Turning around a financially distressed practice: the operational review.

Given substantial changes in the marketplace, many physician practices have responded by growing rapidly, merging with or acquiring other practices, or selling the practice to physician practice management companies (PPMCs) or hospital systems. The hoped-for economies of scale, increased market share and profit, or other goals often have not come to fruition. Many practices now find themselves in difficult operational and financial circumstances. This article describes how group practices can solve such operational and financial problems while retaining independence and strategic control of the practice. The strategy involves retaining a professional turnaround company with expertise in reestablishing the financial security of group practices. The article provides characteristics of how turnaround companies operate and the key elements of operational reviews, the tool used by turnaround companies to detect and analyze existing practice problems. Operational reviews include organization analysis, management review, and financial analysis, each of which is described in detail. Finally, the article provides an in-depth case study of how one turnaround company reestablished the financial security of a nine-physician internal medicine group within a 2-year period.