By Natasha Mohr
In this two-part blog series, we have been exploring advice to help you work more efficiently. In Part 1, we focused on things you can do on a personal level to work smarter. In Part 2, we offer expert and peer-proven tips for increasing efficiency throughout your office that will make things smoother for you and your staff, which ultimately contributes to happier patients and a more profitable practice.
By now, we hope you’ve picked up one or two tips from last week’s post and have identified some areas in which you can tweak your own efforts which – hopefully very soon – will give you more time to do the things you love.
It’s now time to take the next step and streamline some things in your office, which will make the day smoother for you, your staff and your patients, improving your bottom line and giving you all more time to enjoy the things that matter the most.
This is a biggie. Processes save time. They bring order to chaos and allow you to then be flexible when needed. And also they keep you from micromanaging your staff.
Developing processes takes time and a commitment to making change, but the outcomes are well worth the effort! When done at the highest level, this is called ‘process mapping’.* For our purposes, we will assume that you already have processes in place and are looking to tweak them to add value for your patients and, in turn, to your bottom line.
An easy entry point for talking about increasing efficiency is patient flow. It is the area in which you have the greatest opportunity to affect productivity.
So ask yourself and your staff to consider, at which points in a patient’s visit can you make changes to better keep things on track? Are there benefits to rearranging the order of any of your steps? Where can you make changes that will minimize disruption and keep you and your staff from having to work late?
Every practice is unique, but here are a few suggestions which may help to move the needle toward greater efficiency in your practice:a. Consider having a dedicated person – one who does not sit at the front desk – to answer the phones, make appointments, handle patient inquiries and distribute incoming calls. This allows your front desk staff to be focused on those patients right in front of them. This clear focus also helps patients feel like a priority. b. When scheduling, take note of specific concerns bringing the patient to your office. Often patients identify one concern but when asked, may specify another as well. If there are multiple issues your staff can better schedule enough time so the appointment does not run over and wreak havoc on your schedule. c. Update patient information during scheduling calls. This way, patients only have to review the information when they come into the office. d. Discuss insurance and payment information before the appointment to give patients an opportunity to contact their insurance if there are any questions about coverage, authorization or co-pays. e. Update street and email addresses at the time of scheduling and send patient paperwork to be completed ahead of time. f. Consider scheduling two appointments. The first appointment is with your office staff and is 15 minutes ahead of the second appointment with the medical staff. This will ensure that patients arrive with plenty of time to check in and take care of any preliminary paperwork. g. Design your schedule to have some lengthier appointments built in and use these for cosmetic patients or for those who may need additional time for whatever reason. h. Allocate time slots at the end of the morning and the end of the day for emergencies or last-minute additions. If they don’t fill up, you have a little extra time in the day to dedicate to other tasks around the office. i. Give appointment reminder calls two days out rather than one. There are at least three benefits to doing so: · You can remind patients of any pre-visit/pre-treatment instructions. · You will reduce the number of last-minute cancellations. · You give yourself a better opportunity to fill open appointment times. j. Put in place a system that ensures patients check out with the front desk staff, so all payments are collected, follow-up appointments are made and the necessary prescription, products and/or follow up information is completed.
How often do you find yourself writing the same things over and over again, such as requests for particular items or instructions for patients? Eliminate these redundancies! For instance:a. Create a sushi-style ‘order form’ for neurotoxins and fillers. b. Use a ‘prescription’-style notepad for frequently recommended home care product recommendations on which you can check the appropriate steps or items for the individual patient. c. Offer brochures with post-procedure care for patients to take with them after a Mohs surgery, laser procedure, chemical peel, etc. d. Provide information on anticipated wait times for lab or test results and an outline of what patients can expect by way of communication from you and your staff.
These items can be made by your staff, printed in-house and kept in each room so you don’t have to leave to get the information – saving you valuable time. Creating the documents in-house also means that you can update them as needed.
Delegate & Filter
In a Modern Medicine Network article on medical economics, Frederick Turton, MD, MBA, MACP, Medical Director of General Internal Medicine at Emory University Hospital Midtown in Atlanta had this to say:
“Physicians are often the busiest people in a practice because they feel they can do everything better than anyone else. And while that may be true, there’s no reason for physicians to perform work that can be performed by a lower-salaried worker . . . it’s about “allowing the least trained—but still qualified—person” to do the work . . . This is about taking decision-making out of a doctor’s hands, and placing it in the hands of a protocol.”
(To read the full article visit: Time is Money: 4 Ways to Manage Practice Productivity, Organize Staff).
It is incredibly important to note, however, that delegating a task cannot simply be dumping it on someone else. This is where the clear expectations and thorough training previously discussed will pay off in spades. Creating layers of responsibility will insulate you and your staff from wasting time getting ‘permission’ for simple decisions.
We must acknowledge here that letting go of things and trusting they will be completed correctly can be difficult for some people. If you are in a very small practice or do not have an office manager to whom your staff reports, or if you have control issues, it will help to have systems in place for reporting. These can be very simple things that will give you confidence that tasks around the office are being handled and a means by which to follow up if they are not. Some examples include:a. End-of-day checklist for restocking patient rooms b. Daily product inventory counts c. A copy of the financial summary from the day and/or a sales report d. Printed preview of the next day’s patient list
Hopefully, as you improve your communication with your staff and they consistently meet (or exceed) your expectations, you can begin to let go of a few things and trust that they are being handled.
Being clear about your goals, priorities and expectations will empower your staff to confidently make good real-time decisions. This will free up your time to deal with the high-level business concerns and see to providing the best possible patient care.
This leads us to item number five . . .
Open lines of communication are essential for creating an efficient work environment. Information must flow freely among everyone involved in your practice for optimal patient care and maximum productivity.
A 5-minute morning huddle to get the day started is a great way to get the pulse of your staff on any particular day – and for them to get a read on you. Your staff is your best resource for helping you to tackle the unexpected and to anticipate needs. They should always be made aware of any unusual disruptions so they can be prepared to incorporate them into the flow of the day. For example, if you need to step out for a personal appointment during the day, if a particular rep is stopping by the office to meet with you, or you need to leave the office right after the last patient so you can make your child’s dance recital – these things should always be shared with your staff so they can plan for them rather than react to them.
The morning huddle is also a perfect time for everyone to take a quick glance at the patient list for the day and anticipate any special needs. Does a particular patient prefer to have wheelchair assistance? Is there a likelihood that a particular cosmetic patient coming for one procedure will wind up adding another that might tie up a patient room for longer than expected? Are you running any in-office special promotions of which staff should be aware and so might need to have extra product at the ready?
As items come up during the day, it is useful to have a central communications board where messages, to-do lists or reminders can be posted. This creates awareness that there is an item to be addressed and when it is removed, lets everyone know the item has been resolved.
In spite of your best efforts and no matter how well you plan, there will be days that things run anything but smoothly. At those times, it is important to rally the troops at the end of the day for a quick check in and to identify if there is anything the collective could do differently to prevent such occurrences in the future.
Lastly, a regularly scheduled, formal staff meeting is also extremely effective for communicating new information and ensuring your staff is all on the same page. This will nurture a sense of ownership, which will lead to on-going evaluation of processes and a commitment to excellence. Open communication will contribute to your employees feeling valued and appreciated and will then foster their further investment in the health, efficiency and success of your practice.
Finally, it is important to recognize when making a financial investment might be the best way to create efficiency.How much time would your staff save if you opted to purchase customizable patient-retention software, rather than making calls to remind patients to make their annual appointment or that it might be time for them to think about coming back in for another round of toxins and fillers? How much time is your staff spending answering the same general patient questions over and over again? Would creating a FAQ page on your website reduce the number of calls? Is the handling of medical waste really something your staff needs to spend time on or will it save time to hire a third-party service to take care of it at the end of each business day? Does your staff waste time and resources designing and printing materials that could easily be made available online or through a patient information portal? Is your staff taking notes on paper, then later entering the information into the EMR when they could simply carry iPads or tablets that would allow them to enter patient information immediately?
When you find companies providing these services that are trustworthy and affordable, you may be able to significantly increase your staff’s availability to focus on patient care and, ultimately, your bottom line.
Each practice is unique and our list of suggestions and tips is certainly not exhaustive. So ask your staff for their input and then really listen to what they have to say. They are feet on the ground every day and thus can be an excellent resource for informing your decisions. Their investment in the health of your practice makes them your best allies in the battle for efficiency.
*While process mapping certainly informs our discussion here, it is a large concept that should really be considered independently and at greater depth than that for which we have time. If you are interested in learning more on the theory, there are many resources available on the subject. But one read that provides a great overview of the concept can be found online at The Profitable Practice: http://profitable-practice.softwareadvice.com/value-stream-mapping-to-improve-workflow-0114/ . It’s worth the read.
Use GoodRx in the room with the patient. GoodRx is an app on your phone that tells you the exact cash price at all the pharmacies near where the patient lives. By making sure the prescription will be affordable even if their insurance doesn’t cover it, you avoid a call back from the patient when they get to the pharmacy and find out it costs too much.
Prescribe via GenRx. This pharmacy carries a limited number of products, but enough for first line therapy of 90 percent of dermatology patients. For insured patients, they receive all prescriptions from GenRx at no cost. For uninsured patients, they receive all prescriptions for $25. Since we started using them, time our staff spends on prior authorizations has dropped by 90 percent.
When I started practice, I was running lean and mean and only had one electrodessicator and one liquid nitrogen can for the office since we only had a few exam rooms that worked fairly well. But as we grew, I realized the efficiencies that having liquid nitrogen canisters and electrodessication units in each room provided. Instead of waiting for a nurse to go and retrieve them, I had them right there and every procedure was much quicker.
Solution Reach (SolutionReach.com) has been an integral part to our practice since we implemented the system in 2013. The recall campaign alone has brought in over $550,000 dollars in revenue for our practice in the last two years, revenue which may have been lost to follow up without the Solution Reach software. The recall system automatically contacts our patients who have not been seen by our practice in over a year. This decreases the manual work of the front office staff and captures patients who normally wouldn’t remember to schedule an annual skin check.
Solution Reach is integrated with our practice management system and automatically updates each patient’s account when they have confirmed their appointments, this also elevates unnecessary work for our staff. The friendly interface offers our patients a chance to reschedule appointments and refer other patients with one click of a button. We have also been able to improve our online reputation with the consistent patient reviews that we have received from the post appointment surveys which are sent after each patient visit. The feedback we have received from these surveys has helped us to improve our practice in many positive ways.
We stock all of our rooms EXACTLY the same and biopsy trays are set up ahead of time. This makes set-up and finding items a breeze.
As we do a lot of cosmetics, we have separate bins in cabinets of each room with frequently used items, including specific gauge needles, female-to-female connectors and pre-drawn and labeled syringes with expiration of local anesthetics.
We also carefully use our practice management system to efficiently keep patients moving well through clinic. Our front desk changes the appointment color to indicate to the back office staff the patient is ready to be seen. Our clinic is “donut”-shaped, and all patients are ushered from the front desk to the photo room for photos, and then around the corner into the respective room.
We also use interoffice-secured texting to communicate from back office to front office product selections and patient invoices/bills from cosmetic procedures performed that day so checkout is discrete and efficient and product selections already hand-selected at the front.
I always want to make my patients feel at home in my practice and that I’m listening to their concerns/what’s going in their lives. This can be time consuming. To do this efficiently, I always take notes about their personal anecdotes in a specific column in their chart and review it prior to their visit. This way I’m following both their previous treatments and what they’ve been up to in the last few months.
I have found the most important approach in my practice is to allow myself to delegate some tasks. I think most of us are very type A and obsessive, yet in reality we all have staff that can help us. We need to use them! So now I have my staff mix my neurotoxin for me, draw up my syringes, dilute my fillers, etc. It saves me a lot of time and they do an excellent job
Like everyone else I am trying to squeeze in communications throughout the day, so I leave 15 minute gaps throughout the day for “computer time.”
I get a lot of out-of-town patients from social media. But if you have a large presence on YouTube or other social outlets, you will get a lot of emails that need to be answered in a timely fashion. I appoint staff to answer low-importance requests such as fees, healing and common questions from tire kickers. I personally answer questions from inquiries I feel may lead to surgery. If they begin asking too many questions, I tell them they must come in for a consult.