Talking shop with Sarah Holt, administrator, Doctors' Park

As administrator of Doctors' Park in Cape Girardeau, Sarah Holt works to make sense of one of the country's most complicated issues: health care. She's actually read all 2,409 pages of the federal health care reform bill, recently signed into law. After successfully overseeing multiple medical billing operations, she recently wrote a book to help other clinics with their billing issues.

Q: You have several roles at Doctors' Park, can you describe them?

A: Starting with the broadest, I am the administrator of Doctors' Park. There I work with the stockholders who started Doctors' Park and were the original owners of the land, the covenant board that oversees the property management and is the decision-making body in the park, and the association that consists of the managers of all the different entities within Doctors' Park. I am the practice administrator at Cape Girardeau Surgical Clinic, working for the general surgeons in the community where I am accountable for the people, process, technology and organizational structure in the medical practice. That is the organization that I have worked for the longest, since 1988. I am the administrator of Cape Medical Billing Corp. that is owned by the general surgeons. I am the administrator of the Breast Care Center at 60 Doctors' Park. Additionally, I teach two health care classes in the MBA program at Southeast Missouri State University -- budgets and reimbursements and health policy. And I do a fair bit of speaking to health care groups on a local, regional and national basis.

Q: What was the motivation behind starting Cape Medical Billing Corp.?

A: Cape Medical Billing was started because of the outstanding success that Cape Surgical Clinic has had with insurance billing and account resolution. We have been awarded national designation as a Best Practice for several years by Medical Group Management Association headquartered in Denver. By starting Cape Medical Billing we wanted to partner with other small medical practices to allow them to have access to our high-quality staff and share in [our] success too.

Q: What do you enjoy most about what you do?

A: I love helping to make sense of the complexity of health care. Working in health care seems to me like a high calling because health care touches everyone's life in a critical way. I respect caregivers and patients alike -- I know what a difficult task physicians have and I know how fearful patients are when they are sick, need help they don't understand, and feel powerless in trying to access the health care system. While medicine is both art and science, sometimes the regulations get in the way of expressing the best of both the art and the science. I enjoy my role helping physicians and staff work as effectively as possible while taking care of patients.

Q: How do you think recent health care reform legislation will affect area patients and your business?

A: The health care legislation that recently passed is massive legislation. I have actually read the entire legislation, all 2,409 pages. The legislation is really too massive, with too many provisions to discuss here. I would say that there are more provisions that impact insurance carriers, hospitals and the broader community than physicians. Certainly some of the insurance reform will make it easier for patients to get health care insurance and there are many community demonstration projects that may be implemented in local communities. As for physicians, the most important thing we can do is restructure Medicare's payment formula, the Sustainable Growth Rate. That formula was not addressed in the legislation, but unless the payment formula is fixed, physicians will experience such a large cut in reimbursement that they will find it impossible to continue to participate in Medicare. That is a shame. I don't know any physician participating in Medicare who wants to drop out, but they cannot sustain a greater than 20 percent cut in reimbursement for their services.

Q: Tell me about your book, "Get the Money in the Door."

A: Our success has been so good that Medical Group Management Association contracted with me to write a book for them titled "Get the Money in the Door: Physician Billing Basics." This book is a primer detailing the complex aspects of medical billing and is available on Amazon or through MGMA.

Q: What did you do before taking your current position?

A: I was a counselor at Cape [Girardeau] Central High School before starting to work in health care.

Q: Tell me about your educational background and where you grew up.

A: I am a Missouri girl, born and raised in Thayer, Mo., where I graduated from high school. Both my undergraduate and master's degrees are from Southeast Missouri State University. My undergraduate is in education and my master's is in counseling. I got my PhD in Public Policy Analysis and Administration with a health care emphasis from Saint Louis University. Also, I am a Fellow in the American College of Medical Practice Executives.

Q: What do you enjoy doing when you're not working?

A: I enjoy spending time with family and traveling. I try to spend as much time as possible with my two daughters who live in Boston, one of whom is a physician and the other who is graduating from law school this month. I have been fortunate enough to complete my goal of traveling to all seven continents. My favorite trips have been a wildlife safari in Kenya, exploring Morocco's cities like Casablanca, Fez, Marrakesh and Essaouria by the sea then taking a tour by camel on the caravan route in the Sahara Desert, spending the night in a Berber tent. The most spectacular trip was an expedition to Antarctica on a retrofitted Russian icebreaker where we had 11 shore landings with treks in landscapes that were awesome in the strictest sense of the word.