Add One More Patient without Compromising Balance

One more patient a day?!

I can hear you now:

As a physician you may say "I am too busy to see what is already on my schedule! I'm burned out and don't want to see more! I need to get home on time!"

Is this your reality or are you making excuses and not really wanting to work harder than you currently do? 'Are these real or are they excuses? In theory, everyone can be more efficient and therefore, it is possible to see one more patient per day or get home on time.

Let's honestly take a look at how the typical day goes to see if you can add another patient or not. Again, is this reality or an excuse? It is well known that there is waste in everyone's day. This includes waiting for something, e.g., a lab or image report or a room to be ready. There is something needed in the exam room that is always there that today is missing. Someone didn't order a test that I requested so I can't really help this patient. The phlebotomist is sick today and blood can't be drawn. The medical assistant is helping others and doesn't have time to update the record, so the provider has to do it which takes time. Too many phone calls from providers or family members that are redundant. Take a look at your day and ask if these or other issues occur.

If we look at these issues they often involve staff more so than  the provider. What can be done to improve the staff's performance? Do we have the right people? Do we train well enough to start? Is there ongoing training? Do we assign the right tasks to the right people? What are the "bottlenecks" in the office that seem to be there everyday?

A practice should seriously take a look at the flow of the "typical" patient. An argument that is often made is that 80 percent of the patients that are seen daily require the same amount of resources regardless of diagnosis, 20 percent require more or sometimes less. By resources, it's not only time of staff but supplies, tools, etc. If you accept this argument, the answer is what can we do to stabilize the flow and gain consistency?

How about a discussion, say a daily huddle to review what happened today (PM) or what is expected to follow (AM). Talking about things will reveal a lot. Getting staff involved and not assuming you must or can come up with the solutions as the provider. Staff involvement will make implementation of the new way of doing things that much more effective.

How about drawing a flow chart and asking staff to identify what is done for each visit and when it is done? Pictures go a long way in identifying things as opposed to lists! Can tasks be shared, shifted to another or done at a different time?

The first step is to accept that there is inefficiencies in your daily flow. The second is to recognize that one person cannot solve the problems or come up with new ideas. The third is to try something to fix, failure is not a bad thing because you tried. Eventually you will get it right.

One more thing, all of the above relate to staff improvement. The provider must do their part, get to the office on time, recognize the efforts of the team by saying thanks, and support these efforts.

Doing this can result in a couple options. First, seeing one more patient a day, four days a week, 48 weeks a year will bring in roughly $18,000 at 99213 Medicare rates. An alternative benefit, is that everyone may still get to go home in time.