By Rebecca Anwar, Ph.D.
Physicians tell us they are working harder and longer hours to maintain a profitable practice. Many are feeling high levels of frustration and anxiety in the face of a financial picture that seems out of their control. Reimbursement keeps chipping away at the ability to meet revenue targets and costs keep going up. In the face of all of this, and expectations for continual government intervention, how can physicians maintain a profitable practice? By improving productivity and efficiency: Time management. Yours and your staff!
Physicians are the greatest revenue source for the practice. The best way for you to generate additional revenue is by eliminating unnecessary downtime and improving productivity. Of course, everyone faces downtime. In fact, it is needed to recuperate, gather our wits and go on to higher levels of productivity. Unnecessary downtime is another story. It is the time you spend doing “things” that can be either eliminated or accomplished by someone else. Here’s how you can examine ways to turn your greatest resource into higher profits.
Eliminate Unnecessary Steps
Start by looking at your physical plant. Exam rooms that are clustered to save you steps will make a big difference. Add a centralized nurse station and you and your assistant will save steps and improve traffic flow. This helps the clinical team accomplish more and communicate easier. It’s even an advantage to front office staff when they need to locate someone (or a chart) in the clinical setting.
Blood draw stations can help you move patients in and out of the exam room quicker, allowing for more patient visits per exam room. Some offices will have a triage exam room for those quick and easy visits such as blood pressure checks, or for nurse triage. This has been a valuable tool to improve productivity and efficiency. If you have diagnostic equipment that is used less than 20 percent of the time, such as EKG or spirometry, they should be placed in the triage room.
Next, evaluate exam room efficiency. Room layouts that are identical and fully equipped with needed supplies are enormous time savers. For example, a rheumatologist who does a fair amount of joint injections should have injectibles and syringes in each exam room. Your goal is to complete the visit without having to leave the room. If the rooms are well stocked, if dictation and diagnostic reports are in the chart, and if there is a signaling system to call for the assistant, you will support this goal.
Next, examine how you are using tools to perform tasks more expediently. If patients are weighed at each visit, have a scale in each room. Patients bottlenecking to be weighed is a waste of time and can result in getting behind. On the other hand, if you only weigh 20 percent of your patients, placing the scale in a centralized location or a triage area will serve the practice needs.
Medical records are often a major contributor to practice inefficiency. Begin with the design of the record. Using tabs to separate information, such as consultative reports, encounter documentation and diagnostic studies will save valuable time. Using flow charts to track meds and prescription refills, and forms for documenting musculoskeletal exams are real timesavers, as well.
Next, look at the amount of downtime caused by chart searches. If charts are scattered in numerous areas around the office and are not returned to the files promptly, it will play havoc with stealing away staff and physician time. Factor time into your daily schedule to complete chart notes, review outside reports and return patient phone calls. Charts can then be routed to the business office without delays. Also, hold one person in the office accountable for chart maintenance and filing. In a larger practice, this would require a medical records team.
Realistically, it is time for physicians to explore electronic medical records (EMR). The cost for this convenience has reduced significantly. This is an excellent time to consider moving to automated record keeping. The investment of time and money is will worth it. A paperless office is no longer a futuristic dream. It’s a reality. Many practices are integrating paperless technology into the practice. It doesn’t take long to see the payoff with streamlined systems, reduced staffing, higher productivity, and improved efficiency and communications. To top it off, patient satisfaction leaps to new heights.
Look for opportunities to delegate both clinical and administrative tasks. Physicians and physician extenders should ask themselves: “What am I doing that does not require my skills and could effectively be done by someone else?” A clinical assistant can record patient histories and symptoms if they are properly trained. They can also play an important role in patient education, calling in new prescriptions and refills, and handling clinical phone calls.
We find many physicians spend more time than necessary on the phone with patients. When properly trained and instructed, staff will be equipped to return a fair amount of patient phone calls. If the time between an initial call and the return call is expedited, you reduce the risk of the patient calling back because they haven’t heard from you. When the patients call more than once about the same issue, they tie up the telephone and staff time. This duplicates effort, reduces quality and is costly to the practice.
Many physicians don’t use their manager to the fullest extent. Most practice managers and administrators are intelligent, talented and resourceful. They can review and analyze practice management and financial reports and present them to you in a graphic presentation and a summary of their analysis. If physicians dedicate two hours a month to a business meeting with the manager, they can keep abreast of human resource and operational issues, overhead expense, capital needs and accounts receivable management.
The manager or administrator can also conduct research and help you define strategic initiatives for the practice. But it is important to recognize that the manager has many challenges and responsibilities.
There are times when it is to your advantage to outsource some administrative functions, such as calling in a consultant to develop and write the strategic plan or conduct a practice analysis when major change, such as adding a partner or satellite facility is under consideration. A skilled, unbiased professional will bring added value to the decision making process.
Improve Productivity and Patient Flow
Effective scheduling begins with setting target numbers for patient visits, based on the number of hours available on your appointment schedule. This will help you in establishing reasonable revenue expectations. Once you define the maximum number of patients you can see, it is important to evaluate and manage the number of no-show and late cancellations. This is an essential element in meeting your patient volume/revenue targets.
After you determine the daily targets, identify the average number of work-in patients that historically have been added to the schedule. Then you will be able to develop a template to achieve your revenue expectations. The appointment scheduler needs to assume responsibility for scheduling you to meet the patient visit goal. This is what predicts your future revenue stream. It is vital to manage the schedule, rather than letting the schedule dictate your productivity.
Another key element to managing the appointment schedule is ensuring the quality of care is not compromised. If you need more time for new patients, the template must be developed based on these time needs and the number of new patients you generally see in a week. If this is not accomplished, you may not give patients adequate time or you will fall behind in your schedule. Quality care and effective appointment scheduling go hand-in-hand.
Physicians with high patient demand are able to see more patients in a day if they delegate and use scribes in the room. This requires extra staffing, but if five more patients a day are seen, it more than pays for itself. When patient demand increases, consider adding a mid-level provider (extenders) to improve patient service, contribute to overhead costs and increase the bottom line. The practice will need to set a specific benchmark number of patient visits for the mid-level provider. Be sure to let him or her know what the expectation is.
Adding ancillary services can further enhance the practice revenue stream. When a high volume of a particular ancillary service is being referred elsewhere and could be accommodated with a reasonable investment, why not consider it? Project the annual number of the services you could perform multiplied by the expected revenue for each procedure. Then calculate the expense of the equipment and staffing needs. Based on these projections, calculate when the breakeven point would be achieved and then decide if adding the new service makes sense.
Value Staff Resources
It is important to recognize the value of staff and respect their contribution to the practice. They are the critical resource essential to improving profitability. If they believe in you, respect you as a leader, and are convinced you believe in them, they will do everything they can to contribute to your success. They will work well together and be highly productive. They will make patients happier and you more productive. They will improve the over-all quality of the office and the services you provide! Together you will create a higher level of success.
Rebecca Anwar Ph.D., is based in Philadelphia and is President of The Sage Group, Inc.