addressed in months because it's just not exciting anymore to prioritize. And so here is what falling in love with boring actually looks like in the practices that we work with that continue to be successful, right? So it looks like the standing monthly billing review that nobody misses. It's that weekly front desk huddle looking at eligibility issues, addressing process workflow struggles. It's also that weekly review of no shows and new patient volume. It's reviewing those expenses bi-weekly with your accountants so that you can really understand how your expenses and your revenue are comparing, so that you can reassess compensation for underperforming physicians, or you can address, you know, no shows and be able to charge for those or put a credit card on file in process. It's dealing with the patient AR that keeps coming over and over again. None of these things are interesting, but they all compound if they get addressed. So the reframe that changes everything, right, is that the boring work is not maintenance. It is compounding. Every month that your denial rate holds steady or your patient AR remains low is you accumulating a performance advantage compared to a competitor that chases the novelty of things that you think look cool. And you do not need to feel it in that month or even in that year. You're gonna feel it years down the road when your profit is above the market average. And you generally do not exactly know when that happened, but it's basically what happened in all of those boring meetings that you continue to show up for. It's in the boring meetings that you address workflow issues again, even though you feel like, gosh, I should have already fixed this once, because those things come up over and over again. And when I think about the fine, the shiny objects, so I'll go over five of them that we see practices get distracted with. It's just something for you to think in the back of my head. Am I chasing after a shiny new object because I don't want to deal with the real issues? Or am I really ready for this shiny new object? And these are the things that we see cost independent practices the most because they're almost, it's almost like a disguise, right? So it feels like you're doing something that you really need to do when in reality, you're reality, you're ignoring the simple, easy things that are more important, but maybe harder to do. So things like a second location before operations are solid, or you have solid revenue at the first location. And so it feels like you're scaling and it feels like, okay, that's that's the direction I need to go. But what it buys you is double the overhead and billing gaps that may be at both sites, or profit gaps that are at both sites, or it feels like an EMR switch, mid-growth, where it feels like, well, gosh, there's an issue with the other one, or I don't like the other one, or it has the other, a new one has a feature that you think you absolutely need. And then it buys you a better part of a year in workflow disruption because you're dealing with EMR switches instead of building patient volume. Or it can be a new service line that feels like um you're diversifying, but in reality, you you still have issues with the current service lines that result in lower profit margins than you would like. Or maybe it's aggressive hiring before you have systems in place to build up at the right team and then payroll is going to start outrunning revenue. All businesses have this distraction issue. It may be you avoiding the boring problems that you already have and that haven't been addressed. So the practice that compounds in terms of growth and revenue and profit is not always the most creative one. It may not even be the most tech savvy one. It is the one whose owner was willing to stay in the room with the boring problems long enough for the repetition to become the advantage, right? And you're hiring the right people to take on these tasks week after week. You're listing out these problems, you're crossing them off one at a time, and you're avoiding the shiny objects that feel easier. You're really focused on the things that need your attention. And again, when you cross all of those off and you've got the revenue and you've got the profit and you're ready for that next new service line, I'm not saying don't do that or don't get the next location. Just make sure the operations and the workflows and the huddles and the meetings and the things that feel boring are continuing to go on day after day, week after week, month after month, before you move on to the next. So, in summary, the three actions we'd recommend for our teams, and again, things that we have our own practices that we work with, you know, recommend when they come to us with some of these dilemmas is I want you to name the hard problem or problems that you've been avoiding in your practice, right? So maybe it's new patient volume, maybe it's payer contracting, maybe it's billing workflows, maybe it's understanding what your billing metrics even mean, maybe it's patient AR, which I think everybody can say say that that may be on their list. You have one. You have more than one, I'm sure. And so list these out and list, okay, so what is the name? Name the problem, right? First, name the problem. Identify, you know, what is it that you're stuck with in solving this? Is it a who problem or is it a time problem, or is it I'm just not focused on it problem? But then sit down with your office manager and have the conversations of why we're putting these things off and then set up the workshops on a weekly basis to address these. Because sometimes it's easy to say, oh, well, I'll get to it. But then if you set the weekly meeting with the right people in the meeting to go and address these things, and you set those weekly meetings recurring until it's addressed, you're gonna get progress. And so write these things down, um, name them. And as Alex Hermozy says, the shiny object only appears when the hard problem makes you want to look somewhere else. The moment you name the hard problem and commit to staying with it, the shiny object loses most of its appeal, its power. So it could be your billing manager, it could be your director of operations, your COO, whoever it is, have them help you identify those problems. And then you have to decide to stay in the room, to delegate the problem, to make sure and hold those people accountable that are responsible for addressing it before you move on to the to the next shiny object. So the next thing is you could even try and look at those problems and try and address, okay, what would that problem, if I don't fix it, cost me in an annual basis, right? So is it eligibility issues? Is it a lack of growing patient volume? Right. And again, you're not solving those problems because it's easy. You're not solving those problems because it's hard. And so again, that could be a who problem, that could be a how do we fix it problem. But addressing those and figuring out how to handle those problems are going to save you money in the long run. And again, that could be five, six figures annually, depending on the problems that you're naming. And then last is I want you to then pick one of those problems. Again, who's gonna be the owner, and then schedule the boring meetings that maybe you've been skipping or avoiding putting on the calendar. Every practice has a meeting that they probably should be having but aren't. And I want to make sure that you're having those. So maybe it's the weekly how do huddle with the front desk staff. Maybe it's you haven't been going to the monthly billing meetings or you're avoiding the charts to sign out because you just don't want to deal with the fact that you have a hundred of them or 200 or 300 of them and it just feels overwhelming. Mark the time on your calendar, start addressing the hard things and eat that frog, as folks will say. And, you know, James Clear is right, the professionals stick to the schedule and amateurs are the ones who let life get in the way. And the meeting is the schedule. If it is not on the calendar with a named owner and a recurrence and an agenda and a goal at the end, the boring work is not going to get done. And the boring work is what's going to compound your success year over year. So practices do not always lose revenue because of bad decisions, right? But because maybe no decision was made at all or somebody wasn't held accountable. And so if you are looking at your practice right now and recognizing the gap between where your, you know, revenue or your billing performance is and where it should be, that gap didn't appear overnight. And it's not going to close it by itself and it's not going to happen, you know, immediately. So we do have a 30-day revenue recovery plan, is the exact framework we use to find boring problems in practices. And so you can download it for free. Show notes will have the link. And if you want us to name the hard problem for you, we do have a free metric audit for practices that qualify. Head on over to our website, notrabmd.com, and top right hand corner will get you to that page. Um, all right, thanks so much for being here. We recognize, and the reason I did this podcast is because our team also struggles with this, right? It's always fun and exciting to chase the next cool thing. But in reality, it's doing the boring work over and over again that helps us serve our practices and helps our practices serve themselves as well. So hopefully you enjoyed this podcast and the next week.