Our secret for saving time, money, and grief

Forget about using standard forms. This doctor customizes his own, saving time and money.

By Shirish Kirtane, MD
Pulmonologist/Longwood, FL

It was 4:45 on Friday afternoon when Martha's son-in-law, a nurse in New York, called my office. He wanted to know what I had told Martha about the "spot" on her lung. I told him to look at the explanation and instructions on the progress-notes form I had given her; he would see exactly how I had arrived at my diagnosis and treatment plan.

In this day when all doctors complain about too much paperwork, I've created my own. But my customized forms simplify my interactions with patients, other primary care doctors, and insurance companies. I've made record-keeping and the transfer of information about patients more effective and efficient, which has saved my practice money, reduced frustration for everyone, and curtailed delays in service and payment.

Just identify those areas in your practice that demand significant staff follow-up, and develop a form that streamlines the process. You may develop one for prescription refills, for example, or for complying with HMO requirements, communicating with other physicians, or getting referrals.

Here's a look at a few of the forms I've developed for my practice. With the help of an office computer, you can do the same for yours. There is no reason to use off-the-shelf forms any longer.

Most valuable is my progress-notes form, the one I gave to Martha. I use it to record notes during all follow-up appointments. It may seem obvious, but the form has my name on it as well as the patient's name and date of visit. Too often, I've seen physician notes that don't identify the doctor.

The front of the form contains information about the patient's chief complaint, history of present illness, and results of the exam and tests. On the reverse, I record my diagnosis, new tests ordered, and additional notes, such as elaboration of positive findings, who was present during the exam, and when the patient should call me back or schedule another appointment.

The entire form can be completed in three or four minutes. During subsequent visits, I quickly refer to this form instead of searching for individual test results again.

If the findings are complex, such as an abnormal X-ray with nodules or masses or a cancer diagnosis, I give a copy of the progress notes to the patient. It's helpful for him to be able to review the findings and to see why I decided on a particular course of treatment.

I also fax the form to the patients' primary care physicians, so they know what information I've used to make my decisions, and they can field patients' questions about treatment and tests. Because the information is being read by others, I take care to write legibly. The form also provides all the documentation required to substantiate the codes I choose. Any physician could customize this form to suit his particular practice.

My consult form may be the one my colleagues like best. In the past, I used to dictate a letter to the primary care doctor when I saw a new patient. But that was time-consuming, and it forced him to wade through the patient's detailed history, which he already knows.

Now I fax him a consult form, which concisely lists what I did in the exam, my impressions or recommendations, and the tests I'd like to run. At the bottom of the form, or on a separate sheet, I'll request authorization to do the tests, and I list the testing sites so the primary can tell us if the patient is required to use a particular radiology group. The consult fax form becomes part of the patient's chart, documenting what I communicated to the primary care doctor.

The consult fax form, also a quick one to fill out, eliminates unnecessary and frustrating delays in relaying information to patients and scheduling treatment. A patient with a lung mass recently called the office wanting to know the recommendations of the thoracic surgeon I had sent her to. There was no letter from the surgeon in her chart. We called his office, but his notes hadn't been transcribed, and he was in surgery so I couldn't speak with him. Had the surgeon filled out a simple consult form as soon as he saw my patient, I would have had a ready answer for her. Instead, another round of phone calls ensued.

We've also dispensed with preprinted Superbills. Our billing form is printed from our computer the day of the patient's visit. Besides listing our commonly used diagnostic and service codes, the software also prints out the referring doctor's name and the patient's insurance company information and billing history. This alerts the receptionist to question the patient if there's an outstanding balance, and to call the primary doctor if an authorization is required for the follow-up visit. After I see the patient, I'll attach a form to the chart that directs my secretary to obtain previous X-rays, doctors' notes, and test reports before the next visit.

If the patient doesn't show up for the appointment, my secretary will make three attempts to find out why, and to reschedule. If she can't reach the patient, or he doesn't want to reschedule, she notes this on a form attached to the chart. And I'll send the guy a letter about the need for follow-up—a certified letter if his problem is serious—or simply file the chart if the problem isn't urgent. I may also contact the primary doctor about a no-show patient.

The point is, I'm a pulmonologist, and these forms are tailored to my practice style. You're probably a primary care physician, and your forms should be made to fit your style. That's one of the things a computer can do for you. No doctor should have to tailor his practice to suit the forms he uses.

 

Shirish Kirtane. Our secret for saving time, money, and grief. Medical Economics 2002;7:85.