Rethinking Your Office Habits

Are You in the Box?

When is the last time you took a very close look at your practice… including the areas that haven’t changed in years, or maybe even decades?  When you came out of chiropractic college and started your practice, you wanted to make sure that everything in your office was operating in a certain way, with a certain look, and for a specific purpose.  However, now it has been months, years or even decades since that time, and although health care continues to change, many things in the office have not.

Why?

The health care system has changed and continues to change dramatically.  We have migrated from a 20% co-insurance world of the 80s to HMOs of the 90s and PPOs of the 2000s, and now we are moving into the world of Health Insurance Marketplaces and Accountable Care Organizations.  Additionally, we have watched the health care environment change from few regulatory requirements to a huge number of compliance requirements and from a short half-page intake form to a mountain of patient paperwork.  I could continue to lay out all of the changes we have witnessed over time, but suffice it to say, we are living in a different world than even last year.

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These changes have and continue to impact not just payment methods, paperwork, documentation, and policies, but they have also impacted the expectations of our patients and employees.  It is probably time to re-evaluate operations within your practice and look outside of your box.  Here are some basic areas to re-evaluate:

Workflow

The flow of treatment through your office should be examined closely.  Every employee should be surveyed and interviewed to find if he or she has suggestions for improving your practice workflow.  Sometimes simple changes can improve efficiencies, such as how paperwork is moved from the front to the doctor and back. 

Doctors should physically walk through the process that a patient encounters each visit.  While walking through, try to put yourself in the patient’s position and ask yourself a series of questions: Are there awkward moments that might create uncertainty for the patient about the process, treatment, waiting, or check-in? Are the patients walking unnecessarily back and forth across the same path? Is the breakroom door open where patients can see employees eating their lunch, creating a less-than-professional atmosphere? Does the reception area appear haphazard, creating a potential question of overall practice and treatment disorganization? Then add to this list any other question that may arise as you perform the walkthrough.

Additionally, doctors should, as best as possible, spend a half-day working closely with each employee as he or she performs job duties.  This may be difficult, but I would encourage you to find a way to help with the check-in process, appointment reminder calls, insurance billings, filings, table cleaning, and all of the many other duties your staff carries out daily.  You may find ways to assist your staff reach higher efficiency and potentially create a better work environment.

In short, where can you improve the workflow of your practice to ensure a better experience for your patients and your employees?

Patient Paperwork

How do you handle the mountain of paperwork now required when a patient first enters your practice?  No patient is happy about the volume of paperwork, but are you giving them the best opportunity to make a molehill out of that mountain?  Here are some thoughts:

·         When a new patient makes an appointment, email a new patient package of information and ask them to complete it prior to coming.  This can help shorten the amount of time they are in your office, and possibly prevent a cancelation because the patient does not have all of the information required.

·         Fill out the paperwork for yourself as a test.  Take home a new patient package and fill out every form.  Do you have unneeded duplication? Is there a form that requires an additional explanation that could be accomplished with a short cover sheet?  Is there a form that may require additional explanation and should be filled out in the office instead of within the pre-delivered new patient package?

Practice Evaluation

Over the last 13 years, I have spoken with a large number of doctors who no longer take x-rays in their office, because the service was ultimately costing the practice more than insurance reimbursed.  This leads to a very important question: what services are you offering that could be either outsourced or left to other providers?  Are you performing a service in your office that ultimately is costing more in employment costs and supplies than the reimbursement covers?  If so, it may be time to refer patients to another provider to receive that service.  Every service requiring the expenditure of resources in your practice should be evaluated regularly, including all patient services, billing services, advertising, website, and social media providers, even janitorial services, and more. 

Another important area to examine in your practice is preferred provider agreements and network affiliations.  When is the last time you really examined all of your insurance agreements and analyzed the overall costs vs. the reimbursement vs. the number of potential patients lost or gained?  In other words, every contract and fee schedule should be examined to determine its continued financial efficacy.

IF  (Total patients in network) x (Average network discounted service charges per visit)

Is less than

(Total patients in network – estimated patients lost if contract canceled)  x  (average non-discounted service charges per visit)

Then maybe it is time to evaluate your network participation.

This is an area where many doctors continue to do what they have always done, simply because they avoid change.  Instead of looking for things to change, look for things to improve.

Survey, Measure, and Benchmark

Lastly, when is the last time that you performed a post-care survey of your patients?  Have you ever surveyed your employees?  To continue in business and to improve, practices must ask and listen to the patients they serve and the workers they employ. 

Surveys should be completed each year (or more frequently) and should obtain measurable results.  Develop questions that can be measured over time.  Patient survey questions could range from length of time in the waiting room to overall satisfaction.  The ICS covered patient surveys in our May 2015 Advantage publication in more depth, and ICS members can access that article at www.ilchiro.org/.

In every business, there is always room for improvement.  We should never get in a routine or habit that does not afford us the opportunity to repair problems and correct inefficiencies.  One of the worst approaches to business is to live out the insanity adage, “doing the same thing over and over again and expecting different results.”  The areas discussed in this article are only a few that should be examined regularly, and doctors are encouraged to examine all facets of your practice. As a business and as a place of healing, your practice can always benefit from operational reappraisal.