Sleep is vital to our health and well being.  Over 100 million people of all ages in the US regularly fail to get a good night’s sleep.  Many of these are your patients. Sleep deprivation is serious because it results in decreased daily performance, dramatically increased safety risks and dangers, and personal and business relationships suffering due to mood disturbances and exacerbated health complications.

Over 80 different sleep disorders have been identified via clinical studies.  Sleep disorders impact cardiovascular health, diabetic maintenance, pregnancy outcomes, child development, surgical success, and other life altering and threatening matters.

The first priority is you. As a health professional, are you managing your own sleep needs so you are benefitting from healthy sleep? How are your family members doing?

For your patients, do you include a sleep screening during your patient H&P exam? A significant amount of your patients have sleep health problems that need attention.  If evaluated and treated, the results combine to make your family, OBGYN, cardiology and most other specialty treatment outcome even more probable and successful.

A number of doctors and physician extenders have inserted the STOP sleep screen into their health intake form or verbal evaluation.  These fours questions quickly bring patient sleep issues to your attention.

• Snoring –         Do you snore loudly?
• Tired –              Do you often feel tired, fatigued or sleep during the daytime?
• Observed –     Has anyone observed you stop breathing during your sleep?
• Pressure (BP) – Do you have or are you being treated for high blood pressure?

The most common sleep issues are snoring, sleep apnea, restless legs, insomnia and simply poor sleep hygiene knowledge.  When treated, many patients have noticeable improvement in their daily performance, safety, and relationships which also often contribute to solving their presenting problem.

The STOP questions, when used with four more questions now called the STOP-BANG  questions, will dramatically improve your quick sleep diagnostics evaluation.

• BMI –                 BMI more than 30?
• Age –                  Age over 50 yr old?
• Neck -                Neck circumference greater than 15” (women) 17” (men)?
• Gender -            Male?

With convenient home sleep studies, proactive computer program sleep awareness education, cognitive behavioral therapy, CPAP and sleep oral appliance, and other sleep health services now available, your practice can orchestrate patient sleep service help that at times dramatically turns patient lives around.  These sleep services, in cooperation with a sleep professional either provided internally through your practice or in referral collaboration with sleep professionals at their sleep center, can ethically and legally add a new revenue stream for your practice.

Make it a professional goal to learn more about how to integrate a patient sleep screening and treatment service into your clinic or practice.  For example, a snoring service is an excellent starting point since it is estimated by theAmericanAcademyof Otolaryngology – Head and Neck Surgery that 25% of theU.S.population are habitual snorers.

Based on my many years of consultative practice experiences, I can assure you that treated sleep patients are so grateful they frequently will spontaneously hug you for their positive life changes, even their marriages you saved.

Oh, by the way, you will also be pleased with the enhanced financial improvements it brings your practice’s bottom line.  

For further helpful information contact:

Duane M. Johnson, PhD

Sleep Center Management Institute

www.sleepcmi.com

djohnson@sleepcmi.com

1-888-556-2203

Duane Johnson, PhD is the Senior Partner and co-founder of Sleep Center Management Institute and a contributing author to Efficiency in Practice.  For more articles like this and our free report, Patient Collections – It’s Make or Break for Many Practices, visit www.efficiencyinpractice.com

This article can be reprinted freely online, as long as the entire article and this resource box are included.

If you are familiar with the psychologist Abraham Maslow, and his famous “hierarchy of needs”, then you will know he clearly was not born in the age of the internet.  According to Maslow, “needs” are listed in order of importance beginning with essentials like: food, water, safety, security, love, prestige and ending with the elusive self-actualization.  However, in today’s modern age it seems the list should go like this: INTERNET, CELL PHONE, food, water, safety, security, love, prestige and self-actualization.

This of course is a little bit of jest but have you considered what your practice would do if you lost your technology?  Do you have a plan for just a day or two of downtime?  What about a long term plan?  Does your practice have any Contingency Plan at all?

In performing over 200 HIPAA audits, I have noticed an alarming trend; most practices do not have a Contingency Plan in place at all!   Did you know that this is a required standard of the HIPAA security rule as stated in citation 164.308(a)(7)(i), and failure to do so could result in fines, or worse, the total loss of your practice in the event of a disaster?

In this article, we are going to focus on the minor disaster.  Minor disasters happen much more frequently – for example, the loss of access to technology.  What would you do?

The first thing you need to do is isolate the problem.  What caused the outage?  Is it the internet service provider?  Obviously this will bring down any web based EMR.  Is it the server that houses your EMR onsite?  Do you have a contact list of entities to call – IT vendor, EMR vendor, internet service provider, etc? 

Tip: When calling IT provider or EMR support be sure to mention you are “completely down” as this usually will expedite the process.  Remember the adage “the squeaky wheel always gets greased first.”

You should have a plan in place that allows you to function and continue to see patients when no technology is available.  On the clinical side you can revert to paper for charge capturing, patient visit recording, prescriptions, etc.  Do you have these items handy? (i.e. super-bills, prescription pads, etc.)?   

What about patient histories?  The move to an “all electronic” world means these charts may not even exist at your practice anymore.   In some cases, it is possible to access the server (assuming it is onsite) using a very powerful UPS (uninterrupted power supply) which can power the server and a printer.  This would give you the ability to print from within your practice management system in a pinch.  Tip:  An entry level UPS should last about 30 minutes. However, the time can vary, depending on the load of the server.     

One other suggestion would be to keep a copy of the EMR and patient database on a local laptop.  This would allow you to access patient records on a machine with a long battery life. Even in a complete power outage, you could gain emergency access to patient data.

What if your internet is down for a few days and your EMR is housed on the web?  

One thing to consider would be to use an “air card.” Most cell phone vendors offer these at reasonable prices.  In some cases, a cell phone with internet access can even be used as an “ad-hoc” modem plugged into PC to get you online.  Also in some cases, the cell phone itself can be used to access the internet and therefore the EMR. 

Another thing to consider is getting a backup internet line.  Example: if you currently use a T1 to access the internet, purchase a cheap DSL or cable line as a backup.

The bottom line is you need to have a contingency plan in place for minor events as well as major catastrophes.  Not only is it a requirement per the HIPAA Security Rule but it is also a wise business decision.

How do you develop a Contingency Plan for your practice?  To start,download this BCP Template – pdf to create your plan.  For more information, please contact:  brian.tuttle@ingaugehsi.com

It is often forgotten how important a referring physician really is to a practice. Referring physicians keep specialists in business. It is not just private practice physicians that need to focus on building and maintaining these relationships, physicians employed by hospitals also need to focus on this issue.

You often hear physicians say “I don’t need to worry about referring physicians” or “I have been getting patients from these physicians for X number of years”. The physicians forget that things happen and referrers may change their referral patterns. Some situations that could change or influence a physician’s referral pattern are:

•The referring physician may become employed by a hospital or merge with another group; when this happens the referring physician may be forced to change where they send their patients.
•The referring physician or his staff may have issues/concerns with the specialist’s staff. (i.e. – problems getting the front desk to answer the phone or relay messages, a rude staff, or a staff that will not accommodate new patients).
•A new physician came to the area and is building relationships/networking/using new techniques.
•A history of poor communication with the referring physician about patients care.

Specialists need to be thinking – How do I keep these physicians happy and keep the business coming? In doing so they should focus on:

•Making sure the referring physician has a seamless way to interact with the physician office.

•Always communicating what is going on with their patient to the referring physician or their office. It could be a phone call, letter, email, etc. AND, make sure to thank the physician for the referral.

•If the specialist is using a new technique or service, it needs to be marketed directly to the referring physicians:

*Put the information on your website, blog, Facebook page.

*Hold a reception for the local physicians to keep them informed. It could be a simple as a wine and cheese event.

*Send out a mass mailing/email. If you are reaching out to new referring physicians in this letter, make sure to introduce the services that separate you from the competition.

*Notify the PR department in hospitals where you work.

•Have a secret shopper call your staff and make sure that they are handling a referring physician in the appropriate manner.

It just takes a few extra steps to keep a referring physician happy and sending patients. It is well worth the effort.

Have you ever wondered if you could bill for an evaluation and management (E&M) service or a diagnostic test without actually providing an “in person” visit with the patient?

For example, a patient in pre-term labor is seen in the Emergency Room (ER).  The ER physician contacts you and you ask them to place the patient in observation on your service.  You receive a telephone call from labor and delivery (LD) later that day or night to inform you of the status of the patient.  You request a fetal non-stress be performed and other specific test(s) and when complete the results are telephoned back to you at your home or office.  A few hours later you discharge the patient to home and request she follow-up with you in the office tomorrow.

Now, you’ve provided a “medical service” and received information on “diagnostic tests” but in this example the E&M services was not provided in conjunction with an “in person” face-to-face encounter with the patient and you didn’t have “direct visualization” of the NST – so in fact, neither service is billable.

According to CMS IOM 100-02 chapter 15:

A service may be considered to be a physician’s service where the physician either examines the patient in person or is able to visualize some aspect of the patient’s condition without the interposition of a third person’s judgment. Direct visualization would be possible by means of x-rays, electrocardiogram and electroencephalogram tapes, tissue samples, etc.

For example, the interpretation by a physician of an actual electrocardiogram or electroencephalogram reading that has been transmitted via telephone (i.e., electronically rather than by means of a verbal description) is a covered service.

To have a billable E&M service you would have to go to the hospital and see the patient “in person.” To bill for the NST or any other imaging test, they would have to be provided to you in an electronic format, prior to interpretation, and not by means of a verbal description. 

Remember, with very few exceptions (care plan oversight, home health certification and recertifications, certain telemedicine services, etc), if you don’t provide an “in person” service or a “direct visualization” of a diagnostic test you are not permitted to bill for your professional services.

Steve Adams is a Certified Professional Coder and Senior Consultant with InGauge Healthcare Solutions.  To read more articles like this and to register for practice management tele-classes, visit www.efficiencyinpractice.com

This article can be reprinted freely online, as long as the entire article and this resource box are included.

Medical bills aren’t always like other bills, many times they are not planned for and the bill is an unexpected surprise that some people cannot afford. If a patient doesn’t have insurance, this can be a real problem, especially in this economy where as more and more people lose their jobs they also lose their medical insurance.

As a doctor billing patients when they cannot pay in full at the time of service, you must have policies and procedures in place for your office staff to follow in order to successfully get paid for your services. You should look at it as part of your job to help your patients be able to pay your office. 

With that in mind here are my top five tips for helping your patients pay off a balance due.

1. Be realistic when talking with patients about payments. If you aren’t realistic, you won’t get paid. Ask them about their income and monthly bills and set a monthly payment they can realistically make, otherwise they won’t make any payment.
2. Get payments twice a month rather than once a month.  Even if the installment payment is less, if someone is paying twice a month it could be more than one monthly payment, resulting in the bill getting paid quicker.
3. Put it in writing. Whatever you decide with your patient in regards to their bill, put it in writing and send them a copy.
4. Follow up. Any collection efforts you put in go down the drain if you don’t follow up.
5. Offer your patients a couple of solutions. Many people are embarrassed to have a past due balance with you, and want to pay it off as quickly as possible. Offer them a couple of options so they can be part of the decision making process on how they will pay you.

Michelle Dunn, author of The Guide to Getting Paid, is an expert on the topics of credit and collections.  For more information on Michelle, visit www.credit-and-collections.com.  To read more articles like this, visit www.efficiencyinpractice.com and sign up for a complimentary subscription to our Efficiency in Practice enewsletter.

This article can be reprinted freely online, as long as the entire article and this resource box are included.

One of the biggest mistakes a medical practice can make when they receive a request for medical records from a payer, such as Medicare or Medicaid, is to quickly copy some records and throw them into an envelope. Most audits start with the payer, or their audit contractor, providing a list of names and dates of service for which they are requesting copies of medical records.

Here are a Baker’s Dozen worth of tips for those type audits:
1. Before submitting records to the payer or their audit contractor, make sure records are legible and that there are records for each date of service. Further, make sure the documents are well-organized so that auditors can easily find the pertinent records.

2. Designate one person to be responsible for responding to the audit and follow-up.
3. Allow plenty of time to respond. Pay close attention to the deadline for responding in the audit notice. Sometimes you may be granted an extension. Request an extension early, and request it in writing.
4. Read the audit request letter carefully. It usually lists the types of information the auditor expects. Don’t worry if the generic list you’re provided includes information that is not applicable to your patient or the services provided. Just make sure you send a copy of documentation in your records that supports each service billed.
5. Send only copies of the record, not the original, and number the pages.
6. Make at least one copy of the records you submit, exactly as submitted. It is more difficult to appeal an audit when you and your advisors are not sure what was sent to the auditors and used to render their initial decision.
7. Make sure to submit documentation for each date of service requested, but do not fabricate documentation if you do not have it.
8. If your office note for an Evaluation and Management (E/M) code refers to a prior history, you should include documentation related to those aspects. This is especially important for new patient visits where all three elements, History, Exam and Complexity of Medical Decision Making, will be reviewed.
9. If lab tests, x-rays or other diagnostic tests were ordered and billed by your medical practice for the date of service, make sure the report is in the record submission even if the report was not available for several days, after the encounter. Even if the tests were performed or billed by another physician or entity, include them because they may help justify higher levels of E & M services.
10. If you performed a consult, even if it is a payer such as Medicare that no longer recognizes consult codes, include a copy of the report to the referring physician. Again, that helps indicate the extent of work performed on the date of service.
11. If your handwriting is not legible, it may be best to have the records transcribed. Some auditors may deny a service if the records are not easy to read. At other times, auditors may miss important aspects and down code or deny the service. If you transcribe old records, make sure it is clear that the transcription is recent, with the current date prominently displayed. When you submit the record, place the handwritten copy behind the transcription. Usually, you should include a comment about the recently transcribed records in the cover letter you send with the audit submission.
12. Write a cover letter outlining the contents of the package. Provide the name of a contact person at your medical practice along with phone and email address in case the auditor needs additional information.
13. Use FedEx, UPS or mail with return receipt requested so that you have a record of delivery. Some payers allow electronic transfer of records.
Finally, the steps you take to comply with the request will make a difference in how the audit proceeds and how much time and effort it takes to appeal any adverse findings.

Hoyt Torras, MPA, MHA is a Senior Consultant Senior with InGauge Healthcare Solutions and a contributing author to Efficiency in Practice. For more information on Efficiency in Practice and to register for Hoyt’s tele-class, “Practical and Achievable Approaches to Compliance – Tips for Preventing Coding/Billing Audits, and What to Do If You Get Audited” click Here. First time attendees register at no charge.
This article can be reprinted freely online, as long as the entire article and this resource box are included.

Traditional Faxing and HIPAA
We are often asked questions by physicians and practice managers regarding faxing and HIPAA compliance. One would assume following the logic that email containing PHI cannot be sent unsecure that FAXing is also a no-no. That’s not entirely true.
HIPAA states in the “Safeguards Principle”: Individually identifiable health information should be protected with reasonable administrative, technical, and physical safeguards to ensure its confidentiality, integrity, and availability and to prevent unauthorized or inappropriate access, use or disclosure.
As you can see from the above, HIPAA lays out rules and guidelines but doesn’t offer any solutions to get this implemented (especially in the case of FAXing). With email it’s quite simple to meet the above by using end to end encryption. However FAXing isn’t quite so “cut and dry”
What sensible steps can you take for HIPAA compliant FAXing?
1. Use a cover letter. This will help to avoid any casual or accidental reading of PHI.
2. Send only the necessary PHI, no more.
3. Use saved speed dial numbers for entities that your practice faxes often. This will help prevent dialing wrong numbers.
4. Verify any new fax numbers with a test fax.
5. Document in your “Policies and Procedures Manual” what to do if PHI is accidentally faxed to the wrong location.
6. Make sure your fax machine DOES NOT save copies of received faxes. This is a simple configuration on the machine.
7. Never leave PHI sitting on fax machine once received or sent.
8. Do not fax if there are other “more secure” ways to deliver PHI (i.e. encrypted email, by hand, etc.)

Look who’s searching…

In today’s medicine, the web and social media are important and beneficial tools that should not be ignored.    According to an article from amednews Feb. 21, 2011, “New vital sign:  degree of patient’s online access” by Pamela Lewis Dolan, searching for health information is the third most common online activity behind checking e-mail and using a search engine, with women more likely than men doing healthcare research.   

A Harris survey conducted in January 2011 on behalf of Insider Pages, an online directory that has a “physician finder”; found that most people look for physicians based solely on their location.  Patients starting with a physician finder normally do a query on physicians in a particular geographic area, and once that is generated, the patients will click on the profiles of the physicians they are interested in.   This is then normally followed by the searching the profile page and then the physician’s personal web page if they wanted more information.  The survey also noted that even though not all adults go online, the percentage of online health information seekers is at 59% of the totalU.S.population.

Designed for Success…

In considering web design/medical website development, you should carefully consider what type of audience you want to attract.  You may want to attract a certain type of patient, specific to your specialty, which will dictate how your design and website should be promoted.  A plastic surgeon would certainly want to promote beautiful photos of before and after surgical procedure pictures, whereas a pediatrician may want to promote an “ask-a-nurse” component or brightly colored home page.  Another consideration is the actual design.   If you aren’t sure what type of design you would like to promote the practice, do some research and find other practices online in your same specialty. 

“Googling” the simple phrase “Family Practice” for instance, will provide hundreds of practices with an online presence.  Review them, making helpful notes to assist you in design.   What was the first thing that caught your eye on their site?  Did it seem professional?  Were there any “special” effects such as flash animation, special links or other features you would like to incorporate in your website?   Did the website allow patient interaction with the providers?  How were the physicians highlighted in the website?   Is it easy for the patients to navigate?  Did they have a pleasing home page, highlighting the practice with easy to read information?    Keeping a list of website links that contained special designs, features or undesirable attributes will help down the road when designing your home page or speaking to the web designers if you decide to use a professional service. 

In respect to website content, this is obviously going to be specific to your practice and specialty.  Some items to keep in mind globally would be using your practice name, address, phone number and any other means of contacting the office on each page.  If you can, include a map for patients to find your location and a link to such as “Mapquest” or “Googlemaps” that will allow the patient to print out directions to your practice. 

Keeping the content fresh and updated is also a good idea for visitors to return.  Information about sunburns isn’t really relative in theMidwestduring a February snowstorm.  If you are using a professional web design company, they will question you for interest in SEO or “search engine optimization” which is normally an additional fee to site design.  By using the design company, they will “promote” your website by SEO optimization, which is done by paying special attention to descriptions and keywords making sure that your scores rate higher in ranking in search results.

There are many free analysis tools to track your site’s SEO performance, such as Yahoo! Site Explorer, Google Webmaster Tools, Google Analytics, SEO Book and SEO Chat that will give you a wide range of options to follow your SEO campaigns.  

Legally Speaking…

Using a website for your practice is treated as advertising under the law, so any legal and ethical rules of advertising for physicians should be applied.  One should also take into consideration any patient-physician-practice contact and the legal ramifications under HIPAA (Health Insurance and Portability and Accountability Act) and ARRA (American Recovery and Reinvestment Act) standards. 

The AMA has guidelines available to help you develop your web presence and social media rules for the practice as well.   Your malpractice carrier should be aware that you are developing a practice website for risk management purposes.   Some malpractice carriers will have specific suggestions/guidelines for their clients to use with legal resources and documents.  A good resource for HIPAA, ARRA and social networking/media updates can be found at the AMAPracticeManagementCenterat www.ama-assn.org/go/pmc.  

In considering truth-of-advertising, if you list or mention your staff on websites, make sure that the written content matches their titles and credentials.  For example, if your office only employs medical assistants in the practice, you wouldn’t want to have a statement or content stating that “our nurses” or “the nurses” provide XYZ services to the patients.  This would be misleading to patients on the website and possibly make them believe they are speaking to a “nurse” in your practice when they are really speaking to a medical assistant.  Patients deserve to know who is providing their care.  The AMA also clarifies in H-405.968 code ethics “Clarification of the Term “Provider” in Advertising, Contracts and Other Communications”.

As mentioned previously, a website in a physicians’ practice is considered advertising under the law, so you would treat it no differently than an advertisement in the newspaper or telephone book, with the exception that the physician must also be aware of truth-in-advertising and testimonials. 

Many attorneys will advise clients to stay away from testimonials and deal with straight facts and information about the office.  Your site may describe to patients why they should choose your practice, as long as they aren’t legally false, deceptive or misleading, as judged by the state medical board.  The AMA has a code of ethics that states “Generalized statements of satisfaction with a physician’s services may be made if they are representative of the experience of that physician’s patients”.

Additionally, while social networking (Facebook, Twitter, MySpace, etc.) continues to be an undeniable presence with 35% of American adults using them in the online community, they are viewed in the medical community as a “minefield” of legal and professional hazards for the medical professionals who “friend” patients to communicate. 

In Summary…

Healthcare providers and physicians see the potential in online interactions with patients for improving access and quality of care.   Healthcare searches compose the third highest volume of online activity.  Patients search initially for physicians demographically then by profiles if interested in further information. 

Website design is specific to your audience and specialty.  A professional appearance with easy to navigate pages and current relevant site content will keep the patients returning to your site.  Women are more likely to be viewing and researching your online presence.  Website SEO optimization increases the likelihood of your site to be “noticed” online and moved higher on the search engines with key words and descriptions based on your site content. 

There are valid concerns to consider in regards to patient privacy, liability, risk management and the compromised situations the practice can be exposed to.   Social networking sites carry an additional legal & ethical concern for the employer-physician and should not be ignored when considering online communication with patients. 

Healthcare and the internet “society” will certainly increase and is destined to be a continuum.  The healthcare community can continue to use these tools to improve the quality of health care and patient outcomes, as well as practice enhancement and patient satisfaction, but should seriously consider how best to use electronic media to everyone’s advantage, by protecting the patients’ rights as well as using best practice techniques and effective risk management.  

© 2012 Efficiency in Practice

Rebecca Umberger, CMA(AAMA), CPM  is currently Vice President of Development at Family Care Centers of Ohio, and over the past 9 years served as part-time Adjunct Instructor in the Health Division/Medical Assisting Department at Stark State College North Canton, Ohio.   She has worked various positions both as a CMA and Practice Manager in an outpatient setting for over 26 years.  During this time, she has focused in clinic operations management, practice design, planning and development, marketing, recruiting, process improvement and workflow efficiency, supervisory training and leadership development with a special interest in medical law/ethics.  She can be contacted at Rsumberger@famcareohio.com or you can check out her company’s website at www.famcareohio.com

Does your practice receive patient complaints about long waits during the visit? Do you have a physician who is constantly behind schedule? Prolonged waiting times affect your practice in several ways. Patients can become dissatisfied to the point of leaving your practice. Physicians and staff become frustrated with delays that can result in long hours and patient complaints.

There are a variety of reasons for prolonged waiting times. Patients who arrive late, staff who take too much time with patients, providers who try to do too many things at once, and poor communication within the office are just a few of the many possible causes. Are you not sure where the problem lies in your practice? It might be time to measure your office visit cycle time.

According to the Institute for Healthcare Improvement (IHI),  office visit cycle time “… is the amount of time in minutes that a patient spends at an office visit. The cycle begins at the time of arrival and ends when the patient leaves the office.” Measuring the office visit cycle time can help you identify where the bottlenecks exist in your practice.

When measuring cycle time, you can measure as few or as many steps in the patient visit process as you wish. The fewer steps you measure, the easier it is – but you get less information. The more steps you measure, the more helpful your information will be – but it will also be more resource-intensive. The steps you will want to consider are:

• Patient appointment time
• Time patient checks in at desk
• Time patient is taken to exam room by staff
• Time staff leaves the room
• Time provider enters the room
• Time provider leaves the room
• Time patient leaves the room
• Time patient checks out at desk

IHI recommends that you measure a total of 15 patients in order to get a good average cycle time. The patients should also be measured on the same day of the week and at the same time of the day. Depending on your specialty – or where you think your bottlenecks are – you might also want to include lab, x-ray, or certain procedures in your cycle time measurement.

Cycle time can be measured manually or, depending on the sophistication of your electronic health record (EHR), automatically. The manual method can be done by staff or by patients. A sample form can be found at IHI’s web site, www.ihi.org. Patient Cycle Tool If you prefer to try to automate it, many EHRs are able to time-stamp several important steps in the cycle: patient check-in, staff logging in and out of the record, providers logging in and out of the record, and the end of the visit (closing the encounter).

Once you’ve identified where the bottleneck exists, focus on that step in the cycle and use basic process improvement tools (process mapping, plan-do-study-act cycle) to make changes that will improve your cycle time.

When measuring cycle time for the first time in your practice, you should consider doing several (if not all) of your providers. This will not only enable you to get an overall average for your practice, but you can also identify best performers within your practice and use them as a model for the others. As for a standard benchmark, IHI suggests that you take the amount of time that a patient spends with the provider and multiply that by 1.5. For example, if a patient spends 20 minutes with the provider, the ideal cycle time would be 30 minutes (20 x 1.5 = 30).

Improving patient cycle time can help reduce waiting times in your practice. It can become a valuable aspect of your practice’s quality program. It not only makes the practice more efficient, it is also a great satisfier to patients, staff and providers.

© 2011 Efficiency in Practice

Tom Ludwig is President and CEO of Forward Healthcare Solutions, LLC, a consulting firm that specializes in working with physician practices. Tom has worked in the physician practice setting for a variety of organizations for 35 years. He has extensive experience in clinic operations management with expertise in strategic and business planning, process improvement and workflow efficiency, advanced access, supervisory training and leadership development. Tom can be reached at tludwig@forwardhealthcaresolutions.com or http://forwardhealthcaresolutions.com/index.html

And for more medical practice management resources and information, visit www.efficiencyinpractice.com
This article can be reprinted freely online, as long as the entire article and this resource box are included.

Healthcare practices often spend time looking at ways to improve patient satisfaction, but how often do they address communication as it relates to improved patient service? I would have to say, not often enough.

Every aspect of patient care involves communication. Whether it is in person, on the telephone or using technology, what you say is as important as how you say it. It is so easy for a patient to misinterpret what is being conveyed. For this reason, practices should look at their communication as a way of improving “the patient experience.”

When a patient is face to face with the front receptionist, does that receptionist look the patient in the eye? Does she address the patient by name and offer her the same respect and consideration that she herself would want? For that matter, every person in the office, from the clinical staff to billing person should treat patients with respect and dignity. Starting with the patient, there is a definite link between a patient’s understanding and patient satisfaction. In improving the relationship between the practice and the patient, it is important to:

• Include the pleasantries. Whether it’s greeting a person by name, offering them a seat or shaking hands, pleasantries and greetings are important.
• Create a rapport with the patient. This includes an understanding of the patient’s concerns, issues and needs.
• Understand the patient’s perspective and what he/she wants out of the visit to the office. This can include areas of scheduling, billing and education as well as the physician visits with the patient.
• Be empathetic and sympathetic to the patient’s concerns. They need to know that you care about them as a person. RESPECT and SUPPORT are essential.
• Do not appear rushed even if you are. Let the patient feel that they are important and you are giving them the time they need.
• Keep the conversation on track.
• Listen without interrupting. Look at the patient so they know you are listening. Hear what your patients are saying. If needed, repeat what they said; “if I understand you, you are saying….”
• Involve the patient in his/her care. Whether it’s educating the patient of his diagnosis, explaining a bill, or discussing insurance, the patient needs to be aware and understand what is happening. Build on the relationship and make the patient and family members PARTNERS in their care.
• Manage patient expectations. Try coaching your patients as to what reasonable expectations are.

Telephone encounters with the patient need to be equally respectful and considerate. Reaching a live person should be easy and telephone hold time should be kept to a minimum. Staff should try and establish why a patient is calling prior to transferring the call and should share the reason with the person they are transferring the call to. There is nothing more aggravating than having to explain the purpose of your call several times during the encounter.

Communication is more than just the spoken word. It is the little things that we do that remind the patient of their importance to the practice.

Some things a practice may want to consider doing are to:
• Send all patients a welcome letter
• Make special efforts to meet the patient’s needs
• Educate your staff on working with patients
• Listen
• Follow up
• Do the unexpected
• Exceed their expectations.

It is the body language we use to make a point and the gestures we make. It is going above and beyond the expectation of the patient to insure that the patient understands what he is being told and recognizes his value to the practice.

Every encounter we share with a patient, whether on the telephone, in person, on the internet or using advanced technology is a means of communicating. Practices should value all forms of communication and look for ways to improve them. Effective communication is customer service at its best.

© 2011 Efficiency in Practice

Donna Weinstock is a Senior Consultant at InHealth, and the President of Office Management Solution. She consults with healthcare practices to perform workflow analysis, improve processes, and increase profits as well as select and implement electronic health records. She can be reached at donna.weinstock@inhealthconsulting.com
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