Transcript American College of Physicians

Physician Time Management:
Creating Patient and Doctor Satisfaction
Jeffrey P. Friedman MD, FACP
Associate Clinical Professor of Medicine of NYU School of Medicine
Founding Member & Former Managing Partner, Murray Hill Medical Group, PC
My Patient Mix
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Fee for Service 20%
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Managed Care ( no capitation ) 50%
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Medicare 30%
Important
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Different timing for different appointments
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Making sure that annuals are done yearly
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Adding same day appts = Open Access
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Time for calls
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Number of rooms
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Number of support staff
Patient Needs
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Analyze the types of appointments you
need/have
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Have enough appointment types to satisfy most
common issues
−Determine time of
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appointment types
Examples: New Patient, Annuals, Travel Visits, New
Problem Visit, Vaccine, Same Day Illness, FollowUp
The Good and The Bad
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Allow enough time for the unforeseen
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Allow enough time for the different
appointment types
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Give yourself time for breaks and calls
Annuals: What You Should Do
 Require complete physical exam every 1-2 years
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depending on patient age or dx list
• Send out reminders
ROS
Examine the patient
Make sure the chronic illnesses are stable
Review medications and interactions
Review allergies
Review vaccines and administer
Review the next year of preventative needs
Counseling as needed
Annuals -What You Should Not Do
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Do not do “lists”
Do not review “Internet Articles”
Do not fill out forms
Do not “combine” the visit with another visit
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Example -- Annual and Travel
If the patient is sick, convert the visit into a
“sick visit”-do not do an annual and sick visit
together
Ancillary Staff Issues
 Determine efficient workflow
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Number of exam rooms and number of staff
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Use ancillary help for escorting patients and getting vital signs
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Use ancillary help for blood drawing, EKGs
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Use ancillary help to call in refills
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If the ancillary help does not hustle or are not good at their job details,
change them
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Have patients make their own appointments for tests if capable and
have them inform staff of time/date
Patient Centric Care
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Keep patient movement to a minimum
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Start all patients except new patients in the exam
room (exception: travel visits)
− Annuals---> fully undressed and gowned
− All others-remove only what is necessary for the most
significant problems
− Vital signs, exam, bloods, EKG’s, PFT’s, vision and hearing
all from the exam table
− Urine tests on the way out
− Place orders and prescriptions at outgoing
Training Patients
Do Unto Others…
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Run on time
• Keep an eye on your schedule at all times
• Use down- time effectively
• Keep to your rules
− No lists for Annuals
− For problem visits, keep lists to 1-2 problems max.
− Extra problems require extra visits
− Emergency/ Same day visits are just for that problem
Do Unto Others…
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Respect your Patient’s time
• If you have to leave on an emergency, have your staff call your
patients and reschedule
• If running late, take a second and go into the waiting room and
apologize
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Give an honest estimate of the wait
Offer to let them reschedule or return later
Offer them a colleague
Remember- We are a SERVICE INDUSTRY and it is
competitive out there!
Free Time – “Do Today’s Work Today”
• Prioritize Phone Calls
− Call sick patients first and offer appointments right away
before getting into a long conversation
− Do not treat on the phone
− Triage to an appropriate doctor if needed
− Review lab and test results, document and call patients if
needed
− Consider letter merge for normal issues
• OK prescription refills and referrals
Open Access
1. Completely Opening the Office All Day
2. Early and Late Walk-In Clinics
3. Setting Aside Blocks of Time
4. Combinations of Above
PROS
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Increased patient satisfaction
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Increased physician satisfaction
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Increased physician income (more patients, less
no-shows)
Cons
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Seasonal
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Daily swings can create havoc for a small practice
− Can be slow during vacation periods, late spring and early
summer
− Not enough coverage during busy times
Initial physician over-time required to work down the
patient backlog/queue
Need coverage that can handle over-flow and vacations
and who work with the same philosophy of seeing
patients
Need employees who can work in that environment
Important to allow enough time for overflow when you
return from vacation
Full open access in a busy practice might require hiring
more doctors and closing panels
Other Issues
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Paper management
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Phone calls
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Multitasking
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Finish before moving on to the next patient
• notes, coding, orders, final billing
Paper
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Paper management
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Finish before the end of the day
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Nothing is “stat”
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Consider charging if it is not covered under most
plans
−camp physicals and employment exams
Phones
 Triage
• If patients need to come in, make them do so – no long winded
conversations
• Non-emergent; fit into your day, train patients that you will call
back that day and there is no need for multiple calls
• Do not take calls while seeing/ examining a patient except
from doctors, nurses, and life-threatening emergencies
• Get the numbers and times when your patient will be where
they can be reached
Multitask
 You can do it if your kids can do it
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While on hold -- finish a note
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While on hold -- message your secretary
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Check your schedule
Finish Before Moving On
 Finish the coding on the visit
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Finish the office notes
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Move on to the next patient with a clear slate
Questions and Answers
 How many annuals and how many patients do you see each
day?
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When are hospital rounds done?
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4-5 annuals / day leave enough time for sick patients and new
patients, 20-30 patients/ day
Hospital Rounds before and after Office Hours -- leave enough time
for problems
Do you use physician extenders?
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NPs & PAs too expensive to be cost effective in Manhattan
Instead MA’s are trained to help “extend” the physician’s productivity,
as previously indicated
Q/A Continued
 How do you use dictation or templates?
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Do you lose patients because of your rules?
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We use templates, quick text and free typing
Yes, but the patients who continue with me appreciate my time
management and I enjoy work
How do you handle late patients, no shows, same day
cancels?
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Try to fit them in if late-come back later
No shows and same day cancellation ( if no good excuse ) get
charged $75 to $200 depending on the type of appointment
Q/A Continued
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How do you code for annuals?
• V codes including Medicare (after they sign a non-covered
service waiver)
• EMR tracks recall for annual
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New patient expectation issues?
• Patients download from the website the practice rules and
regulations
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Office visit hours?
• 8am-7pm most work days