5 Tips for Promoting Efficiency at Orthopedic Practices

Practice Management

Here are five ways to ensure your orthopedic practice is running efficiently.

1. Perform activity-based costing.
Focus on activities that consume the most resources. What is the cost of entering charges, posting payments, processing refunds or even opening the mail? The first step is to measure the time it takes to do a task, says William R. Pupkis, CEO of Capital Region Orthopaedics in Albany, N.Y. You can use a stopwatch or you can ask staff to self-report their times. You need to reassure employees with comments like: "I'm not looking to fire any of you. I just want to get an accurate time down." If the employee is paid $10 an hour, you multiply that amount by the time it takes for that person to do the activity and you have a value of that activity. Then you need to ask, "Does the value of the activity match its value to the organization?" Take a closer look at costly activities and scrutinize the bottlenecks.

2. See where you can rearrange workspace. Our practice has six physicians and four mid-level practitioners, says Penny Forbes, practice administrator at Sierra Regional Spine Institute in Reno. At any given time we have four providers and six medical assistants in a very small area sharing nine patient rooms. To alleviate some of this crush we scanned all of our paper charts, pulled out the metal file system and have converted this area to a work space for our medical assistants. We rotate the MAs out of clinic on days the MAs don't support clinic patients, thus opening the clinic work space to those who do. In the end, we have effectively removed unneeded bodies from clinic, which has opened up space for providers with patients to work more effectively.

3. Only see patients in your subspecialty. Orthopedic surgeons are trained to think that the more surgeries they perform, the more money they earn. Craig Levitz, MD, an orthopedic surgeon and partner at Orlin & Cohen Orthopedic Associates in Rockville Centre, N.Y., says this line of thinking isn't always true and is a contributing factor in revenue loss for many practices. "One of the biggest reasons surgeons lose money is because their surgeries cost more than their expenses," he says. General orthopedic surgeons often take time to perform an array of surgeries and treatments for their patients, which takes a great deal of time, especially if the surgeries are performed in hospitals. Additionally, even though the surgeon is at the hospital, he or she is still running the clinical office and paying employees to work there. "Orthopedic surgeons don't run their practice like a business," says Dr. Levitz. "They aren't always cognizant of the revenue they are getting for their case or how much that case is costing them."

Send patients who don't fit within your subspecialty to another surgeon in the practice or another specialist elsewhere. It might seem like a loss of business at first, but sending that patient away allows you to focus on providing efficient care for the rest of your patients.

4. Hire an athletic trainer as a physician extender. The athletic trainer can conduct patient histories and injury assessments and communicate that information to the physician so that he or she already has the information upon entering the patient's room. "I think the advantage athletic trainers bring to the table is that we have a more advanced musculoskeletal background and that is valuable, especially in an orthopedic setting," says Kathy I. Dieringer, EdD, ATC, co-owner and president of D&D Sports Med in Denton, Texas. "Having athletic trainers conduct the histories and assessments means the physician can see a higher volume of patients by spending less time with each individual patient."

With an expertise in rehabilitation, athletic trainers are also trained to educate patients on post-surgical treatment plans. This includes appropriate post-operative care, on-site rehabilitation and development of home exercise programs. Having the athletic trainer on-site means patients stay at the practice for multiple steps of the so the patients are not referred to other facilities.

5. Leverage EMR to the best of your ability. An increasing number of orthopedic practices are investing in electronic medical records, and if used to its maximum potential, this costly investment can improve overall efficiency. Ken Austin, MD, an orthopedic surgeon with Rockland Orthopaedics & Sports Medicine in Airmont, N.Y., says his practice has coordinated its EMR with its scheduling and billing components. By capturing patient data at the beginning of the process, the practice has been able to increase efficiencies by reducing the number of staffing hours spent entering information into a separate system. "Instead of spending extra time filling out forms, we are about to get in to the office and manage care better by making efficient use of the staff's, physician's and patient's time," he says.

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