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    Build a strategy to boost productivity

    Thomas J. Ferkovic, RPh, MS
    Q: A close friend from medical school runs a practice in another state. Our practices closely mirror each other—same specialty, similar number of staff, etc. His practice, however, sees up to 50 patients a day, whereas we often struggle to manage 30 in the same amount of time. What are we doing wrong?

    A: It seems simplistic to say that some practices just do it better, but it truly is the case. And it all comes down to a doctor's preferences and practice processes. Both contribute to how easily patients are processed.

    Better processing yields increased volume. Increased volume leads to improved quality of care and a stronger bottom line. No magic is involved, just strategy and a few simple improvements.

    First, align your preferences and incentives with your financial performance goals. Compensation that's commensurate to production levels is crucial.

    Next, look at your processes. Scheduling, registration, and room turnover and use can help or hinder patient volume growth. Time allotted for each appointment should optimize your time. To accomplish this:

    • Require schedulers to ask questions regarding the nature of the appointment.
    • Tell patients to arrive at least 10 or 15 minutes ahead of their scheduled appointments to ensure that paperwork is completed.
    • Quickly clean and prepare rooms between patients during office hours to keep turnover delays to a minimum.
    • Set aside a specific room for procedures to maintain a steady flow in your exam rooms.
    • Use midlevel providers to handle appropriate activities and free you up for more acute, higher-level visits.

    The complexity of your patients' cases is important to your overall productivity. Older populations or patients with chronic multiple diseases take more time to work up. Often, however, it is not the complexity of the patient's problem that impedes productivity. You must have the skill to treat only the problem for which the appointment was made, not the additional problems the patient would like to add to the time-limited visit.

    In general, the percentage of patients who are more complex in one practice and deemed similar overall to another practice is insignificant. What can cause a decrease in productivity, however, may be a particular payer mix (for example, heavily Medicare or Medicaid versus commercial), excessive patient no-show rates, and scheduling practices that do not limit the type of visits or spread them in an efficient manner (consults or physicals versus follow-up visits, for instance).

    Productivity rates also depend on the specialty and support system your office has developed to assist you. For example, do you spend time answering questions from your patients and their families about therapy, or does a trained nurse handle that task? Does your support staff write prescriptions based on your orders, or do you?

    Your productivity also depends on the clinical style you want for your practice. One way to see how you're doing is to work backward from your practice's expense budget and calculate the revenue necessary to cover expenses and your compensation and benefits. Then, determine the average reimbursement for one patient visit, and calculate the number of patients needed to meet the goal. Also, determine what support you can add to assist you in attaining the goal (consider using midlevel providers such as physician assistants or nurse practitioners).

    Lastly, use good management skills. Monitor, on a daily basis, key indicators to maximize your practice's productivity. Although these indicators vary by practice and business situation, some of the key ones you should monitor include new patients per week, daily cash collections, weekly no-show rates, patient-payer mix, and next open new patient appointment. As you identify new issues for your practice, change key indicators, and monitor them until the issue is solved, then review annually, at least.

    I liken key indicators to a heart monitor during a workout. In real time, they allow you to determine whether you are meeting productivity and efficiency goals and give you the opportunity to change if you are not.

    Answers to our readers' questions were provided by Thomas J. Ferkovic, RPh, MS, managing director, SS&G Healthcare Services LLC, Akron, Ohio.

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