MGMA In Practice blog

By Rosemarie Nelson, MS
Principal, MGMA Health Care Consulting Group

Health care is all about the patient, and efficiency from the moment he or she walks in the door will make you and your customer happier. From filling prescriptions to scheduling, here are my top 10 must-do's to improve your medical practice's work flow.

1. Issue prescriptions and refills at the visit.
   If the follow-up visit is a year from now, provide a full year of the patient's medication(s) and eliminate a phone call (or a fax or e-transaction from a pharmacy) that will pull a nurse away from supporting physicians.
2. Adopt e-prescribing.
   Stop your staff from pulling charts to check patients' medications and recording new prescriptions. Maintain all patient medication information electronically for easy access.
3. Stagger staffing hours.
   Create a late-day nursing position so you always have coverage without paying overtime. You'll also prevent upheaval among nurses as the negotiations for "who can stay" take the nurses away from their work.
4. Staff up for peak times.
   To start on time and stay on time, have sufficient staff to prep and room patients, and answer phones first thing in the morning and again after the lunch break. Part-time staff can supplement your full-time staff so you don't have excess capacity as the workday ends. 
5. Use your telephone auto-attendant wisely.
   Patients want your phones to be efficient; they don't want to waste time getting transferred or having to repeat their story. Provide a short directory - no more than three options - for incoming calls: make an appointment, speak to a nurse/doctor or other. Short and simple.
6. Use your Web site to offload incoming phone calls.
   You'll meet your return on investment in months if you promote online interactive services. Encourage patients to use your Web site to schedule appointments, request prescription refills, get diagnostic test results and complete their visit registration – including medical history.
7. Clean up appointment-scheduling templates.
   Generally a short appointment slot and a long appointment slot will do the trick for any physician's calendar. When a practice gets too fancy and tries to control the demand for appointments by forcing them into a predefined, structured template, gaps occur in the physician's day and causes patients to wait a long time for some types of appointments. Get the patients in and keep the doctor's day full with two appointment types: long and short.
8. Reduce denied claims by verifying patient insurance eligibility and coverage benefits.
   Match MGMA better-performing practices with a 3 percent denial rate on first submission. To see how much you'll save, let's assume your denial rate is 5 percent (only 2 points higher):
   
   
• You generate 25 claims each day for each doctor.
• Each physician works four days/week and 48 weeks/year for a total of 4,800 claims.
• If your practice has an extra 2 percent denied, that's 96 claims denied each year per physician.
• It costs between $25 and $40 to re-work a claim. (According to Physicians Practice and Susanne Madden of The Verden Group.)
• Reduce denials to better-performing status (3 percent) and you'll reduce costs by $2,400 to $3,840 annually.

Imagine what your staff can do instead of reworking all those claims.

9. Use your bank's lockbox service to file explanations of medical benefits (EOMBs). Based on my 15 years of experience, even a solo physician's office spends 60 to 90 minutes every week filing and retrieving EOMBs. Improve your accounts receivable status by devoting that hour to real work instead of filing. A bank lockbox service accepts all your payments, deposits the checks on the same day, provides Internet access to electronic copies (usually for 90 days; you can then transfer them to CD). Who wants to spend time filing when denied and outstanding claims need follow-up?
10. Track patients using your practice management system's appointment-scheduling tools.
    Avoid paper and lights and flags and intercoms and instant messaging – use the inherent features in your practice management system to smooth patient flow. Let your nursing staff keep the charts for the day so they can prepare for patient visits and use the scheduling system to "arrive" patients electronically. Nurses can also use the system to assign exam rooms and let physicians know who is up next. The system will also help you route patients to your lab or other departments and alert the receiving staff to their arrival.

MGMA has even more ideas on improving patient flow. Which tips have you done or are planning to do? Share them in the comments.