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Increase Patient Satisfaction and Physician Productivity


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Improved access to a physician practice increases physician productivity and patient satisfaction.

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Increase Patient Satisfaction and Physician Productivity

  1. 1. OPERATIONAL SOLUTIONS C Increase Patient Satisfaction and Physician Productivity Through Access and Continuity By Rick E. Weymier, MBA, FACMPE and Mark Murray, MD, MPAIntroduction to operate under a system that is two factors will almost guarantee a consistent with the requirements and solid patient base contributing to the Much like the rest of the service expectations of its customers. The viability of the business. It is a myth toindustry sector in the United States, number one factor that contributes to assume that patients do not care abouthealth care is coming under increasing high patient satisfaction is “access” to from whom they get their health carepressure to be more consumer- the provider of their choice at a time services. Clinical capabilities are oftenfocused. The demands and and manner that is convenient for that assumed to be a given and fall farrequirements of the consumer continue patient. Access also is the key driver in down the list of satisfiers whento accelerate as the perception of the retaining and attracting the practice’s compared to other interaction care industry as being exempt patient base, which ties directly into Patients place a high value on thefrom a consumer-driven focus the practice’s ability to capture development of a strong relationshipdiminishes. Consumers are beginning sufficient revenues to ensure financial with their provider of view health care services like any viability. Access not only encompasses Continuity is critical to both theother type of service industry. They the traditional face-to-face visit, but patient and the practice, and iswant what they want, when they want also includes access to information, becoming a quantifiable indicator ofit, and they expect to collaborate and results, medical records, medications, quality.sometimes direct their provider in educational material and non- The traditional physician practicedetermining the level of service and physician staff in a hassle-free manner. sets the “rules of engagement” insatisfaction at a price that they deem Improving access in of itself is not terms of hours of operation,offers substantial value. This is enough to ensure success. Access scheduling parameters,congruent with the health insurance needs to be coupled with “continuity.” communication channels and serviceindustry moving from a restrictive Optimal continuity is the ability of a delivery options. “Rules ofdelivery system to one that allows for practice to create a process that allows engagement” is a military term, and ifgreater flexibility and choice. the patient to see the provider of you were to poll the typical patient, For a physician practice to choice nearly 100 percent of the time. they would indeed describe their questsucceed in this environment, it needs A practice’s ability to focus on these for health care services as a battle. PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA 41
  2. 2. Operational SolutionsThose practices that adopt a patient- practice is encouraging that patient to Pushing patients into the futurecentered approach will be the practices seek services elsewhere and sending a creates “bad backlog” or inventorythat earn a competitive market message to the community that it that is suspect. The cost of carryingadvantage and offer themselves the cannot accommodate incremental inventory is expensive for the opportunity for long-term patient demand. Having adequate Patients do not show up for theiroperational and financial success. access and capacity to meet patient appointments, they get better, demand is directly proportional to a significant resources are spent onAccess practice’s ability to generate sufficient reminder systems or they go All physician practices that aspire revenue for financial viability. someplace else. And worst of all, theto be operationally and financially practice does not have the opportunitysuccessful should focus on improving Cancellations and to sell that appointment slot to anyonetheir access as an initial step. No-Shows else given the fact that the practiceImproving access impacts a practice in Too many practices accept usually does not become aware of athe following ways: “cancellations and no-shows” as a cancellation or no-show until after the normal part of doing business, without patient was supposed to have arrived.Growth truly understanding what drives this When the practice is designed to situation. Cancellations and no-shows do “today’s work today,” backlog is at In any type of business, the best an acceptable level and access to careway to grow is to be able to offer are a direct result of the lack of access in the short-term to meet the needs of is available, the incidences ofcustomers the chance to purchase cancellations and no-shows virtuallyservices during a period when that the patient as determined by the patient. Practices tend to push patients disappear. Eliminating the need tocustomer perceives that he or she manage the cancellation and no-showneeds the services. This is especially out into the future based on practice- driven criteria. This sends a negative situation has a favorable impact oncritical for the patient that is new to staffing costs, staff satisfaction andthe community or is seeking a new message to the patient. Patients expect to be able to participate in the patient satisfaction.provider. Having the ability to offerservices through improved access is determination of their care and have their perception of their health status Demand is Predictableessential to patient growth. By nothaving time available to provide health respected and taken into consideration A common concern expressed bycare services to the new patient, the when seeking care. physician practices that are introduced to the concept of “advanced access” is the fear of insatiable demand. This is a FIGURE II.C.1 PANEL SIZE misconception that is hard to overcome. However, many other 3,500 service industries have tools and 3,065 methods for determining demand and 2,947 building the appropriate capacity to 3,000 meet that demand. These tools and 2,426 methods are equally applicable to the 2,500 2,186 health care industry. Historical 2,162 patterns, market conditions, payor 2,000 1,949 mix, patient diversity, physician practice style and available services all 1,500 factor into determining demand. When determining demand, it is critical to remember that the demand 1,000 is already there. Providers are seeing a certain number of patients per day, 500 which is not likely to change to a great extent when moving to advanced 0 access. What will change is the Group 1 Group 2 Group 3 manner in which providers treat their own patients and the simplification of Yr1 Yr2 the entry point for the patients. In most instances, the provider will see the42 PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA
  3. 3. Operational Solutions component of a successful FIGURE II.C.2 ACCESS IMPROVEMENTS % TIME OPEN IN THE FOUR WEEKS AHEAD physician/patient relationship. 45% Familiarity A primary care physician has the 40% capability of taking care of between 35% 2,500 and 3,500 patients, depending on demographic, payor mix and 30% Dr.S market factors. This is a manageable 25% panel of patients that will allow the Dr.T physician to obtain a high degree of 20% Dr.V familiarity with all of his/her patients. Familiarity leads to efficiency and 15% efficiency leads to better operational 10% and financial results. As much as 50 percent of a patient visit is wasted 5% when a provider is required to meet 0% the health care needs of an unfamiliar patient. Sep-99 Oct-99 Nov-99 Dec-99 Jan-00 © Murray / Tantau Patient Satisfaction Many in the health care industrysame, or slightly more patients when expense structure of a physician assume that the most importantmoving to advanced access. practice. Every single one of these concern of a patient is to get a medical Physicians who move to advanced examples is counterproductive and is condition taken care of irrespective ofaccess have the sense that they are not designed to drive business away rather the provider of the service. Because ofquite as busy and that there is a greater then encourage growth. this, many practices operate under thebalance between their personal and assumption that all “sick” patientsprofessional lives. By eliminating all Patient Centeredness need to be squeezed into the scheduleof the non-productive activities that go Access is all about providing the regardless of provider preference. Thison in a practice, and focusing purely patient with the services that they want is false. There is a greater degree ofon seeing patients, the increased (and need) in the time that they want patient satisfaction associated with theefficiency leads to expense reduction (and need) them. Traditional practices relationship that the patient developsand patient growth. are set up in somewhat of a standard with their provider of choice than with format that requires the customer to the actual care that is given. In otherScheduling make sacrifices to purchase services. words, who gives the care is more The traditional physician practice Hours of operation and availability of critical than the actual delivery of thecreates a scheduling process that is services are determined independent care from the perspective of theinflexible and incorporates numerous of input from the people who are patient.barriers that make it difficult for the seeking to purchase those services. In numerous instances wherepatient to acquire health care services. Those practices that have the ability patient satisfaction is measured, aIn reality, the process, in its current to adapt to marketplace reality have strong patient to provider relationshipformat, is designed around the needs the best chance for success over the consistently results in satisfactionof the physician practice, not the needs long run. scores greater than 90 percent. Inof the patient (customer). instances where the patient did not get The cost of scheduling Continuity to see the provider of choice, therestrictions, for example physicals Access by itself is not sufficient to satisfaction scores can drop as low asonly on Thursdays, the triage nurse increase efficiency, productivity and 50 percent. In either instance, there is(making the patient prove they are sick patient satisfaction. Continuity, the immaterial difference in the clinicalenough to be seen) and “patient to ability of patients to choose and see approach and diagnosis of the medicalreceptionist to nurse to physician to their own physician when they want to condition.nurse to receptionist to patient” see their physician, irrespective of the High patient satisfaction is a keymessaging is truly burdensome on the actual medical condition, is the second to patient retention and growth. It is PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA 43
  4. 4. Operational Solutionseasier and less expensive to invest in Recent data has shown that physician further placing unnecessaryretaining patients than it is to attract patients who see a provider on a demands on the patients. In fact, traditional regular basis have greater than a 90 In some cases it is difficult tomethods of marketing are debatable in percent chance of getting appropriate identify coding problems, astheir effectiveness to grow a physician near-term care and long-term documentation and coding often arepractice. The best method appears to preventive care. In instances where supportive of each other. Where thebe “word of mouth,” and the best there is a lack of continuity between deficiency occurs is that unmanaged“word of mouth” are current patients the patient and the provider, the frequency of visits and a focus onwho are highly satisfied with their potential for receiving all of the taking care of just the “urgentprovider. Patients who are seeking to appropriate health care needs may problem” results in a low level offind a physician ask for drop as low as 50 percent. coding. By taking a few extra minutesrecommendations from their friends with a patient, especially a physician’sand colleagues. It does not cost the Coding Issues own patient, additional necessarypractice anything extra to develop a Continuity enhances the review will result in more efficient usehighly satisfied patient base. effectiveness of appropriate coding of time and increased coding that is and documentation. When another justifiable.Quality physician in a practice is required to From both a payor’s and patient’s see an unfamiliar patient from within Professional Balanceperspective, quality is an expectation. the same practice and the same The typical physician officeHowever, quality is difficult to specialty, the patient is a “new patient” operates under the perception that it isquantify in the traditional physician to that physician. However, because of totally booked up, and that there ispractice. If one were to define quality coding guidelines, the physician must little opportunity to meet the demandas an assurance that the patient is code the visit as an “established of its patients in a more productivegetting all health care services that are patient.” This discourages the way. Physicians will insist that theyrequired to maintain good health and physician from doing anything but the are seeing as many patients as theyensure that future eventualities are very basics of meeting just the urgent can, and all patients that truly needrecognized in a timely manner, then condition. On top of that, in most care are taken care of. There is ancontinuity may be the single most cases, patients will attempt to secure appearance of organization throughcritical factor in assuring quality. follow-up visits with their own scheduling parameters, triage functions and urgent care processes. However, when you question FIGURE II.C.3 AVERAGE RVUs / MONTH physicians about their sense of fulfillment from a personal and 700 professional perspective, they will tell you that “it is not fun” anymore or 580 something just does not “feel right.” In 600 535 spite of this situation, the practice feels that they are doing the best that 500 493 they can, and there are no other 436 effective options to make it better. 400 379 Operating under its current “busy” 355 format does not seem to yield acceptable operational and financial 300 results. The vast majority of physician practices are just getting by. According 200 to MGMA data on revenues and compensation, physician incomes 100 continue to go up, but physicians have to generate proportionally more revenue to achieve a modest increase 0 Group 1 Group 2 Group 3 in income. The physicians and individuals in the practice are working Yr 1 Yr 2 harder for a lesser return from their efforts.44 PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA
  5. 5. Operational Solutions In other words, this continued Nurse Triage triage function, as well as itsincrease in “busyness” is not yielding This function appears to be the disruptive impact on patient flow in itsthe requisite reward. If practices are result of managed care’s impact on the present format. Practices that haveoperating at a perceived capacity, yet operations of a physician practice. moved to advanced access have almostthey are operationally and financially Over time, practices have developed totally eliminated the nurse triagemarginal, the key is to use what you the mentality that only those that are function as a barrier and reallocatedhave in a more effective manner. By sick enough, from the perspective of these resources to providing additionalcreating a system that encourages the practice and/or managed care direct patient care.continuity, simplification of the access company, deserve to receive medical Another bane of the triageprocess and matching of capacity to services. Because of this, practices function is the assumption that areal time demand, throughput is have created a whole set of rules and person, who is not sick enough to bemaintained, but the cost of providing procedures to discourage the use of seen, is a person that is wasting theservices decreases significantly. medical services unless it is absolutely time of the physician. In reality, by In most practices that have necessary. turning that patient away, foradopted the concept of advanced This process has also created a something that the patient perceives asaccess, the results have shown that the high degree of patient dissatisfaction, a real problem, encourages that patientsame amount of patients can be seen, as well as patient astuteness in gaming to seek help from another RVUs increase and the physicians the system. In reality, when a practice What the practice is telling itsdo not feel that they are as busy as quantifies the impact of the triage customers is that the business onlythey once were. When a practice function, the practice typically wants to sell its services on its ownquantifies the amount of time that it determines that well over 90 percent terms and that the customer has littlespends on squeezing patients into the of the people who go through the to say in the matter.schedule, triaging patient concerns, triage process end up getting an Health care may be one of the lastattempting to return patient telephone appointment anyway. If this is true, remaining service industries that hascalls and reminding patients of their one needs to question the value of the failed to wholeheartedly adopt theappointment times, the practice will concept of consumerism. Patients havefind that a significant amount of timeis non-productive. This is time that FIGURE II.C.4 AVERAGE NET INCOME / MONTHconsumes resources with nomeasurable return to the practice in $18,000both financial and patient satisfactionterms. $16,054 $16,000 $14,654Comprehensivenessof Visit $14,000 Familiarity and continuity allowthe provider to meet a variety of $12,000 $11,581current and ongoing conditions with $10,265 $10,800very little additional investment in $10,000time and staff. This makes the visit $8,881very efficient and allows a justifiablehigher level of coding. In fact, $8,000practices that have moved to advancedaccess have seen the total number of $6,000visits drop while RVUs for the periodhave increased. According to MGMA, $4,000one of the key characteristics of betterperforming groups is the amount ofthroughput per square foot that a $2,000practice is able to generate. Doingmore with each visit results in a better $0 Group 1 Group 2 Group 3return on the practice’s assets. Yr 1 Yr 2 PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA 45
  6. 6. Operational Solutionsgreater access to data and are information, patients will demand to Conclusiondemanding more choice in have a greater participation in making Access and continuity have adetermining his/her receipt of health determinations about their health care. direct impact on the productivity ofcare services. Instead of focusing on In order for a collaborative the physician and the practice’s abilityjust seeing sick patients, the practice environment to exist, the patient and to enhance patient satisfaction. Accessshould take the time to invest in its the provider must develop an ongoing and continuity are the essential linkscustomer base. In every instance that a and continuous relationship. Although between the product (physicianpatient wishes to buy health care the physician must maintain the services) and the customer (patient).services, for whatever the reason, the ultimate responsibility for providing Without excellence in each of thesepractice should accommodate that appropriate care, failure to allow the areas, the financial viability of thepatient’s request. patient to participate in the decision- practice is at risk. making process will decrease patientCollaboration retention and growth. Patients will As technology increases and gravitate to those practices thatpatients have greater access to medical encourage patient to physician collaboration.The Medical Group Management Association (MGMA) has set the industry standard for over 50 years in reporting medicalpractice cost and compensation benchmarking data. Likewise, the Performance and Practices of Successful Medical GroupsReport focuses on medical groups that exhibit exceptional performance in the areas of Productivity, Capacity and Staffing,Profitability and Cost Management, Managed Care, and Accounts Receivable. Key indicators are provided throughbenchmarking statistics, as well as, articles and “real-life accounts” that tell how the best performing practices actuallyachieved success. In just four years, the “gold book” has become one of the most popular and revered resources for medicalpractices across the country.To purchase the Performance and Practices of Successful Medical Groups: 2001 Report Based on 2000 Data or any other MGMAresources, go online at or call toll free 877.ASK.MGMA (275-6462).46 PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA