Secretary, nurse, MA do ‘prework,’ so doctor has more time with patient
By Sandra Lee Breisch
Struggling to beat the clock, be efficient and spend lots of time with your patients? If so, you’re not alone.
"No matter what the practice size, there’s a universal hindrance to efficiency," says Timothy A. Pella, administrator for the Orthopaedic and Reconstructive Surgery Associates, PC, in West Burlington, Iowa, and 1998 president of the BONES Society.
Yet, efficiency comes at a cost, notes Pella. "You can’t always sacrifice staffing levels or a patient’s needs to try to be more efficient because in the long run you won’t be," he says. "Why? Because there might be delays in getting patients scheduled due to staffing problems. Also, patients who felt they didn’t get enough of their doctor’s attention because they felt rushed might schedule another appointment. Or they might call in with questions, thereby using additional staff time that could be used more efficiently in other areas."
By assigning one secretary, nurse or medical assistant (MA) to an orthopaedist, Pella creates efficiency within the practice. "The doctors feel very comfortable in working with the same person, especially if they have any questions that need to be answered," he says. "And the secretary, nurse or MA knows the doctor’s personality traits, how to help the doctor before, during and after the exam."
Prior to clinic hours, the nurse or MA reviews their assigned physician’s schedule and makes follow-up phone calls to ensure patients bring in any X-rays or other diagnostic results. During the exam, a real time-saver for the physician is when the nurse or MA takes patients to the radiology or cast room and facilitates durable medical supplies, so the physician can see another patient, notes Pella.
Pella says their nurse also supervises the MA and schedules surgery, prescription refills, lab reports, diagnostic testing and more. "This is truly a team operation that helps efficiency when the nurse, MA and doctor all work together," he adds.
Five orthopaedists practice at North Shore Orthopaedics in Milwaukee, Wis. On clinic days, each physician sees an average of 30-35 patients, according to administrator Jean Pereles-Strouse. To achieve efficiency, the group also assigns one MA to work directly with each physician. Additionally, they have a trained floating MA—if the assigned MA is not available. "The floating MA was a big decision because that’s adding an FTE. But we looked at the cost-effectiveness in it and it worked," says Pereles-Strouse. "That’s because we were not pulling a different MA to work with another physician and this eliminated overtime in having one medical assistant work with two doctors."
An additional tool used to increase efficiency is a computer software package that calls patients in advance to remind them of their appointments. "This system has greatly reduced no-shows, and by eliminating down-time during clinic hours, makes sure that there are full schedules of patients with no gaps to creative inefficiencies of the doctor’s time," explains Pella.
Aiming for efficiency in dictation is a tough one, points our Pella, because physicians’ practice patterns differ. "Some physicians prefer to dictate patients’ notes directly after the visit, while others prefer to do it when they have a break in the day or after clinic or surgery," he says.
No need to hire a transcriptionist at the Southern Orthopaedic Specialists in New Orleans, La. Instead, a voice recognition software-based system called Documentor™ (designed by Medical Dictation Systems) allows seven orthopaedists to dictate their patient notes and transcribe them immediately.
"The doctors like it because they can dictate from anywhere and download that information to the computer at any time and don’t have to spend time looking for a patient’s chart," explains Marion Eigenbrod, the practice’s administrator. "And they don’t need anybody’s assistance."
Although it took about three to six months for physicians and staff to learn how to use the software, the time investment was worth it, points out Eigenbrod.
And it’s reduced the practice’s overhead costs. "Although we invested $35,000 in this system’s software, this investment is equivalent to the salary we would’ve paid for a 1.25 FTE transcriptionist," explains Eigenbrod.
Customized templates were designed so voice patterns for each physician could be recognized and jargon for each physician’s specialty (knees or upper extremities) could be easily transcribed. The software also includes a general orthopaedic dictionary, documents diagnoses, procedures and codes based on physician input. It can also generate referral letters, produce educational materials, prescriptions, and produce an electronic signature.
To maximize patient flow, increase physician productivity and interoffice communication, the practice installed a four-colored light monitoring call system to monitor patient and physician location and status of the patient’s exam. Panels that flash colors are posted outside and inside the exam rooms and are operated by the front desk staff.
"For instance, when a patient goes into the exam room, the front staff pushes a red button to indicate the room is occupied," explains Eigenbrod. "When doctor goes in, he pushes the red button that blinks to let the staff know where that doctor is. Or, suppose he needs an X-ray, he or she pushes a blue button, an assistant comes to take the patient for the X-ray. In the meantime, the doctor leaves the room and heads towards a room with a red panel that lets him or her know a patient is waiting."
The practice also installed a Digital Subscriber Line to gain greater data transmission speed for their computer systems and smoother communication between the two satellite locations. "We can now transfer huge data banks from our computer to both satellite locations," says Eigenbrod.
Yet, in spite of these staffing efficiencies, how does a physician spend more time with a patient and be efficient?
"Sometimes you have to give a little time to get a little more efficiency out of your day," says Pella. "We add a double or—at a rarity—a triple time slot for patients who need more time or just may take longer communicating with the physician, based on their problem. In effect, it’s kind of an efficiency thing if you think about it. Why? Because we’re also not going to book more people into that time slot and the physician is still going to get to surgery on time."
Adds Pella, "The main thing is that patients feel like the physician spent an appropriate amount of time to accommodate their needs as a person and to address their medical problem."
Physicians also reap rewards for giving patients a little more time. "Patients will tell others about the good care they received," says Pella. "Word-of-mouth referrals are always better than any kind of print ads or advertising you can spend money on."