Monday, February 8, 2010

Paving the Way to Efficient Healthcare



Physicians everywhere are in a rush to see more patients every day. In fact, some are so overworked that they very well end up sleeping on the office sofa to get an early jump on the previous day's paperwork. Such a story was the case with Charles Whitney who states he felt so overworked that he didn't have any emotional energy left for his family.

Whitney decided to change his work habits and make some simple changes to help him provide the care he feels he should be providing. You don't need to to have to implement all suggestions, but a little goes a long way considering you're willing to create sound work habits.

Here are a few items to help you on the road to becoming more efficient and increasing your cashflow:

Use Your Staff
I wouldn't recommend putting all the burden on your staff, but you should definitely make sure your nonphysician staff is trained at completing key tasks that will make best use of your time with the patient. Hilton Family Practice, out of Newport News, VA has developed such a plan in which they trained their nurses and medical assistants to conduct thorough patient histories, resulting in a seeing 40 patients a day, up from a previous of 24 patients a day. Doctors on average now also work 45 hours a week, down from 50; and have now also seen an increase of income per provider by $70,000 a year.

Create Flowsheets for Chronic Conditions.
One can create two types of checklists. The first would be a list of "Five things I Need to Check During an Exam" for use with patients with certain conditions. The second type of list you can make is a "Five things I Need to Do Ahead of Time" before you see a patient with a chronic condition. As these lists become standardized and you continuously repeat these steps they will become second nature and you will become less reliant on the checklist.

An even better model would be to integrate an automated template if you currently have an EHR system. (My next blog will be on this task specifically.)

Code for Time
E&M visits that take up more than 50 precent of exam time for patient counseling using time based codes which may earn you a higher reimbursement if you code for it correctly and documented thoroughly.

Use Preventative Codes
Speaking on the subject of counseling, many people counsel on tobacco and smoking cessation. Take advantage of codes 99406 and 99407, which most payers pay for but many physicians don't think of using.

Bring Back Patients
While some patients are good about coming back for annual checkups, others might let follow up appointments slip and may need a reminder to do so. One can do it the old fashion way by creating a manual list, or if you have an EHR system, run a report on those due for a follow-up appointment or preventative care services. Some systems can connect to a service which sends out a notice or handling it the old fashioned way by giving them a call in-house.

Create thorough intake forms
Intake forms are there to help you speed up the process by letting patients jot down information that would otherwise take you or your nurse time to ask. This form should be balanced in length as to not have the patient glaze over the form and not fill something out. Those that are available online are an added plus as the patient can find them and fill them out prior to their visit. As EHR systems move to integrate with online intake systems this process will become even more streamlined so getting them used to going online will ease the process later on.

Become an Information Source
In this age of the internet, sources for information are everywhere. The downside is that your patients are likely to find misinformation on the Internet and you don't want to have to spend time decoding what your patients are learning or having to change their preconceived notions of certain diagnoses.

A suggestion would be to add a section to your website dedicated to common health issues related to your field. Some practices have seen an increase of up to 10 percent due to such implementations. But there is also no need to reinvent the wheel. You can get in front of the problem by identifying existing web sites with information you can trust and making a list available for your patients.

Knowledge is power. By building the foundation and identifying the areas for improvement, you can be well on your way to overcoming them and providing the standard of healthcare you expect your patients to receive.

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