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Practice's
Ask an Expert
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
I am following advanced access scheduling principles. If I
take a vacation, I’m swamped on the first few days I’m
back in the office. How can I alleviate that?
A
Coordinating vacations with advanced access scheduling is
challenging, but possible. The key is controlling what you
can. Namely, make sure neither you nor your staff members
schedule any follow-up or revisit appointments during the
week following a vacation. That will leave more time open
for patients who experienced new symptoms during your absence
or who want same-day access. Patients coming in for a regular
checkup can wait a few extra days. Also, try to find some
coverage for your patients while you are away. Locum tenens
can help, although that can be an expensive option. Or, trade
vacation coverage with your partners; agree that you will
cover for one another.
Q How
many patients can the average physician handle?
A
The average patient panel
— or number of active patients — varies quite
a bit by physician and by specialty. An internist typically
sees 1,500 to 2,500 patients a year; a pediatrician treats
2,500 to 3,500; and a physician in family practice juggles
from 2,500 to 4,000.
Why the variation? Some
patients demand more than others do. The oldest and youngest
patients need more time, for example, as do female and sicker
patients.
Q
How many vacation days do most physicians get per year?
A
The average time away from the office for physicians —
for vacation and continuing medical education — is five
to six weeks per year.
Q
We are looking for new
office space. How do I know how many parking spaces we will
need?
A
There are two ways to
think about parking spaces. First, you can allow one space
per patient per hour for all doctors seeing patients at one
time. Then add a space for every employee and for every physician.
A looser way is to plan for five spaces per 1,000 square feet
of office space.
Q
Where
can I find guidelines for storing and distributing drug samples?
A
The Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) has recommendations
for handling drug samples. These are only guidelines —
not legal requirements — and are mostly relevant for
hospitals and hospital-owned clinics looking for JCAHO accreditation.
But they are good standards. You can review the standards
at www.jcaho.org/accredited+organizations/hospitals/
standards/hospital+faqs/care+of+patients/medication+use/drug+samples.htm.
That Web page also has a link to pharmacy-related frequently
asked questions.
Another resource is your local Drug Enforcement Agency (DEA).
A listing of offices and pertinent contact information can
be found at: www.usdoj.gov/dea/agency/domestic.htm.
Q
To
manage daily operations I want to set up standardized policies
and procedures. What should I make sure I cover?
A
Standard policies and
procedures should include:
- handling of professional
courtesy,
- handling accounts with
credit balance,
- printing a face sheet,
- voiding a procedure,
- prebilling analysis,
- printing of encounter
forms — pursuant to scheduling and on demand,
- no-show encounter tracking,
- encounter tracking
report,
- appointment templating,
- financial agreement
and
- daily balancing.
Q
How and why should I calculate
the value of a patient?
A
Too many physicians, administrators and staff don’t
consider what it costs the practice when a patient gets tired
of waiting or is annoyed by bad service and leaves the office.
Physicians who habitually run behind schedule or who want
to cut back on contact hours may not immediately see the impact
of their behavior. Calculating what each patient is worth
brings home the message that each patient needs to be treated
right.
First, calculate your
average revenue per patient: divide total collections by the
number of unique visitors (not patient visits as most individual
patients will visit more than once). From this average revenue
per patient, subtract the average overhead costs per unique
visit. The result is the average value per customer.
Since surgeries bring
more money to a practice than other services, you might want
to calculate those separately.
Q
Do representatives from
pharmaceutical companies really need a physician signature
when they visit?
A
Yes, drug representatives
do need a physician signature. The Prescription Drug Marketing
Act (PDMA) regulates how samples of controlled substances
must be tracked. The representative is required to describe
how the drug acts and what the side effects are before handing
over the sample. In the pharmaceutical industry, this is called
“detailing.” Then the representative must collect,
either on paper or electronically, the physician’s signature
confirming receipt.
See page 29 and 30 of
this summary of the PDMA: www.fdli.org/pubs/Journal%20Online/51_1/art2.pdf.
Look under the headings “Drug Sampling” and “The
Written Request.”
Q
What can I do about a
physician who won’t dictate in a timely manner?
A
It’s crucial for physicians to dictate quickly. Not
only does this expedite billing, it keeps busy physicians
from forgetting what happened.
Before you reprimand the
physician, however, make sure you have set a norm or a group
expectation for what constitutes timeliness. And be sure the
physician knows what’s expected. If he can’t (or
won’t) comply, find out what is making it so hard. Then
come up with a solution. Maybe something as simple as having
all the files piled up neatly on his desk in the morning will
provide motivation.
If that agreed-upon solution
doesn’t help either, apply pre-established economic
sanctions. Dock his pay, for instance, or charge him for each
hour the dictation is late. Just make sure that whatever punishment
is meted out does not become a badge of honor. Some physicians
like to flatter themselves that they are too busy doing real
work with patients to bother with dictation. |
