Concerned about declining collections? Cutting overhead isn't necessarily the best response.
In an effort to maintain their incomes in the face of flat or declining collections, doctors all over America are obsessing about cutting overhead. I'm as much against wasteful practice spending as the next person. But cutting costs isn't the only way-or even the best way-to preserve the bottom line.
Here are some basic rules of efficiency that should help make you and your staff more productive. Evaluate your own practice based on these measures.
1. Doctors shouldn't do work that others can do.
2. Communication is more reliable when written than when spoken.
Instead of "telling" your medical assistant what you need, check a box or circle a code on the charge slip. This improves efficiency in two ways. First, you don't have to wait for the nurse to come listen to you; just use your "nurse come" signal to bring the assistant to the exam room, and you can head off to the next patient or phone message. Second, it's possible to prove what was ordered when it's written, which avoids the "you never told me" situation. Of course, the downside here is that you can also be held accountable for the clarity of the instructions.
3. People shouldn't write unnecessarily.
Use forms with boxes to be checked, items to be circled, or blanks to be filled in. You can use them for routine requests like test orders, surgery scheduling preferences, prescription refill messages, and such.
Here's a corollary: Rewriting is wasted effort. Why take notes of a phone call on scratch paper and then copy them to a message form when the call is completed? Why type up the appointment schedule for tomorrow when a photocopy of the schedule book will do the job? We find receptionists with computerized appointment systems taking down the information by hand, only to key it into the computer later, "when they have a minute." It's a prescription for errors of transcription and omission.
4. People shouldn't do work that machines can do faster and better.
For example, you could let a computer figure elapsed time on workers' time cards; use sheet-fed photocopiers with a collating feature; have frequently used forms printed (vs photocopying them internally); generate superbills with account histories by computer; and use voice mail to deliver test results.
5. Doctors shouldn't wait for patients or staff.
Each new patient should fill out the demographics/registration form first. Only when the patient has finished should a staffer hand him the health history questionnaire. That way, if he hasn't finished the history form in the waiting room, he can take it into the exam room and finish it there. If the doctor enters before it's done, they can complete it together. (And, if you're outpacing your medical assistants often, get more help.)
6. People shouldn't do work nobody needs to do.
For instance, by keeping the billing function up to date and providing clear statements, it's possible to reduce or avoid phone calls from patients who are confused about their bills. Filing copies of insurance claims in the chart is extra work and clutters the medical record with irrelevant business information. Keeping logs (of X-rays, tests ordered or labs run, etc.) that nobody ever refers to is an example of work that's no longer necessary but is continued because "we've always done it that way."