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% Managed Care ( no capitation ) 50% Medicare 30%

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 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 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 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 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 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 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, EKGs, PFTs, vision and hearing all from the exam table Urine tests on the way out Place orders and prescriptions at outgoing

Training Patients

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 Others… Respect your Patients 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 Todays 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 1. Completely Opening the Office All Day 2. Early and Late Walk-In Clinics 3. Setting Aside Blocks of Time 4. Combinations of Above

PROS Increased patient satisfaction Increased physician satisfaction Increased physician income (more patients, less no-shows)

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 Paper management Phone calls Multitasking Finish before moving on to the next patient notes, coding, orders, final billing

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 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 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 the coding on the visit Finish the office notes Move on to the next patient with a clear slate

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, 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 MAs are trained to help extend the physicians productivity, as previously indicated

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 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