by James T. Krupienski, CPA, MSA , published in February 2011 issue of Healthcare News

Every day, the story seems to stay the same. A couple of patients arrive late for their appointments, and then a few unscheduled visits appear on your schedule. As the physician, you stay late into the evening, but never really seem to get caught up, especially once the pile of messages and paperwork on your desk are factored in. To make matters even more difficult, Medicare and insurance carriers continue to cut reimbursement rates, and expenses continue to rise.

In order to keep your employees happy and productive, they receive an annual pay increase. The effect of this is that your own pay is sure to suffer.

One of the best ways to help combat these pressures is effective time management. The problem is that we typically get so caught up in our daily schedules that we don’t always take the time to evaluate our daily schedules and ways we can improve them. This is one area, however, where a little time and money up front can help reap significant financial benefits.

This article will look at some of the ways that a physician can more effectively manage his or her time.

Office Workflow

The first step that should be taken is to review the workflow of your office. What inefficiencies exist from the time a patient walks in the door to when they leave? Is there a bottleneck of patients crossing paths in the hallway, or does the physician have to search to locate supplies that are continuously moved from place to place? Each of these issues, along with many others, creates time inefficiencies, which, if corrected, can result in the physician seeing more patients throughout the course of a day.

To identify inefficiencies, try putting yourself in the shoes of one of your patients. Come in as a patient, and go through the entire process of being a patient within your practice. Take into consideration what your staff assists with and any redundancies that may occur. By looking at the flow from a different set of eyes, you may identify many areas where the flow of your office can be improved.

This is an area in which an outside consultant may be extremely helpful. Such an individual would be able to look at your workflow in an unbiased manner and compare what they see to models of successful practices. Additionally, this would make the best use of your time, by allowing you to continue seeing patients while this takes place.

As you review the workflow of your practice, consider also how communication flows. After seeing a patient, do you need to track down one of your nurses or assistants to explain to them the next steps in the care of the patient? Consider the use of technology in this process. A lighting or internal messaging system could let the nursing staff know that a patient is ready for discharge or that they need to have lab work scheduled, while allowing the physician to move right on to the next patient. Such a system may also allow the physician to be informed when something comes up that requires attention, without being interrupted during a patient visit.

Improving the efficiency of your practice workflow is also an area where your electronic health records (EHR) system may come in to play. Consider meeting with your EHR vendor to see what features or functions may exist in the system that you are not utilizing to their fullest potential. A review of this process may help eliminate unnecessary paperwork, or the need for documentation after an appointment that could have been documented during the patient visit.

Best Practices

The second step in improving the effectiveness of your time management is to review some of your own daily tasks. When you arrive for the day, after getting your cup of coffee, make sure that you have reviewed the schedule for the day before seeing any patients. This should include a review of the reason for the visits, as well as a review of the patient’s chart.

For those patients coming in for a follow-up visit, this will ensure that you have received all test results before the patient arrives, as opposed to scrambling to locate them with the patient in the room waiting to be seen. A review of the schedule will also help you to nail down the agenda for each patient visit, and stick to it. If the patient brings something up that was not scheduled, and it is non-life-threatening, consider requesting that they make another appointment so that you will be able to spend adequate time discussing the issue with them.

Additionally, be sure to build time into your schedule each day to catch up when you fall behind and to return e-mails and phone calls. Many physicians work late each day and follow up on these items after everyone else has gone home for the day. The problem with this is that a patient waiting for a return phone call may call back multiple times until they hear from the physician. Additionally, leaving a pile of paperwork for your staff for when they return the next morning will make them stressed out for the day before they have even placed the first patient in an exam room.

Managing Patients

The one way that all physicians can help to more effectively manage their own time is to better manage their patients. First, when scheduling, particularly with new patients, consider changing your policy so that all patients arrive 10 to 15 minutes prior to their visit with the physician. Explain to them in advance this policy so that paperwork can be completed and the nursing staff can check weight, blood pressure, and changes from the last visit before their scheduled time with the physician. Without this policy, the very first patient of the day sets the physician behind before the day even starts.

Second, call patients in advance of the appointment to remind them of their visit. In this call, be sure to confirm with them the office’s policy for no shows and late arrivals.

While many physicians are busy with their caseload for the day, it is easy to get behind in your daily schedule. In order to be the most effective and productive, however, take a step back and evaluate some of the areas discussed in this article. They are all areas where a little time and possibly money up front will lead to greater rewards at the end of the day.

James Krupienski, CPA is manager of the Health Care and Pension Audit divisions at Meyers Brothers Kalicka, P.C.; (413) 536-8510.