Physician Time Management: Creating Patient and Doctor Satisfaction

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Physician Time ManagementCreating 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

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My Patient Mix

• Fee for Service 20
• Managed Care ( no capitation ) 50
• Medicare 30

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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

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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

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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

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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

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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

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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

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Patient Centric Care

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

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Training Patients
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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

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Do Unto Others

• Respect your Patients 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!

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Free Time Do Todays 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

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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

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PROS

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

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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

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Other Issues

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

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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

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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

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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

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Finish Before Moving On

• Finish the coding on the visit
• Finish the office notes
• Move on to the next patient with a clear slate

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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 MAs are trained to help extend the
  physicians productivity, as previously indicated

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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

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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