From Obstructed to Productive: Boost Your Bottom Line with Practice Flow

August 10, 2018

The secret to delivery of more efficient care may lie in office set-up and staff utilization.
By Larry R. Brooks, AIA, Practice Flow Solutions, Original Publication – Practice Neurology

Doctors to into medicine in order to care for people. But to provide the opportunity to do this, the practice must, like all businesses, make a profit to be able to keep the doors open and reinvest in the practice. In the tough healthcare payer and economic climate we are in, it is increasingly more difficult for practices to accomplish this. But one thing about tough time in business is that negatives can often turn into positives. They make us look inward to see how we can better provide the services we offer, how we can offer those services more economically, and how we can be more productive.

This article will review concepts and offer suggestions for improving practice flow to allow you to be more productive and efficient. For the purpose of this article, practice flow is defined as the movement of patients, staff, doctors and information through your practice.

For some doctors, being more productive is sometimes viewed as a negative. A connotation emerges that the doctor will have to spend less time with patients in order to see more of them. But there is a better way to be more productive as a doctor and as a practice. A simple axiom I’ve learned strikes at the heart of the issue at hand:

“The doctor’s main task is to care for patients. Tasks that do not require II medical education should not be consuming the doctor’s time.”

Your business is dispensing medical knowledge and skill. The more time you are doing that and the less time you are doing other things, the more productive you can be, the more patients you can care for. The more care you dispense (whether that be more care to the same number of patients, or more care to more patients) the more productive, the more profitable you will be.

Upon hearing this, some physicians invariably think, “There is no way I could possibly see more patients in the same amount of time each day.” Others agree, “Yes… if l were not doing this or that I could see several more patients every day.” In either case, the physician should identify all the tasks that consume time in the clinic day that do not require his/her education, knowledge, and skill. Those serious about stopping time drains must measure the amount of time these tasks/events take in order to determine the amount of time with patients that is lost. Then determine how many patient visits would be possible if that time were spent caring for patients. Determining the amount of revenue that is being lost shows the true magnitude of the loss and enables a practice to begin to solve the practice flow issues that are causing loss of time.

It is often hard to assess one’s day objectively. The following guide will aid in the process of identifying, measuring, and solving your practice flow problems and allow you to be more productive and boost your practice’s bottom line. In the end, it’s all about time management.

Physician Productivity

Because he/she is the reason the practice, staff, and patients are there, start with the doctor in identifying the logjams in the clinic day. To identify logjams in the doctor flow of your practice consider these questions:

  • Are doctors out of their exam pod (group of exam rooms) while seeing patients?
  • Does the doctor have to walk more that 12-14 feet between patient visits?
  • Do doctors have to walk to give instructions or information to support staff in your practice?
  • Do doctors in your practice have times when there are no patients ready to be seen?

If the answer to any of these questions is “yes,” then there are doctor flow problems in your practice. If the doctor has to leave the pod or walk to give instructions/information, then time of the higher paid staff (the doctor) is being consumed to walk to a lower paid staff. This indicates an emphasis placed on keeping the lower paid staff efficient but not the higher paid resource.

If the doctor is walking farther than 12-14 feet between visits there is lost time. This additional walking could be from having to deliver instructions/information as discussed above, or it could be that the arrangement or complement of rooms is such that the doctor walks further. For instance, if all your exam rooms are on the way side of the corridor, you walk farther than if they were directly across the hall from one another. lf you do not have a workstation in your pod (where you can take calls and review charts) but must walk to your private office that is not near your pod, you are losing time.

And if you do not have a patient ready to see when you finish with the previous patient the practice is losing time to care for patients. A number of factors could contribute to this delay from the way the check-in desk is staffed, problems with the assigned duties of staff handling patients conflicting with the task of getting the patient smoothly through the office, or the amount/layout of the space.

As you begin to identify these and other tasks/events that are causing you to lose time, also note the amount of time each consumes. Do this by observing the start and end time of each task/event. This time study will give you the information you need to determine the amount of time revenue your current practice flow problems are costing you and your practice.

Table I (next page) provides an example of a portion of the time study, where the Practice category are tasks only the doctor can perform, the Staff category are tasks that could be delegated that the doctor is performing now, and the Lost category are events that are consuming time that could be engineered out of the system.

Understanding a Time Study

Let’s assume a time study on you determines that 15 minutes of both your morning and afternoon sessions is lost to non­medical tasks/events, such as not having a patient ready to see, having to walk to find a support staff, not knowing which room is next, etc. This is 30 minutes lost each day you are in clinic. If you see about 16 patients in a four-hour session, this equates to spending on average about 15 minutes with each patient. If you got these 30 minutes back to see more patients, the economic benefit to your practice would be as shown in Table 2.

To perform this calculation for your practice you will need to determine the true amount of time you spend with each patient practicing medicine (this is after the non-medical tasks/events are subtracted out) and the average collection per office visit (not the amount charged but what actually the practice collects for the visit).

Table 1: Time Study Excerpt

  Timing Timing Distribution Distribution Distribution Total
TASK START TIME FINISH TIME PRACTICE STAFF LOST  
Find next patient 8:19:30A 8:20:00A   0:00:30   0:00:30
Review hr 8:20:00A 8:23:23A 0:02:23     0:02:23
Exam 1 8:23:23A 8:35:59A 0:12:36     0:07:36
Look for staff 8:35:59A 8:37:14A   0:01:15   0:01:15
Exam 1 8:37:14A 8:39:19A 0:02:05     0:02:05
Dictate 8:39:19A 8:40:42A 0:01:23     0:01:23
Walk 8:40:42A 8:41:05A     0:00:23 0:00:23
Talk in hall 8:41:05A 8:41:58A     0:00:53 0:00:53
No patient 8:41:58A 8:45:20A     0:03:22 0:03:22

 

If the practice identifies time that can be recaptured, there may be a need to invest in staff, space, or technology to recapture that time and revenue. In that case, determine the revenue potential, subtract the investment dollars, and determine if the net gain is worth it. Remember that some investments, like space and technology, will be onetime expenses that generate additional revenue year after year whereas additional staff will be an ongoing expense. You should find that the additional revenue will far outweigh the additional expenses.

Logjams Upstream from the Doctor

In addition to solving the logjams that happen in the doctor’s flow, you will need to assess the flow of the staff, patients, and information, then remove any logjams identified. In this way, you can be sure that a flow of ready patients for the doctor is not impacted.

Just as you observed your flow and identified flow issues, do the same for the staff that have direct patient contact while the patient is in for their visit. This will he mainly the receptionists and clinical staff. Identify tasks/events that are preventing them from addressing the patients in the office that day. For instance:

Table 2: Financial Impact

  30 Minutes regained each day
/ 15 Minutes on average with each patient
= 2 Additional patients each day
X 4 Days per week worked
= 8 Additional patients each week
X 46 Weeks worked per year
= 368 Additional patients each year
X $250 Money collected per visit on average
= $92,000 Additional dollars generated each year!

 

Receptionists 

  • The receptionists may be getting caught up on the phone and not able to check in patients, which delays the patient being ready for the doctor.
  • The task of delivering ready charts may require the receptionist to leave her/his area and walk, which limits the time they are actually able to check in patients.
  • Other duties such as medical records may cause them to lose time to check in patients.

Clinical support staff 

  • The clinical support staff may be tasked with patient triage calls that tie them up and keep them from readying the next patient or assisting the doctor in the exam.
  • There may be communication systems that require staff to leave their doctor’s pod to see if there is a ready patient or deliver instructions/information, which wastes their time and makes them unavailable to the doctor.
  • The space layout may be confusing and require the clinical staff to escort the patient out after the exam which consumes their time and keeps them from getting to the next patient.

All too often practices get caught up in keeping overhead down and do this by using a staffing model that is too lean. The staff end up performing tasks that are counterproductive to the ultimate goal of having a patient ready for the doctor to see. When observing the staff to identify and measure the logjams, keep in mind their main focus should be on having for you a ready patient to see. If duties are keeping them from doing this, then their job descriptions need to be adjusted.

Table 3: Solutions to Common Staff Model/Flow Problems

  • Phones should not be answered by the receptionist tasked with greeting patients and checking them in. Have staff dedicated to answering the phones, making phone appointments, and pre-registering patients so the receptionist can better concentrate on having you a patient ready to see.
  • Use electronic communication systems such as EMR, light signaling systems, printers, “ear buds” attached to walkie-talkies, etc. to eliminate the need to walk to transmit instructions/information.
  • Have clinical staff with main focus of readying patients for the doctor and assisting the doctor in the exam room. These staff can perform other non-urgent tasks when they have available time, but the key is to not assign them tasks such as phones and diagnostic tests that would take them away from their doctor for long periods.
  • Provide the staff work stations that are located and equipped so they do not have to leave their area.

Time is Valuable

The most valuable asset your practice has is the time of the doctor. Using that time as wisely as possible will allow your practice to be in the best position possible to deliver quality care at a lower cost per patient visit and address the changing payer and healthcare system.

The key to using your time best is having an understanding of the patient volume capacity of the doctor if there were nothing keeping him/her from only practicing medicine, then organizing the practice flow and space to allow the doctor to achieve that potential.

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