Streamlining your practice

Efficient workflow isn’t natural. It’s earned. With so much riding on a well-tuned office-from the most effective use of your time to creating the best patient experience-now is an opportune time to focus on streamlining the business operations of your practice.

Before delving into specific work functions, let’s focus on some key management principles of a successful medical practice.

First, it is important to recognize that your time is your practice’s greatest asset. Therefore, make sure the infrastructure of the practice is geared toward optimizing it. Second, your prime directive is to care for patients, so each work function must be patient-centric and support this imperative.

Read: Building a team-based medical practice

Here are some key dos and don’ts to transform your front office, mid-office and back office into a successful medical practice.

The front office: Directors of first impressions

Recruit well. Start by taking a deliberate approach to new employee orientation. Pay close attention to the quality of the training you provide to front office employees, just as you do for clinical staff. The front office plays a critical role in how your practice is perceived by your patients.

Provide resources. Don’t tolerate slow computers, inadequate workspaces or haphazard floor plans. Give employees the resources they need to get the job done efficiently. Install computers with high processing speed and dual monitors to facilitate efficient access to systems, and install top-notch workstations. At least once a quarter, ask each employee the question, “What is the one thing I can get you so that you can do your job better?”

Develop a start-of-day checklist. Put in writing all of the steps you would like taken before your office opens each day. Requesting employees to “turn on your computer” and “switch the phone off of the service” may seem trite, but stumbling over these basics is where problems start.

Keep a pulse on the practice. The schedule is dynamic, but it can’t be filled without good communication between all employees. Put a process in place so that if a patient cancels his or her appointment or the triage nurse sends a patient who has a scheduled appointment to the emergency department, the front office team is alerted to fill that patient’s appointment slot from a list of patients seeking a walk-in or “earliest opportunity” visit. Track wait times for appointments to ensure you are accommodating patients within your targeted timelines.  The supervisor in this sector of the practice should create a daily action plan and share it via your intranet or a white board so that the entire team understands the nuances of the day.

Ask patients to prepare for their visit. To prevent delays at the front office, put information requests into the registration packet. Transmitting these requests to patients before they arrive produces a faster and more complete patient registration and intake process. It pays off with fewer delays and, potentially, the snags that cause claim denials

Focus on accuracy. Mistakes happen, but often they are the result of poor training or lack of understanding regarding the importance of the work. Recognize that investing in your front office means saving money later on. If your business office is busy correcting errors made by your front office employees related to patient demographic and insurance information, you are spending a lot of money on rework-and delaying your reimbursements. Avoid claim denials and delays caused by messy or incomplete patient information by providing education to your front office team and tracking and monitoring the quality of their work.

Receive the patient in the scheduling system. With the advent of electronic health records (EHRs), the root word of receptionist-to receive-seems to be lost. Teach the front office team how to appropriately greet patients and ensure that each patient gets due attention, without overlooking important business processes, such as collecting patient balances and copayments, verifying coverage and other details. The front office is truly the director of first impressions.

NEXT PAGE: Mastering efficiency in the mid-office

Once the patient is seated in the reception area, focus on streamlining the workflow that takes place around the clinical team’s efforts to get ready for the patient. Preparedness is the overriding principle of effective patient flow.

Preview charts. Streamlining patient flow actually starts the day before the patient’s arrival. Assign a member of the clinical team to review the records of the following day’s patients, noting any tests, consultations or other orders placed during the patient’s previous visit. This serves as an early warning for any missing results. Assess any clinical alerts-an overdue screening exam, for example-and make notes, pull together forms, patient education materials or other paperwork that may be needed in connection with the visit.

Huddle. Gather your team each morning for a brief, stand-up meeting. Peruse the schedule, noting any necessary preparations (an interpreter is needed for Ms. Smith at 2:30, for example), predictable no-shows (Mr. Jones was admitted last night), and opportunities for add-ons. Always conclude the huddle with a quick review of the previous day’s mistakes-and how to avoid them in the future. These brief overviews will help instill the spirit of performance improvement that, over time, should become embedded throughout your practice.

Develop a standard intake process. Put the rooming criteria in writing, including patient gowning and vital signs, based on reason for the visit. Create standing orders based on patient complaint (for example, request urine sample if the patient complains of frequent urination). If deployed effectively, these standing orders can save precious time for you, your employees, and your patients.

Standardize exam rooms. Ensure that every exam room is set up in a uniform manner, with supplies, forms, and equipment in the same place in all rooms. Stock exam rooms before the morning starts; assess their status at mid-day as well.

Create a flow station. Popping into your office between patients consumes a lot of time. Instead, develop a flow station that has access to your EHR, as well as a telephone. The flow station may be an anchored workstation or it could be a workstation on wheels or computer on wheels. Route messages via your EHR’s task function, noting that time-sensitive ones should be printed and tucked into a designated red folder on your workstation, or another such alert system. Stop by this area when between patients and encourage your employees to use it to communicate with you. This permits work to be conducted in an asynchronous fashion rather than requiring a face-to-face interaction with your nurse or medical assistant, thereby improving productivity.

By executing an effective patient flow strategy, the mid-office can successfully achieve the status of masters of efficiency.

NEXT PAGE: Working smart in the administrative office

What’s the use of streamlining workflow and patient flow if you don’t get paid? Apply the same principles of efficiency you’ve brought to your front office and mid-stream areas to the back office so you can get paid what you deserve. 

Leverage technology. Determine every opportunity to leverage technology. For example, turn manual lists into an online database that can be sorted and accessed by multiple users. Use online access to payers in lieu of phone calls to streamline the work. Share important resources and tools rather than require each employee to reinvent the wheel. For example, retain appeal letters and other documents in an organized, shared intranet-based “library” for employees to use repeatedly. Meet with employees to look for ways to better harness your system. From replacing manual payment postings with automated remittances  to using automated work queues in lieu of manual accounts receivables, there are many functions in which technology can be deployed successfully.

Track key billing metrics.  Make sure you monitor your key billing metrics to include the percentage of accounts greater than 90  days in receivables outstanding, net collection rate, claim denial rate, and bad debt rate. Create specific targets, and track and trend these metrics over time.

Revise work processes due to healthcare reform. Even though the majority of your patients may have insurance, many today also have a high deductible health plan. This means that they are truly “self pay” until they have met their deductible. Revise your work processes to determine the patient’s unmet deductible and either attempt to capture that at the time of service (provided your contracts permit) or shorten your patient collections cycle to ensure timely revenue. Optimizing patient payments is now “mission critical” for medical practices.

Deliver feedback. Don’t let employees work in the dark. Share performance data with them to include revenue, aged trial balance and days in receivables outstanding, for example. Hold regular discussions of key performance indicators. If employees know what you expect, they are more apt to deliver the “work smart” performance that ensures you get paid what you deserve.

Remember, streamlining strategies presents routes to greater efficiency throughout the practice. Improving workflow takes time and effort, but the payoff is well worth it.

Elizabeth Woodcock, MBA, FACMPE, CPC, is a consultant, speaker, trainer and author with Woodcock & Associates in Atlanta, Georgia. Deborah Walker Keegan, PhD, FACMPE, is a healthcare consultant and president of Medical Practice Dimensions, Inc., in Asheville, North Carolina.