Common Problems in a Medical Office



As the year comes to a close, I did my usual assessment of office priorities, and came up with the following list of potential pitfalls I think are important for every practice to work on:

1. I realize that the front desk is often staffed with underqualified, younger help who can be easily overwhelmed by phone calls and patient demands. Still, it's imperative that all patient intake information (i.e., insurance information and subsequent updates) be properly entered. It pays to go with a more experienced person on the front desk, and I make sure to never have someone new or easily flustered in the position


2. Make sure to update your fees and charge tickets annually.


3. Have a quality control procedure in place regarding charge tickets. Make sure that everyone is being properly charged for everything. Have separate personnel keep a daily tally.


4. Staff your office properly. Make sure the ratio of staff to physicians is adequate. Many practices tend to cut corners on this one, and the workload makes them suffer. Good medicine can't be practiced on the cheap.


5. Make sure to follow-up with patients on things such as mammograms and other preventive tests.

Of course, this is an incomplete list. There are endless ways to improve any business, especially a doctor's office. Last month, a patient jokingly suggested we get Starbucks coffee for the waiting room. A member of my staff took the suggestion to heart and researched it. A week later, we had Starbucks coffee in the waiting room, and the response was overwhelmingly positive.

Sometimes we forget that it's the little things which people notice, and when you make something as onerous as a waiting room experience a little brighter, you reap the reward of happy patients. I support anything which makes a visit to the doctor more user-friendly.

Anyway, I'd love to hear any suggestions or comments you might have, as the year comes to a close. Any thoughts on what to look out for in a medical practice? Ways to make it better?

In Case of Emergency


As the recent fires in Southern California proved, disaster is always ready to strike when you least expect it. Because of the importance of medical records, it's vital for every practice to safeguard their information as a precaution. The following are simple steps that can and should be taken:

1. Always keep up-to-date employee contact information, as well as a complete master vendor list of purchased and leased equipment, both on and offsite.



2. Determine a separate location where you can temporarily see patients, should your practice become inaccessible. Should disaster strike, be sure to let your patients know where your alternate location is, and alert the local media.



3. Back up all of your computerized information on a second server that is offsite. This will ensure that you never lose any critical clinical and financial data.



4. Invest in business interruption insurance. Make sure your policy covers payroll, rent, and other essential bills, as well as all sorts of multi-peril incidents. (The waiting period for implementation on most policies is three days.)

Where I live in California, natural disasters seem to be a way of life, but I also know of many colleagues who suffered tremendous losses in Hurricane Katrina. God willing, most of will never have to experience such catastrophes, but it is crucial to never forget that preparation is a cornerstone of medicine. That mindset should extend to disaster readiness, for your own piece of mind as well as for your patients.


Lest we forget the lessons learned from Katrina on the volatility of having only paper medical records (see article), of course it's always a good idea to have your patients' medical records stored electronically offsite. Our medical transcription prodiver actually stores all of our records online for us, which is very handy.


As always, I'd love to hear from you. Any suggestions or points which I missed? What do you think?

The Mission



Every medical practice should have a mission statement, which is simply a written document of the goals and attitudes of the physicians in charge. It needn't be a lengthy or lofty document. In fact, the more precise and to the point it is, the more effective it will be.



The key is to be succinct and clear. What sets your practice apart from others? What can be done to achieve these goals? Is the statement which results a problem-solving document? A rulebook to use when necessary?



Once written, it's important to post your mission statement in a public place and refer to it whenever necessary. Review it annually and allow input from staff members if they have a strong or important point of view that augments what you create.



As far as I'm concerned, the mission statement is a necessary lynchpin in creating a good working culture. Of course, the lead physician sets the overall tone, but as an office manager, I am constantly aware that my problem-solving abilities are crucial to maintaining order. If I keep my cool and react with good humor, I set a positive example for my staff. Ultimately, I am there to support the doctors, and I never forget that.



And our doctors are extremely gracious and loyal to our staff as well. Little compliments noted here and there are vital to morale, in addition to incentives that I've discussed here previously. (Recently, I instituted the option of employees having their birthday off as a paid day after a year of service, which was extremely well-received.)



The other culture which is important to any practice is the one you are treating. What is the general median income of the community you work in? Are your patients affluent or lower to middle class? The expectation of your customers is important. It influences the look and demeanor of your practice, and knowing something simple, like the eating habits of patients, gives physicians deeper insight on how to treat them.



Again, a mission statement is extremely useful to staying on track. It should encompass the needs of your patient culture as well as the internal one in your office. It gives your practice a spine to support major decisions, and keeps everyone on the same page.



As always, I'm curious to know what you think. Do you have a mission statement? Does it help in running your practice?

Improving Patient Relations




As with any service, we want our medical office to be the best, since that's how you create brand loyalty. While medicine may seem quite different from, say, a hardware store, the fact is both are quite similar from a business standpoint. People come in seeking individual attention and expertise, and often are intimidated by the surroundings. In either case, an inviting atmosphere is more likely to entice and keep people in the fold, and it truly pays to think of ways to make the patient/customer feel important.




One of the things we started to do this past year was stop with the flimsy, paper gowns provided to patients. After listening to a sales presentation from a local healthcare linen and laundry chain, we decided to try their service. Patients immediately responded by saying they found the new garments less drafty and embarrassing, and when you factored in waste disposal, we really weren't paying that much more for the new service. Even the doctors had to admit it made us seem more like a class act.




Another easy area to improve things is the waiting room. Discard older magazines, and make sure the ones you have target the people who visit your practice. If you aren't sure what people might want to read, ask them occasionally. The Guinness Book of World Records is a great addition to any waiting room, as are coffee table books featuring art, photography, or even healthy recipes. For very little cost, you can provide a variety of materials for people to browse, relieving their anxiety as they wait for their appointment.




If you have a television in your waiting room, monitor what's playing on it. Again, it's important to keep in mind who your target audience is. If you have a lot of children in your practice, you might want to provide a small sample of current DVDs to play, whereas a more adult crowd would probably appreciate a cable news channel or even something on Turner Classic Movies.




Finally, the best way to keep patients happy is to schedule them properly, so their appointments start as close to the time promised as possible. I'll admit that is often easier said than done, and the chaos of an average workday can derail even the most punctual staff. However, I've found that when that happens, it never hurts to update the patients accordingly, so they don't feel neglected.




I think the best businesses identify with their clientele. This is especially true of medicine, which is often intimate and invasive by necessity, and works best when people are made to feel welcome and treated with respect.




As always, I'm open to suggestions. What do you do to make your practice a more welcoming place?

RE: From the Mailbag

I want to thank everyone for taking the time to help out with Jennifer's inquiry. Here are a few more responses that came in email form:

From Keith:

"I'm a practice administrator in the DC area. I find the national and Maryland chapters of the MGMA to be very helpful on a lot of the questions or concerns that I have. I would recommend contacting the Maryland chapter for a referral as a starter; the Executive Director Peter can be emailed directly from the website for the chapter and he is very responsive. National MGMA does have their own consultant team; I've never used them. Many years ago I worked with the Health Care Group in Pennsylvania and found them knowledgeable and helpful.I would have no problem being called by this physician if he/she wants to bounce something off of me. My contact number is: Keith Kelley, Calvert Internal Medicine Group 110 Hospital RD #310 Prince Frederick, MD 20678, 410-414-5311"



From Stephanie:

"MGMA (Medical Group Managers Association) has a strong presence in theDC area. She should contact them online or look them up and see howthey can help her. They have great contacts! Stephanie SmithManager, The Heart Care Center, A Service of Hattiesburg, ClinicPhone: 601-425-5544"



From Chuck:

"You can suggest that the new doctor in Wash DC contact MGMA to find a localconsultant. Terms can be worked out. ChuckCharles E. Everett, MPH, Health Care Strategy and Business Development, chas2020@pacbell.net"



From Joe:

"I'm located in the NW Phila suburbs.....the problem with going to the DC area is travel time. Anyone from Philly would have to be willing to eat about 8 hours for a job that really should won't net much long term revenue. A down and dirty analysis should cost this physician no more than $1,500-$2,500, which is probably all he can afford..I don't know any consultants in the DC area. Wish I did because I've had other inquires from docs in that area but no one to referr them to. Sorry."