Physician Time Management: Creating Patient and Doctor Satisfaction

1. Physician Time Management:Creating Patient and Doctor Satisfaction Jeffrey P. Friedman MD, FACP Associate Clinical Professor of Medicine of NYU School of Medicine Founding Member & Former Managing Partner, Murray Hill Medical Group, PC

2. My Patient Mix • Fee for Service 20% • Managed Care ( no capitation ) 50% • Medicare 30%

3. Important • Different timing for different appointments • Making sure that annuals are done yearly • Adding same day appts = Open Access • Time for calls • Number of rooms • Number of support staff

4. Patient Needs • Analyze the types of appointments you need/have • Have enough appointment types to satisfy most common issues • Determine time of appointment types • Examples: New Patient, Annuals, Travel Visits, New Problem Visit, Vaccine, Same Day Illness, Follow- Up

5. The Good and The Bad • Allow enough time for the unforeseen • Allow enough time for the different appointment types • Give yourself time for breaks and calls

9. Annuals: What You Should Do • Require complete physical exam every 1-2 years depending on patient age or dx list • Send out reminders • ROS • Examine the patient • Make sure the chronic illnesses are stable • Review medications and interactions • Review allergies • Review vaccines and administer • Review the next year of preventative needs • Counseling as needed

11. Annuals -What You Should Not Do • Do not do “lists” • Do not review “Internet Articles” • Do not fill out forms • Do not “combine” the visit with another visit • Example -- Annual and Travel • If the patient is sick, convert the visit into a “sick visit”-do not do an annual and sick visit together

12. Ancillary Staff Issues • Determine efficient workflow • Number of exam rooms and number of staff • Use ancillary help for escorting patients and getting vital signs • Use ancillary help for blood drawing, EKGs • Use ancillary help to call in refills • If the ancillary help does not hustle or are not good at their job details, change them • Have patients make their own appointments for tests if capable and have them inform staff of time/date

13. Patient Centric Care • Keep patient movement to a minimum • Start all patients except new patients in the exam room (exception: travel visits) • Annuals---> fully undressed and gowned • All others-remove only what is necessary for the most significant problems • Vital signs, exam, bloods, EKG’s, PFT’s, vision and hearing all from the exam table • Urine tests on the way out • Place orders and prescriptions at outgoing

14. Training Patients

15. Do Unto Others… • Run on time • Keep an eye on your schedule at all times • Use down- time effectively • Keep to your rules • No lists for Annuals • For problem visits, keep lists to 1-2 problems max. • Extra problems require extra visits • Emergency/ Same day visits are just for that problem

16. Do Unto Others… • Respect your Patient’s time • If you have to leave on an emergency, have your staff call your patients and reschedule • If running late, take a second and go into the waiting room and apologize • Give an honest estimate of the wait • Offer to let them reschedule or return later • Offer them a colleague • Remember- We are a SERVICE INDUSTRY and it is competitive out there!

17. Free Time – “Do Today’s Work Today” • Prioritize Phone Calls • Call sick patients first and offer appointments right away before getting into a long conversation • Do not treat on the phone • Triage to an appropriate doctor if needed • Review lab and test results, document and call patients if needed • Consider letter merge for normal issues • OK prescription refills and referrals

21. Open Access 1. Completely Opening the Office All Day 2. Early and Late Walk-In Clinics 3. Setting Aside Blocks of Time 4. Combinations of Above

22. PROS • Increased patient satisfaction • Increased physician satisfaction • Increased physician income (more patients, less no-shows)

23. Cons • Seasonal • Daily swings can create havoc for a small practice • Can be slow during vacation periods, late spring and early summer • Not enough coverage during busy times • Initial physician over-time required to work down the patient backlog/queue • Need coverage that can handle over-flow and vacations and who work with the same philosophy of seeing patients • Need employees who can work in that environment • Important to allow enough time for overflow when you return from vacation • Full open access in a busy practice might require hiring more doctors and closing panels

24. Other Issues • Paper management • Phone calls • Multitasking • Finish before moving on to the next patient • notes, coding, orders, final billing

25. Paper • Paper management • Finish before the end of the day • Nothing is “stat” • Consider charging if it is not covered under most plans • camp physicals and employment exams

26. Phones • Triage • If patients need to come in, make them do so – no long winded conversations • Non-emergent; fit into your day, train patients that you will call back that day and there is no need for multiple calls • Do not take calls while seeing/ examining a patient except from doctors, nurses, and life-threatening emergencies • Get the numbers and times when your patient will be where they can be reached

27. Multitask • You can do it if your kids can do it • While on hold -- finish a note • While on hold -- message your secretary • Check your schedule

28. Finish Before Moving On • Finish the coding on the visit • Finish the office notes • Move on to the next patient with a clear slate

29. Questions and Answers • How many annuals and how many patients do you see each day? • 4-5 annuals / day leave enough time for sick patients and new patients, 20-30 patients/ day • When are hospital rounds done? • Hospital Rounds before and after Office Hours -- leave enough time for problems • Do you use physician extenders? • NPs & PAs too expensive to be cost effective in Manhattan • Instead MA’s are trained to help “extend” the physician’s productivity, as previously indicated

30. Q/A Continued • How do you use dictation or templates? • We use templates, quick text and free typing • Do you lose patients because of your rules? • Yes, but the patients who continue with me appreciate my time management and I enjoy work • How do you handle late patients, no shows, same day cancels? • Try to fit them in if late-come back later • No shows and same day cancellation ( if no good excuse ) get charged $75 to $200 depending on the type of appointment

31. Q/A Continued • How do you code for annuals? • V codes including Medicare (after they sign a non-covered service waiver) • EMR tracks recall for annual • New patient expectation issues? • Patients download from the website the practice rules and regulations • Office visit hours? • 8am-7pm most work days