Last month, I reviewed several ways to improve practice efficiency in the areas of facilities, equipment, and information technology. This article will deal with efficiencies in the areas of staffing, processes, and physician work habits.
Costs related to employee salaries and benefits are usually the largest ongoing, nonprovider cost in an orthopaedic clinic. Having the right number of appropriately skilled individuals in the right roles at the right time is critical to a practice’s success. As benchmarking studies have shown, “better performing practices” generally have more employees and higher staff costs per physician than the median. Having enough staff enables physicians to maximize their output.
A good medical assistant (MA) will help ensure that the physician uses his or her time efficiently and effectively in the clinic. Thus, when hiring an MA, proven organizational skills may be a better predictor of success than clinical skills. While the physician in the exam room concentrates on the needs of the patient, the MA remains aware of the constantly changing environment of the clinic as a whole and acts as a global positioning system for the doctor.
The following MA activities are helpful in improving clinic productivity:
- Review the schedule in advance to identify and address potential bottlenecks and alert the physician and ancillary services of times of abnormally high or unusual usage.
- Prepare the clinic to ensure adequate supplies, availability of test results and any necessary forms, equipment function, and information service performance.
- Ensure smooth operation of the clinic so that physician productivity is optimized, standard care is initiated for postoperative patients, distractions are minimized, and priority or time-sensitive matters are highlighted.
Lower-level staff can often do routine functions such as escorting patients from one area to another; don’t turn your radiology technicians into high-cost people movers. Data entry clerks may be able to take over some of the duties normally done by certified professional coders. Using part-time staff during peak times may enable practices to improve efficiency while remaining cost effective.
Physician assistants (PAs), nurse practitioners, and physical therapists can perform provider services that otherwise would fall to the physician. Physicians and clinics use these staff in various ways, and patients may not always understand the differences between them. Providing patient education brochures about their services may cut down on long explanations.
Practice employees should understand that they are key marketers of the practice and have a profound effect on patient satisfaction. Using name tags with the practice logo, letting patients know that staff is proud of their organization, and holding staff accountable are important steps to quality care.
Processes are planned methods for accomplishing tasks in the clinics. They may be codified in policies and procedures or they may be unofficial “norms” passed from employee to employee. Effective and efficient processes should improve productivity and the bottom line. Processes should be dynamic and change as necessary.
Scheduling is a key process. Most offices schedule according to a template (a set of instructions on what time to schedule certain types of patients and how many can be scheduled at any given time). Schedule templates can be relatively simple or extremely complex. Orthopaedic practices should regularly evaluate and adjust scheduling to maximize physician productivity and minimize patient waits. (See “Don’t Drown: Ride the (Modified) Wave!” AAOS Now, February 2012.)
Casting is another process that needs to be adapted to the practice style of the doctor, the case mix, and the style/case mix of other physicians in the clinic at the same time. Some offices will use cast technicians, while others will have the MA apply and remove casts. Unless it is a highly specialized cast, it is generally not efficient to have the physician or PA perform casting in the office.
Some offices have decentralized cast rooms near exam rooms while others use a common area for casting. Centralized cast rooms may generate economies of scale and lower overall cost, but decentralized cast rooms may help minimize “travel time” between locations and facilitate physician oversight of the casting.
Advance verification of eligibility can streamline the intake process as well as identify specific formularies and referral guidelines that the physician may need to know. This information is also helpful to those who are collecting co-pays, certifying surgeries, and billing insurance. Office policies should cover how eligibility will be verified, who will verify eligibility, and when verification needs to be done. A busy office should consider automating eligibility verification with all payers who offer that service.
If no-shows are a problem, a reminder system that uses phone, email, or texting to contact patients the day before their appointment may be helpful. An adjunct to the reminder system is a recall system. Recall systems ensure that test results, cast removals, and other tasks aren’t missed.
Honest self-assessment is critical if the physician wants to have an efficient and effective office practice.
In groups of three or more physicians, standardized methods for common tasks make the practice as a whole more efficient, even though an individual physician would prefer a different way of doing things. Outliers need to determine if their special need is truly important, or be willing to compromise.
Although patients may not complain directly to the physician about excessive wait times, they will complain to the staff and their friends. For this reason, physicians should try to run on time to avoid backlogs of patients.
In addition, physicians should dictate their notes soon after they see the patients. In most practices, many individuals other than physicians rely on the doctor’s notes to accomplish their jobs. For examples, coders may verify levels of service, medical records staff may need to know when to retrieve (or check on) test results, and surgery schedulers may need to verify diagnosis, treatment plan, and site of care. If the notes are not readily available, employees often have to leave their work area to hunt down information or pending items to be processed later.
Finally, physicians should know their comfort level for delegating tasks. PAs can be trained to do most routine assessments and will recognize when the patient needs to be referred to the doctor for further evaluation. MAs can often return phone calls for the doctor. Although proper training takes time, the benefits over the long-term are worth it.
Improving practice efficiency is an evolving task that requires frank appraisal and commitment to make necessary changes on an ongoing basis. The goal of efficiency is to make the physician more productive and more profitable. Although some changes may require significant capital outlay, improvements in physician efficiency will often recoup that cost relatively quickly.
Delegating responsibility to well-trained employees can free the physician to perform tasks that only she/he is qualified to perform. In a group setting, ensuring efficiency for all the doctors should take precedence over placating one individual.
Dale A. Reigle is chief executive officer for Rocky Mountain Orthopaedic Associates, PC, in Grand Junction, Colo. He can be reached at firstname.lastname@example.org
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