Here are several ways, both large and small, that you might go about improving things.

The greater the market pressure on your practice, the more important practice improvement becomes.

You need to know your practice at least well enough to know whether it is well managed.

The watchword is efficiency. Make sure that systems work smoothly and that you are making optimal use of facilities, staff time — and your time.

As you will see, these recommendations cover a lot of ground — far too much to allow me to go into any of them in depth here. These are directions you might want to head rather than road maps.


Key points:

1. Learn to manage.

You need to know your practice well. Learn to read reports and understand data. Talk with your practice manager, your accountant or other consultants regularly.

2. Focus physician time on patient care.

To maximize their value to the practice, physicians and other providers should spend at least 37 hours per week on direct patient care.

3. Delegate, delegate, delegate.

Delegate as many administrative tasks as possible without impairing your understanding of how the practice runs. If you’re in a small group, and your practice manager or administrator isn’t equipped to accept extensive delegation, help him or her develop the needed skills to stay on top of everything.

4. Improve patient flow. Regardless of the patient mix, the goal is to have an efficient schedule. Focus on providing appropriate care to all of your patients. If you feel overloaded seeing a patient every 15 minutes, the process needs reform. Most family physicians can average four visits per hour  in busy clinics, when those visits are appropriately scheduled. Avoid schedule gaps, and stay on schedule.

5. Dictate progress notes in the consult/exam room. This takes time getting used to, and it may not always be appropriate. But dictating notes in front of the patient saves time, improves communication, gives the patient a good summary of the visit, helps with coding, and gives you more legible notes without the need to invest dictation time outside the visit.

6. Enhance communication with handouts. You can reduce the number of unnecessary phone calls for simple questions by using brochures and handouts. These can focus on both clinical topics and information about your practice. Using handouts about patients’ conditions or treatments can also help focus the visit so that important information is appropriately communicated.

7. Use a good scheduling system. Many practices schedule appointments manually. Yet the schedule has an enormous impact on productivity and efficiency. Dedicate resources to developing a good scheduling system, ensure that the entire staff understands it. This is especially important for solo practices that are growing into groups. Good scheduling can increase patient flow by two or more patients per day, which is net income to the practice. If you use a manual system, consider computerizing it. Your billing system may have a scheduling module that is adequate for solo and small-group practices. when uprading systems ensure you think of all your future needs.

8. Confirm appointments. This is time consuming, if you don’t have the staff to do it for all appointments ensure your system is generating the confirmations. Remember, no-shows are costly. They don’t give you 15 “free” minutes to sort through mail or catch up on reading. Instead, they create idle time and waste resources.

9. Schedule by grouping like activities. Doing like tasks together is more efficient. Vaccination clinics are an example. The office can handle 15 patients an hour per provider if they are pre-screened as flu-vaccine visits. The patients expect a quick visit, and you’re meeting their needs.

10. Build and rely on a budget. A serious effort to build a budget is a good learning experience, and it offers an opportunity to measure performance and progress by analysing variances during the year. Review published data to help establish budget goals, but remember that service, regional and market differences make such data only a rough guide.

11. Collect co-payments. Collect them before rendering the service, if that’s what it takes. It’s easy for patients to slip out after the visit, since they are often in a hurry. Remember, under most managed care contracts, collecting the co-pay is obligatory. And co-pays are a serious source of income — as long as you don’t have to go to the expense of billing for them.

12. Watch those salaries. A common mistake is to control costs by being tight on salaries. To attract and retain good people, you must pay well, but pay should be for skills and performance, not longevity. Be prepared to pay above market value for exceptional staff, but make sure they are exceptional. In some cases, a highly skilled back-office person can increase patient flow and enhance patient communications, thus saving the doctor’s time. Be assured of the benefit before you reward it.

13. Establish an incentive system. Make it worth your employees’ while to meet ambitious production goals. It helps to make staff feel vested in the outcome. A good incentive system improves teamwork, outcomes and efficiency. And, you can keep it fairly simple. Communicate your expectations, provide needed training, establish fair salaries and reward performance.

14. Eliminate overtime. There is no reason to have routine overtime. In fact, it often results from the staff’s poor organization or performance — or from a disorganized physician. Examine the reasons for overtime. You might find that it is really for convenience, not necessity, and can be eliminated by reassigning duties. Don’t get to the point where employees expect overtime as part of their regular compensation.

15. Use midlevel providers wisely. Expanding provider staff by employing a nurse practitioner or physician assistant can be financially beneficial in group situations. Do a careful assessment, including financial projections.

16. Make full use of facilities. Managing the work load and provider schedule can significantly reduce facility cost as a percentage of collections. Develop an efficient office schedule, and spread out days off. This may mean expanding your daily office hours, which can also be favourable for patients and providers.

17. Use a staffing strategy. Spot excess staff capacity, and grow volume to absorb it. Routinely analyse work allocation and work flow. Make sure that your processes continue to make sense. Make sure each staff member has an appropriate mix of skills to manage his or her responsibilities and relieve providers of work.

18. Be prudent when hiring. Troublesome staffers are easier to find than to get rid of. A problem staff person increases stress, work load and cost, while increasing your risk of a wrongful termination action. Establish skill requirements and expectations before hiring, and ensure that an appropriate hiring process is followed. To help ensure that you hire the right person, measure candidates’ skills; objective tests can provide valuable information. Communicate expectations to each new hire and hold him or her accountable.

19. Make sure your systems and procedures work well. Eliminate redundant, non-contributory functions. Get professional help if necessary to identify them, but be careful. Many practice management consultants are process-oriented and don’t focus enough on outcome. Using forms for histories, physicals and progress notes should reduce documentation time. Use check-off forms where practical to avoid writing — for instance a well-designed prescription form for your 15 most frequently prescribed medications, if that makes sense for your practice.

20. Critically evaluate new services and equipment. Don’t start a new service or buy a major equipment item without a cost-benefit analysis. You’ll need to make assumptions about anticipated volume and the cost of delivering the service, but don’t shy away from the work. These investments can produce poor results and can occasion disputes among the practice owners, so make sure you know what you are getting into before you make the leap.

21. Be cautious with small payer groups. Some health plans may not be adequately capitalized, and their administrative burden is often heavy. If they only have a few patients for you, make them convince you that the contract is worth the trouble —and don’t be easily convinced. We often find practices with dozens of contracts producing little volume but bringing with them the same credentialing hassles and other administrative chores as big contracts.

22. Form a group or join one. A well-organized and well-managed group provides the greatest probability of effective management. A well-managed group will produce higher physician incomes for the same amount of business. Expenses may increase, but resource utilization should improve. An efficient group should have at least six or seven physicians or have the potential to grow to that size in the near term. A group of six or seven can afford better infrastructure, technology and facilities, and it can offer increased leverage in negotiating with health plans.


The bottom line

Chances are good that your practice expenses are higher than they need to be and your revenues lower than they could be. The potential might be there for as much as a 20-percent increase in net income. If you manage your resources effectively, you will be better positioned to manage risks.