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Physician Time Management: Creating 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. My Patient Mix . Fee for Service 20%

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physician time management creating patient and doctor satisfaction

Physician Time Management:Creating 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

my patient mix
My Patient Mix
  • Fee for Service 20%
  • Managed Care ( no capitation ) 50%
  • Medicare 30%
important
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
patient needs
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
the good and the bad
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
annuals what you should do
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
annuals what you should not do
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
ancillary staff issues
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
patient centric care
Patient Centric Care
  • Keep patient movement to a minimum
    • Start all patients except new patients in the exam room (exception: travel visits)
      • Annuals---> fully undressed and gowned
      • All others-remove only what is necessary for the most significant problems
      • Vital signs, exam, bloods, EKG’s, PFT’s, vision and hearing all from the exam table
      • Urine tests on the way out
      • Place orders and prescriptions at outgoing
do unto others
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
do unto others1
Do Unto Others…
  • Respect your Patient’s 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!
free time do today s work today
Free Time – “Do Today’s 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
open access
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

slide22
PROS
  • Increased patient satisfaction
  • Increased physician satisfaction
  • Increased physician income (more patients, less no-shows)
slide23
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
other issues
Other Issues
  • Paper management
  • Phone calls
  • Multitasking
  • Finish before moving on to the next patient
    • notes, coding, orders, final billing
paper
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
phones
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
multitask
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
finish before moving on
Finish Before Moving On
  • Finish the coding on the visit
  • Finish the office notes
  • Move on to the next patient with a clear slate
questions and answers
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 MA’s are trained to help “extend” the physician’s productivity, as previously indicated
q a continued
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
q a continued1
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