The Doctors Company | The Doctors Company Integrates RGI Insurance Services

The Doctors Company | The Doctors Company Integrates RGI Insurance Services

How to Manage Your Time as a Medical Practitioner

Getting More Done

(Digested from Medical Economics. 4/6/07. "Advice from the Experts")

All anyone needs today is more time! That seems to be the common lament of anyone in any industry, particularly the medical profession. Demands on your time seem overwhelming and there doesn't seem to be much left for family and recreation.

Here are some simple steps to help you more effectively manage your time:

1. Develop a Master Plan. If you haven't delineated long-term professional and life goals, you will be addressing momentary needs, but you are not carving out time for that which gives you the ultimate satisfaction and profitability. Determine a limited number of goals that you really want to achieve. If you don't identify what you want to accomplish, you will never schedule time to do it.

2. Create Lists. Develop a Master List showing long-term, 3 to 10 year goals. Develop a Mid-Term List of goals you want to accomplish within the next 6 months to 3 years. Finally develop a Short Term List for goals you would like to achieve within the upcoming 6 months. Break down all goals into the steps or actions necessary to achieving them.

3. Create a Daily List. Start out each day with a list of your goals and priorities for the day. This will help keep you focused and enable you to seek out and find efficiencies. It's a good idea to make tomorrow's list at the end of today. That way you can hit the ground running in the morning.

4. Limit Your Goals. Too many goals can promulgate the feeling of being overwhelmed. Remember that you can probably do anything you set your mind to doing, you just can't do everything.

5. Develop Work Efficiencies. On a regular basis, review your work processes. Many may be outdated, or you may be doing things the old way in spite of new technology. Analyze all your activities with the mindset of streamlining your efforts or re-engineering the process itself. Remember that you want to be both efficient and effective during the work day.

6. Be Realistic about Time. Most jobs take longer than we think they do. Small activities, which we think only take a couple of minutes, actually take much longer. Keep the time factor in mind when making your lists.

7. It's OK to Say No! Although your entire career is all about helping others, you need to set your personal boundaries. Evaluate requests to determine how they fit into your overall goals for the day and for the future. Sometimes you can finds ways to be of assistance that do not require your time. Be discerning.

8. Delegate. If your medical degree is not required to do the job, delegate it to an appropriate person on your staff. If they are not able to do it right, it may be better to take time to teach them in order to save time in the future. Develop guidelines and operational procedures to ensure that delegated efforts are carried out correctly.

9. Avoid Perfectionism. Mistakes in the medical industry are bad, but perfectionism can be just as bad. The term refers to overemphasis on details that are not that important to the overall effectiveness or success of the goal.

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Ways to Improve Telephone Processing in Your Medical Practice

(Excerpted from the 2/2/07 issue of Medical Economics)

Here are some suggestions to improve the efficient processing of telephone calls within your practice:

1. Keep your office open during lunch. Practices that close and switch incoming calls to an answering service (or worse, answering machine) lose a certain amount of quality control and image. Try rotating staff during lunch periods so that an experienced person is always available to handle the phones.

2. Answer all calls by the fourth ring; and by a real person. High quality customer service is becoming ever more important in the health field. If a call isn't answered by the fourth ring, have the call automatically switched to the back office. Another possibility is to hire retired staff or those on maternity leave to field "overflow" calls from their home.

3. Teach courtesy. To some people telephone courtesy comes naturally, to others it doesn't. For those that need more training, consider a scripted greeting and some coaching on how to listen to the caller. Some telephone companies even offer free training for your staff.

4. Spell out priorities. Who comes first, that patient on the phone or the patient at the window? If you're on the phone with a patient and are almost finished with the caller, signal the patient at the window that you'll be with them shortly. If the call promises to be a long one, the receptionist should excuse herself and place the caller on hold in order to attend to the patient at the window.

5. Don't rush to fill empty appointment slots. If there's an empty slot on the calendar, most receptionists will quickly fill the spot with requests for routine visits. However that can squeeze out any available room for sick patients that really need to be seen. Consider a policy to ration the routine slots, scheduling non-urgent calls at a future time, in order to maintain some flexibility for urgent calls.

No practice handles all calls perfectly. But if you set the procedures to process calls the right way, your staff will be happier and your patients will be giving you higher marks for courtesy, efficiency and professionalism.

Front Line Defense - Encouraging Your Front Desk to Treat Patients Well

Excerpted from Medical Economics, 3/16/07

You've heard it before: "Patients are more likely to sue physicians that they don't like."

Unfortunately those ill-feelings sometimes have nothing to do with the physicians. They stem from feelings generated at the front desk of your practice.

For instance, this is a summary of a patient complaint: "I needed a referral to a specialist, but the receptionist said I had to come in, which meant a $30 co-pay just to get a referral letter from my doctor. When I questioned that, I was told that that is their policy. They are money-grubbers! They know I have to see this specialist twice a year and do not need an extra examination."

In this case the doctor knew nothing about visits to such a specialist. In the past, the insurance company had not required a referral for this particular specialty. Although there was no merit to the patient's complaint, it could have been handled differently.

Rather than focusing on the co-pay, the receptionist could have told the patient:

1. The doctor is now required by her insurance company to assess her request.

2. He can't make the referral without an appropriate history and medical indication.

3. There may be a problem of which the doctor is unaware. He needs to understand that problem in order to provide the best overall care.

4. This condition could have an impact on another condition or medication.

5. The doctor needs to determine if additional treatment, testing or referrals are necessary.

Some patients may have still been upset, focusing only on the $30 co-pay, but properly explained, the patient may have better understood the necessity for the visit.

Counteract such problems by:

1. Instructing employees to tell patients why they might need to be seen prior to issuing a referral.

2. Be sure that patients know that care in one physician's office can affect care and treatment in another's office.

3. Reinforce to employees that rude treatment could leave the patients angry at the doctor.

How do Other Practices Handle the Cost of Benefits?

Excerpted from MGMA Connexion, April 2007

Every employer is fighting the battle of continually increasing health insurance costs for employees. More and more employers, including those in the medical profession, are trying to determine a fair” way to share t”he burden. Even insurance agencies are wondering what to do with the cost of benefits that used to be covered 100% by the agency.

Here are some replies from a survey by MGMA:

"We offer three options: HMO, PPO and POS. Employees pay 20% of single coverage. If family members need to be covered, the employee pays the full difference."

"We are envious of practices that can offer benefits. We do not pay for our employees' group health coverage; and several employees are currently uninsured. The cost is too great of a burden for our practice."

"Our clinic pays 60% of the employee's cost and 50% of the family coverage. This is considered very generous, especially the family coverage, for our area. However this is a decrease from 100% payment for everything six years ago."

Here is the formula for our practice:

1. 100% for full-time employees (32+ hours per week), 75% family.

2. 75% for part-time employees (20-31 hours per week), 50% family.

3. If no insurance is taken, $3,000 full-timers or $1500 part-timers is placed in a medical flex plan. If they want cash, they can take half of the above amounts.

Our employees pay 15% of their health premiums (pre-tax). Everyone pays the same, but we offer a coverage waiver benefit for those with spousal coverage.

Our employees have 50% of their premiums, 100% for dependent coverage.

As you can see, policies vary widely. Decisions should be based on the fiscal soundness of the practice and the market conditions required to recruit and retain good employees in your area. Additionally, many companies are offering higher levels of deductibles and/or Health Savings Accounts to help mitigate costs.

If the Patient Lacks Capacity

(Digest of an article by Lee J. Johnson, JD in the 2/2/07 issue of Medical Economics.)

Patience and time are key ingredients in dealing with patients who can't accurately report their history or current symptoms, don't understand your treatment recommendations and probably won't remember to take their prescribed meds. You may not have the time to comfortably give these patients – but you may be at risk. Particularly when an octogenarian forgets to mention the numbness in her right arm, or doesn't make an appointment with the neurologist you've referred her to. You may be exposed to a “failure-to-diagnose” lawsuit with allegations of “failure to follow up”.

Here are some tips to avoid this trap:

1. Expand the initial history and physical to assess whether the patient has the capacity to make decisions on his own behalf. Legally “capacity” means the ability to understand a physician's discussion of the risks, benefits and alternatives to recommended treatments. If an incapacitated patient can understand and make medical decisions, you will breach patient confidentiality and HIPAA regulations if you involve family members without first getting the patient's consent.

2. Order a psychiatric evaluation if you can't ascertain capacity on your own. A patient who can handle personal finances may not be able to make medical decisions. Likewise someone who insists he was kidnapped by aliens might still easily grasp medical specifics. A psychiatric consultation will clarify the situation and serve as your best legal backup.

3. Find out if the patient has appointed someone to help make healthcare decisions. A patient's representative usually has the right to all information that a fully capacitated patients would have access to. If there is no such designated person, but an elderly patient arrives with a relative, ask if the patient would like to have the relative come into the exam room. Chances are the answer will be “yes”. If so, at the end of the visit, ask both the patient and the relative if they have any questions and to let you know if a new medical problem develops or if the patient is having trouble following the treatment regimen.

4. Get explicit and documented consent from the patient (or representative) when ordering high-risk meds, aggressive treatment or invasive surgical procedures. If something goes wrong in the treatment, the question of whether the patient understood—and would have consented upon understanding—is paramount.

5. Repeat information and instructions if you are not sure the patient has fully comprehended them. Ask the patient to repeat everything back to you. Provide written treatment and medication instructions – and write the diagnosis on the same sheet of paper. If the patient's eyesight is poor, make it in large print.

In any lawsuit, a major issue is whether you and your staff could have done anything more for the patient. So be sure your staff reminds incapacitated patients of upcoming appointments and follows up on recommended referrals, treatments and procedures.

Train Non-Critical Staff to Answer Phone Calls

Telephone Triage (Excerpted from an article in the 2/2/07 issue of Medical Economics)

Your telephone is frequently answered by a nonclinical staff member. They often do not know what to say, what questions to ask and what action to take. They often do not know what is important and what is not. As a result, precious time is expended in conversations that are longer than necessary and/or call backs by medical assistants or nurses. The solution is to train nonclinical staff and provide written guidelines on handling both routine and urgent phone calls. Here is a three-step process to accomplish that job:

1. Gather information. Conduct an office-wide brainstorming session. Have staff members discuss the types of calls they receive. Have the medical staff explain how they want specific calls and situations handled. You might even poll new and established patients to find out how they feel urgent calls are being handled. And don't forget about the handling of routine calls for appointments, billing or insurance questions and lab results. Each doctor within your practice must explain, in detail, how referral calls from other doctors are to be handled and personal calls for them. Doctors need to spell out how they want different appointments scheduled. For instance, if a caller complains of mild chest pain, some doctors may want same-day appointments, some may want them scheduled for a long appointment and some may want them sent to emergency.

2. Draft written guidelines. Once the information has been gathered, put it in writing. Draw up written guidelines that explain how to handle the various calls for the specific doctors in easy-to-understand language. You may even want to consult the book Telephone Triage Protocol for Nurses by Julie K. Briggs (Lippincott Williams & Wilkins, 2006).

3. Practice Actual Scripts. Conduct periodic meetings and utilize role-play to practice the handling of various types of calls - both urgent and routine. Remember, the nonclinical staff person should not respond to requests for medical advice. Their goal is to extract pertinent information for transmittal to the medical professional. Typically a telephone clerk's duty does not need to go further than collecting the caller's major signs and symptoms, unless the doctor requires more information. Aside from collecting the information, the clerk's only other duty is to be empathetic and reassuring.