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    How to prepare your practice for flu season

    Preparation and patient outreach during flu season will enable your practice to better compete in a crowded marketplace

    While its impossible to accurately predict the exact severity of each year’s cold and influenza season, there are a variety of steps primary care practices can take to prepare staff and patients for its arrival. The result? A more efficient and proactive practice that can better respond to the needs of its patients.

    READ: Same-day care, capacity key to managing flu season

    The first item on most primary care practices’ to-do list regarding flu season is to plan how they will get their patients vaccinated, according to Owen Dahl, MBA, FACHE, a medical practice management consultant in The Woodlands, Texas.

    Where practices often fall short, he says, is in making proactive decisions about how they might handle increased patient volume, supply needs, modifications to their schedule, and communicating all of these updates to their patients. “I think they should be talking about what happened last year and the year before,” Dahl says. “What were our problems? What could we have done differently in terms of responding to demand?”

    Operation vaccination

    Nonetheless, practices do need to consider their plans regarding flu immunizations early.

    According to the latest fact sheet from the Centers for Disease Control and Prevention (CDC), shipments for the 2014-15 vaccine  began in mid-summer and will continue throughout September and October. For this season, manufacturers have estimated they will provide between 153 and 158 million doses of vaccine for the U.S. market, according to the CDC.

    READ: Immunizations - How to make this vital service financially viable

    As of mid-July, Candy Le’Oso, practice administrator at Drs. Borders & Associates, PSC, in Lexington, Kentucky, says her office already ordered its vaccines, but has more work to do before patients begin rolling up their sleeves. “Once we’ve ordered our vaccine, we always check to see whether there have been any CPT [current procedural terminology] code changes, and what the reimbursement is going to be so we can make sure we’ve got the charges correct and our revenue is appropriate there,” she says.

    Next: Breaking down the costs of influenza vaccines


    While Le’Oso says that her internal medicine group’s experience and electronic health record system make ordering the correct inventory relatively painless, the process is often more complex for pediatric offices, according to Brandon Betancourt, business director at Chicago-area Salud Pediatrics and author of the blog PediatricInc.com

    “It’s hard to predict a plan of action because historically deliveries have been very inconsistent,” he says. What’s more, delays are often more severe in vaccines provided through the federally funded Vaccines for Children program. “So it’s very uncomfortable, and it creates a lot of disruption in the practice because we have about 30% Medicaid, and it’s hard to accommodate them because we don’t have the vaccines for them even though we may have the private ­vaccines.”

    As a result, practices face greater competition for vaccine administration from pharmacies and retail clinics that often get their supplies earlier, advertise aggressively, and are now able to give the vaccine to younger patients than they’ve been allowed in years past, Betancourt says.

    Influenza vaccine costs

    Next: Add-on or clinic?


    Coding influenza administrationAdd-on or clinic?

    Although some practices have decided in recent years (typically for financial reasons) to refer patients to pharmacies or community clinics to get flu shots, those that continue to provide the service in-house typically use one of two strategies.

    One popular method is to conduct a dedicated flu clinic, whereby the practice sets designates specific office or extra hours to invite patients to come get vaccinated. Drs. Borders & Associates finds this approach not only more convenient for patients, but also offers a personal touch patients can’t get at a pharmacy, Le’Oso says.

    The clinic is staffed by a retired registered nurse (who maintains her license) who enjoys being able to conduct clinical activities, such as giving vaccinations, that don’t wear her out. And because the office’s regular clinicians are still able to see patients during this time, they can easily send patients, who may be in for other reasons, to get vaccinated after their appointments, Le’Oso adds.

    Finally, to keep the practice’s full-time, nonclinical staff from being overburdened with billing all of those vaccinations after the clinic, Le’Oso typically offers the project to a part-time employee interested in picking up extra hours.

    Betancourt says Salud has tried holding flu clinics in the past but found doing so to be cumbersome. “Some practices do it all the time, and it works very well for them,” he says. Instead, his office uses nurses and medical assistants to provide flu shots during regular hours for patients who are in for wellness visits or other reasons.


    One common fall-winter challenge Salud has not faced in recent years, however, is that of managing a large influx of sick patients.

    According to Betancourt, the practice stopped seeing a seasonal surge in appointment demand in the fall of 2009, which happened to be the season the H1N1 virus pandemic caused an estimated 274,304 hospitalizations and 12,469 deaths in the United States, according to CDC data.

    “My theory is that H1N1 scared a lot of people and more people got vaccinated in the following years, especially adults,” Betancourt says. 

    Other factors he suspects have led to fewer sick children being seen in the office are the increase in high-deductible health plans, falling birth rates, better public awareness of what childhood conditions warrant medical attention, and excellent preventive care.

    “On one hand, we can pat ourselves on the back because we’re doing our job very well with vaccines, prevention, wellness, and education—which is better medicine, of course,” he says. “But in this business, unfortunately, it’s been detrimental to our financial success that we’ve been very successful in making sure people don’t come in.”

    To make up for the lack of sick visits, Salud devoted more resources to wellness visits, Betancourt says. As part of its efforts to make sure people come in for their annual physicals—which children tend to miss more frequently as they get older—the practice has begun sending reminder post cards and making monthly phone calls to remind parents when their children are due for physicals, immunizations, or medication checks.

    “We’re doing more preventive wellness, and I think that’s having an effect on the sick season,” Betancourt says.

    For practices that get extremely busy during cold and flu season, Dahl recommends to try block scheduling. Under a block scheduling system, a practice might decide to schedule all sick visits for between 3 p.m. and 5 p.m.

    A block routine allows a practice to manage the volume than if it’s mixed with other routine visits, Dahl explains.

    Like many medical offices, Le’Oso’s practice tends to be slowest in July, with activity picking up as flu season gets closer. “In the fall, everybody’s concerned, and particularly the elderly are coming in. So we ensure the space is there to take care of them,” she says.

    The strategy that works for them is simply to build more room for work-in slots into the schedule.

    Next: Patient outreach and education


    Patient outreach and education

    Whatever your practice’s plan for handling the season for coughs, colds, fevers, and the calls and questions that come with them, be sure to include your patients in the message, Dahl says. “I do think the more communication we make with our patient population right now about what’s happening, the better off we’re going to be,” he says.

    Even early summer is not too soon to inform patients you’ll be holding a flu clinic (even if dates aren’t set), or to remind them that you’ll be using a block scheduling format, extending office hours, or expanding staff to accommodate all of their seasonal needs.

    Dahl suggests reaching out through whatever channels work best with your patient population, whether it be social media, updates to your website, or fliers in your reception area. If patients don’t know you are prepared, he notes, they may turn to retail clinics when they feel ill, under the misconception that getting care there will be faster and easier.

    “There are things practices can do to be more accommodating to their patients, and they need to be aggressive because those retail clinics are taking a lot of those quick easy visits, and that’s not good for a general practice,” Dahl says.

    Now is also a good time to educate patients about common concerns such as vaccine safety, antibiotic resistance, and when to make an appointment versus trying to treat at home or getting care at the emergency department. Salud, for example, has a very strong social media presence through which it conveys reliable information about these topics and more. The practice website also includes a blog that covers matters of interest to patients.

    The most-searched topic on the blog has been when to worry about a child’s fever, Betancourt says. As a result, parents have been waiting about a week before bringing children into the office for fevers, he says.

    Another communication tool Le’Oso is enthusiastic about is the practice’s patient portal. By using the practice’s EHR and the portal, for example, staff can identify which patients are due for their flu shots and send them an email blast to remind them about the clinic through the portal, she says.

    “It’s really a significant and wonderful tool,” she adds.


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