Simply getting through the day has been an incredible achievement over the past two years for anyone working in a medical practice. Off-the-charts staff turnover, heightened patient expectations, and the infusion of new technological tools have added to the operational pressures. Now patients are flooding in, seeking care that was delayed due to the pandemic. To avoid getting overwhelmed by the circumstances, here are some ideas to ensure that the core infrastructure of your operation remains efficient and effective:
There are so many pockets of time in the day that incorporate waits or delays; it’s impossible to eradicate them all, but I urge you to pursue the reason for at least one challenge every day. Let’s consider the moment you walk into the door: clinic starts at 8 a.m. Is the first patient ready to be examined by the physician? If not, where is the patient in the process? Is the patient still in the waiting room? On the scale? Being roomed? What does an “8 a.m. appointment” even mean? Break down the start-of-the-clinic into individual components, making sure you have the people and tools in place. Establish the workflow, then hold your team accountable. There are often waits and delays that occur at the start of both the morning and afternoon clinic sessions. Examine those, and then move onto the smaller pockets of time that may be plaguing your practice. There’s no magic bullet to make the practice flow perfectly; it’s the little things that may equate to big opportunities.
Your practice’s most important asset is time. Every minute of your physician’s time, as well as that of your billable providers, is critical, and the delivery mechanism for that time is your schedule. Manage it obsessively; every slot is precious. Ensure that your scheduling horizon isn’t too far out; your no-show rate rises as your time-to-next-available slot increases. If you are scheduling weeks to months out, make certain that your confirmation campaign is effective. Convert every cancellation when it arises, which means an electronic waitlist is a must. View your schedule at least twice a day, looking ahead to tomorrow – and next week - to watch for empty slots. Urge them to be filled, noting that it’s human nature to do just the opposite because a filled slot means more work for everyone. Appoint a ‘schedule optimizer’ for your practice – a seasoned scheduler, or perhaps a member of your clinical team. Monitor your fill rate by doing a retrospective measure of arrived minutes as compared to available time on the schedule and then reward your practice for a high fill rate.
Technology can offer an incredible advantage for your practice, but deploying it correctly is crucial. When a vendor sells you a solution, don’t forget to ask about the integration into your current system, and the extent of the orientation, training, and service they offer for the product. Have a user – one of your employees – offer their input and test drive the tool before you buy it. After you purchase a tool, consider the changes in workflow that are required to gain the tool’s full value. If you, for example, invest in an app to document hospital charges, then consider how and when the list of patients on whom you round will be uploaded to and managed in the tool. Also, how are nuances handled, like billing shared/split services? A critical step includes engaging the person(s) who keys your hospital charges, if only simply to ask the key questions about the “hows” and “whys.” Too often, a practice will purchase a technological tool but fail to gain the promised return on investment. Don’t fall into that trap.
Despite all the equipment, supplies, and tools used by your practice, a medical practice is really all about its people. You can have the finest electronic health record system on the planet, but it still requires support staff to keep a watchful eye on alerts about ‘red flag’ messages, critical test results, and so forth. Further, the service and experience your practice provides offers a safe, attentive, and healing environment that nurtures patients, as well as employees. It’s been a challenging time for everyone; show your appreciation with a verbal, “I appreciate you,” a written thank you note, or a gift of gratitude (e.g., a gift card from a gas retailer or a casserole that can be used for a family dinner). For a team that feels highly valued, getting through the busy days will feel satisfying instead of frustrating.
The operations of a medical practice have never been simple, but the challenges of the past two years have made efficiency and effectiveness even more difficult to achieve. Pause and reflect on the foundational elements that may have been tossed aside out of the necessity to survive. As normal operations resume, your practice will benefit from reconstructing a good footing.
Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical practice operations and revenue cycle management for more than 25 years. She has led educational sessions for a multitude of national professional associations and specialty societies, and consulted for clients as diverse as a solo orthopaedic surgeon in rural Georgia to the Mayo Clinic. She is author or co-author of 17 best-selling practice management books, to include Mastering Patient Flow and The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania. She is currently a doctoral student at the Bloomberg School of Public Health of Johns Hopkins University.
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