8 ways I improved my bottom line

These practical changes don't require a huge effort, and could mean extra income for your practice.

Key Points

As a busy full-time internist, I constantly struggle to increase my productivity and income. While I can't do much about smaller federal and private reimbursements, I can examine my practice to see how to boost my bottom line. After doing just that recently, I came up with several changes that increased my productivity and income by over 25 percent. I'd like to share these simple and practical methods so that you, too, can take advantage of them.

1. See more patients. Most internists I know allocate 40 minutes for new patients and 20 for follow-ups and "urgent" visits-for those patients who can't wait a week for an open appointment, but who aren't ill enough to go to the emergency room. Challenge yourself to decrease those times to 30 and 15 minutes. Or, add two patients to your schedule each day by converting six 20-minute existing-patient visits to eight 15-minute urgent ones. By double-booking my 11 a.m. and 1 p.m. lunch hour slots, and tacking on 20 minutes each morning and evening, I've increased my patient load by four each day. That could translate to 80 additional appointments a month for your practice.

2. Change your schedule. You'll maximize your time-and therefore your income-by taking a hard look at your schedule. I studied mine for three months before I came to a useful conclusion. My evening hours were always full, as were Tuesdays, Thursdays, Fridays, and Saturdays. Wednesdays weren't as busy, so I now use that day to fulfill my hospital teaching obligations. Take time off during your slowest days and rework the others to take advantage of a heavier patient load. Alternate every week between adding an extra evening or Saturday office hours, so you don't lose that income to urgent care centers or emergency departments. Why be available and waste your time when patients aren't there? Be available when they want to see you.

4 Advertise. You'll have a good excuse to advertise if you extend your office hours: You're open earlier and staying later to meet patient needs. Point out to patients the convenience of seeing you on weekends, in the evening, or before they start their workday. My elderly patients like to get out of the house early, and tend to fill up the 7 to 8 a.m. time slots. Along with your new office hours, advertise coffee and juice to welcome those early morning patients. Run your ads in local and neighborhood papers, and get the word out to community organizations.

5. Decrease no-shows. Many systems can help you remind your patients to keep their appointments; it's up to you to decide which will work best for your practice. An internist colleague of mine personally calls each patient the day before their appointment. He tells them he's looking forward to seeing them, and answers any medical questions with "we'll talk about that tomorrow." His no-show rate is infinitesimal. If you don't have the time to call your patients yourself, have your staff call instead with a reminder. Or do what another colleague did when faced with an alarming no-show rate of 60 percent: Send out a questionnaire for patients to complete and bring on their first visit. This simple step cut his no-show rate in half. A similar, more common tactic is to mail written appointment reminders a week in advance.

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