Examine practice's efficiency before making cuts to staff, resources

February 1, 2011

Looming reimbursement cuts from government and commercial payers worry many dermatologists, all of whom fear a decline in practice profitability. Before you take dramatic cost-cutting measures, make a careful review of your practice's efficiency.

Key Points

Set a realistic patient-care schedule. Your time is the practice's most precious asset. From the very beginning of the day, however, your infrastructure fails to recognize this important principle. Office hours start at 8 a.m. and patients are scheduled at 8 a.m. Given the fact that the transaction time at the front office of a dermatology practice ranges from five to 20 minutes, you're guaranteed to run late from the first patient onward.

Efficiency requires that the practice focus on you and any other billable providers. Decide when you want your work to begin and schedule patients for arrival times five to 20 minutes before you anticipate walking into the exam room. You'll capture lost time at the beginning of the morning and afternoon sessions, plus you won't automatically start "in the hole." Stagger staff to ensure that patients are processed as soon as they arrive. Therefore, when you're ready for patients, they are ready for you.

Establish a start-of-the-day checklist for your receptionists as well as your clinical support team. Be sure to cover the basics - for example, turning on the computers. Your best employee already performs these tasks, but checklists ensure that everyone knows what needs to be done to prepare for the day. Recording the tasks and requesting daily sign-off promotes performance and establishes accountability.

Consistency engenders efficiency. Standardize the layout of each exam and procedure room, with equipment, supplies, forms and other resources in the same location. Delineate your expectations for procedure set-ups by photographing the equipment and supplies in the desired positions. Establish written protocols for clinical intake. Bind the written protocols and pictures in a notebook for employee orientation and reference. With your expectations in writing and pictures, you can institute accountability for performance.

See patients promptly, and don't appear rushed. With patients now scheduled for your optimal workflow, it's imperative that you start on time. If you're consistently tardy, your patients will respond by showing up late for their appointments. Patients kept waiting a long time expect more time from you. Knowing the time may seem a minor issue in breaking this cycle of lateness, but it's important to avoid looking at your watch. Even a quick glance makes the patient perceive that you're in a hurry. Instead, place a clock behind the head of the exam room table. This lets you watch the time as you attend to the patient. Giving the appearance of rushing causes patient satisfaction to plummet. Appear relaxed. Introduce yourself using a handshake or gentle touch; sit down with your legs crossed and make eye contact. Instead of reviewing the patient's chart outside of the room where he or she can't see you, perform the pre-work in front of the patient.

To ensure you don't encounter missing information, require that staff review all charts a day or two before a patient's arrival. Establish what you expect from the review process, such as having test results in place. Consider this an opportunity for staff to alert you to any preventive care for which patients are due. During the appointment, you can address such recommendations.