Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How medical practice operations impacts productivity and profitability

Rosemarie Nelson
Physician
October 12, 2010
Share
Tweet
Share

“How many staffers should we have per doctor?” was the opening question in a recent column . We looked at the impact of staff on provider productivity and ultimately practice profitability as an approach to address that question.

In that piece, we focused primarily on clinical staff, but in this column, we’ll dig even deeper into medical practice operations, looking at the way a practice utilizes nonclinical support staff for traditionally administrative functions, such as check-in, check-out, patient scheduling, and telephone management. Those functions, too, can affect efficiencies and, ultimately, the bottom line.

First, let’s look at when and how a new patient is registered with the practice.

A patient new to the practice calls the office for an appointment. Practice A gathers minimal information (name, phone number, date of birth) over the phone. Practice B captures the full demographic and billing information from the patient on that initial phone call, or sends the patient history form to the patient to fill out and send back before the appointment.

What happens next?

When the patient presents at Practice A, the staff has to collect the patient’s demographic and billing information in addition to getting the patient to sign a release of information and notice of privacy form. Typically, the patient sits and fills out page after page of this information. That process can take 10 or 15 minutes or longer. Sometimes the providers in Practice A are pacing the hallway waiting for the nurse to room the patient, because there is a delay getting the paperwork finished, the data entered into the computer, and insurance coverage verified.

When the patient presents at Practice B, however, the most that needs to be completed is a signature on the release of information and notice of privacy forms. Practice B has already verified insurance eligibility because they obtained the required information over the phone at the appointment request call. The front desk triggers the nurse to room the patient sooner in the process.

Does it seem like Practice B has a better process? To those Practice As who say they couldn’t afford the additional staff they’d need to take incoming phone calls, Practice Bs would say that they need fewer staff operating the front desk and so can shift staff to the incoming phone calls.

Is it a wash in the numbers? Let’s look at how the practices are staffed based on each seeing about a hundred patients/day.

Seeing 100 patients/day Practice A Practice B
Telephone appt. and
registration process
2-3 minutes 5-6 minutes
In-office registration 5 minutes 1 minute
In-office insurance
eligibility verification
2-4 minutes 0 minutes
# Telephone staff 1.0 FTE 1.25 FTE
# Check-in desk staff 1.6 FTE 0.80 FTE

It can get a bit more complicated if we pose slightly different scenarios: Practice B uses a service that uploads patient insurance information for every patient on the schedule two days in advance and automates insurance eligibility verification. Practice A uses an in-office kiosk where patients check themselves in and complete their registration process on the kiosk which sends a real-time insurance eligibility request out for verification.

Now, which process uses fewer staff or gets better results?

As it happens, adding the kiosk will mean that Practice A will require just 1 FTE, instead of 1.6. So letting patients do the keystroking actually gives practice A a slight edge over Practice B as far as number of FTEs goes (2.0 versus 2.05), but Practice B still comes out ahead in terms of time — the process takes a total of six to seven minutes in Practice B versus nine to 12 minutes in Practice A.

And that’s only at the beginning of the encounter; how about the end of the encounter?

Look at how follow-up appointments are scheduled in two busy practices. The providers in Practice X and Practice Y have schedules that are fully booked about four weeks out into the future. To monitor a patient’s problem, the provider orders a follow-up appointment to see the patient in about one week.

ADVERTISEMENT

The check-out staff in Practice X handles scheduling for follow-ups, but the clerk must call back to the provider’s nurse and ask for guidance on where to double-book (or even triple-book) the patient.

In Practice Y, the provider’s nurse schedules the patient’s appointment because the order for a one-week follow up falls within the standard established by the practice: provider-specified appointments that are to be scheduled during the subsequent four-week booking period are scheduled by the provider’s nurse, who can best determine the appropriate spot during the day for adding the patient onto a fully-booked schedule.

Does Practice Y need more nurses than Practice X to take on the scheduling duties? Or does Practice Y need fewer nurses because they are not interrupted or called away from their work to take a call and look at the schedule? Let’s chart it:

Practice X
(follow-up at checkout desk)
Practice Y
(nurse schedules follow-up)
Check-out staff time 2-5 minutes 0 minutes
Nurse time 3-4 minutes 2-3 minutes

The total time investment is more with the traditional model of scheduling follow-up appointments at the check-out desk, and the nurse-only time is actually less when we think outside the norm and implement a different work flow.

Work flow, technology, and shaking up traditional job duties can all have an impact on headcount. Dig into your processes to get the numbers right.

Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.

Originally published in MedPage Today. Visit MedPageToday.com for more practice management news.

Prev

Intimate partner violence an epidemic of grave proportion

October 12, 2010 Kevin 4
…
Next

Too much data can overwhelm physicians and harm patients

October 12, 2010 Kevin 10
…

Tagged as: Primary Care, Specialist

Post navigation

< Previous Post
Intimate partner violence an epidemic of grave proportion
Next Post >
Too much data can overwhelm physicians and harm patients

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Rosemarie Nelson

  • a desk with keyboard and ipad with the kevinmd logo

    Increase patient and provider satisfaction by reducing phone messages

    Rosemarie Nelson
  • a desk with keyboard and ipad with the kevinmd logo

    How to improve patient engagement

    Rosemarie Nelson
  • a desk with keyboard and ipad with the kevinmd logo

    What’s your plan for the transition to ICD-10?

    Rosemarie Nelson

More in Physician

  • The hidden incentives driving frivolous malpractice lawsuits

    Howard Smith, MD
  • Mastering medical presentations: Elevating your impact

    Harvey Castro, MD, MBA
  • Marketing as a clinician isn’t about selling. It’s about trust.

    Kara Pepper, MD
  • How doctors took back control from hospital executives

    Gene Uzawa Dorio, MD
  • How art and science fueled one woman’s path to medicine

    Amy Avakian, MD
  • In a fractured world, Brian Wilson’s message still heals

    Arthur Lazarus, MD, MBA
  • Most Popular

  • Past Week

    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
  • Recent Posts

    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • It’s time for pain protocols to catch up with the opioid crisis

      Sarah White, APRN | Conditions
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How locum tenens work helps physicians and APPs reclaim control

      Brian Sutter | Policy
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
  • Recent Posts

    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • It’s time for pain protocols to catch up with the opioid crisis

      Sarah White, APRN | Conditions
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How locum tenens work helps physicians and APPs reclaim control

      Brian Sutter | Policy
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How medical practice operations impacts productivity and profitability
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...