Inefficiency lurks in areas unseen and overlooked

Leave no stone unturned when looking for places to improve your practice.

By Zack Tertel, Senior Editor

Even if you think your practice is operating at optimal efficiency levels, it’s in your best interest to evaluate all processes to get more people walking into your practice who walk out as regular patients.

“Allowable Medicare fees, under even the rosiest scenarios, are most certainly slated for some level of reduction in the years ahead,” says John Pinto president of J. Pinto & Associates Inc., an ophthalmic practice management-consulting firm in San Diego. “For the typical general ophthalmologist with a 40% profit margin today, a 10% Medicare fee reduction along with even mild inflation will result in a 20-plus% surgeon pay cut.”

Increasing your practice’s efficiency helps to fight the elevated threat of a shrinking profit margin. To ensure consistent monitoring of productivity and efficient operating levels, comparative data benchmarks have become standard in strong practices, says Corinne Z. Wohl, MHSA, COE, administrator of Delaware Ophthalmology Consultants in Wilmington, Del.

“In the past, with higher profit margins, if you didn’t pay close attention and missed an occurring inefficiency, there was a wider acceptable range to make some mistakes or to miss some opportunities,” says Ms. Wohl. “You could run a little ‘fat’ and it wouldn’t hurt a strong practice. But now profit margins are tapering, so every move we make and every decision we make is much more critical, and we cannot afford to not be careful with every single thing we do.”

“Practices get so accustomed to doing things the way they do them, they just don’t see the waste,” adds Tom Ludwig, RN, MBA, FACMPE, president and chief executive officer of Forward Healthcare Solutions, LLC, in McFarland, Wisc., which provides consulting services to healthcare organizations. “To do something different can be very difficult. Once you can get the light bulb turned on over their head, then it starts moving.”

Here, practice management experts explain how you can trim those areas where you may be carrying a little heft.

BECOMING EFFICIENT

What is optimal efficiency?

Those interviewed offered several suggestions on creating an efficiency plan. But what is the ideal goal for your plan?

“Optimal practice efficiency is one of your administrator’s top goals,” Ms. Wohl says. This scenario includes having: strong control of staffing levels-to-patient visit ratios, full patient schedules, appropriate technician support for each doctor, tight inventory controls and the right amount of space to fulfill all practice functions.

“(Efficiency) standardizes as many processes as possible to reduce variation and increase consistency and familiarity,” Mr. Ludwig says. “It uses all the members of the team to identify issues and improve workflow and quality, and it uses staff to the highest level of their education, training and licensure.”

How to reach your goals

For many practices, the most challenging part of becoming more efficient is identifying where improvements can be made. “Even the most experienced administrators I know are always looking to find something they’ve missed or a new opportunity,” says Ms. Wohl.

Rather than giving blanket dictums asking staff to be more efficient, let one staff member spearhead the process, says Mr. Pinto — the CFO in a large practice, the office manager or administrator in a mid-sized practice and the doctor-owner in small offices.

To start, those interviewed suggest mapping out each step of the current patient-flow process from room to room to identify problematic areas.

“It’s really important to look at your practice with fresh eyes,” says Ms. Wohl. “We all get busy, and it’s easy to overlook things that aren’t on fire. I like to challenge myself and ask, ‘Why are we doing it this way?’”

Also, involve staff members from all areas in the discussion of what works and what doesn’t, says Elizabeth Holloway, a senior consultant with BSM Consulting in Clearwater, Fla. “When working on efficiency, it is important for the office to have common goals. The physicians and administration should include staff to determine the areas where they will focus energy first. Develop goals for the entire staff, monitor progress, and celebrate success.”

In addition, this helps to ensure your solutions don’t unknowingly create problems for other staff members, Mr. Pinto says.

“While most mid-level managers come up through the ranks and know how to do the jobs of the people they supervise, the administrators of larger practices are frequently separated from life on the assembly line.”

Beyond increasing efficiency, gleaning input from all staff members increases their ownership of the practice, whether they’re a fiscal owner or not, Mr. Ludwig says. “They become part of the practice and realize their viewpoint is valuable. You end up with a lot more employee satisfaction — they buy in and have a lot of their heart and soul invested in the practice.”

OVERLOOKED AREAS TO IMPROVE

Scheduling

One road to increased efficiency begins with effective scheduling. Without consistently monitoring the schedule, appointment slots can remain unfilled, says Ms. Wohl. And each appointment slot is a significant revenue source. For example, if a doctor adds three appointments per clinic day to his or her schedule, it can result in approximately $100,000 added directly to the practice’s bottom line per year (assuming 3.5 clinic days per week with 48 clinic weeks per year and a $195 average ticket).

To avoid having an unfilled patient schedule, Ms. Wohl says she audits the practice recall system quarterly or semi-annually, depending on the last result. “We also work hard to not get complacent about appreciating referral sources,” she says. This includes responding to patient needs with extra care, sending the patients back to the referring doctor’s office for follow-up care consistently and the doctors writing patient care exam letters promptly to keep everyone informed and included in all communication.

Also, the timing of appointment types can be key for efficiency, says Ms. Wohl. For example, she says the schedule starts each morning with shorter visits that don’t require a full patient work-up. That way, doctors begin seeing patients quickly.

Use of labor

A $1 million annual revenue practice operating 2,080 hours in a year produces about $481 in revenue per hour, or about $8 per minute. Every minute counts in the practice, so maximize the most costly resource in the practice: the physician’s time, says Mr. Pinto.

“Should a doctor go to his office and read e-mails when he has an open room and could jump in to start a patient, or go to the ‘sidelines’ and meet socially with a pharma rep for 20 minutes?”

Conversely, if a physician tries to accomplish too much and has trouble keeping up, move some of these tasks to other underutilized staff members. “Decide what you can take off the physician’s plate and can be done safely and effectively by someone else,” Mr. Ludwig says.

When analyzing each step of your patient flow, determine what tasks the doctor performs that could be done by someone else and ensure all staff are working up to their training and expertise levels, Mr. Ludwig says. For example, if a physician returns calls or moves patients from one room to the next, consider finding another qualified employee who can perform these tasks, even if they only take a few minutes ­— every minute spent with the patient makes an impact, says Ms. Wohl. For example, if the doctor sees 50 patients in a day, spending one fewer minute with each patient frees nearly one hour in his or her schedule that could be spent elsewhere. And the newly available hours add up fast.

“Having the doctor being as efficient as he can and having the tech doing as much for the doctor as they can really helps,” she says. “The doctor could leave earlier and enjoy more time outside the office or could choose to see more patients in that day.”

Streamline flow

While practices with multiple physicians may not be able to make every protocol identical, the more physicians can agree on uniform processes, the more streamlined practice efficiency will become.

Practices with varying protocols that require different tests at different times can create the potential for inefficiency and confusion among staff members, says Ms. Holloway. If physicians can meet together and determine their office’s standard of care, the staff will be more successful in preparing patients to see physicians.

“When practices have multiple facets going off in different directions — different scheduling templates, different testing protocols, different technician work-ups — this can become overwhelming,” Ms. Holloway says. “That’s when I really see the efficiency break down, and there are very long patient wait times in those practices.”

After ensuring each doctor’s processes are as uniform as possible, consider your practice’s layout and its impact on workflow, says Mr. Ludwig, suggesting patients should move through the building linearly.

“If you have staff going from exam rooms on one end of building to a workspace on the other end or you have patients too spread out within the practice, you need to have things set up in a common sense [based], streamlined fashion,” says Mr. Ludwig.

Training guides scheduling

Once the physicians have agreed on a standard protocol, it is important to provide training and resources for all office positions, says Ms. Holloway. If the front desk staff does not understand dilation, they may schedule dilated exams in late morning, creating delays that will impact the afternoon schedule. “There’s a continuum of training that goes on throughout the office, and the staff need to understand what is expected for specific patients, she says.

REMAINING EFFICIENT

No quick fixes

After establishing his clients’ overlooked areas and concocting plans to solve them, Mr. Ludwig says these problems should not return. “I stay away from quick fixes,” he says. “I set up [my clients] with processes and infrastructure.”

Once the practices increase their efficiency, patients and staff members are sure to notice the benefits.

“High employee satisfaction correlates strongly with patient satisfaction,” Mr. Ludwig says. “And, in the long run, you’ll see less employee turnover, more longevity and all of the benefits that go along with it.” OM