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is a question and answer forum featuring
leading practice management experts who may or may not be
employed by Physicians Practice. On average, Physicians Practice
receives 250 questions per month from physicians, office managers,
office administrators and others. Have a question about the
operation of your practice? Visit www.PhysiciansPractice.com.
Your question will be answered within three business days.
Q
What
is a drop-in group medical appointment, or DIGMA?
A In a DIGMA, patients are invited
to “drop-in” for an appointment. There are no
criteria for participation other than being on the physician’s
panel. The groups, which are based on the work of Ed Noffsinger,
Ph.D., are led by a physician and a behavioral health professional,
but may include other disciplines. The group generally meets
at the same time and day each week; patients can drop-in when
they choose (although they are asked to phone in their registration,
so charts can be pulled in advance).
There also are variations on this theme. Many practices offer
educational programs for their patients. For example, an OB/GYN
practice might provide or host a childbirth class. These courses
generally are scheduled in advance and are often led by nurses.
There are also cooperative health care clinics (CHCCs), which
include the educational component of educational sessions,
but primarily are focused on helping patients meet certain
health criteria. Developed by John Scott, M.D., for managing
his population of geriatric patients, this model has expanded
to include groups whose members have a particular chronic
disease (e.g., congestive heart failure) or other shared situation
(e.g., pediatric well-child visits). CHCCs often involve a
multidisciplinary team but are led by a physician.
For patients, the value of all these types of group visits
is derived from the access to multiple resources, as well
as the socialization allowed in a group. This socialization
has health benefits, as members encourage one another, exercise
together and so forth. For physicians, it’s a way to
improve access, compliance and patient satisfaction.
Q What
steps do I need to take when closing a medical practice?
A If you are preparing to close
a medical practice, you need to consider all the logistics,
based on your practice situation.
What will you do with your building? Do you rent, lease or
own? If you rent, you need to notify your landlord about your
intentions. If you own, do you plan to sell? Find a realtor
and start your preparations.
Also, what will you need to do to move your equipment, files
and furniture — and where will you put them? If you
lease your equipment, notify your vendor. If you own your
equipment and want to sell it, you’ll need to find a
seller—have a yard sale, put your equipment up for sale
on eBay or find another way to locate a buyer.
Q I know
unhappy patients don’t always speak up. If we hear a
complaint from one patient, how many other patients can we
assume are also upset?
A Approximately one in 15 dissatisfied
patients will tell you they are unhappy, according to practices
Physicians Practice has spoken with. Up to 90 percent of unhappy
customers look for another physician without saying a word
to you.
If a patient asks you to transfer his medical record to another
physician in the same community, do it — but make sure
to call the patient and ask what went wrong. Identify problems
so you can fix them.
Q How
do I prevent embezzlement?
A There are as many ways to
prevent embezzlement as there are ways to embezzle. Here are
some general guidelines:
- Hire
honest, bondable people
- Use a
lockbox for petty cash
- Install
financial controls
- Restrict
signature authority on the checkbook
- Have
an annual audit
Q Our
transcription service just raised our prices and started charging
per byte. Is it normal to pay for transcription by byte?
A No, most companies price by
line or by character: The industry average is 11 to 13 cents
per line.
Q How
can I reduce transcription costs? I’ve heard macros
can help. What are they?
A Macros are templates that
physicians write for common exams, problems, plans and so
on. They save costs because instead of dictating every detail
— then paying for transcription — the physician
simply dictates “insert XYZ macro,” and the transcriptionist
knows to cut and paste pre-set language, which is much faster
than re-typing it each time. For example, for urinary tract
infections, the physician will dictate “UTI macro”
— and the transcriptionist then adds the issues pertinent
to the specific patient being treated.
In addition, look at your costs. The average line costs 11
to 13 cents. If you’re paying more than this, go with
another service. There are now services using labor overseas
to get better rates. They transfer information via the Internet.
You might look into this option for even better pricing.
Finally, consider whether you could cut transcription costs
by using a voice recognition system instead. These systems
take dictated notes and automatically turn them into digital
documents — no transcription required. The catch is
that even the best voice recognition systems have some error
rate; they don’t understand every word the physician
speaks. If, as a result, the physician has to spend a lot
of time reviewing and correcting the notes, you may end up
spending more in physician time and lost productivity than
you are paying now for old-fashioned transcription.
No matter what option you choose, don’t let it substitute
for good documentation. You must document each visit appropriately.
Q When
calculating overhead, how do you account for additional services
such as in-office echocardiograms or Dexa scanners? If I add
them into my overhead costs, won’t my costs seem unnecessarily
high?
A You should include all ancillary
costs and revenues when calculating overhead. The resulting
overhead rate will not seem high if the ancillaries are profitable
— although you are adding to the cost side of the equation,
you also are adding to the revenue side, so the results balance
out.
If, however, the ancillaries are not profitable, you will
indeed have a high overhead. That doesn’t mean you should
throw your scanner out the window. It just means you should
be aware of the business decision you are making by having
them around. Do the payoffs in patient loyalty and convenience
counteract the costs of providing the ancillary service?
The best way to look at overhead is:
- calculate
your practice’s overhead/overhead rate — include
all services, even ancillaries;
- take
each ancillary service and evaluate:
– the revenue
associated with that service and
– the expenses
associated with that service.
If there is no profit,
then consider the strategic benefits for that service. If
there are no financial, strategic or capital benefits, eliminate
the service. |
