When Bob Lodes took over as administrator for Mississippi Sports Medicine & Orthopaedic Center (MSMOC) in the fall of 1989, he masterfully laid the groundwork for success for the three founding physicians and 18 employees.

Today, Lodes is widely revered in medical circles as the consummate practice manager, and MSMOC is known nationally as one of the most comprehensive clinics of its kind. The clinic has grown to 14 partner physicians, including two specialists who recently moved from the University of Mississippi Medical Center (UMMC). MSMOC’s prestigious sports medicine and arthroscopy fellowship program adds five fellows under the roof, with one fellow rotating to Tulane University on a 5-week cycle. X-ray technicians rotate through MSMOC, as do residents from UMMC. Mississippi College leaders recently dropped by to see if the practice would consider rotating physician assistants; absolutely, Lodes said. Including the MDs and a nurse practitioner, MSMOC has more than 160 employees.

“I know everyone by their first name, save one or two,” said Lodes, a constant fixture roaming the halls of the clinic, always wearing a crisp white shirt and tie with a suit or dress slacks. “How’s your mother doing?” he stops to ask a doctor. “How did your son do on that math test?” he asks a nurse. “How are the wedding plans coming along?” he asks a patient scheduler. He has mastered the art of genuine compassion at an arm’s length, always cognizant of maintaining a professionalism distance. “It takes practice,” he admitted.

Juggling various programs and partnerships, while managing a busy practice, requires a great deal of organization. Schooled in the practice of the One-Minute Manager, Lodes would love to have every board meeting agenda reduced to one page, with talking points covered in less than an hour. These days, particularly with a renewed focus on community outreach projects, board packets are more than an inch thick. It takes an afternoon every week to review the material.

“Right now, our biggest challenge because of our size is how to give back to the community through outreach programs that fit into our business plan,” said Lodes. “It’s still a trial and error process.”

So what’s the secret of running such a large practice seemingly seamlessly?

“Communication and accountability,” said Lodes. “I’m very passionate about accountability from my CFO days, customizing benchmarks to achieve goals and to be true to the mission of the practice.” 

To ensure the practice is on track, Lodes has in place a patient survey that rates the complete patient experience, from the patient scheduler to the physician to the physical therapist to the billing administrator. If something’s askew, he calls the patient directly to address concerns. He also compares internal employee surveys with employees’ self-rate systems annually.

“We review and tweak our processes – for physicians, patients and personnel – until they fit what we’re trying to accomplish,” he said. “It takes time to do that.”

RELATED STORY -BIO: Robert R. Lodes

A native of Wisconsin, Bob Lodes learned a strong work ethic during his childhood days on the family’s dairy farm. In fact, he is so dedicated to his work that until surgery earlier this year required him to miss two days of work, he had only been absent one day in 22 years.

In the 1970s, Lodes headed south after earning a business administration degree and posting four years as business manager for the 60-bed Calumet Memorial Hospital in his home state. He chose Mississippi so he could “play golf 10 months out of the year instead of four,” he joked.

Lodes joined Humana as a controller for the 101-bed Natchez Community Hospital “at a time when we used to count the forks and spoons when we left a room. I call that a bit cost crazy,” he said.

He made a home in Jackson in 1976, joining Respiratory Care Services as CFO. The company sold to American Medical International in 1984. Until he joined U.S. Axminster Inc. in Greenville in 1986, he spent two years consulting on financial matters for Inhalation Therapy Services in Lexington, Mass., and Mississippi Medical, a development company that acquired small durable medical equipment companies.

“I’ve always been good with numbers and relating them to people,” he said. “Financials are nothing but a report card – not a goal – and the key is to understand what comprises them and whether the bottom line serves the overall goal.”

The 3-year CFO post for the manufacturer of Axminister Woven Carpets in the Delta ended with a successful merger. Then he learned about a new sports medicine practice opening in Jackson that needed a practice manager. He has been at that practice, Mississippi Sports Medicine & Orthopaedic Center, since 1989.

“I enjoy what I do, who I work with, and for. Not everybody can say that,” said Lodes, whose initial goal was to be a hospital administrator. “This is, in many ways, a mini-hospital with its ancillary services. It’s my dream job.”

RELATED STORY: The Practice Manager’s Manager

In a rare personal interview, Bob Lodes, administrator of Mississippi Sports Medicine & Orthopaedic Center (MSMOC), shared his views on changes in practice management, the landscape of post-healthcare reform, and Mississippi culture.

How has practice management changed over the last several decades, and how have you adapted to those changes?

I’d say major changes cover three subjects: technology, regulations and reimbursements, and personnel.

1.     We’ve embraced technology, which covers many areas. Ten years ago, I had no staff dedicated to IT; now I have three. We’ve been paperless regarding patient chart information since 2006. The electronic part of the practice management side has made our practice extremely efficient and seamless, and has connected us with clearinghouses that serve as an important business tool. We have more than 200 wireless devices in place to keep the practice running smoothly. Then we have technology that’s advanced in equipment, such as digital x-ray machines and the hana® table, which allows surgeons to use the anterior approach for hip replacement. Fortunately, prices on some technology have dropped over a few short years. For example, we have five digital x-ray machines. The first digital x-ray machine cost us $500,000; we just paid $200,000 for one. It’s a constant balancing act: How can we better manage costs and still have a high quality patient experience? Partnerships (with River Oaks and Baptist Hospital, for example) have been very important.

2.    Regulations and reimbursements. Just keeping up with them and understanding the changes is a job in itself. I’ve been in the hospital/healthcare field now for nearly 40 years and I always tell the story about 1972, when President Richard Nixon implemented price freeze to curb what he deemed outrageous healthcare costs. It was a very sensitive subject. I remember writing a check to a patient for $3.52 because we unknowingly violated some type of price freeze regulation. More recently, Congress has kicked the can down the road on SGR cuts for many years now. It’ll be interesting to see where they end up. Healthcare costs have been spiraling for 40 years, and everyone’s tried to add a Band-aid to it. First, it was within the hospital market. Now, it’s outside hospital walls. Baby boomers are going to put a greater pressure on the system. Overall, I’ve taken threats regarding regulations and reimbursement issues as an opportunity. At MSMOC, we look at how we can think outside the box, especially because we take care of everyone, following the mission statement of our doctors. We do have some headaches with worker’s compensation, mostly because of the pre-certification process, but we take all comers.

3.    Personnel.  We work hard to hire special people who have a higher set of skills, whether it’s a skill set as a clinician or computer skills or social skills. We hire compassionate people. We have high expectations for patient encounters. My philosophy has always been: smile or go home. That hasn’t changed over the years. We’ve had an employee handbook for 20 years – I wrote it my first year on the job – and we’ve obviously updated it as needed so everyone knows what’s appropriate and expected. We’ve also nurtured employees who wanted to continue their education and advance within the organization. I continue to – and always will – have an open door policy, though I encourage employees to first go to their department head with concerns. Here’s what has changed: personnel used to be a combined role with me and an assistant. Because we have so many employees and related required paperwork, and cover a wide range of labor grades, there’s now an entire department devoted to human resources.

What are the most pressing issues that practice managers are facing today, particularly as an unprecedented number of mandates take shape this year and next?

Whatever the U.S. Supreme Court decides on healthcare reform, there’s going to be some type of pushback on some type of reimbursement process. There are some very good parts to healthcare reform; some are nebulous unless there’s a good definition, like meaningful use. We were reimbursed at the end of 2011 for electronic medical records implementation, and we’re firmly in phase 2. We’re fortunate the software we selected was very aggressive concerning compliance issues.

Ongoing rules need to be developed; other rules are coming out. The issue of ACOs will be interesting to see unfold. I don’t know if we’re ready for capitation care, because Mississippi is very rural. You’ll see more partnerships evolving between hospitals and physician groups. If you’re a large group, you have to consider it, as long as both organizations’ philosophies match.

Do you have three gems of advice to pass along to young practice managers?

• Have good processes in place; keep them simple.
• Practice management by walking around. Every day, I walk the floors. Employees are an important resource.
• Be a good listener. If you are, you can communicate very well.

Have you ever implemented a practice that you regretted?

Yes, casual Friday. I tried it once and was surprised by the change. One employee came to work in clothes that were better suited for late night TV viewing! I’m not a jeans person, but I tolerate it on Saturdays. The employees rib me about that.

What legislatively needs to change (or has recently changed) in Mississippi concerning practice management and the state’s healthcare industry?

Before tort reform (in 2003 and 2004), many orthopedic doctors didn’t want to stay in town. We have a better environment now, and many decided to stay. With the Mississippi Supreme Court upholding those legislative changes, I believe state lawmakers have done a very fair job for both sides. However, we want to continue tort reform efforts, to see the numbers tweaked a little more in a way that still makes sense for patients and businesses. We’re constantly monitoring it.

The state Medicaid program is always on the forefront because of the reimbursement processes and funding mechanism for it. Not everyone takes all comers, and we sometimes end up as the last resort for patients. We wish Medicaid would provide more encompassing care so we wouldn’t be so limited to what we can do for patients.

When you’re not in the office, what do you like to do, in addition to playing golf?

My wife, Marie, also known as Mimi to the grands, is semi-retired. Between us, we have three children – Christy, a mother of five; Jason, a father of two; and Grady (who sells sports medical implants for Smith & Nephew in Shreveport, La.). Our seven grandchildren range in age from four to 17. We keep two of them four nights a week. We’re very much involved in their lives; they love water sports and are getting to the age they can be more helpful.

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