Make Your Medical Practice More Efficient

In 2004, family physician Lynn Ho opened a medical practice in North Kingstown, R.I., and she decided to go it alone - completely alone. Though she outsources her billing, she employs no other staff members - no receptionist, no nurses, no administrator.

During the first few years following the practice's opening, Ho says she was completely "bombed" with work. "I would sometimes stay until 2 or 3 [a.m.] in the office once a week just trying to get the billing out."

Yet Ho's office is thriving today because she has added tools that she says are vital to keeping her workday moving efficiently and productively.

These tools - such as online appointment booking, e-mailing with patients, and having patients enter medical histories online - allow Ho to spend less time completing administrative tasks and more time seeing patients. "It's extremely important to be efficient," Ho says of running her practice. "The less efficient I am, the later I go home. The more efficient I am, the less I work."

From technology additions (like those Ho put in place), to rearranging staff responsibilities, to cross-training employees, to benchmarking and goal setting - small changes at your practice can help you move forward more efficiently and productively.

Getting started

If you think your practice is operating as efficiently as possible, think again, says practice management consultant Owen Dahl. "Regardless of specialty, regardless of size of a practice … everyone needs to recognize that they are not as efficient as they could be."

There is always room for improvement, and though it may be tempting to continue running your practice as usual - who really has extra time to seek out improvements when you're already struggling to keep up with your daily workload? - Dahl says taking the time to look for inefficiencies will pay off in the long run.

Finding and eliminating one redundancy in the reception area for example, could reduce each patient visit by one minute. That could add up to an extra 20 minutes per day. "Well, that 20 minutes, that's something you could do something with," Dahl says. And small improvements beget bigger changes. "If we clean up the smaller issues - those that are easier to fix, those that bring a good change - that frees us up with more time available to really take a look at what we can do to improve in other areas," he says.

Practices should start the efficiency improvement process by asking: "What's important to us?" he says. The answer could be reducing patient wait times, increasing the number of patient visits per week, or reducing the amount of time nurses spend on the phone each day. "Identify just one thing that needs to be fixed that you can fix," Dahl says. "Don't tackle the entire practice."

Identify time wasters

Not sure how to get started? Assessment tools can help. They provide a quick and easy way to look at your processes differently, and as a result, they shed new light on how things could be better handled.

Benchmarks. When too many people share the same responsibilities, it wastes time and resources. On the other hand, when employees are stretched thin, tasks are not completed on time. Rob Culbert, president of Culbert Healthcare Solutions, a healthcare consulting firm in Woburn, Mass., recommends determining how your staffing compares to practices of similar sizes and specialties. That can help you "understand where [you] fall on the spectrum of being heavy on the staffing side or light on the staffing side or not having the right people in the right places," he says. Consider using a benchmarking tool, such as the Medical Group Management Association (MGMA) Cost Survey report, available for purchase at MGMA.com. It provides average staffing ratios for practices of various sizes and specialties.

Flow Charts. Creating a simple diagram of your office and the activities that take place in each area can help identify where, when, and why inefficiencies occur, Dahl says. Look at the flow chart and consider how activities in each area of the office relate to and influence other areas. "When you start to draw some pictures of how things flow, you'll begin to get a better understanding of, 'Oh, that doesn't have to be done here,' or 'It can be done at a different time,' or, 'Oh, that can be done by a different employee,'" he says.

Paper trails. Work flow, the way in which patients or work tasks move through your office layout, is often a source of inefficiency issues. One way to identify problems is by following one piece of paper - for example, a patient's bill - as it moves through the office. Document which employees handle the bill and when. For instance, the front desk, the doctor, the biller, and the coder all might interact with the bill at least once. "One has to ask, 'Each time I touch that piece of paper, is it necessary?'" Dahl says. If the answer is no, determine how the process could be reduced.

As practices acquire new technology, a paper flow assessment is especially timely, says Jeanne Smith, a CPA based in Fort Worth, Texas, who specializes in healthcare. Many practices have not yet fully adjusted their work flow processes to account for the new technology they have acquired, she says.

When attempting to eliminate inefficiencies, consider how more "fully utilizing" your technology can help. For instance, if your practice has a scanner, place it next to the computer at the front-desk. Encourage your staff to scan patient documents, such as driver's licenses and insurance cards, right there at the desk, rather than getting up and walking to the copy machine to scan items. It keeps check-in moving faster, says Smith, and it also ensures that scanned information is quickly placed in electronic files.

Utilize tech tools

Practices should also consider acquiring new technology to boost efficiencies, says MGMA consultant Rosemarie Nelson. For instance, if you are struggling to keep up with administrative responsibilities, as Ho was, implementing a patient portal can help. Portals enable patients to do everything from updating insurance information to checking test results online. That means staff members no longer deal with those responsibilities. And that means, they have more time to complete other tasks, says Nelson.

For instance, when patients input registration information online, data entry takes up less time in the office. And when patients book appointments online or send requests to the practice through a secure messaging system, staff members spend less time placing calls, taking calls, and playing phone tag with patients each day. "If we can reduce incoming calls, people will be more efficient," Nelson says.

Though implementing a portal can be a daunting task, especially if you've had a "tough go of it" with an EHR, keep in mind that portals are "fairly simple" to set up because a good vendor will help tailor it to your needs, says Nelson. And once the technology is in place, it's easy to manage. Staff just needs to check it frequently for updates or inquiries (the same way they would check phone messages).

If a portal isn't the right fit for you, consider adding software tools that connect to your website and provide similar services. For instance, Ho uses an online appointment-booking database her patients can access through a link provided on her website. "It's a lot cheaper for me to do it [that way], plus I can switch pieces out if I find things that work better," says Ho.{C}

Some online tech tools you might consider adding are:

• Appointment bookings
• Lab or test result postings and/or notifications
• Prescription renewal requests
• Billing, insurance, and registration information updates
• Medical history information forms
• Secure messaging

New technology can be expensive, but if it will increase your efficiency, it's likely to increase your revenue in the long run, says Smith. "Always think about how many more patients you are going to be able to see [by increasing efficiency]. Or sometimes it's the reverse: How many [fewer] patients a day will I have to see to be able to make the same money."

Maximize staff productivity

As Culbert mentioned, assessing whether you have the right number of staff members in each area of your office is a great way to start identifying staffing inefficiencies. But you can also greatly improve efficiency by more fully utilizing staff members. Here's how:

Time checks. Consider whether tasks are conducted at the right time, says Nelson. For instance, if a nurse waits until the end of the day to separate the normal Pap smears from those that require the physician's attention, the physician has to stay late to review those tests. If instead the nurse sets a few minutes aside throughout each day to sort the tests, the physician would be able to leave work earlier. "There's always going to be some work on the table," Nelson says. But you must consider "who does it, when they do it, what they are doing, and is it the right person."

Rethink responsibilities. Make sure that employee responsibilities match their skill levels, says Nelson. For instance, if a nurse is stocking rooms rather than completing her clinical tasks, that's inefficient. Instead, assign that role to a lower-paid staff member who can do it just as well. "Look at the level of license," she urges.

Cross-train staff. Have staff members spend time "shadowing" other employees as they complete their day-to-day responsibilities. That way, when an employee is absent, another can fill in quickly and easily, Smith says. "It doesn't take much to break the link in a physician's office by one person being gone, so if they're cross-trained, someone else can fill in and keep things going for the day, or the couple of days, or the week."

Eliminate redundancies. Use shadowing to identify inefficiencies and repetition in responsibilities. For instance, when one employee is observing another complete a task, she might recognize a more efficient way of doing it. In addition, she might realize she is tasked with a redundant responsibility.

Add staff when necessary. More staff members might be just what your practice needs to improve efficiency and therefore revenue, says Nelson. A physician who is drowning in paperwork has less time to see patients. Additional administrative support could help reduce his administrative burden and allow him to spend more time in clinic, which should generate more revenue for the practice than the administrator would cost.

Simplify exam room layout. Make sure all exam rooms are organized the same way. "The prescription pads should be in the same drawer, the tongue depressors, the alcohol wipes, whatever it is, should all be located in the same place in each exam room," Dahl says. That way, staff members always know where supplies are and they don't waste time searching for them. He suggests designating an employee to check that all rooms are organized and stocked appropriately each morning.{C}

Anticipate change

The most efficient practices anticipate change and adapt to it quickly. One way to better enable your employees to work productively despite unexpected day-to-day issues is by "huddling," says Dahl. Have small groups of staff members meet briefly at the beginning of each day to discuss the schedule and identify what each can do to keep things running smoothly. "A huddle can be very simple, with the provider talking to the medical assistant and looking at the schedule and saying, 'Oh, here comes this patient with this problem,' or looking at this patient and saying, 'Oh, here comes this patient and every time they come in they always have four, five, six, or 10 complaints, so that one's going to take me longer,'" he says. Receptionists should also participate in huddles so they can better prepare for patients in advance of appointments, Dahl says.

Huddling can also help you continually identify efficiency improvements. During huddles, discuss what problems occurred the day before and identify what might resolve them more quickly in the future, he says.

Foster growth

When employees leave early, take breaks when they shouldn't, and/or skimp on responsibilities, efficiency suffers. If you're facing such problems at your practice, hold a meeting with physicians and supervisors to make sure everyone is on the same page regarding the line of authority, says Nelson. "If a staff member makes a request and the manager says no, the physicians need to back up the manager," she says. There needs to be a "well-defined process" in place. Then relay that process to employees and hold them accountable for their actions.

If staff members continually fail to meet your expectations, staffing changes, rearranging supervisor roles, and/or linking raises to performance expectations could help turn things around, says Nelson.

And, if your staff is simply failing to work well as a team and/or individual employees lack initiative, set practice-wide goals, says Smith. Goals could include anything from decreasing patient wait times to increasing yearly revenue. If the goal is monetary, Smith says, start with the end in mind. Determine how many more patients per day, per week, per year, you need to see to reach that revenue target. Then, relay the goal to the entire staff and provide frequent progress reports. "That way," Smith says, "everyone in the office is working toward the same goal."

In Summary

Small changes can create big efficiency improvements:

• Set goals to encourage teamwork and productivity
• Rethink responsibilities to maximize productivity
• Cross train employees
• Organize and implement a plan to stay organized
• Huddle to jumpstart each day effectively

Aubrey Westgate is associate editor of Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the April 2012 issue of Physicians Practice.