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Physicians Practice's
Ask the Experts
is a question-and-answer forum featuring
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Q
We are a geriatric, internal medicine clinic practice,
and we are considering moving from a 20-minute appointment
schedule to a 15-minute appointment schedule. What insights
can you offer?
A
I certainly think 15 minutes is doable. Many in internal medicine
(though not necessarily geriatrics) set a 10-minute schedule,
though heaven knows it’s tight. You obviously don’t
want to hurt patient safety.
You may want to create
three appointment types — allowing longer time slots
for new patients and those coming in for preventive exams
and establishing shorter time slots for those coming in for
quick follow-up visits.
Keep in mind that it will
not do to change patient schedules in your books just to have
your physicians continue to practice at the same 20-minute
pace they were before. You’ll just produce long waits
and lots of staff frustration rather than heightened productivity.
If you want to shorten
your appointment times, you’ll also have to change some
of your workflow practices to make the short times doable.
For example, physicians can be more efficient if exam rooms
are always fully stocked, if nurses do a thorough intake and
handle all follow-up, and if someone is previewing patient
charts to ensure everything that is needed is there. Your
physicians will need to “stay in the paint,” or
the exam rooms, at all times — no more escorting patients
or leaving exam rooms to look for a missing piece of equipment.
If you have an in-office
lab, make sure you don’t create a backlog of orders
for your phlebotomist as a result of the increased patient
flow. Measure the actual cycle time for your patients —
from time in to time out — not just the time spent waiting
for physicians. For example, I routinely visit my primary
care practice, and I see the physician fairly quickly. But
then it’s back to the crowded waiting room for 30 minutes
to wait for a blood draw.
You also might want to
sit in on some exams with your physicians and time them. Can
patient exams really be completed faster? How? Base any changes
on reality; not just your desire to see more patients.
It may be that in a longer
session physicians can actually generate more relative value
units (RVUs) and more revenue than they would by seeing additional
patients each day. You’ll want to keep a very close
eye on outcomes, by RVU and revenue, to see if any scheduling
changes are having the effect you want. You can always change
back next month.
It is important to share
all the numbers you track with your physicians so they can
immediately see the results of working faster and more efficiently.
You might also consider
whether it would be more effective to extend your office’s
work day rather than cramming more visits into the same amount
of time.
Finally, I’m a huge
fan of the “fourth virtual appointment.” What
this means is that your schedule is set up so that a physician
performs three 15-minute patient sessions. During the fourth
“session” of the hour, rather than seeing another
patient, the physician completes documentation on the first
three patients and returns any phone calls. That means that
even if a physician is technically working longer (say, seeing
patients up to 5 p.m.), he or she still gets to leave the
practice shortly after the last patient leaves since there
is no documentation backlog or waiting messages to return
at the end of the day.
Q
I want some new practice management literature, and
I want to know if you had a title or two in your library that
you could not live without. I really need just a good nuts-and-bolts
book with some specific recommendations concerning payment
policies and addressing formulating collection ratios/run
rates. Really just some new thoughts on the old stuff.
A
How fun. I especially like these three books: Secrets
of the Best-Run Practices by Judy Capko; Mastering
Patient Flow by Elizabeth Woodcock; and Physician
Practice Management by Lawrence Wolper, ed. (This is
more like a textbook; it is a collection of essays by various
experts.)
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