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A series of initiatives that help doctors work smarter and an emphasis on physician productivity has helped the Hedges Clinic in Frankfort, IL, maintain profitability and manage costs at a time some physician practices are floundering. "In order to run our practice like a business, we work to streamline the process and to help the physicians to be able to see more patients," says Frank Schibli, administrator for the multispecialty, primary care-based practice in suburban Chicago. "The more patients we see, the more profitable it can become."
The group is independent and is owned by the physicians. There are nine full-time equivalent (FTE) physicians and a support staff of 34 FTEs. The group offers pediatrics, internal medicine, OB/GYN, and general surgery, as well as a variety of ancillary services including laboratory, radiology, mammography, ultrasounds, and allergy testing.
The practice is independent and is owned by the physicians. It is featured in a video education series based on the Medical Group Management Association’s Performances and Practices for Successful Medical Groups survey report. The Hedges Clinic is spotlighted in the video Improving Profitability.
"When you look at the numbers in the Medical Group Management Association reports, it looks like we have too many support staff based on the number of physicians we have. But when you look at patient encounters, our staff is a lot busier than the staff in other practices. Our staff tends to do more work and to work harder," Schibli says.
Among the practices that help improve the clinic’s profitability are hiring RNs to assist physicians, creating a "runner" position to assist nurses, and having ancillary services in-house so test results are available before patients leave. Schibli credits the RNs with helping increase physician productivity. Each physician has the same RN working with him or her all the time. The practice works better for Hedges than having a pod of nurses because the nurses are familiar with the physicians’ practice styles, and creates continuity, particularly for tasks that carry over into the next day.
For instance, if a physician sends a patient to the hospital for tests and the results aren’t available that day, the nurse knows is familiar with the situation the next morning and doesn’t have to be re-educated. Some RNs have been with the practice more than 20 years.
To optimize the nurses’ time, the practice has positions called "patient care coordinators," better known as "runners," who work with the nurses. Their job includes cleaning up the rooms, stocking the rooms, getting patient charts, and taking patients to ancillary services. "Their purpose is to allow the nurses more time to prep the patients and make phone calls. This in turn gives the doctors more time to see more patients," Schibli says.
Even though ancillary services aren’t as profitable as they were a few years ago, they save money in the long run by saving staff and doctor time, Schibli points out. In most cases, physician can get test results while patients are still in the office, enabling them to make a care decisions without having to play telephone tag with patient after the test results come in. "It also allows the physician to get the patient’s chart done and out of the suite instead of having to go back to it in the future," Schibli says.
Schibli anticipates that Hedges will always have a laboratory. "It’s good for the bottom line in time savings. We still make some money but it’s not like it used to be," Schibli says.
Like most administrators, Schibli struggles with keeping good employees. "Medicine is one of the few industries where everyone else tells you what you are going to get paid. Some employees don’t understand it," he says. One key to employee retention is Hedge’s profit-sharing plan for employees who have been with the practice two years.
Here are some other keys to the Hedges Clinic’s success:
• Careful selection of insurance contracts. The practice looks carefully at the insurance contracts it accepts and tracks the percentage of each type of payer, such as capitated, fee-for-service, Medicare, and Medicaid. The practice is fortunate because no one company controls more than about 20% of the market. "We have every contract that we want. We have terminated some based on other issues. We got to the point when we decided that the hassle factor wasn’t worth the additional income," he says. Only 10% of the practice currently is capitated. The practice has set a limit of 20% capitation.
Taking the steps to terminate the first contact was difficult because of the uncertainty of how it would affect the practice, Schibli says. Some patients the group lost had the opportunity to change plans, however, and Hedges was able to get them back. "Quality of care and patient satisfaction are very important to us. When we terminated a contract with one insurer, some of our patients were willing to change plans to keep coming to us," he says.
Because the practice is in an affluent area, 2% or fewer of its patients are on Medicaid. "Some of our Medicaid patients are those who came into a difficult situation that forced them to go on public aid. When they are employed again, they remember that we were willing to see them when they were down and out," Schibli says.
• Convenient appointments. The practice reserves 25% to 30% of each physician’s time slots for same-day appointments. "It makes it more stressful for the staff but it’s good for the patient. If a child wakes up with a fever, the parents can bring him in that day, instead of having to wait for an appointment," Schibli says. Overall, the same-day appointments improve patient satisfaction, which is part of the entire chain of operations, Schibli points out.
In addition, the clinic offers "urgent care hours" until 9 p.m. four days a week and from 2 p.m. to 6 p.m. on Saturdays. The practice contracts with a part-time physician who treats patients with minor problems such as injuries and sore throats. "Many in our client base are not interested in taking the day off work because they have a sore throat," Schibli says. The practice charges slightly more for urgent care visits than for regular office visits but the fees in no way approach what a patient would pay in an emergency room.
• Re-educating the staff. The practice makes sure the staff understand why things have to be done a certain way and how everything they do affects the rest of the practice. For instance, Schibli emphasizes to the reception staff why they need to verify insurance coverage when the patient checks in and what happens when they don’t. Now, the receptionist gets the appropriate insurance information to determine what doctor the patient can see and whether the ancillary services can be done in-house or if the patient must be referred to someone else with whom his or her insurance has a contract, Schibli points out.