August 15, 2002
Practice Management
John W. McDaniel
High-performance physicians use a number of different strategies to promote growth in their practices. One of their most effective strategies involves raising patient volume by increasing both patient satisfaction and physician productivity through improved patient access and continuity of patient care.
In fact, the number one factor that contributes to high patient satisfaction is giving the patient access to the provider of his or her choice at a time and in a manner that are convenient for the patient. Access is also the key factor in attracting patients to a practice in the first place and then retaining them after they have visited the practice at least one time. In this regard, access is directly linked to a practice’s ability to capture sufficient revenue to ensure its financial success. Access encompasses not only the traditional face-to-face visit between patient and practitioner, but also access to information, medical results and records, medications, and educational material.
Access and Continuity
A practice should link a patient’s access to care with continuity in how that
care is provided. The best continuity of care comes from a process that allows a
patient to see the provider of choice as much as possible. A practice that
focuses on improving both a patient’s access to, and continuity of, care is
almost guaranteed to garner a solid patient base that contributes to the
viability of the business.
For the average primary care practice, providing excellent patient care combined with a system for recalling patients on a periodic basis can help to ensure practice growth. Specialty physicians, on the other hand, must understand the importance of referrals from physicians to the viability and growth potential of their practice. Specialty physicians should continually analyze the nature of their referrals by tracking the number and type of referrals they are receiving and from which physicians. Developing relationships with potential referring physicians and cultivating the referral relationships they have already formed are key steps specialty physicians can take to help ensure practice growth.
Another strategic planning tool for practice growth involves conducting a patient origin analysis. By using this planning tool, a practice can determine where its most promising growth opportunities lie. This process involves determining both the number and type of patients categorized by primary Zip Code area in order to ascertain the demographic and socioeconomic mix of patients within the practice and to analyze areas for targeted growth.
To illustrate: Suppose an obstetrics and gynecology practice would like to target Zip Code areas where 18- to 35-year-old females who have annual household incomes in excess of $20,000 reside. By conducting a patient origin analysis, the practice would be able to determine whether it makes sense to locate its primary office in this geographic area or whether a satellite office would be sufficient to meet the needs of this targeted population.
Ancillary Growth
Given the continued decline of reimbursement for the average medical practice,
every effort must be made to improve the utilization of ancillary services
within the practice to provide additional sources of revenue as well as to
increase patient care and convenience.
One ancillary growth strategy involves preventive medical services. Depending on
the type of specialty, physicians can profile the types of patients whom various
providers see, making sure to pay particular attention to the types of
preventive medicine services that patients are receiving. In this way, a
practice can ensure that patients are seen on a basis defined under their health
care benefits program. This step not only promotes appropriate patient care but
also ensures that the practice receives continued revenue for providing
preventive health care services.
A focused growth strategy for any medical
practice should involve
e-business opportunities, particularly regarding information technology
solutions. While the average practice does not have such a strategy in place,
developing one is necessary to ensure the appropriate technological growth of
the practice and to avoid technological obsolescence. What’s more, technology
solutions help to increase the efficiency and productivity of physicians and
their staff.
Survey Data Needed
Very few medical practices survey their patients, physicians, and employees with
any regularity. The Medical Group Management Association, in its Performance and
Practices of Successful Medical Groups: 2000 Report Based on 1999 Data, reported
that 71% of high-performance practices conduct patient satisfaction surveys,
while only 57% of other practices survey their patients on satisfaction.
Interestingly, only 31% of high-performance physicians routinely engage in
employee satisfaction surveys, while 27% of other medical practices survey their
employees regularly.
A particularly telling statistic from the MGMA’s report shows that only 13% of high-performance practices survey referral physicians and only 9% conduct internal physician satisfaction surveys. Medical practices have a long way to go in order to mirror successful businesses with respect to monitoring constituency demand, which is an effort that could open up many practice growth, efficiency, and productivity opportunities.
One of the most important steps practices seeking to become high performers can take regarding their future growth capabilities involves the development and implementation of a strategic plan. This process is undertaken by virtually every successful business. An essential component of any strategic plan involves the SWOT analysis. In a SWOT analysis, a practice makes a critical review of its strengths, weaknesses, opportunities, and threats within its market to position itself for future growth.
Differentiating their practice from the
practices of their competitors is a strategic step many successful practices
take to position themselves for future growth. Often this strategy involves the
use of Web-enabled technology. High-performance medical practices use a number
of the following information systems to increase productivity and efficiency:
• Internet-based patient registration and appointment scheduling
• Electronic charge capture tools using hand-held touch devices
• Medical practice management systems for scheduling, billing, collections, and
electronic medical records
• Managed care transaction processing of online eligibility, referral and
benefits management, and claims submission
• Online coding tools
• Electronic inventory management and supply ordering (called e-procurement)
• Electronic prescription processing
• E-connectivity with hospitals, other physicians, laboratories, imaging
centers, and other ancillary providers
• Internet-based practice management benchmarking
• Online patient education
• Access to Web sites for regulatory and legislative information from federal
and state sources and to medical business information from professional and
online agencies.
As medical practices position themselves for future growth, it is also crucial that they implement a productivity improvement program, centered around patient scheduling and physician and provider work flow. Most high-performance practices have begun measuring physician productivity by using work relative value units. WRVUs reflect the intensiveness and resource utilization necessary to produce patient care based on the acuity of services offered.
Using various information technology solutions—such as computerized scheduling, electronic medical records, personal digital assistants, and voice recognition—can also lead to overall productivity improvement. In fact, one of the most beneficial uses of technology is the simple Dictaphone. By dictating progress notes while the patient is in the examination room, the physician not only saves time but also adds a personal touch. Since the patients can hear what the physician is saying about their care while they are being examined, this simple strategy can help reduce the number of questions patients ask at the end of visits.
In summary, high-performance physicians invest their money, time, and efforts in areas that offer the potential for the greatest return on their investment.