Prepare Your Pediatric Practice for Q4: 8 Year-End Priorities

The end of the year can feel like a sprint to the finish line for pediatric practice owners. Between well visits, vaccination clinics, end-of-year reports, and everything else vying for your attention, there is plenty to accomplish. But the start of Q4 also gives you an opportunity to step back and take stock. With most of the year behind you, you have the information to see where you and your team stand, identify what still needs attention, and make thoughtful moves for the year ahead.

We asked PCC’s Chip Hart and Alex Meyer, MBA what pediatric practice owners should consider as they prepare for Q4 and beyond. Drawing from their experience consulting with hundreds of independent pediatricians, Chip and Alex offer practical guidance for understanding your practice’s financial and clinical metrics, identifying meaningful gaps, and focusing on what you can realistically address before the end of the year.

Here are eight priorities to consider as you prepare your practice for the last quarter of the year.

1. Review Your Pediatric Practice’s Key Metrics and Trends

As in our previous post on how to prepare for Q1, Alex and Chip’s first recommendation is to identify the key metrics that can help you understand your practice’s financial and operational health and plot a course for your goals. The last quarter of the year is a good time to revisit those metrics and look at how they’ve changed throughout the year.

If you’re newer to tracking metrics, select a few that help you gain understanding, and add a few more annually. Some that Alex and Chip suggest include:

• Sick vs. well visits
• Well visit distribution
• New patient ratio
• Patient panel growth or shrinkage
• Revenue vs. projections
• Clinical measures
• Schedule utilization
• Staff overtime
• A/R aging
• Progress toward annual goals

Your goal for measuring metrics should be to identify trends over time, rather than specific numbers. For example, are you gaining fewer new patients this year, despite meeting well-visit targets? That’s a trend to identify and address early — learn how to identify and leverage leading metrics in our previous post.

“Metrics often aren’t useful as a single data point,” Alex explains. “You need to see the trend over time to understand what’s happening.”

A single number rarely tells the whole story. The useful question is whether the number represents a meaningful trend, and whether that trend makes sense in context. A decline in well visits may be expected for a physician winding down toward retirement. A steady decline in new-patient growth with no obvious explanation deserves attention.

Chip cautions practice owners against two opposite mistakes: overreacting to a number before understanding it, and explaining away a real problem after the trend becomes clear.

“The biggest thing to watch out for is that pediatricians can react too quickly and without enough context. So there's context setting, but then there's also denial.” — Chip Hart

A useful Q4 review asks both: What does the data show? And does the story we are telling ourselves about it fit the evidence?

2. Identify What You Can Still Accomplish Before Year-End

By the fourth quarter, your annual goals should serve as actionable checkpoints against observable performance. You now have enough information to determine which of these goals are within your practice’s reach, which need refinement, and which goals may no longer be realistic.

Start by comparing where your practice is now with where you wanted it to be — then determine which gaps you can still close before year-end. This is particularly important, Alex notes, when your practice participates in payer incentive programs or other performance-based plans.

"The time to look at your progress toward meeting payer incentives is at the start of Q4," Alex says. "Figure out what your gap is and make your plan to close it. You don't want to find out in January that you missed your well-visit rate bonus by ten well visits, to the tune of $100,000."

Questions to consider when your aim is to close the gap on your goals:

• Where are we now?
• What is the gap between our metrics and our goals?
• What would it take to close the gap?
• What’s realistic to accomplish during Q4?

You can't change everything before the end of the year. But you can identify what is still within your control and focus your energy there.

3. Don’t Wait: Complete Year-End Tasks Now

Your tasks are difficult enough without adding a deadline and a holiday schedule. If you know your practice has year-end work to complete, early in the fourth quarter is the time to get started.

That might include:

• Reviewing or implementing planned fee-schedule changes
• Pre-purchasing vaccines
• Completing end-of-year reporting
• Preparing for a known contract or payer change
• Finishing other projects or commitments with a deadline

Give yourself plenty of time to implement these tasks and incorporate delays, especially if other people need to weigh in. Alex's advice is blunt but honest: "You're not going to get a call back from anybody – except PCC! – in the last two weeks of December." To prevent delays or missed connections, plan days or weeks ahead of time for any calls or meetings you need to organize around year-end and holiday schedules. That way, your tasks are completed early or on-time, and you can tie up loose ends before the first quarter’s fresh start.

4. Review Past Performance to Prepare Your Practice for Fall and Winter Demand

Q4 also marks a major transition in the pediatric practice calendar. As summer well-visit demand gives way to vaccination clinics and the return of respiratory illness season, Chip recommends taking the opportunity to look back on your summer well-visit volume as you prepare to transition to fall and winter demands.

"One of the things that I would do right now is ask, ‘Did we accomplish the well-visit volume this summer that we needed to accomplish in order to maintain a high well-visit coverage?’”

Take a look at whether your practice is ready for fall and winter:

• Assess staffing needs for upcoming holiday breaks
• Review your schedule and plan ahead for the increase in demand for sick visits over the winter
• Review your workflows and work to resolve any recurring workflow, staffing, or scheduling issues you are encountering

The summer well-visit rush is just one season of your practice’s year. As you approach the final quarter, it’s time to turn the page from summer to winter, and shift your focus to the months ahead. Once you know what’s working for your practice right now and what isn’t, you can begin to make a plan that supports your goals and, importantly, helps prevent overwhelm.

5. Choose One Problem to Solve in Q4

Chip and Alex have seen a common phenomenon at pediatric industry events: someone comes away from a conference, meeting, or class with a long list of everything their practice is going to change or achieve this year. Once they return to their practice and the demands of daily routines, that list can get pushed aside, making it difficult to move from goals to action.

While it’s important for pediatricians to get out of the office to gain inspiration and support, it’s not necessary to tackle everything at once. Instead, begin by identifying a problem, deciding what you're going to do about it, and assigning ownership rather than creating an enormous list that nobody has the capacity to address. Chip sees iteration as a way to build momentum.

"It’s all about making an incremental improvement," he says. "If there's something that you feel that you can get your hands around to make a change in your practice, that will give you traction to climb the ladder to the next problem."

In other words, don't let your vision of the ideal pediatric practice prevent you from making a useful improvement. Start by identifying the problem with the greatest potential impact on patient care, practice revenue, or both. If that problem is too big to solve in one quarter, break it into a smaller piece. What's one part of the problem you can meaningfully address in 90 days?

And don't assume you have to own the solution yourself. Alex describes quarterly leadership meetings as an opportunity to bring the right people together and ask a few straightforward questions: “What are we going to do about this problem? Who is going to own it? What are they going to do about it in the next 90 days?”

Inspiration is important. So are realistic goals and collaborative planning to reduce your overwhelm and embrace incremental change. Start with one goal. Assign it an owner. Check in on progress regularly, and adjust as needed. Build that momentum, and then you can move on to the next challenge.

6. Start Planning Your Pediatric Practice's Goals for Next Year

Preparing for Q4 isn't only about finishing this year out strong. It's also an opportunity to start thinking about the year ahead.

This is an important opportunity to step out of your usual routine and consider where you want your practice to go.

Questions to ask:

• What worked well this year that we want to carry forward?
• What should we stop doing?
• What do we want to accomplish next year?
• What needs to be prepared now?
• What needs to change?

Alex recommends making time for this kind of planning outside the daily practice environment. "Get out of the day-to-day firefighting and really focus on the practice as a whole," he says.

That can be especially valuable when you consider what January looks like in pediatrics. After the holidays comes the crush of sick season. Pulling your leadership team away from the practice for an extended planning meeting may be much more difficult once January arrives. Consider an early December meeting, or delay until February if that suits your needs better.

7. Review Your Practice's Long-Term Goals and Financial Health

It's easy to spend so much time thinking about the next quarter that you lose sight of the next five or ten years. Or maybe the idea of planning for the next decade feels overwhelming. Q4 is a good time to zoom out.

"I think it's a good time to really stop to consider the mission, the values and the one-, three-, five-, and ten-year visions for the practice," Chip says.

Chip’s advice is to take a look at the bigger picture: Does the way you're running the practice today support the future you want to build?

1. Revisit your practice's mission and values.
2. Think about where you want the practice to be in one, three, five, and ten years.
3. Consider what needs to happen to move from where you are today toward that vision.

This is also a useful time to review the practice's financial health and consider whether a practice valuation is due.

A valuation isn't only relevant if you're preparing to sell. Understanding the value and financial position of your practice can be useful for long-term planning, ownership decisions, succession planning, and other major business decisions.

The point is to make sure the practice you're operating today is moving toward the future you envision, whatever your goals may be.

Every practice owner's long-term goals will be different. You might focus on excellent patient care, adding another partner or practice, participating in research, or pursuing something entirely different. Think creatively about what you want your practice to become.

That’s a theme shared by Dr. Tanya Altmann, MD FAAP, on episode 24 of Charting the Future with PCC: “I think there's so many things you can do as a physician outside of the exam room walls to help kids and families live longer, be healthier, be happier, more successful.”

8. Delegate Q4 Priorities, Build Leadership Across Your Practice

Once you've identified your Q4 priorities, it’s time to take a hard look at who is responsible for making them happen. Practice owners can't personally own every problem, though many try.

"I think the number one skill that pediatricians who want to be successful practice owners and practice leaders need to develop is delegation," Alex says, attributing this advice to many of the pediatricians he has consulted over the years.

Physicians are trained to solve problems themselves. They identify the problem, solve it, and move on to the next one. But leading a practice requires a different skill: enabling other people to solve problems, too. "If you're going to lead an organization, you need to get much, much better about enabling other people to solve the problems," Alex says.

That doesn't mean simply handing someone a task. Effective delegation means giving someone the responsibility, authority, and support they need to make decisions and move the work forward. Q4 priorities can provide excellent opportunities to practice delegation.

Some examples you might consider:

• Someone on the leadership team takes ownership of improving the vaccine purchasing workflow.
• An office manager investigates and reports back on a trend of staff clocking in late.
• A staff member is nominated to review monthly reports while the person usually assigned that task is away.

The immediate benefit is obvious: more people can move important work forward. But there's a longer-term benefit, too.

"It's about being able to multiply your ability," Alex says. Delegating responsibilities helps build the leadership capacity your practice will need in the future. It gives other people opportunities to develop judgment, solve problems, and become more confident leaders. Alex quotes the advice of pediatrician Dr. Nola Ernest: "Delegation is leadership training." Q4 is an opportunity to develop the people who will help you lead the practice tomorrow.

Use Q4 to Take Stock and Plan for the Year Ahead

The end of the year can create plenty of pressure to crush your goals and finish those last-minute tasks that always seem to be overlooked. But Q4 doesn't have to be a frantic race to fix everything.

Use this time as a runway for your larger goals and plans. Look at your numbers and identify trends behind them. Put those numbers in context. Identify the gaps that still matter. Decide what you can realistically influence before the end of the year.

Then choose one meaningful problem to work on. Give it an owner. Start planning for next year. And take a step back to make sure the practice you're building today is aligned with the future you want. “That’s using your CEO brain,” Alex says.

If you find yourself stuck during planning conversations, unsure where to start, or facing a challenge that would benefit from an outside perspective, PCC Grow consulting can help. Our consultants, including experts Chip and Alex, can work with you to align your mission, vision, and values. With that foundation, they’ll assist your team to identify opportunities for improvement, and create a practical plan to get your practice moving in the right direction.