Increase Patient Satisfaction and Physician Productivity
1. OPERATIONAL SOLUTIONS
C
Increase Patient Satisfaction and Physician Productivity
Through Access and Continuity
By Rick E. Weymier, MBA, FACMPE and Mark Murray, MD, MPA
Introduction to operate under a system that is two factors will almost guarantee a
consistent with the requirements and solid patient base contributing to the
Much like the rest of the service
expectations of its customers. The viability of the business. It is a myth to
industry sector in the United States,
number one factor that contributes to assume that patients do not care about
health care is coming under increasing
high patient satisfaction is “access” to from whom they get their health care
pressure to be more consumer-
the provider of their choice at a time services. Clinical capabilities are often
focused. The demands and
and manner that is convenient for that assumed to be a given and fall far
requirements of the consumer continue
patient. Access also is the key driver in down the list of satisfiers when
to accelerate as the perception of the
retaining and attracting the practice’s compared to other interaction factors.
health care industry as being exempt
patient base, which ties directly into Patients place a high value on the
from a consumer-driven focus
the practice’s ability to capture development of a strong relationship
diminishes. Consumers are beginning
sufficient revenues to ensure financial with their provider of choice.
to view health care services like any
viability. Access not only encompasses Continuity is critical to both the
other type of service industry. They
the traditional face-to-face visit, but patient and the practice, and is
want what they want, when they want
also includes access to information, becoming a quantifiable indicator of
it, and they expect to collaborate and
results, medical records, medications, quality.
sometimes direct their provider in
educational material and non- The traditional physician practice
determining the level of service and
physician staff in a hassle-free manner. sets the “rules of engagement” in
satisfaction at a price that they deem
Improving access in of itself is not terms of hours of operation,
offers substantial value. This is
enough to ensure success. Access scheduling parameters,
congruent with the health insurance
needs to be coupled with “continuity.” communication channels and service
industry moving from a restrictive
Optimal continuity is the ability of a delivery options. “Rules of
delivery system to one that allows for
practice to create a process that allows engagement” is a military term, and if
greater flexibility and choice.
the patient to see the provider of you were to poll the typical patient,
For a physician practice to
choice nearly 100 percent of the time. they would indeed describe their quest
succeed in this environment, it needs
A practice’s ability to focus on these for health care services as a battle.
PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA 41
2. Operational Solutions
Those practices that adopt a patient- practice is encouraging that patient to Pushing patients into the future
centered approach will be the practices seek services elsewhere and sending a creates “bad backlog” or inventory
that earn a competitive market message to the community that it that is suspect. The cost of carrying
advantage and offer themselves the cannot accommodate incremental inventory is expensive for the practice.
best opportunity for long-term patient demand. Having adequate Patients do not show up for their
operational and financial success. access and capacity to meet patient appointments, they get better,
demand is directly proportional to a significant resources are spent on
Access practice’s ability to generate sufficient reminder systems or they go
All physician practices that aspire revenue for financial viability. someplace else. And worst of all, the
to be operationally and financially practice does not have the opportunity
successful should focus on improving Cancellations and to sell that appointment slot to anyone
their access as an initial step. No-Shows else given the fact that the practice
Improving access impacts a practice in Too many practices accept usually does not become aware of a
the following ways: “cancellations and no-shows” as a cancellation or no-show until after the
normal part of doing business, without patient was supposed to have arrived.
Growth truly understanding what drives this When the practice is designed to
situation. Cancellations and no-shows do “today’s work today,” backlog is at
In any type of business, the best an acceptable level and access to care
way to grow is to be able to offer are a direct result of the lack of access
in the short-term to meet the needs of is available, the incidences of
customers the chance to purchase cancellations and no-shows virtually
services during a period when that the patient as determined by the
patient. Practices tend to push patients disappear. Eliminating the need to
customer perceives that he or she manage the cancellation and no-show
needs the services. This is especially out into the future based on practice-
driven criteria. This sends a negative situation has a favorable impact on
critical for the patient that is new to staffing costs, staff satisfaction and
the community or is seeking a new message to the patient. Patients expect
to be able to participate in the patient satisfaction.
provider. Having the ability to offer
services through improved access is determination of their care and have
their perception of their health status Demand is Predictable
essential to patient growth. By not
having time available to provide health respected and taken into consideration A common concern expressed by
care services to the new patient, the when seeking care. physician practices that are introduced
to the concept of “advanced access” is
the fear of insatiable demand. This is a
FIGURE II.C.1 PANEL SIZE misconception that is hard to
overcome. However, many other
3,500 service industries have tools and
3,065 methods for determining demand and
2,947 building the appropriate capacity to
3,000
meet that demand. These tools and
2,426 methods are equally applicable to the
2,500
2,186 health care industry. Historical
2,162
patterns, market conditions, payor
2,000 1,949
mix, patient diversity, physician
practice style and available services all
1,500 factor into determining demand.
When determining demand, it is
critical to remember that the demand
1,000
is already there. Providers are seeing a
certain number of patients per day,
500 which is not likely to change to a great
extent when moving to advanced
0 access. What will change is the
Group 1 Group 2 Group 3 manner in which providers treat their
own patients and the simplification of
Yr1 Yr2
the entry point for the patients. In most
instances, the provider will see the
42 PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA
4. Operational Solutions
easier and less expensive to invest in Recent data has shown that physician further placing unnecessary
retaining patients than it is to attract patients who see a provider on a demands on the system.
new patients. In fact, traditional regular basis have greater than a 90 In some cases it is difficult to
methods of marketing are debatable in percent chance of getting appropriate identify coding problems, as
their effectiveness to grow a physician near-term care and long-term documentation and coding often are
practice. The best method appears to preventive care. In instances where supportive of each other. Where the
be “word of mouth,” and the best there is a lack of continuity between deficiency occurs is that unmanaged
“word of mouth” are current patients the patient and the provider, the frequency of visits and a focus on
who are highly satisfied with their potential for receiving all of the taking care of just the “urgent
provider. Patients who are seeking to appropriate health care needs may problem” results in a low level of
find a physician ask for drop as low as 50 percent. coding. By taking a few extra minutes
recommendations from their friends with a patient, especially a physician’s
and colleagues. It does not cost the Coding Issues own patient, additional necessary
practice anything extra to develop a Continuity enhances the review will result in more efficient use
highly satisfied patient base. effectiveness of appropriate coding of time and increased coding that is
and documentation. When another justifiable.
Quality physician in a practice is required to
From both a payor’s and patient’s see an unfamiliar patient from within Professional Balance
perspective, quality is an expectation. the same practice and the same The typical physician office
However, quality is difficult to specialty, the patient is a “new patient” operates under the perception that it is
quantify in the traditional physician to that physician. However, because of totally booked up, and that there is
practice. If one were to define quality coding guidelines, the physician must little opportunity to meet the demand
as an assurance that the patient is code the visit as an “established of its patients in a more productive
getting all health care services that are patient.” This discourages the way. Physicians will insist that they
required to maintain good health and physician from doing anything but the are seeing as many patients as they
ensure that future eventualities are very basics of meeting just the urgent can, and all patients that truly need
recognized in a timely manner, then condition. On top of that, in most care are taken care of. There is an
continuity may be the single most cases, patients will attempt to secure appearance of organization through
critical factor in assuring quality. follow-up visits with their own scheduling parameters, triage
functions and urgent care processes.
However, when you question
FIGURE II.C.3 AVERAGE RVUs / MONTH physicians about their sense of
fulfillment from a personal and
700 professional perspective, they will tell
you that “it is not fun” anymore or
580
something just does not “feel right.” In
600
535 spite of this situation, the practice
feels that they are doing the best that
500 493
they can, and there are no other
436 effective options to make it better.
400 379 Operating under its current “busy”
355 format does not seem to yield
acceptable operational and financial
300
results. The vast majority of physician
practices are just getting by. According
200 to MGMA data on revenues and
compensation, physician incomes
100 continue to go up, but physicians have
to generate proportionally more
revenue to achieve a modest increase
0
Group 1 Group 2 Group 3 in income. The physicians and
individuals in the practice are working
Yr 1 Yr 2 harder for a lesser return from their
efforts.
44 PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA
5. Operational Solutions
In other words, this continued Nurse Triage triage function, as well as its
increase in “busyness” is not yielding This function appears to be the disruptive impact on patient flow in its
the requisite reward. If practices are result of managed care’s impact on the present format. Practices that have
operating at a perceived capacity, yet operations of a physician practice. moved to advanced access have almost
they are operationally and financially Over time, practices have developed totally eliminated the nurse triage
marginal, the key is to use what you the mentality that only those that are function as a barrier and reallocated
have in a more effective manner. By sick enough, from the perspective of these resources to providing additional
creating a system that encourages the practice and/or managed care direct patient care.
continuity, simplification of the access company, deserve to receive medical Another bane of the triage
process and matching of capacity to services. Because of this, practices function is the assumption that a
real time demand, throughput is have created a whole set of rules and person, who is not sick enough to be
maintained, but the cost of providing procedures to discourage the use of seen, is a person that is wasting the
services decreases significantly. medical services unless it is absolutely time of the physician. In reality, by
In most practices that have necessary. turning that patient away, for
adopted the concept of advanced This process has also created a something that the patient perceives as
access, the results have shown that the high degree of patient dissatisfaction, a real problem, encourages that patient
same amount of patients can be seen, as well as patient astuteness in gaming to seek help from another source.
total RVUs increase and the physicians the system. In reality, when a practice What the practice is telling its
do not feel that they are as busy as quantifies the impact of the triage customers is that the business only
they once were. When a practice function, the practice typically wants to sell its services on its own
quantifies the amount of time that it determines that well over 90 percent terms and that the customer has little
spends on squeezing patients into the of the people who go through the to say in the matter.
schedule, triaging patient concerns, triage process end up getting an Health care may be one of the last
attempting to return patient telephone appointment anyway. If this is true, remaining service industries that has
calls and reminding patients of their one needs to question the value of the failed to wholeheartedly adopt the
appointment times, the practice will concept of consumerism. Patients have
find that a significant amount of time
is non-productive. This is time that FIGURE II.C.4 AVERAGE NET INCOME / MONTH
consumes resources with no
measurable return to the practice in $18,000
both financial and patient satisfaction
terms. $16,054
$16,000
$14,654
Comprehensiveness
of Visit $14,000
Familiarity and continuity allow
the provider to meet a variety of $12,000 $11,581
current and ongoing conditions with $10,265 $10,800
very little additional investment in $10,000
time and staff. This makes the visit $8,881
very efficient and allows a justifiable
higher level of coding. In fact, $8,000
practices that have moved to advanced
access have seen the total number of $6,000
visits drop while RVUs for the period
have increased. According to MGMA, $4,000
one of the key characteristics of better
performing groups is the amount of
throughput per square foot that a $2,000
practice is able to generate. Doing
more with each visit results in a better $0
Group 1 Group 2 Group 3
return on the practice’s assets.
Yr 1 Yr 2
PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA 45
6. Operational Solutions
greater access to data and are information, patients will demand to Conclusion
demanding more choice in have a greater participation in making
Access and continuity have a
determining his/her receipt of health determinations about their health care.
direct impact on the productivity of
care services. Instead of focusing on In order for a collaborative
the physician and the practice’s ability
just seeing sick patients, the practice environment to exist, the patient and
to enhance patient satisfaction. Access
should take the time to invest in its the provider must develop an ongoing
and continuity are the essential links
customer base. In every instance that a and continuous relationship. Although
between the product (physician
patient wishes to buy health care the physician must maintain the
services) and the customer (patient).
services, for whatever the reason, the ultimate responsibility for providing
Without excellence in each of these
practice should accommodate that appropriate care, failure to allow the
areas, the financial viability of the
patient’s request. patient to participate in the decision-
practice is at risk.
making process will decrease patient
Collaboration retention and growth. Patients will
As technology increases and gravitate to those practices that
patients have greater access to medical encourage patient to physician
collaboration.
The Medical Group Management Association (MGMA) has set the industry standard for over 50 years in reporting medical
practice cost and compensation benchmarking data. Likewise, the Performance and Practices of Successful Medical Groups
Report focuses on medical groups that exhibit exceptional performance in the areas of Productivity, Capacity and Staffing,
Profitability and Cost Management, Managed Care, and Accounts Receivable. Key indicators are provided through
benchmarking statistics, as well as, articles and “real-life accounts” that tell how the best performing practices actually
achieved success. In just four years, the “gold book” has become one of the most popular and revered resources for medical
practices across the country.
To purchase the Performance and Practices of Successful Medical Groups: 2001 Report Based on 2000 Data or any other MGMA
resources, go online at www.mgma.com or call toll free 877.ASK.MGMA (275-6462).
46 PERFORMANCE AND PRACTICES OF SUCCESSFUL MEDICAL GROUPS: 2001 REPORT BASED ON 2000 DATA
