Medical Practice Productivity Pitfall to Avoid: Rework

Rework is the biggest drag on productivity (and profitability) in most medical offices.  It is a bigger problem than government regulations.  Unlike regulatory burdens, however, much of rework is avoidable.

Here are three types of rework practices encounter, and how practices can mitigate them:

1. Rescheduling patient appointments. The practice has already done all of the work to schedule an appointment. Often it has also done the work to prepare for the appointment: insurance verification, chart review for outstanding tests, lab work and documentation, etc. If the appointment is not kept, all of the work already done is wasted.

The cancellation may require additional work. If the patient is a no-show, that needs to be noted, and in some cases the practice may attempt to contact the patient to reschedule the appointment. In the case of a practice still using paper charts, there is the additional work of returning the chart to the file room. In terms of practice revenue, all that work is wasted, too.

Some rescheduling is unavoidable and is the cost of doing business. Most rescheduling can be avoided, however, if the practice runs on time and if the schedule goes out no farther than physicians' and patients' reasonably assured availability.

I once worked with a provider who generally ran very late and regularly changed her availability with less than a week's notice. We discovered that the receptionist spent 80 percent of her time rescheduling appointments, a burden that also reflected patients' perception that they could also cancel on extremely short notice.

2. Lost/misplaced documents. Practices spend a huge amount of time looking for documents and charts. Any time spent searching for a misplaced chart/document is essential, but a drag on productivity.

In theory, the problem of misplaced charts and documents goes away with EHRs. In practice, EHRs can make the problem worse. A misfiled electronic document is almost impossible to find. A central facility for scanning documents generally introduces a time delay in availability that looks just as though the document has been lost, and the volume of paper in the central facility makes early retrieval almost impossible.

To reduce the amount of time spent searching for misplaced charts and documents, charts should have a minimum number of places where they belong, and those are the only places where they should be. Documents should be scanned and attached to files as soon as they are received. Centralized scanning can make sense in an EHR implementation, but not after go-live.

3. Telephone calls from patients. Many patient calls are unavoidable, however, there are two types of calls that practices can reduce:

• The first is a patient calling for verification or instructions regarding what he was told during his appointment. Clearly written information provided to the patient during the visit can eliminate this type of follow-up call.

• The second is a patient's repeat call for the same issue. For example, a patient calls with a question about her upcoming surgery. She leaves a message with staff. Two hours later she hasn't heard from the office so she calls again and leaves a message. If she still hasn't heard from the office, she may begin calling every 30 minutes. If staff provides the patient with information regarding when she should receive a call back from the practice, however, it's less likely the patient will call back repeatedly until that time has passed.

The goal is to minimize rework, which will free up resources for additional work that adds value, increases productivity, boosts income, and lowers costs.