Viewpoint: Increase efficiencies to cut costs

November 20, 2009

Get a head's up on efficiency basics.

Key Points

Don't do work that others can do. Patient-care functions such as data collection and patient education can be delegated to trained assistants. Another common waste of doctor time: deciding, case-by-case, when patients can be seen. Specify the rules for add-on patients and let your staff make the call.

Communication is more reliable when written than when spoken. Instead of "telling" your medical assistant what you need, use your fee ticket/route slip as an order form.

Don't do work that machines can do faster and better. Examples: computerized employee timekeeping to figure elapsed time, sheet-fed photocopiers with a collating and stapling feature, computer-generated superbills with account history printed on them and reference numbers for tracking lost charge slips, or voicemail test-result delivery.

Don't wait for patients or staff. Give new patients the demographics/registration form to fill out first. Only when they are done, hand them the health history questionnaire. That way, if the patient hasn't finished the history form in the waiting room, he or she can finish it in the exam room. If you enter before it's done, complete it together.

Don't do work nobody needs to do. Answering billing calls from confused patients can be avoided by keeping the billing function up-to-date and statements clear. Filing copies of insurance claims in the chart is extra work and clutters the medical record with irrelevant business information. Don't keep logs no one uses.

Quality work shouldn't rely on workers being careful or remembering what to do. Use systems that remind like tickler files, calendars, checklists, and printed forms. Structure work to be checked easily, such as balancing the daily deposit to the computer total of receipts or checking the date of service when you sign your dictation to see whether there's an unacceptable delay.

We'll stipulate that overhead is the devil's creation. Having said that, though, every expenditure in your practice should buy you something necessary to your quality of care, quality of service, or quality of life. If it doesn't, then it represents waste and is eligible to be cut. But when you run out of waste to cut, think a while on becoming more productive.

Judy Bee is a management consultant with Practice Performance Group ( in La Jolla, California. Send your feedback to