1. Understand that practices are different from other workplaces. A medical practice is not a place where efficiency experts can take over and make wholesale changes. Efficiency systems such as the Toyota Production System and Six Sigma haven’t flourished in many practices. "You try your best not to get in the way between the physician and the patient," Mr. Pupkis says. "The physician is the one with the medical degree and it’s his practice style that drives the relationship. You try to respect that."
2. Find a doctor who is willing to champion a change. Skeptical doctors will listen to a peer who supports a new approach, especially if it does not directly impinge on their clinical work. "If you can find a solution that speeds the time up but doesn’t affect them directly, doctors will be all for it," Mr. Pupkis says.
3. Get input from your staff. One of the easiest and most effective things to do is to bring your staff together and ask them, "If there were something that you could change, what would that be?" And then ask, "Is there something that we might change that you feel we shouldn’t?" Mr. Pupkis says: "It’s all about getting ‘buy-in’ from those folks who will be affected by the improvements that you wish to make."
4. 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. 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.
5. Standardize activities. Mr. Pupkis recalls that some years ago, each surgeon’s secretary would take care of that surgeon’s surgical billings. "Each of them had a very different style," he says. "Some got out their bills within a day; some took 30 days." The doctors agreed to hire two coding experts and hand over all surgical claims to them. Although this added a new layer of staff, it dramatically improved cash flow. The practice went from bills paid in an average of 45 days to half that time at 22 days. Also, the coding experts were trained to maximize income in ways such as legally unbundling services. That is, the coder breaks down one CPT code for services rendered into several codes that command a higher total payment.
6. Install an electronic health record. EHRs create very obvious efficiencies, such as erasing the time taken to find and then take a chart to where it is needed, says Mr. Pupkis. When everything is on paper, it sometimes takes half an hour or longer to find a missing piece of paper. Going paperless means that the whole medical records section can be eliminated. Installing an EHR, however, may have to be done in stages. For example, physicians are used to dictating the chart, while some EHR systems require the doctor to point and click on a computer to build the chart. Doctors may prefer to continue dictating into voice records, which would only be transcribed into text if needed. Alternatively, the practice might hire clerks to enter information into the computer during and after the doctor examines the patient.
Contact Leigh Page at leigh@beckersasc.com.
