Strategies to Maximize Patient Appointments

Family physician Robert L. Wergin is all too familiar with the challenge of finding enough time to spend with his patients. Since he began practicing more than three decades ago, the Milford, Neb.-based physician has seen the amount of face-to-face time he spends with patients fall. He attributes that to his EHR (documenting while interacting with patients is difficult, he says), the complicated regulatory environment, lack of standardization of quality metrics among payers, and complicated payer requirements.

The resulting time crunch, says Wergin, who is president-elect of the American Academy of Family Physicians, takes a heavy toll. "In my practice and in family medicine, I think relationships are important - you knowing me and me knowing you," he says. "I think there are evidence-based articles that show that just that one thing can improve your outcomes by almost any measure."

But Wergin doesn't need to read those articles to know that this is the case - he sees it on a daily basis. Just recently, one of his elderly patients visited his practice because he was not feeling well. As soon as Wergin began interacting with the patient, he sensed that something was seriously wrong. "We ended up being much more aggressive than I might have been with someone I didn't know," he says. "I knew his cognitive functioning and alertness was changed and we ordered a CAT scan and he actually has a brain tumor that we diagnosed early."

Many of you have similar stories to share, and you don't need to be told how important your relationships with patients are. But as the amount of time you can spend with them decreases, you do need to find new ways to protect those relationships. Here are some simple ways to ensure that you are maximizing your patient visits.

Start off right

Since you're already pressed for time, getting patients back to your exam room on time is critical. One way to help guarantee patients are ready in the exam room when you are: streamline patient check-in, says Atlanta-based practice management consultant Elizabeth Woodcock, founder of Woodcock & Associates.

Any information that patients can fill out and return to your practice prior to appointments, such as medical history information and administrative forms, should be completed and returned in advance, says Woodcock. That way, staff won't need to gather that information at check-in, and they will have extra time to address any unexpected questions or problems that arise, such as issues related to benefits eligibility.

Asking patients to complete and transmit pre-visit paperwork, of course, will require some pre-visit communication. Since most patients tend to return paperwork to practices the same way they receive it, Woodcock recommends electronically transmitting paperwork to patients, such as through a patient portal. That way, patients will likely send the information back through the portal electronically, which will help streamline data entry.

Pre-visit paperwork is not the only homework that staff should assign patients. They should also ask patients to bring a list of relevant health information with them to appointments. That list should include any medications and/or supplements they are taking and the dosages; any allergies or recent allergy changes; and any major life changes or new stressors, says Wergin, adding that patients with acute illnesses should list their symptoms and the duration of the symptoms. When patients bring this list with them to the exam room, it streamlines the patient visit because patients can quickly consult it when questions arise, says Wergin.

To make certain patients know what to bring with them to appointments, consider posting this information on your practice's website or patient portal, asking staff to remind patients when booking and/or confirming appointments, and/or routinely highlighting it in your practice's patient newsletter. Wergin's newsletter, for instance, often includes a short "tips on seeing your doctor" blurb.

Prep for success

Just as patients need to complete pre-visit homework, so do you and your staff members. Prior to each patient visit, review and compile as much information relating to that visit as possible. That way you will have more time to spend interacting with the patient and delving into deeper issues during the visit itself, says Frank Adams, a solo pulmonologist based in New York City. "I love to have a patient come in and [be able as a physician to] say, 'I've already looked at your CAT scans; I've read your records from your other doctor,'" says Adams. "Then we can spend a lot more time getting to the bottom line trying to figure out what's wrong."

Woodcock recommends instituting a chart review process at your practice so that you and your staff compile and review any necessary information prior to patient visits. This review process should be conducted a few days prior to patient appointments, she says. "We need to look at the patient's previous record, previous documentation; or, if they are a new patient, what they're presenting for, and determine what the doctor will need."

While this may sound time-consuming, it will pay off in the long run, says Woodcock. If you wait to compile or review this information until the patient is waiting in the exam room, for instance, your time spent doing so will cut into that patient's face-to-face time, and perhaps even into your next patient visits.

One other way to prepare as much as possible for each patient visit: huddle up. At the beginning of each day, Wergin spends a few minutes discussing his schedule with his nurse and identifying any prep work that needs to be completed prior to visits. If he sees that a patient is coming in with a particular health issue, for instance, he might ask his nurse to make sure that relevant patient education materials are placed in the exam room, so that he can access them quickly during the appointment.

Delegate

Spending a few minutes to review your day with your team members has another benefit: It will help you identify tasks you can delegate to staff members. This will help ensure that you have enough time to address the elements of the visit that require a physician's expertise, says family physician Bruce Bagley, president and CEO of TransforMED, an organization that specializes in helping practices transition to Patient-Centered Medical Homes, which emphasize a team-based approach to patient care.

"Anything that can be written into an algorithm, that's fairly straightforward, should be off-loaded from the physician work and distributed to the proper team members," says Bagley. For example, if any patient older than 50 years old comes in for a visit and the physician sees that the patient hasn't had a colon cancer screening, the physician should ask one of his staff members to talk with the patient about the need for that screening and discuss the procedure with him.

"If you can offload all these routine tasks that take up time, that gives more time for the relationship stuff, the 'How's Uncle Charlie doing with his drinking?' or 'How are the kids doing in school? I understand Johnny wasn't doing so well last time you were here.' That kind of stuff is what builds that relationship," he says.

To ensure you are delegating properly, Bagley recommends creating a list of your daily responsibilities. Then, noting which can be delegated to a staff member. "We've been operating on the hero model," says Bagley. "The hero model is that the doctor is the source of all knowledge, wisdom, decision making, and education, and that's just no longer OK. We know better."

Efficiently educate

One item that you are likely to see crop up on the delegating side of your list is patient education. In many cases, another clinical staff member can do just as good a job educating a patient as a physician, if not better, says Bagley. "When I was practicing, you'd have these little tapes in your head and you'd click them on and you'd talk for a couple minutes about 'X' disease. I'd be willing to bet it comes out pretty much the same every time you do that. That's the kind of thing that probably should be done by somebody else."

While delegating patient education can save time, so can focusing on more efficiently educating patients. Wergin places patient educational materials in his exam room and organizes it by medical condition. When he needs it during patient visits, he can quickly access it, write the patient's name on it, and highlight key portions. "There are studies that show that if I just write your name on a handout and say, 'Now I want to point out the highlights on this,' and hand it to you, you're more apt to follow through on that," says Wergin.

Visual tools are another great way to educate patients more quickly and ensure that they retain more information, says Woodcock. For instance, show patients a quick video relating to their condition, or use medical apps to explain a particular problem. The drawMD apps, for instance, allow physicians to draw on their tablets to illustrate and explain different medical conditions. "A picture speaks a thousand words, so undoubtedly it's more efficient," says Woodcock.

Regardless of how efficiently you educate patients, however, you may still feel like you don’t have enough time to cover all that you would like. If that's the case, consider sending out a weekly or monthly newsletter to patients so that you can educate them when they are outside your exam room. Adams sends out an e-newsletter every Friday that includes health articles and health tips.

Keep conversations on track

Smart education tactics will help you maximize your time with patients, and they will reduce the number of questions your patients ask during (and after) appointments. But many patients will still bring up unexpected questions or concerns that don't necessarily relate to that day's visit. Knowing how to gracefully navigate these unexpected inquiries will help prevent them from taking up too much time. Here are some tips:

• Set a clear agenda. At the beginning of each visit, ask patients to outline their primary reason for the visit, and ask if there is anything else that they would like to discuss, says Woodcock, adding that it's important not to ignore clear signs that something else is troubling the patient. "If the patient is holding a notebook that says hormone replacement therapy, don't ignore that," she says.

• Smoothly transition. If patients do bring up other concerns (and they are non-urgent), politely push those issues to the back burner, says Woodcock. She recommends saying something like, "That is so important that I really want to have time talk about that. Let's go ahead and schedule another appointment so that we can address your concerns."

• Address it later. As more patients research their health issues on the Internet, more are toting online research with them to appointments. When this happens at Adams' practice, he asks patients to leave the research with him so that he can spend time looking it over later. Once he has reviewed the information, he messages his thoughts to patients through his patient portal.

Better engage

While Adams does not shy away from engaging with patients through his portal, many of you might cringe at the thought of adding more tasks to your day. Still, Adams says, it's worth it in the long run. "You have to work at it and get comfortable with it, but I think, if you take advantage of what's out there, then you can preserve those important visits," he says.

Medical Group Management Association consultant Cindy Dunn agrees, adding that using technology to interact with patients leads to better engaged patients, which in turn, leads to more streamlined patient visits.

If patients can send you their questions through a patient portal, for instance, and you or your nurse can answer those questions quickly, that might cut down on the number of questions patients ask you during appointments, says Dunn. "When people have a better understanding of what's going on with them, they don't come back over and over with the same questions," she says. "They are not calling back in to your office two hours later or the next day saying, 'I don't understand.'"

Another added benefit of engaging with patients outside of your exam room: It could result in better patient outcomes. "I think if people are engaged they pay more attention to their health," says Dunn. "They're going to feel better, they're going to do maybe what you want them to do, and so it is going to be a better visit."

Efficiency boosters

Looking for some great tools to maximize patient visits? Visit bit.ly/Time-Tools for a slideshow featuring some of our top picks.

In Summary

Here's how to make the most of the limited time you can spend with patients:

• Review patient information prior to patient visits

• Meet with staff each morning to discuss prep work

• Delegate tasks that don't require your expertise

• Place education materials in each exam room and organize it by condition

• Use visual education tools

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

This article originally appeared in the April 2014 issue of Physicians Practice.