Physiatry Practice Management Resources

The practice collection rates and accounts receivable ratio are within the norms that have been established by other internists in my area, and I see an average number of capitated patients. What else can I look at to help identify the source of this problem?

Answer It is clear that you have spent time analyzing the practice's billing and collection process.

One area that is often overlooked is the appointment-scheduling process. An efficient appointment-scheduling process can enhance the profitability of the practice. At the same time it can help minimize the "hectic" feeling you mentioned.

The first step to analyzing this aspect of your practice operations is to determine how many appointments are scheduled each day and how many patients you actually see.

The expected average number of patients seen per day depends on the length of the practice's office hours and the medical specialty.

The Medical Group Management Assn. Web site (http://www.mgma.com/) and other regional and local organizations can supply that information.

In addition to looking at daily numbers, it is important to look at trends over several weeks and/or months. You may even want to study the differences (if any) between each weekday. Determine the "no show" rate over a set period as well.

The office staff still has to "process" that visit (or lack of visit) information, which may be time-consuming depending on the degree of the problem. This information should be easy to obtain if your practice uses a computerized appointment-scheduling system.

The next item to research is whether the practice has an appointment-scheduling/time-management policy. If it does (and most practices do), determine what method is used and if the office staff adheres to it on a daily basis. There are several appointment-scheduling techniques, including wave scheduling, modified wave scheduling and grouping.

If there is no policy then one should be developed and implemented. The starting point for this is to conduct your own time-management study to determine the average patient time for various visit categories, such as new patients, established patients, referrals and consults.

Next look at the appointment-scheduling procedures. They should provide for new patients, established visits, follow-up appointments, referrals, emergency or urgent "work ins," and medical procedures, if applicable.

What about the automated appointment-scheduling system? Many physician practice office managers are leery about depending on a computer for scheduling, especially if the computer is not always operational.

But there are many benefits of automated appointment-scheduling systems, including the ability to view several days and weeks at a time using specific screening criteria and the ability to "block" and designate certain appointment types and times. These features often increase the scheduling staff's accuracy and efficiency.

Another important area to study is the presence (or lack) of supervision. If you have taken your frustrations regarding appointment scheduling to the office manager, she may not have the most effective organization in place to review and monitor the related policies and procedures.

After performing this analysis you may discover that the hectic feeling in the office is not due to an unwieldy number of patients, but rather to ineffective time management or the staff's lack of adherence to appointment scheduling policies and procedures.

Here are some ideas to address this situation.

• Determine which appointment-scheduling/time-management technique (or combination of the different techniques) will work best for your practice. The one for your practice should take into consideration the needs of your patients, your practice preferences and habits, and the available facilities, such as the number of exam and procedure rooms.
• Discuss telephone protocols and triage procedures with the clinical support staff and the appointment scheduler. The clinical staff in particular should be able to handle a large number of the patient calls for you. Clearly documented procedures will make it easier for the receptionist to designate appointment slots that are most appropriate for the reason for the visit.
• Work to reduce patient contact time -- the number of minutes you spend with each patient -- by delegating or eliminating activities that could be performed by clinical staff, or activities that don't contribute to patient care.
• Establish your own schedule that compliments the appointment schedule and makes best use of your time. An example may include setting aside a certain time each day to make return phone calls instead of answering the calls whenever they arrive. Another example would be to allow enough time after each appointment to immediately complete dictation instead of waiting until the end of the day to complete dictation on all of the day's visits.
• Identify the best day for "work ins" as well as the days and/or time periods to avoid scheduling physical exams. According to experience and literature, Mondays work best.

Once policies and procedures are established, it will be important to train the entire staff so as to minimize problems that may occur due to lack of understanding.

Also, implement a monitoring system to identify scheduling concerns, such as continually long patient waiting times or an increased number of no-shows. This may require the hiring of a new front office supervisor or promoting another staff member to this position.

By Karen S. Schechter