Ten Steps to a Better Practice

Steps to a
Better
Practice
FOCUS ON THE SIMPLE THINGS THAT CAN IMPROVE
PATIENT CARE AND EFFICIENCY [ BY LEIGH PAGE Contributing Writer ]
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Medical EcoNoMics
December 19, 2008
memag.com
ing strategies may be just what you need to get your
practice back on track or take it to the next level.
1
Get control of your space
When clients ask Greg Korneluk the best way to
maximize space and streamline office procedures, his
answer is very simple: It involves virtually eliminating
the waiting room and sending patients directly back
to the exam room area, where check-in and checkout are administered and patients sit in small waiting
areas that are more personal. “If you can reduce the
size of the waiting room, you can add two more exam
rooms,” says Korneluk, chairman of the International
Council for Quality Care in Boca Raton, Florida.
modernmedicine.com
Getty images / photodisc / Rob Melnychuk
sk 10 doctors about their toughest practice
challenges and you’ll get 10 different answers.
Ask 100 of them and common themes start to
emerge: Many agree that the single greatest factor that could improve their practice—often even their lives—is anything that could
rid them of that constant, nagging feeling of falling
behind. Whether the issue is cramped quarters, piles
of paperwork, crowds of patients, or phones that
never stop ringing, it’s growing ever more difficult to
get—and keep—a practice under control.
To help you out, Medical Economics asked physicians and practice management experts for advice on
getting control of your practice. Many of the follow-
Practices building new
offices have taken up this
once-radical idea, Korneluk
says. Meanwhile, an ear, nose,
and throat practice in Lincoln,
Nebraska, went ahead with plans
for a waiting room that it hardly
uses; its physicians have told
Korneluk it is “a waste of space.”
2
Get control of
your schedule
3
Get control of the phones
No one likes phone menus, but is there a better
alternative? Medical Plaza Family Medicine of Florence,
South Carolina, has found one. Patients are directed to
call separate numbers for each physician in the fourmember practice. Each doctor’s own staff makes it a
point to answer every call. They help each other out by
answering calls that come through the main number. In
many practices, it can take hours
for a phone message delivered to
Network
See Index Page 10
the front office to make it back
to the doctor, but calls to MediPRACTICE MANAGEMENT
cal Plaza always hit their target,
For more info on this topic, see
www.memag.com/360
says Richard Alexander, MD, a
N
partner in the practice. In fact,
E
he says, he often overhears the
A
conversation because he is just a
C
few feet away.
T
Contrary to popular belief,
receptionists at the front desk
should not be answering calls, says Cynthia L. Dunn, a
Medical Group Management Association consultant based
in Cocoa Beach, Florida. She believes practices should
hire a separate operator for around $30,000 a year and
locate that employee away from the front desk. The result
is a much quieter reception area with fewer mistakes
because there are no phone distractions.
In the waiting room of a busy family practice in
the western U.S., Dunn saw a patient approach the
receptionist, who was talking on the phone
through a hands-free device, and try to talk
to her. “[The receptionist] just began talking
louder,” Dunn recalls.
It can be hard to know what is
slowing down the schedule, says
Kenneth T. Hertz, a consultant
based in Alexandria, Louisiana.
So when he assesses a practice,
Hertz takes out his stopwatch and
times each step in the patient visit.
At a family medicine practice in
Vermont, he pinpointed a slowdown in the exam room. Patients
were taken to exam rooms and
then waited up to 30 minutes to
be seen by a doctor.
“[Exam rooms were] tied up,
and patients were very aggravated,” he says. Where was the
doctor? He was answering phone
calls. Callers were instructed to contact him
at another time.
Schedules can also
be bogged down
simply by daily
lunch breaks.
Lori Foley, a
principal at
Gates Moore &
Company, a practice management consulting firm based in Atlanta, recalls an
orthopedic practice in the southeastern
U.S. that completely shut down
for lunch.
“Ramping down the whole practice
before lunch and then ramping up afterwards is very inefficient,” she says.
Foley convinced the practice to
operate through lunch, staggering staff
lunching times. Physicians now work
straight through, grabbing lunch between patients. The practice has more
visits and is thriving.
— Lori Foley, Principal,
“RAMPING
DOWN THE
WHOLE
PRACTICE
BEFORE LUNCH
AND THEN
RAMPING UP
AFTERWARDS
IS VERY
INEFFICIENT.”
modernmedicine.com
Gates Moore & Company,
Atlanta
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4
Get control of
The paperwork
While few people relish dealing with
paperwork, Hertz advises physicians
to routinely keep tabs on it. He once
got an anxious call from a solo primary
care physician: While his bookkeeper
was on vacation, he stumbled over
three weeks of charges that had never
been submitted to third-party payers.
Hertz advised the doctor: “Before
you start blaming her, you need to
look at the flow of your paperwork.” It
turned out the bookkeeper was in over
her head and needed help from the rest
of the staff.
Of course, much of the paperwork
can be eliminated by switching to an
electronic health record system, but
December 19, 2008
Medical EcoNOMics
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A south
Carolina
practice
moved its
patient
charts from
tHE front
to the back.
“we did not
want to
operate in
the past.”
more sparingly because the nurses
said there are other means of pinpointing patients who may need the
vaccine and, Fowler adds, the practice
loses money on each test. “We would
never have been able to have that insight without bringing different points
of view into one room,” he says.
There are other ways to brainstorm. At Medical Plaza Family
Medicine, Alexander and his staff have
— Richard Alexander, MD,
been meeting as a book club, readMedical Plaza Family Medicine,
ing chapters of If Disney Ran Your
Florence, South Carolina
Hospital: 9½ Things You Would Do
Differently by Fred Lee (AHA/Second
River Healthcare, 2004). The book
discusses why perceptions are more
important than reality, patient loyalty
Streamline
is more important than satisfaction, courtesy is
relentlessly
more important than efficiency, and experience
Making a practice more efficient means ferreting
is more important than service. “The book has
out problems before they hit the radar screen.
prompted a lot of discussion about how we
Foley recalls a large ob-gyn practice in the
could do things differently,” Alexander says.
South that had trouble with long appointment
times. It turned out the practice did not have enough Doppler fetal monitors for each exam room, so physicians who
Train your staff well
needed one had to go searching,
Dunn says most practices provide very minimal
often in the middle of a visit. The
training for new hires, and it shows. A lot of employees
Power
practice’s refusal to buy one device don’t know basic facts about the practice, such as the
Points
for each room, at a cost of $300
names of the physicians, the hours of operation, and the
Making a practice
to $400 each, made no economic
fax number.
more efficient means
sense, she says.
Training can be done in-house, Dunn says, but managferreting out problems
Efficiency
can
get
a
boost
from
ers
must think carefully when selecting a trainer. You need
that never hit the
entirely new strategies, such as
employees that explain things well, have patience, and can
radar screen.
asking patients to fill out forms
be taken away from their jobs for a few hours. To boost
Most practices fail
that the staff usually has to do on
efficiency, trainers should develop a checklist of things
to train new hires
its own. “The most underutilized
the new employee needs to learn. Staff can provide the
properly and don’t
employee
is
your
patient,”
Korbest input for the checklist, Dunn says, because they can
thoroughly consider
neluk says, adding that patients
remember what it was like when they were new.
the role of the trainer.
are less prone than staff to make
At Medical Plaza Family Medicine, “a new hire follows
Consider tying staff
mistakes filling in their own
around a seasoned employee like a shadow” for a week,
bonuses to quantifiable
information.
says partner Edward Behling, MD. He adds that learning
performance.
Staff time can also be reduced
tools help tremendously, such as a dummy chart stuffed
with technology. For example,
with all the pertinent folders and reports, which the
Foley endorses automated appoint- new employee can consult. Dunn and others recommend
ment reminder calls to patients. These phone systems,
providing “cheat sheets” for various clinical and office
which cost about $1,000, use an artificial voice that can be
duties, even compiling an employee handbook that holds
custom-programmed.
important information in one place.
that can be expensive and overwhelming. Korneluk advises taking an intermediate step: Scan all your paperwork
into your computer. Rather than using
an expensive EHR system, files can be
organized in folders on your computer.
This is what one of his clients, Scott &
White Clinic, a 600-physician group
practice in Temple, Texas, is doing in
anticipation of installing an EHR.
Korneluk concedes that asking staff
to feed all your documents into a scanner is challenging, but after a relatively
short period of time, using low-priced
scanners placed all around the office
becomes routine.
5
7
6
Make it a team effort
Jon Fowler, practice manager at Village Pediatrics, a
two-physician practice in Chapel Hill, North Carolina, says
when his staff comes together, new ideas come out.
“Every so often, you get some real gems,” he says. For
example, the practice decided to use the rapid flu test
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8
Reward exceptional effort
Bonuses can boost staff morale, but Foley prefers not
to make them across the board because some employees
may not have earned them. She recommends tying bonuses to quantifiable performances, such as the number of
days invoices remain in accounts receivable for the billing
modernmedicine.com
“Health
care is
continually
evolving.
it can’t be
the way it
used to be.
never stop
changing
means
never stop
learning.”
staff, a measurement that can be easefficiencies. Two years after opening,
ily followed using practice managethe practice not only has a full schedment software.
ule, but is financially promising.
Behling, on the other hand, was
Alexander also swims against the
not happy with the bonus system at
tide. When Medical Plaza Family
his practice and dropped it a few years
Medicine redesigned its office space,
ago. At Medical Plaza Family Medicine,
“we did not want to operate in the
each physician has a team consisting
past,” he recalls. Charts are traditionof a nurse and other staff who are atally put in the front office, but that
tuned to that physician’s practice style.
bothered him. Alexander thought
The bonus system had been based on
they should be in the back, where
— Kenneth T. Hertz,
the performance of each team, but “it
doctors could consult them. The
Consultant,
created divisiveness” among the teams,
charts went in the back.
Alexandria, Louisiana
he says. “People were thinking, ‘I’m
not going to help your team because
Never stop
you wouldn’t help us.’ ”
changing
Praise and recognition have as
Practices are faced with a dilemma:
much impact on staff as money, Hertz
Change is good, but when it comes,
claims. He recalls that as a manager of a New
many people want to run in the other direction.
Orleans practice many years ago, he and the
Korneluk tries to make change less threatening
physician would regularly select an employee
by telling physicians to dole it out in bite-sized
to praise. The doctor would write a note on elpieces. Try out a new idea just for one day, he
egant stationery and send it to the employee’s
advises. He calls this “a perfect day.”
home. “When it was opened in front of her spouse, that
If the practice tried out an idea for a short time and
had a lot of impact,” he recalls.
thinks about what it liked and didn’t like, “they can tweak
it,” Korneluk says. “That way, they can get a better idea.”
Behling is an inveterate tweaker. He began developFind your own ways to do things
ing a check-off form for dictation several months ago and
There are plenty of books on how to improve your
has been streamlining it ever since, so that it would fit on
practice, but successful practices seem to follow their own
one page and only contain information that is essential
path, says Marjorie Satinsky, a consultant based in Durfor coding. He started off with two forms, for a symptom
ham, North Carolina.
visit and a routine visit, and then combined them and
When Kimberly Gush, MD, founder of Village Pediatshrunk the type so that all the information fit. He has
rics, was planning the two-physician practice a few years
been improving it ever since. “You can wax eloquent on
ago, she came to Satinsky with a plan that went against
conventional wisdom. While other practices were trying to these forms, but much of the information is not necessary,” he points out. He recently completed an 11th version
see five to six patients per physician per hour, she wanted
of the form, providing space for the medical assistant to
to see two or three. Viewing her practice from the peradd information in freehand, such as the history of present
spective of a mother of small children, she did not want
illness or that the patient stopped taking his meds.
patients to feel rushed.
“Health care is continually evolving,” Hertz says. “It
Longer visits could be a great marketing tool for Village
can’t be the way it used to be. Never stop changing means
Pediatrics, but the practice had to make them economically
never stop learning.”
sustainable. Satinsky worked hard to negotiate favorable
managed-care contracts, the practice bought an EHR system
that would keep costs down, and Fowler came up with more Send your feedback to [email protected].
10
9
DO’S AND DON’TS FOR RUNNING AN EFFICIENT PRACTICE
DO
DON’T
■ Stagger staff lunch breaks.
■ Have the front desk receptionist answer phone calls.
■ Routinely keep tabs on your paperwork.
■ Undertrain your staff.
■ Ask patients, not staff, to fill out information forms.
■ Exclude your staff from brainstorming sessions.
■ Purchase an automated patient reminder phone system.
■ Be afraid to try out new ideas.
■ Praise and recognize staff for their efforts.
■ Operate in the past when redesigning your practice.
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December 19, 2008
Medical EcoNOMics
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