Productivity is the key to boosting profitability

Use efficiency to boost your bottom line

In a physician office, the doctor is the only element that actually generates revenue. Everything and everyone else is overhead, according to Dick Haines, president of Medical Design International in Tucker, GA.

That’s why Haines asserts that the best way for a physician practice to increase its bottom line is to optimize the physician’s ability to produce revenue. Medical Design International is a health care consulting firm that specializes in efficiency and productivity issues. If you’re putting all your energy into reducing expenses, you may be taking the wrong tack, he says.

When Haines conducts a patient-flow and productivity analysis, he encourages doctors to add staff so they can delegate the jobs that don’t de-pend on the physicians’ medical school training.

"Yes, a doctor could replace a nurse and hire an LPN and save $25,000 a year. But if she hires a physician assistant, she could increase productivity and increase revenue by $100,000 a year, or more," Haines says.

Haines gives an example of a physician/surgeon who increased her gross income by $300,000 a year by adding a physician assistant to whom she delegated many examinations.

To increase productivity and your bottom line, first look at what you can do to help the physicians in your practice optimize their time and effectiveness. "To generate revenue, a doctor needs to go from CPT [current procedural terminology] code to CPT code. The more time between the two, the less income he or she has," Haines points out.

Making optimal use of physicians’ time is the best way to generate more revenue for your practice, but it also optimizes a scarce resource in your community by allowing doctors to use their skills on tasks for which they were trained.

"If a doctor has the ability to see six patients an hour and he’s seeing only three an hour, he is robbing the community of a scarce resource," Haines says.

The types of activities on which a physician spends his time can be divided into three categories, Haines explains:

1. Essential tasks.

This is everything physicians went to medical school to learn, but it also may be talking to a young patient about an upcoming football game to establish rapport.

2. Tasks that can be delegated to other staff members.

An example is setting up an injection.

3. Tasks that are time-wasters.

One example is going to the waiting room to get a patient because the nurse is busy.

When time is wasted, there typically are three reasons: poor systems of communication, poor office layout, or inadequate staffing, he says. (For details on how time-motion studies can identify your problem areas, see p. 139.)

"A lot of doctors use the step-out-in-the-hall approach to communication, which doesn’t get the job done very efficiently. If you need to communicate, you need to find another way," Haines says.

Rather than looking for the nurse in between seeing patients, or having the nurse wait for you, recognize that both of you have a job to do and find another way to communicate, Haines says.

This could be through a communication light-signal system, a check-off form for tests and studies, or use of a scribe who takes progress notes and tracks down other staff the physician needs to contact.

"When the systems are set up well, the doctor and staff can establish a rhythm," Haines says.

But interruptions break the rhythm and may throw the entire day out of kilter. For instance, a doctor may come out of an examination room and see several people lined up waiting to get an answer. This means the doctor hasn’t delegated effectively, and the rhythm is about to be broken, he says.

Schedule the interruptions

Doctors should allow interruptions to take place on their schedule, not when it is convenient for their nurses.

Haines suggests having certain times allotted in the doctor’s schedule when he or she can be interrupted for questions. Another way to avoid constant interruptions is to have a triage nurse who is authorized to refill certain prescriptions.

"One reason you have staff is so you can delegate things you don’t need to do. [Delegating to] staff is good, not bad," he says.

Delegating tasks to your staff can increase your efficiency, increase your patient volume, and improve your bottom line.

Despite the fact that some of their peers disapprove, doctors who see a high volume of patients often are popular because they address the issues quickly and effectively. And since they are delegating the tasks they don’t want to do to others, they get more satisfaction out of their practice, Haines says. "High volume doesn’t have to do with money. It’s what you are willing to delegate to others."

Recognize that if you increase the support staff, you’re likely to increase the doctor’s output because physicians won’t have to do jobs that can be delegated effectively. Many of the published staffing ratios don’t distinguish among physicians who see six patients an hour and those who see four. Therefore, the statistics can be misleading, Haines points out.

Coordinate use of space with schedules

For a more efficient operation, organize your space so that physicians and staff do a minimum amount of walking. No one gets anything done when he is walking from place to place.

Also, maximize the use of the space and staff. For instance, one physician may want to come in for 1½ hours twice a week. You’ll make better use of the space if he works three hours one day a week, leaving the space available for other doctors the rest of the week.

Fine-tune the appointment scheduling to maximize output. The appointment schedule governs the doctor’s output, and if it’s in disarray, it can have a negative impact on the doctor’s best use of her time. Avoid double and triple booking. Remember that doctors don’t go faster because they are overbooked.