Customer Service is Key

Written by on April 3, 2012 in Features, Practice tips - No comments
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Experiences from Primary Care

By Judith Rayl MD, PhD

Today a 24 year old man named Ted made an appointment at my clinic. He is an earnest young man who struggles with depression. Ted travels forty-five minutes to be seen at my clinic because he has not been able to find a doctor in his area who could help him with his medication. Despite seeking care at multiple offices Ted said that all the doctors seemed too rushed. During Ted’s visit I spent half an hour with him (which is normal in my practice) reviewing his symptoms and medications. I genuinely listened to his concerns, answered his questions and helped him improve his medication regimen. At the end of his visit, Ted expressed his gratitude for being able to be seen on short notice. He was pleased that I remembered him that my staff was so kind and helpful. Ted was disappointed that the other doctors he had visited only were able to spend a few minutes with him. He was upset that they could not provide him with the care that he needed and asked, “Why aren’t other doctors’ offices more like yours?”

I do things very differently in my practice. I have implemented changes in my practice management techniques that connect me with my patients, allowing me to spend more time with them and to maintain a personalized practice. These enhancements are simple and lend excellent patient satisfaction. In fact, I have been voted my community’s “Best Doctor” since 2007. These innovations involve two very basic concepts; I have developed an extremely efficient workplace and have eliminated all of my unnecessary expenses.

I believe that efficiency does not mean working faster to push more patients through the office, nor does it involve spending any less time with patients. Instead efficiency functions behind the scenes to improve my work processes.

Here are some specific steps to improve practice management:

Efficiency should only benefit in ways that help my patients directly

I no longer chart on paper, I use a computerized medical record system that puts patients’ health information literally at my fingertips. Test results are electronically delivered directly from our lab into each patient’s file and I am immediately notified by an automated email. My staff scans specialists’ notes into the patient’s electronic chart so they are easily accessible. With computerized medical records time isn’t wasted scavenging for old chart volumes, paper notes or lab printouts.  With electronic charting I can easily access a patient’s current contact information allowing me to leave them a message with detailed information, instead of expending time making multiple phone calls back and forth. During appointments I complete the electronic chart notes in front of the patients and then print a copy of the plan from the patient’s visit note. The feedback received from patients regarding this change has been uniformly positive. Some patients file these notes at home so they can easily recall our long-term plans which have reduced follow-up phone calls from patients needing reminders about clinical information.

Check-in has also been simplified; two medical assistants keep their desks at a station in the front lobby. When patients arrive, the medical assistants collect their co-pay, confirm their address and insurance information and then room the patients immediately. Patients seldom have to sit in the waiting room because there is no delay between check-in and moving to an exam room.

All non-controlled medication prescriptions are faxed to a patient’s pharmacy and automatically recorded in their chart.  Electronic prescribing eliminates handwriting errors and is also much quicker than writing a paper prescription.  In addition, it cuts my patients’ wait times at the pharmacy as they no longer need to wait in the prescription drop-off line at their pharmacy, and their medication is often ready to pick when they arrive.

Every computer has internet connectivity and is loaded with medical databases that are continually updated. This provides instant access to current medical data during patient visits and eliminates having to leave an exam room to find a textbook, which may already be outdated. I can also print updated information handouts for patients as well.

My exam rooms are fully stocked at all times. I never have to interrupt appointments to find missing equipment or supplies. Each exam room contains a cabinet for ancillary supplies such as printer paper, ink, drinking cups and bandages. Workspaces are designed so that frequently used equipment is easily within reach. For example, in my office, when sitting in my chair I can reach my computer, phone, copy machine, printer, paper supply, stapler, date stamp, inbox/outbox trays, envelopes, paperclips and address stamp.

These advances in efficiency allow me to spend more time with my patients.  I’m no longer tied up with phone calls, chart issues, or running around the clinic looking for lost items.  I also no longer have to wait ten minutes just for a patient to move from the front desk to an exam room. We generally run on time and I seldom have to stay late at work.

Commitment to a healthy reduction of overhead

High overhead forces doctors to either pass costs on to their patients and/or to limit staff salaries and benefits. With my low overhead, I am able to avoid overcharging my patients and do not need to add any concierge fees. My staff has the highest wages of all medical assistants at similar clinics in our region and I give raises twice a year, an annual bonus, and a 401k with profit sharing and matching funds. I am also able to compensate myself fairly.

To achieve a low-cost clinic, I started by renting a small space in a beautiful mixed-use complex that is a 1000-square foot jewel. Because I don’t use paper charts I have no excessive storage needs and can comfortably rent such a small space. Also, I built my clinic with multiple tall cabinets so we have extra room for supplies.  All expansion occurs either electronically or vertically rather than in square-footage, so rent stays low.

Electronic records have also eliminated filing and chart maintenance and the cost of medical records personnel. In my opinion, a small, healthy clinic does not necessarily require an office manager.  At our clinic, workplace conflicts are solved directly, without any triangulation through an administrator. I work closely with my accounting and billing staff as well, so no manager is needed to control finances. This administrator-free process has been seamless.

My practice has an automated phone system that obviates the need for a receptionist.  When patients call in, they are greeted by a message recorded by me. If they press one, they get a message with our location and business hours. Pressing two allows them to leave us a message and pressing five gets them through to us directly on our back line. Many of my patients make use of the message line, at all times of the day and night, for non-urgent communication.  This frees my staff for other tasks, instead of keeping them tied to the phones.

My staff is highly experienced, cross-trained medical assistants. Since both of my assistance are talented phlebotomist, I haven’t had to hire a dedicated lab tech, an injection nurse, anti-coagulation nurse, nor triage assistant at my clinic. The practice management changes that I have implemented have been extremely popular and sustainable. I also have little turnover in my patient panel and staff roster.

Catherine is a 66 year old woman who transferred her health care to my clinic in 2007.  Five years prior she had endured a severe accident that resulted in a hip injury. Three subsequent surgeries were only partially successful leaving her in chronic pain. When I met her she was unhappy with her prior primary care provider’s office because her medical visits were too short. The physicians worked too rapidly and were out of the office frequently, so her care lacked continuity. This caused conflicts among the various primary care doctors participating in her care. According to Catherine, one doctor asked her to start taking narcotics for her pain, while another suggested that Catherine was engaging in drug seeking behavior.

When we started working together it became clear to me that Catherine’s care at her prior office was terribly fragmented. Through a series of frequent, intense visits over the course of about three years we were able to piece together a productive regimen of physical therapy, acupuncture, specialist visits, and new medication.

Last week Catherine came to see me for a complete physical exam. For the first time ever, we had the luxury of discussing preventive care because her acute and chronic pain was resolved. She stopped narcotic medications fourteen months ago, and her quality of life is nearly normal. She is swimming, traveling and even dating again. Her recovery from the injury is finally complete and I am happy to have been able to assist her.

I would not have been able to help Catherine improve her situation without my new practice model. With my low overhead commitment, I have time for good, comprehensive patient care. Also, with my efficient practice and electronic records, I was easily able to track Catherine’s progress as we monitored her specialists and medications.

I hope that other physicians will be inspired to make positive practice management changes. Without such change, I fear that we will only alienate more patients and make more mistakes in their care. Simple practice management alterations have allowed me to be the physician I aspired to be early in my career. My work is now once again sustainable and satisfying because I am able to make more of an impact on my patients’ lives.

Practice management isn’t just about balancing the checkbook.  It’s about giving patients the time and respect they deserve. My practice management innovations help to connect me with my patients and to improve the care that they receive at my clinic. Compassion and healing are paramount.

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