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8/2/2019 34 Ways to Make Your Clinic More Productive
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SpecialCoverage:Practice
Management
34 ways to
make yourclinic more
productive
by Candace Simerson, COE, and
Allen Giannakopoulos, MBAIf you learn from all the books, journals, speakers,and conferences about productivity improvement,you'd eventually come to the conclusion thatimproving the throughput of your clinic comes downto some good old-fashioned common sense, mixedwith some current technology for fine-tuning. Weagree. Much of the information for the clinicadministrator to review does have the flavor of
productivity improvement; but what we will do hereis present a quick "executive review" article ratherthan an in-depth discussion. 1. Cross-train yourclinic's front-end staff to perform all identified
basic functions.Many clinics simply haven't had the time to create alist of processes and responsibilities that front-endstaff must adequately perform. These could (andshould) include answering telephones, collecting cashand copayments from patients, and directing patientsto other functions within the clinic. The staff must be
able to answer patients' typical questions about
common eye problems. We don't mean medicaltriage; but staff must know the difference, forexample, between laser in-situ keratomileusis and
photorefractive keratectomy. Collectively, theprocesses that the administrator assembles as themandatory processes for performing basic officefunctions will serve as a springboard for trainingprotocols, flow charts, and for measuring revenueanalysis, patient throughput, coding, and productivityimprovement.
2. Cross-train staff when possible.For example, cross-train the receptionist and
scheduler, the accounts payable (AP) and insuranceclerks, the optical staff, and the scheduler. Practicesize, styles, and culture will determine whichpositions offer the best cross-training potential.Cross-training enhances productivity,
communication, and efficiency. The practice benefitsby increased employee capabilities and many staffmembers will enjoy the opportunity to learn a newskill.3. Train all staff to answer the telephones.A clinic in California wanted to know why its call-waiting times were so long and why patient
complaints about the number of telephone ringsbefore pick-up were so severe. This practice had anadvanced telephone system that could measure
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every variable imaginable; however, the one thingnot measured was good sense. New telephonesystems measure waiting time, not patientsatisfaction! The problem? Not one supervisor ormanager answered the telephones during the heavycall periods; this caused the senior management to
have a meeting about increasing operator andreceptionist staffing, an entirely wrong approach.Every staff member, regardless of position, can andshould answer the telephone, especially during peak
times. Administrators set the example.4. Show staff monthly reports and charts onaccounts receivables (A/R).Explain and show examples of the accountsreceivable (AR) "days out." Give samples of ARproblems (for example, wrong insurance data) andhow they can be prevented. Stimulate a discussion
and a problem-solving culture for developing ideas
on continuous improvement projects. Motivate thestaff to create and implement changes that improve
processes.5. Do a "people flow" of patients through theclinic.If you are wondering how to improve your practice,
start by asking what happens when a patient calls foran appointment. Then, work your way through theprocess from a patient's perspective, askingquestions at a high level. You can always get to the
details later. You'd be amazed at how many peoplecan't define the process from start to finish. As
administrator, your job is to know this process at ahigh level, because it's your staff's responsibility toknow the details. Don't start with anything fancy,
just begin with a drawing of the office or clinic.Identify how patients flow through the clinic and put
numbers on the drawing that correspond to themajor process steps. Identify bottlenecks that can besolved by changing patient flow, scheduling
protocols, office layout, or job responsibilities. Thenuse the drawing to help you.6. Institute voice mail with an operator todirect staff callsStart with a person, but add voice mail. Plan amailbox for each staff member: It's faster and moreaccurate than taking messages. Remember to haveall incoming calls answered by a person, but use the
voice-mail system for non-urgent messages. Beginhaving staff members check their voice mail threetimes a day. Encourage appropriate and effective use
of voice-mail capabilities.7. Jan. 1: Request an insurance card from everypatient.Every year, more than 30% of the populationchanges insurance. In 2 years, the majority of yourestablished patients have changed insurance
carriers. This is an easy issue to resolve to preventpayment delays. It's also a good catalyst for
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implementing a document imaging system if youhave multiple clinic sites.8. Copy the insurance card and attach it to thecharge ticket.Get a legible copy of the front of the card, and don'tforget to copy the back. Explore scanning the cards
into a new database. This makes a great reference ifyou need to follow up on a claim.9. Tag medical records for past-due amounts.First, have the staff use stickers on the front of the
chart. Then have the physicians remind patients withpast-due amounts (which they recognize by thesticker on the chart) to stop at that desk on their
way out. The next step is to create protocols for notscheduling those patients unless payment is receivedat the time of service.10. Conduct in-service training on various
surgical procedures.
Your teachers (the physicians) are already in placeand paid for. The stronger your staff's knowledge of
ophthalmology, the more confident they will become.An educated staff promotes patient confidence in thepractice. Patients respond to intelligent answers, not"I don't know" or "I'll have to locate someone who
can answer your question."11. Conduct in-service training on changes inreimbursement or bil- ling protocols.Reimbursement requirements change continuously.
Have several in-house experts on reimbursement forthe major payers. Include the physicians! Create a
system for communicating billing changes to all staff.12. Perform in-service training on patientscheduling triage.Many clinics have tried such training but say they didnot see the value in it. Ask yourself what should be
discussed at in-service sessions. Then ask yourselfwho would benefit from the discussion. For example,updating staff on new technology or procedures may
be appropriate for certain staff members.Conduct in-service training once or twice a year fornew employees to explain all services you provide.Hold a different in-service session for all staff to
review emergency medical procedures and disastercontrol. Explain the signs and symptoms of trueemergencies. Determine emergency protocols forstaff to follow, if you have not already done so, and
have your physicians develop the procedures afteryou outline them. With luck, you'll never need to usethese protocols; however, history indicates that
every office gets a patient emergency at some point.13. Create a triage reference sheet for all staff.List common patient concerns, complaints, andsymptoms that occur in your clinic. Then refine thelist into specific ophthalmic categories. Have yourphysicians review the list and add comments,
assisting with appointment priority issues. Laminateand keep a copy of the triage sheet at all
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appointment scheduling areas, as it is a greatreference and training tool.14. Institute a suggestion award process.Your staff members have ideas for improvements, sothink of creative ways to unearth these hidden gems.Develop a simple system for "quick fixes" and "good
catches" that the staff can use to reward one anotherwithout instituting a complicated system ofpurchasing and stocking gifts.Written thank-you cards are incredibly effective, but
most offices don't use them. We continue to forgetthat the best motivator is a sincere compliment. Asfor a suggestion award process, keep suggestions
anonymous until you and two physicians approvethem. This way, you will probably know who madethe suggestion, but the probability increases that aperson will just make the suggestion in the first
place. Poll the clinic to see the types of rewards
desired and don't forget that next to cash, time off isthe No. 1 motivator. Accumulating points that can be
cashed in for a half-day off is a powerful way toreward suggestions.15. Use one core package for all functions (e.g.,scheduling, A/R).
Increased communication and operational ability isdependent on system integration. All basic functionsmust work with one another. If not, productivity andefficiency are adversely affected and money lost.
Make certain your software packages can "talk" toone another without conversion of data. If your clinic
has multiple locations, this is a must in being able toshare information.16. Use one operating system version on everycomputer.Many clinics buy new hardware with newer operating
systems. This is great, but for simplicity andconsistent operations, upgrade all your personalcomputers to the same system and version, as well
as all operating software. As improvements occur,you'll know which computer should get what,because they'll all need the improvements. If youhave a network, you already copy software from the
server to the PC, so upgrades will simply go from theserver to the users' stations. Don't forget tostandardize the packages you use. There is no sensein having some use Word, some WordPerfect, some
Excel, and others Lotus 1-2-3. This merely increasesthe costs of upgrades, necessitates user experts inmore packages, and increases the amount of time
repairing system conflicts and computer bugs.17. In the optical shop, use certificates forpatients who need eye wear.For example, the certificate could offer a percentageoff the price, if the eyewear is purchased within 2days. Create a simple certificate in-house. Change
the percentage and the time span to see what worksbest. Add an incentive for purchasing a second pair.
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Have your optical staff monitor the trends anddetermine what works best for your region and city.18. In the optical shop, bring the edgingprocess in-house.If the demand warrants, you can perform lens edgingin-house. You should recoup your investment in less
than a year. Small savings per patient add up.19. In the optical shop, bar code the inventorysystem.Institute automatic reordering to your major vendors
with electronic data interchange (EDI). Chart yourinventory orders to monitor stock turnover and sales.Replace your PCs as needed to allow bar coding.
Bring your vendors in and talk to them; you mightfind that they already use bar coding for theirinventory, and that they have a good plan for codingyour inventory.
20. In optical, increase the patient-retention
rate.Have the physician suggest stopping at your optical
shop. If the patient has a problem, guaranteesatisfaction; don't make the patient struggle to getthe problem fixed. Patients appreciate convenienceand quality assurances. Train all staff to encourage
optical sales. Retention rates vary from 30% to 80%of patients who purchase their eyewear at youroffice.21. Implement a gain-sharing program.
A gain-sharing program can be especially effective inthe optical and contact lens operations. The plan can
work using base revenue achieved or a percentagecommission on sales. Expand the program so all staffmembers have a way to achieve a bonus if theydesire.22. Enhance communication through
networking capability.Physicians and administration should have remoteaccess capability for all major clinical functions. In
addition, all major departments and administrationstaff should have an e-mail address. Patients are on-line and there is no going back.23. Put human resources information on-line.This program should be tied to the payroll systemand group benefits broker. It also enhancescompliance with regulatory requirements and is aneasy management tool for monitoring the costs of
benefits or compiling an employee census. Developthe protocols for system access and use. Allow thestaff to perform benefits administration online.
24. Re-engineer processes that have becomeoverly complex.Re-engineering is an overused buzzword that hasgarnered much bad will, but you can still use thebasic premise behind it to improve your operations.Use team members to develop ideas for changing
processes that give people headaches. Insuranceprocessing, revenue cycle, patient scheduling, and
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collections are processes that continue to growwithout restriction. Don't bother trying to standardizethese processes until you have a small groupevaluate ways to complete the process. People drawon their knowledge base from other offices and use itto apply different ideas. Let your staff have a
brainstorming session or two on each major area.You might garner good relations with your staff orstrike a gold mine of ideas.25. Track and trend the mix of production data.Note the trends by physician or division. Also followprocedure code trends and use the data to create runcharts. These data sets are useful in creating and
evaluating marketing strategies, as well as inmeasuring goal achievements and determiningappropriate staffing needs.26. Track reimbursement on your top Current
Procedural Termin- ology volume codes.Do this for the top 15 to 20 codes, by payer.Determine average reimbursement by code to
facilitate forecasting and planning.
27. Use available call-accounting capabilities.Newer telephone systems have call-accounting
features. These will help you manage staffing levelswith proper back-up and facilitate managementdecision-making.28. Provide data to staff. Provide charting days
in A/R to the business office staff monthly.For the optical shop, use the percentage of cost of
goods sold to the industry standard and yourhistorical data. For scheduling and patient care staff,measure patient volumes and revenues. Compareyour results with industry standards in your marketregion.
29. Establish a formal training program.Formal training programs for teams, such asreceptionists and business office personnel, are
effective. Determine and prioritize steps for effectivetraining. Identify a key training person, and use thebuddy or mentoring system to give a new member aperson to go to with questions.
30. Create a collaborative hiring process.Involve other team members to create support andhelp identify strong candidates. There is so much
that your staff can do in the hiring process, includingwriting advertisement templates, reviewing resumes(paper and e-mail), first stage interviewing, and new
employee orientation. This will provide insight intopersonality dynamics by seeing which of your staffmembers accept new people and new roles.31. Establish expectations for conflictresolution.Every day in every office, some kind of conflict
arises. It is not possible to avoid it, but it is possibleto plan some steps in dealing with the conflict. You
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can try these three steps with staff conflicts. The firstis to resolve the conflict between the individualsinvolved. The second step is to have a third partymediate. The third step is disciplinary action,because unresolved conflict destroys the teamworkenvironment. In clinics, the most common
breakdown in disciplinary action occurs when anindividual circumvents the administrator's authorityand has a physician intervene. This is a true test ofan administrator's stamina and leadership ability.
Define each step and have the staff members discusshow they would like to be approached and treated ifthey were in such a situation.
32. Flowchart and standardize commonprocesses.A good ophthalmic office has many attributes;standardized processes are but one. The goals are
easy: Reduce bottlenecks, variation, and lost
productivity. Flowchart the major processes startingat the front desk for standardization and training,
because if your office is like others, that's yourhighest turnover area. As staff come and go, you willneed a tool to help bridge the knowledge gap that'screated when a person leaves. Include scheduling,
accounts receivable collection, and revenue-cycleanalysis as key areas to flowchart, and then set goalsto reduce variation or ongoing problem areas bytalking with your staff about day-to-day operations.
Ask them how they would standardize processes.33. Minimize insurance claim rejections by
auditing claim rejec- tions.Start with major payers, such as Medicare. Track andidentify causes for rejection of claims. Once you starttracking the causes, chart the data using a Paretochart, which is the 80-20 rule, and then determine
which are the most common areas to fix.34. Develop an insurance cheat sheet for theregistration area.
List required information for processing each type ofinsurance, such as billing and insurance codes. Notewhich plans require referral authorizations. Post thissheet with the same intent as the patient triage
sheet. This is another great training tool. Mostphysicians and administrators realize that clinics willcontinue to face increasing economic pressures.Controlling costs is critical to increasing profit. The
key to success is to decrease cost and increasevolume without lowering quality. Volume, cost, andquality are all tied to efficiency. Improving efficiency
allows a practice to reduce its average cost perpatient. hThis article was originally published in the Winter2000 edition of Administrative EyeCare andpresented at the 11th annual American Society ofOphthalmic Administrators' Congress on Ophthalmic
Practice Management, Seattle, April 1999.
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