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    8 ways to make your practice more efficient

    Boosting productivity can be an alternative to cutting costs

    In an effort to maintain your income in the face of flat or declining collections, you may be obsessing with cutting overhead. You're against wasteful spending, but cutting costs isn't the only way—or even the best way—to preserve your bottom line.


    Judy Bee
    It's a handicap to avoid spending money that makes you and your staff more productive. So here are some efficiency basics you can implement.

    1. Only do work that others cannot do

    Many patient care functions, such as data collection and patient education, are commonly—and successfully—delegated to trained assistants, freeing you to work faster.

    You may be reluctant to delegate tasks, however, if past experiences proved disappointing. Keep in mind that delegating is not the same as dumping.

    If you ask your staff to do something and then walk away, you are simply dumping work on them. Delegation, however, requires you to train your staff and provide benchmarks to ensure they understand their assigned tasks, and it requires you to offer feedback so you get the performances you expect. Taking these steps will ensure they do their jobs to your satisfaction. It helps to think of delegation as an investment that will pay off.

    Another waste of your time: deciding, case-by-case, when patients can be seen. Many receptionists admit that they add patients to an already full schedule at their peril, so they always ask the doctor what to do. The decision is usually the same, however: "work them in." Why not specify the criteria for an acceptable add-on patient and let your staff make the call?

    When you train your receptionist, stress that he or she never, ever has the last word. Instead, ask your receptionist to take the patient's information, including details about the problem, and offer the next appropriate appointment that's available. If the patient argues that he or she cannot wait, instruct your receptionist to say that a nurse will be in touch within an hour or two. Then, the nurse who returns the call should advise the patient that no appointments are available. Any patient who insists on coming in anyway should be told that the doctor does not have an issue with their visiting the emergency department if they cannot wait a day or two.

    You just trained your receptionist to add two layers of filter to every call so you do not get them all. Your staff members are there to help you, so train them so they know not to turn away a patient whose health is at risk. The receptionist's affirmation for the day should be: You may not be able to treat every patient who calls, but you will be able to help everyone who calls.

    In addition, you may choose to delegate callbacks, but not all of them. If the news is big or may be a shock, call the patient yourself or ask him or her to come into the office. For example, during an exam, discuss with your patient what to expect from a routine lab test and explain that the nurse will call if the results come back as expected. Then delegate that task to your nurse and include instructions on the patient's next steps.

    Although data collection can be delegated to staff members, you must train them to gather quality information. A patient who answers health-related questions, for example, may mention facts that should be brought to your attention. Your staff needs to know how to highlight this critical information so you do not overlook it during the patient's visit.

    2. Communication is more reliable when written rather than when spoken

    Instead of telling your medical assistant what you need, use a fee ticket/route slip/superbill as an order form. Checking a box or circling a code allows for efficiency improvements. That way, you don't have to wait for your assistant to come listen to you. Just use your "assistant come" light signal to bring the assistant to the exam room, and then head off to the next patient or phone message because your instructions are on the order form. If you use an electronic health record (EHR) system, use task lists to communicate with your staff. For example, you can "task" your receptionist to make an appointment on a specified date.

    A well-designed fee ticket/route slip/superbill includes a place to indicate when you want a patient to return. You can simply add the number of days, weeks, or months and ask the patient to hand it to the receptionist on the way out of the office. As a result, your receptionist no longer will be required to ask patients, "When does the doctor want to see you?"

    In addition, doing this makes it possible to prove what was communicated when someone says, "You never told me." Of course, the downside is that you also can be held accountable for the clarity of your instructions. The question, "What did the doctor tell you to do?" comes up too often because patients and staff members really do believe they understand a doctor's instructions.

    Staff members who have been trained well to listen will ask you to repeat what you say. Written instructions are especially helpful to staff if you're a doctor who tends to forget what he or she says and then blames someone else. Nobody likes a "gotcha," so a polite and well-trained staff member may tell you that he or she must have misunderstood your directive, despite the fact that it's in writing.

    3. Write once, not repetitively

    Even without an EHR, you can get more productive using forms with checkboxes, items that can be circled, or blanks to be filled in. Common applications include routine items such as test orders, prescription refill messages, and the like.

    If you still use paper charts, write concise and legible progress notes that you and your staff can copy and attach to any number of forms. So if a patient must take a doctor's note to work that shows why he or she will be off a few days due to illness, don't rewrite what is already in the chart. If your notes are thorough, rewriting becomes unnecessary.

    Ask yourself how many times you write the same information over and over again and what would happen if you didn't. If the information is important for patients to have, however, create handouts that you can keep in every exam room. Give each a unique title so you can refer to it in your patient's chart (your notes may say: Patient was given dairy restriction diet handout, for example), and you will know exactly what it is. (Also visit www.MedicalEconomics.com/patient handouts for educational materials you can use.)

    You also can get creative and make your handouts and forms specific to your practice. See to it that staff members know how to use word processing and spreadsheet programs so they can develop these time-saving materials. Delegating these tasks can be an excellent training tool for your staff members because it allows them to become familiar with the rationale behind the advice you give your patients and, in turn, effectively educate them. Plus, your staff member can help you write this important information in language that is free of medical jargon and easy to understand.

    A corollary: Rewriting is wasted effort. It's unproductive to take notes of a phone call on scratch paper and then copy them to a message form when the call is completed. Receptionists with computerized appointment systems often take down the information by hand, only to key it into the computer later, when they have more time. This is a prescription for errors of transcription and omission.

    4. Let machines do your work faster and better

    Examples of how you can take advantage of the equipment in your office include computerized employee timekeeping to figure elapsed time on workers' time cards, sheet-fed photocopiers with a collating and stapling feature, printed forms for long-run print jobs (versus internally photocopied forms or rubber-stamped return addresses on envelopes), and computer-generated superbills with account history printed on them and reference numbers for tracking lost charge slips.

    Before you purchase any equipment for your office, make sure you and your staff will use it often. Otherwise, it will not be a good investment.

    Consider, for instance, the purchase of a new photocopier. Before you buy, compare the cost of the machine with the hourly rate you pay your staff member who typically copies, collates, and staples the paperwork for your practice. Chances are, you will discover that the new machine will practically pay for itself. Plus, your staff member can devote his or her time to more important tasks.

    If you rarely do that type of work, you are better off sending big jobs to print shops or office supply stores that can do the work quickly and inexpensively. Group practices comprised of five or more doctors who provide patients with handouts on a regular basis, however, would be wise to invest in new equipment.

    When you're ready to make a purchase, make your needs clear. Stick with a vendor that has provided you with excellent service in the past. It may offer you a contract that allows you to upgrade to a larger machine when you reach a specified threshold of volume, for example. Or it may recommend using low-cost refurbished equipment instead of leasing something new.

    If you're in the market for new equipment, annual meetings are a good place to check out the latest technology. The Medical Group Management Association—American College of Medical Practice Executives annual conference (this year October 21 to 24), for example, is a good place to walk the exhibit floor and see what's new.

    Also, encourage your administrator or office manager (if you have one) to join local business-related organizations. They provide excellent opportunities to speak with other office mangers who are willing to share their valuable experiences with vendors and equipment.

    5. Don't wait for patients or staff

    Give new patients your demographics/registration form to fill out first. Wait until they're finished to hand them the health history questionnaire. That way, if a patient hasn't finished the history form while in the waiting room, your receptionist or nurse can send him or her to the exam room with a clipboard to finish it there. If you enter before it's done, complete it together.

    If, for example, a patient's history questionnaire indicates missing immunizations, you may have to wait for your medical assistant, who is with another patient, so you can ask her to administer those shots. Instead, write down what needs to be done. Doing so eliminates any confusion and allows you to move on to something else.

    And, if you're outpacing your medical assistants a lot, get more help or change your processes. For instance, don't make the mistake of telling a patient to arrive 15 minutes early for his appointment so he can complete paperwork. The patient will arrive at 2 p.m., not 1:45 p.m., because he knows he is going to have to wait for the doctor anyway. Instead, tell patients that you want them to arrive at 1:45 p.m. for a 2 p.m. appointment. When they get there, explain that, before the doctor will see them, they have to update their paperwork. Remember: Don't tell patients to come in early; just tell them what time to be there.

    6. Do only the work that needs to be done

    You can, for example, avoid answering phone calls from patients confused about their bills by keeping the billing function up to date and statements clear. Filing copies of insurance claims in patients' charts is extra work and clutters the medical records with irrelevant business information. Keeping logs (of x-rays, tests ordered, or labs run, etc.) that nobody ever refers to is an example of work that may have started out with some valid purpose years ago but is continued because "we've always done it that way" even though it's no longer necessary.

    Eliminate unnecessary work by requiring every member of your staff to fill out a task list once a year (or 90 days after you hire someone new). Doing so will show you how each person spends his or her time on the job. If your practice recently implemented new technology or work processes, you (or your office manager) must examine your staff's job duties to ensure that three people are not doing the same work.

    7. Quality work shouldn't rely on staff being careful or remembering what to do

    Instead, use systems such as tickler files, calendars, checklists, and printed forms that remind staff for you. For instance, an easy way to ensure you receive the results from your patients' routine tests is to make a copy of the lab slip and file it by the date the test results are due. Doing so eliminates the need to rewrite the name of the patient, laboratory, and test. Doctors who have in-house labs also must keep detailed logs, however, to comply with strict regulations.

    Structure work, such as balancing the daily deposit to the computer total of receipts or checking the date of service to when you sign your dictation, so you can check it easily to see whether an unacceptable delay exists. You will, for example, know whether your staff members collected, tallied, and deposited all of the checks for the day if you ask them to give you a copy of the deposit slip and balance sheet before they leave for the day. You may not care what the numbers show, and you might not even have time to look at them. But you will notice when it isn't on your desk, because that means someone isn't doing his or her job. Reports such as these give you confidence that work is getting done.

    Find a computer program with a calendar and checklists that you and your staff like enough to use regularly. Take care to ensure access during planned—or unplanned—absences. Meet with any staff member who is scheduled to be out of the office to go over his or her calendar and tickler files, ensuring that no one "drops the ball" while he or she is gone.

    8. Use the work to supervise the worker

    Typists always know what to do because they work on the recordings in their in-baskets. And they know to go home when the recordings all are transcribed. The work, not the manager, supervises the worker.

    Similarly, instead of reminding staff to restock exam cabinets, line the shelves with colored paper before loading them with boxes of supplies. Write on the shelf paper what is stored there. Enforce the rule that staff members must immediately restock when they can see the colored shelf paper. Or, place a rubber band around the last two jars of an item. The act of removing the rubber band will serve as a reminder to order more. Implementing these types of processes ensures you will know that a staff member did not do his or her job if you suddenly run out of supplies.

    For items on backorder, include the order form in a tickler file and follow up with the vendor if supplies do not arrive when promised. Doing so will give you time to get what you need from a different vendor or conserve your use of your existing supply. Either way, you should never go without.

    Overhead is the devil's creation. Having said that, though, every expenditure in your practice should buy you something necessary to your quality of care, quality of service, or quality of life. If it doesn't, it represents waste and is eligible to be cut. But when you run out of waste to cut, think a while on becoming more productive.








    Judy Bee is a 30-year veteran management consultant with Practice Performance Group in La Jolla, California, with clients in 39 states. She also is a Medical Economics editorial consultant.Send your feedback to
    . Also engage at www.twitter.com/MedEconomics and www.facebook.com/MedicalEconomics.

    Judy Bee
    The author, a practice management consultant with Practice Performance Group in La Jolla, CA, is an editorial consultant to Medical ...

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