RE: RE: [Practiceimp WAS Re: efficiency and money

[Guest guest]

Are you

solo-solo? If so, I think you need a multi-tasking front desk person to

help. I just do not see how it can be cost efficient/productive to have

zero staff. I could not get by without my one staffer. I CAN get by

without an MA/LPN/RN but not without the one person answering calls, messages,

calling back on labs, etc.

RE: [Practiceimp WAS Re: efficiency and money

Lynn, I am finding that I

am providing free services to office visits at

a rate of almost 10 to 1. Is that what you mean by admin time? For

every visit a patient makes I have to respond to two specialist

contacts, one radiology report, two lab reports, two formulary and/or

" care management " issues, three phone calls from the patient, and one

pharmacy phone call (not a formulary issue).

" I am checking my Admin time: patient time ratio and it is HORRIFIC!

something

like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

I'm

going to break down my times even more to see where it's leaking out to.

I

really want to get to a sustainable work load over the next year, or I

will

be BERSERK! I'll keep you guys posted. Thanks again for all the

support

and it was lovely to see you all in the flesh.

Lynn "

In a " big office " where MAs do a lot of this stuff they don't

probably

realize how much time it eats up, but if you do it all yourself....I

have randomly reviewed charts in the past to look at this question. In

the past week and a half I have started leaving all charts open until

the end of the day... for every patient I actually see during a day

there are 9 - 10 more open at the end of the day, for who I have had to

do SOMETHING, but for whom I am paid nothing...What can we do about

this?

Annie

[Guest guest]

After I was seeing 10-12 peoplea day, I found that I could not add anymore appointment times without help because of all the misc extras. I hired an RN as my front office, lab tech office manager and now I can see an additional 4-7 people a day...easily paying for her salary and decreasing my phone time. I also discovered that I have a true adversion to listening to phone messages. She writes them down and, for some reason, that works great. No logical reason, but I've always said that if I am working, I'd rather do what I like so I can pay someone to do what I don't.

Are you solo-solo? If so, I think you need a multi-tasking front desk person to help. I just do not see how it can be cost efficient/productive to have zero staff. I could not get by without my one staffer. I CAN get by without an MA/LPN/RN but not without the one person answering calls, messages, calling back on labs, etc.

-----Original Message-----From:

[mailto: ]

On Behalf Of Annie SkaggsSent: Tuesday, October 10, 2006 9:20 PMTo:

Subject: RE: [Practiceimp WAS Re: efficiency and money

Lynn, I am finding that I am providing free services to office visits ata rate of almost 10 to 1. Is that what you mean by admin time? Forevery visit a patient makes I have to respond to two specialist

contacts, one radiology report, two lab reports, two formulary and/or " care management " issues, three phone calls from the patient, and onepharmacy phone call (not a formulary issue). " I am checking my Admin time: patient time ratio and it is HORRIFIC!

something like 40 hours of admin to 20 patient hours. I have got to FIX THIS!I'm going to break down my times even more to see where it's leaking out to.I really want to get to a sustainable work load over the next year, or I

will be BERSERK! I'll keep you guys posted. Thanks again for all thesupport and it was lovely to see you all in the flesh.Lynn " In a " big office " where MAs do a lot of this stuff they don't probably

realize how much time it eats up, but if you do it all yourself....Ihave randomly reviewed charts in the past to look at this question. Inthe past week and a half I have started leaving all charts open until

the end of the day... for every patient I actually see during a daythere are 9 - 10 more open at the end of the day, for who I have had todo SOMETHING, but for whom I am paid nothing...What can we do aboutthis?

Annie

-- Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Wow,

you saw 10-12/day with NO help? How? I’m busy seeing that many now with

one front desk staffer.

RE: [Practiceimp WAS Re: efficiency and money

Lynn, I am finding that I am providing free services

to office visits at

a rate of almost 10 to 1. Is that what you mean by admin time? For

every visit a patient makes I have to respond to two specialist

contacts, one radiology report, two lab reports, two formulary and/or

" care management " issues, three phone calls from the patient, and one

pharmacy phone call (not a formulary issue).

" I am checking my Admin time: patient time ratio and it is HORRIFIC!

something

like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

I'm

going to break down my times even more to see where it's leaking out to.

I

really want to get to a sustainable work load over the next year, or I

will

be BERSERK! I'll keep you guys posted. Thanks again for all the

support

and it was lovely to see you all in the flesh.

Lynn "

In a " big office " where MAs do a lot of this stuff they don't

probably

realize how much time it eats up, but if you do it all yourself....I

have randomly reviewed charts in the past to look at this question. In

the past week and a half I have started leaving all charts open until

the end of the day... for every patient I actually see during a day

there are 9 - 10 more open at the end of the day, for who I have had to

do SOMETHING, but for whom I am paid nothing...What can we do about

this?

Annie

--

Lynette I Iles MD 210 South Iowa Ste 3 Washington IA 52353 Flexible Family Care

'Modern medicine the old-fashioned way' This e-mail and attachments may contain

information which is confidential and is only for the named

addressee. If you have received this email in error, please notify

the sender immediately and delete it from your computer.

[Guest guest]

Annie-

I think that is it in a nutshell. I'm going to try to get some more exact

data: how many hours: 1) billing and posting, 2)trying to implement new

processes/software, 3) fiddling with the printers/scanners/computers/PDA, 4)

dealing with phone calls, 5)posting and calling/emailing test results,

6)doing phone medicine. I guess this is the reason lots of people HAVE an

MA/front desk person. It really IS a lot if you are solo-solo and seeing a

moderate amount of patients in an 8 hour day (6-10).

I know that some people are fairly draconian about the amount of phone

medicine they won't do, but I happen to feel it IS an efficient way for

people to get care. for example, would you discuss an abnormally high

%neutrophils on a complete blood count over the phone? how about a high

MCV? how about a cholesterol that was borderline abnormal? a fasting blood

glucose of 116? Rather than make people come in, I often will deal with

these over the phone, but as we all know it isn't paid. It helps them in

the short run, but of course if I go out of business because I can't stand

the amount of free admin time I'm putting in, it may not help them in the

long run. But I am going to try to quantitate how much time goes where and

then put the kibosh the practices that are the worst offenders, and it

actually may be phone medicine; I may have to get meaner!

Did you have a particular plan to deal with your issues? Should we compare

notes in a few weeks?

Lynn

>

>Reply-To:

>To: < >

>Subject: RE: [Practiceimp WAS Re: efficiency and

>money

>Date: Tue, 10 Oct 2006 22:20:26 -0400

>

>Lynn, I am finding that I am providing free services to office visits at

>a rate of almost 10 to 1. Is that what you mean by admin time? For

>every visit a patient makes I have to respond to two specialist

>contacts, one radiology report, two lab reports, two formulary and/or

> " care management " issues, three phone calls from the patient, and one

>pharmacy phone call (not a formulary issue).

>

>

> " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>something

>like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>I'm

>going to break down my times even more to see where it's leaking out to.

>I

>really want to get to a sustainable work load over the next year, or I

>will

>be BERSERK! I'll keep you guys posted. Thanks again for all the

>support

>and it was lovely to see you all in the flesh.

>

>Lynn "

>

>In a " big office " where MAs do a lot of this stuff they don't probably

>realize how much time it eats up, but if you do it all yourself....I

>have randomly reviewed charts in the past to look at this question. In

>the past week and a half I have started leaving all charts open until

>the end of the day... for every patient I actually see during a day

>there are 9 - 10 more open at the end of the day, for who I have had to

>do SOMETHING, but for whom I am paid nothing...What can we do about

>this?

>Annie

>

>

>

[Guest guest]

Lynn, the problem with phone medicine is that there is a lot of

misunderstanding. I would rather tell a patient " you have anemia and

need a colonoscopy " then explain the significance of high MCV. People

just don't understand things on the phone. If they are more articulate,

I would rather send an e-mail or a letter.

> Annie-

> I think that is it in a nutshell. I'm going to try to get some more

> exact

> data: how many hours: 1) billing and posting, 2)trying to implement

> new

> processes/software, 3) fiddling with the

> printers/scanners/computers/PDA, 4)

> dealing with phone calls, 5)posting and calling/emailing test results,

> 6)doing phone medicine. I guess this is the reason lots of people

> HAVE an

> MA/front desk person. It really IS a lot if you are solo-solo and

> seeing a

> moderate amount of patients in an 8 hour day (6-10).

> I know that some people are fairly draconian about the amount of phone

> medicine they won't do, but I happen to feel it IS an efficient way

> for

> people to get care. for example, would you discuss an abnormally high

> %neutrophils on a complete blood count over the phone? how about a

> high

> MCV? how about a cholesterol that was borderline abnormal? a fasting

> blood

> glucose of 116? Rather than make people come in, I often will deal

> with

> these over the phone, but as we all know it isn't paid. It helps them

> in

> the short run, but of course if I go out of business because I can't

> stand

> the amount of free admin time I'm putting in, it may not help them in

> the

> long run. But I am going to try to quantitate how much time goes

> where and

> then put the kibosh the practices that are the worst offenders, and it

> actually may be phone medicine; I may have to get meaner!

> Did you have a particular plan to deal with your issues? Should we

> compare

> notes in a few weeks?

>

> Lynn

>

> >

> >Reply-To:

> >To: < >

> >Subject: RE: [Practiceimp WAS Re: efficiency

> and

> >money

> >Date: Tue, 10 Oct 2006 22:20:26 -0400

> >

> >Lynn, I am finding that I am providing free services to office

> visits at

> >a rate of almost 10 to 1. Is that what you mean by admin time? For

> >every visit a patient makes I have to respond to two specialist

> >contacts, one radiology report, two lab reports, two formulary and/or

> > " care management " issues, three phone calls from the patient, and one

> >pharmacy phone call (not a formulary issue).

> >

> >

> > " I am checking my Admin time: patient time ratio and it is HORRIFIC!

> >something

> >like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

> >I'm

> >going to break down my times even more to see where it's leaking out

> to.

> >I

> >really want to get to a sustainable work load over the next year, or

> I

> >will

> >be BERSERK! I'll keep you guys posted. Thanks again for all the

> >support

> >and it was lovely to see you all in the flesh.

> >

> >Lynn "

> >

> >In a " big office " where MAs do a lot of this stuff they don't

> probably

> >realize how much time it eats up, but if you do it all yourself....I

> >have randomly reviewed charts in the past to look at this question.

> In

> >the past week and a half I have started leaving all charts open until

> >the end of the day... for every patient I actually see during a day

> >there are 9 - 10 more open at the end of the day, for who I have had

> to

> >do SOMETHING, but for whom I am paid nothing...What can we do about

> >this?

> >Annie

> >

> >

> >

>

>

>

[Guest guest]

Lynn, the problem with phone medicine is that there is a lot of

misunderstanding. I would rather tell a patient " you have anemia and

need a colonoscopy " then explain the significance of high MCV. People

just don't understand things on the phone. If they are more articulate,

I would rather send an e-mail or a letter.

> Annie-

> I think that is it in a nutshell. I'm going to try to get some more

> exact

> data: how many hours: 1) billing and posting, 2)trying to implement

> new

> processes/software, 3) fiddling with the

> printers/scanners/computers/PDA, 4)

> dealing with phone calls, 5)posting and calling/emailing test results,

> 6)doing phone medicine. I guess this is the reason lots of people

> HAVE an

> MA/front desk person. It really IS a lot if you are solo-solo and

> seeing a

> moderate amount of patients in an 8 hour day (6-10).

> I know that some people are fairly draconian about the amount of phone

> medicine they won't do, but I happen to feel it IS an efficient way

> for

> people to get care. for example, would you discuss an abnormally high

> %neutrophils on a complete blood count over the phone? how about a

> high

> MCV? how about a cholesterol that was borderline abnormal? a fasting

> blood

> glucose of 116? Rather than make people come in, I often will deal

> with

> these over the phone, but as we all know it isn't paid. It helps them

> in

> the short run, but of course if I go out of business because I can't

> stand

> the amount of free admin time I'm putting in, it may not help them in

> the

> long run. But I am going to try to quantitate how much time goes

> where and

> then put the kibosh the practices that are the worst offenders, and it

> actually may be phone medicine; I may have to get meaner!

> Did you have a particular plan to deal with your issues? Should we

> compare

> notes in a few weeks?

>

> Lynn

>

> >

> >Reply-To:

> >To: < >

> >Subject: RE: [Practiceimp WAS Re: efficiency

> and

> >money

> >Date: Tue, 10 Oct 2006 22:20:26 -0400

> >

> >Lynn, I am finding that I am providing free services to office

> visits at

> >a rate of almost 10 to 1. Is that what you mean by admin time? For

> >every visit a patient makes I have to respond to two specialist

> >contacts, one radiology report, two lab reports, two formulary and/or

> > " care management " issues, three phone calls from the patient, and one

> >pharmacy phone call (not a formulary issue).

> >

> >

> > " I am checking my Admin time: patient time ratio and it is HORRIFIC!

> >something

> >like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

> >I'm

> >going to break down my times even more to see where it's leaking out

> to.

> >I

> >really want to get to a sustainable work load over the next year, or

> I

> >will

> >be BERSERK! I'll keep you guys posted. Thanks again for all the

> >support

> >and it was lovely to see you all in the flesh.

> >

> >Lynn "

> >

> >In a " big office " where MAs do a lot of this stuff they don't

> probably

> >realize how much time it eats up, but if you do it all yourself....I

> >have randomly reviewed charts in the past to look at this question.

> In

> >the past week and a half I have started leaving all charts open until

> >the end of the day... for every patient I actually see during a day

> >there are 9 - 10 more open at the end of the day, for who I have had

> to

> >do SOMETHING, but for whom I am paid nothing...What can we do about

> >this?

> >Annie

> >

> >

> >

>

>

>

[Guest guest]

Hi

,

I am not totally without help. I have two students who help out 10-15

hrs/week each, and my landlord’s office manager helps out some too. I try to get the students to do as

much as they can, but I still have to have my eyes on everything they do. The cost of hiring around here prevents

me from getting a “multi tasking” sort of person. That sort of skill goes for as much as

$35/hr. And anyway, services that

aren’t going to be paid for are even more painful if you have to pay

someone else to do them…

Annie

RE: [Practiceimp WAS Re: efficiency and money

Lynn, I am finding that I am providing free services

to office visits at

a rate of almost 10 to 1. Is that what you mean by admin time? For

every visit a patient makes I have to respond to two specialist

contacts, one radiology report, two lab reports, two formulary and/or

" care management " issues, three phone calls from the patient, and one

pharmacy phone call (not a formulary issue).

" I am checking my Admin time: patient time ratio and it is HORRIFIC!

something

like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

I'm

going to break down my times even more to see where it's leaking out to.

I

really want to get to a sustainable work load over the next year, or I

will

be BERSERK! I'll keep you guys posted. Thanks again for all the

support

and it was lovely to see you all in the flesh.

Lynn "

In a " big office " where MAs do a lot of this stuff they don't

probably

realize how much time it eats up, but if you do it all yourself....I

have randomly reviewed charts in the past to look at this question. In

the past week and a half I have started leaving all charts open until

the end of the day... for every patient I actually see during a day

there are 9 - 10 more open at the end of the day, for who I have had to

do SOMETHING, but for whom I am paid nothing...What can we do about

this?

Annie

[Guest guest]

Hi Lynn,

You have a lot of issues below, and it is

late, so I am going pick on the phone med thing just for the moment.

When it comes to lab results, I mail each

and every result to the patient, with an interpretive letter. With my emr,

that is easy to do, and MUCH faster than talking to people on the phone. Even when I customize the letter and add

education items, it is still faster than a phone call. If I think the findings require a

discussion, then that needs to be an office visit about 99% of the time, tho’ there are always exceptions. I like sending letters better than

talking on the phone for a couple reasons: Saving time is #1, but a close

second is that there is clear, accurate recording of what I told the patient; none of this “You

never told me I have diabetes, you just said my sugar was a little high” stuff

– it’s right there in black and white (or 1s and 0’s). Also it avoids the “while I have

you on the phone…” add-ons…And if labs are abnormal and some

sort of follow up is needed soon, I hate to say it, but I really try not to

call those folks myself. A staff

person calling to say “Dr. Skaggs wants you to come over as soon as you

can takes under 5 minutes. If I

call, it’s “Why can’t you just tell me on the phone? If I need a surgery referral, can’t

you just do it and let me know where to go and when?” I find it really hard

to say “When you came in for your “sprained ankle” I only

charged you for a 99213, but if I now have to get you some crutches, excuse you

from work for a while, get a referral cleared thru your crappy insurance, find

an orthopod who takes your crappy insurance and set

up the appointment….well, I need to get you in here so I can get paid for

all that stuff” Easier to

just have the college girls give an appointment…

More later, bed

now,

Annie

RE: [Practiceimp WAS Re: efficiency

and

>money

>Date: Tue, 10 Oct 2006 22:20:26 -0400

>

>Lynn, I am finding that I am providing free services to office visits at

>a rate of almost 10 to 1. Is that what you mean by admin time? For

>every visit a patient makes I have to respond to two specialist

>contacts, one radiology report, two lab reports, two formulary and/or

> " care management " issues, three phone calls from the patient, and

one

>pharmacy phone call (not a formulary issue).

>

>

> " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>something

>like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>I'm

>going to break down my times even more to see where it's leaking out to.

>I

>really want to get to a sustainable work load over the next year, or I

>will

>be BERSERK! I'll keep you guys posted. Thanks again for all the

>support

>and it was lovely to see you all in the flesh.

>

>Lynn "

>

>In a " big office " where MAs do a lot of this stuff they don't

probably

>realize how much time it eats up, but if you do it all yourself....I

>have randomly reviewed charts in the past to look at this question. In

>the past week and a half I have started leaving all charts open until

>the end of the day... for every patient I actually see during a day

>there are 9 - 10 more open at the end of the day, for who I have had to

>do SOMETHING, but for whom I am paid nothing...What can we do about

>this?

>Annie

>

>

>

[Guest guest]

Hi Lynn,

You have a lot of issues below, and it is

late, so I am going pick on the phone med thing just for the moment.

When it comes to lab results, I mail each

and every result to the patient, with an interpretive letter. With my emr,

that is easy to do, and MUCH faster than talking to people on the phone. Even when I customize the letter and add

education items, it is still faster than a phone call. If I think the findings require a

discussion, then that needs to be an office visit about 99% of the time, tho’ there are always exceptions. I like sending letters better than

talking on the phone for a couple reasons: Saving time is #1, but a close

second is that there is clear, accurate recording of what I told the patient; none of this “You

never told me I have diabetes, you just said my sugar was a little high” stuff

– it’s right there in black and white (or 1s and 0’s). Also it avoids the “while I have

you on the phone…” add-ons…And if labs are abnormal and some

sort of follow up is needed soon, I hate to say it, but I really try not to

call those folks myself. A staff

person calling to say “Dr. Skaggs wants you to come over as soon as you

can takes under 5 minutes. If I

call, it’s “Why can’t you just tell me on the phone? If I need a surgery referral, can’t

you just do it and let me know where to go and when?” I find it really hard

to say “When you came in for your “sprained ankle” I only

charged you for a 99213, but if I now have to get you some crutches, excuse you

from work for a while, get a referral cleared thru your crappy insurance, find

an orthopod who takes your crappy insurance and set

up the appointment….well, I need to get you in here so I can get paid for

all that stuff” Easier to

just have the college girls give an appointment…

More later, bed

now,

Annie

RE: [Practiceimp WAS Re: efficiency

and

>money

>Date: Tue, 10 Oct 2006 22:20:26 -0400

>

>Lynn, I am finding that I am providing free services to office visits at

>a rate of almost 10 to 1. Is that what you mean by admin time? For

>every visit a patient makes I have to respond to two specialist

>contacts, one radiology report, two lab reports, two formulary and/or

> " care management " issues, three phone calls from the patient, and

one

>pharmacy phone call (not a formulary issue).

>

>

> " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>something

>like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>I'm

>going to break down my times even more to see where it's leaking out to.

>I

>really want to get to a sustainable work load over the next year, or I

>will

>be BERSERK! I'll keep you guys posted. Thanks again for all the

>support

>and it was lovely to see you all in the flesh.

>

>Lynn "

>

>In a " big office " where MAs do a lot of this stuff they don't

probably

>realize how much time it eats up, but if you do it all yourself....I

>have randomly reviewed charts in the past to look at this question. In

>the past week and a half I have started leaving all charts open until

>the end of the day... for every patient I actually see during a day

>there are 9 - 10 more open at the end of the day, for who I have had to

>do SOMETHING, but for whom I am paid nothing...What can we do about

>this?

>Annie

>

>

>

[Guest guest]

I think of this issue as how much work time do I put in per patient seen.

So that takes into account the time for appts, lab result

evaluation/communication, phone calls/listening to voice mails, emails,

prescriptions, etc... all the work of a doc caring for patients. But it

also includes the scanning, printing, calling insurance, ordering

vaccinations, billing, mail opening/sending, marketting ... AND such

things as cleaning counters, dusting, documenting frig temps, making

coffee, stopping at OfficeMax/post office/bank... and real peripheral

stuff like this listserv (which I used to only read at night but now I

knock off during the day).

But for me the efficiency is only part of the issue. My goal is to have

the time be 1hr of work per patient seen. I'm currently between 1hr15min

and 1hr 45min depending on the day. I figure about half of the difference

will be my own efficiency which continues to improve. But at least one

half the difference are malleable " other " issues such as appt mix (ie how

many chronic care appts vs acute cold/OM/rash appts), number of first-appt

patients (takes much longer to see a patient the first time than for later

appts) and day of the week/time of day.

So I've recently adjusted the hours that patients can book appts at

AppointmentQuest and I plan to build around that for additional appts.

I'm reminding myself that as I approach the point of not accepting new

patients I'll have fewer and fewer first time appts. I know that in the

winter I'll be seeing more " quickie " colds/OM/etc. And finally, as I

become more efficient with my aesthetics work, appts become shorter too

(and adding Botox soon will allow for shorter-but-good-paying appts in the

mix).

Thus I'm pretty confident my time-per-patient-seen will hit or drop below

1hr. I just need time as my practice matures and to continue evaluating

the little things I do to be more efficient/effective.

By the way, in my previous job within a large organization, I calculated

my time-per-patient-seen as about 40 minutes. What killed me there was

that after I finished seeing patients and staff went home, I still had a

big pile of loose paperwork. But by then I was fatigued and frustrated so

the work took twice as long to complete than it would have if I was rested

and energized. So I was still in the office doing stuff for a few hours...

and realizing I was absolutely inefficient and unhappy.

Now I have a lot more happiness related to my work. And I'm a lot more

even-paced. My appts are calmer and relaxed so I don't get as fatigued

and frustrated. Other people's work habits don't affect me or my job. My

patients are happier which makes dealing with them a pleasure (talk about

a way to lessen stress). And knocking off stuff like emails/listserve

postings during the day allows me to have a better time with my family

once the work day is done.

Admittedly I like being a doc and I don't mind having some days of 13

hours in the office... yes, I know many of you cringed at that, but we

must face our personal realities as we shape our world! ... but the

QUALITY of those hours is now so much better that I leave and go home

happy and proud of the environment I've established to provide care.

Thus the issue of " time efficiency " is blurred with " life effectiveness "

(I just made that up, but I think it's good for the point ;-) as I come to

realize that doing a good job and enjoying my workplace makes the quality

of life after I leave a lot better. I no longer have the distractions and

frustrations that linger in my head from work once I'm home with the

family and I have more flexibility to adjust my work hours to fit outside

opportunities and activities.

So keep evaluating your work efficiency but keep the big picture clear

that work is just another sliver of life and you should be there with joy

just like when you are not at work.

Finally, two books/concepts which help me (and which I need to keep going

back to in efforts to improve my inefficiencies and bad habits) are

Covey's " Seven Habits " books (they help me to think of whether my

actions are " important vs not-important " and " urgent vs non-urgent " so I

can keep trying to focus on the " important + non-urgent " stuff as that

ultimately helps the most... also reminds me to " sharpen the saw " which is

to do things to help me be better like exercise/sleep/cme/etc) and a book

called " Don't Answer Email In The Morning " or something like that by an

author named thal (I think)... but she has some good practical tips

for time efficiency. For me, her explanation about procrastination was

quite helpful and I'm trying to get to the point where I do things " well

enough " and not try to put them off until I think I can do them

" perfectly " ... that has helped (not yet cured however) my tendency to put

off some important matters.

Tim

> Annie-

> I think that is it in a nutshell. I'm going to try to get some more

> exact data: how many hours: 1) billing and posting, 2)trying to

> implement new processes/software, 3) fiddling with the

> printers/scanners/computers/PDA, 4) dealing with phone calls, 5)posting

> and calling/emailing test results, 6)doing phone medicine. I guess

> this is the reason lots of people HAVE an MA/front desk person. It

> really IS a lot if you are solo-solo and seeing a moderate amount of

> patients in an 8 hour day (6-10).

> I know that some people are fairly draconian about the amount of phone

> medicine they won't do, but I happen to feel it IS an efficient way for

> people to get care. for example, would you discuss an abnormally high

> %neutrophils on a complete blood count over the phone? how about a high

> MCV? how about a cholesterol that was borderline abnormal? a fasting

> blood glucose of 116? Rather than make people come in, I often will

> deal with these over the phone, but as we all know it isn't paid. It

> helps them in the short run, but of course if I go out of business

> because I can't stand the amount of free admin time I'm putting in, it

> may not help them in the long run. But I am going to try to quantitate

> how much time goes where and then put the kibosh the practices that are

> the worst offenders, and it actually may be phone medicine; I may have

> to get meaner!

> Did you have a particular plan to deal with your issues? Should we

> compare notes in a few weeks?

>

> Lynn

>

>>

>>Reply-To:

>>To: < >

>>Subject: RE: [Practiceimp WAS Re: efficiency and

>> money

>>Date: Tue, 10 Oct 2006 22:20:26 -0400

>>

>>Lynn, I am finding that I am providing free services to office visits

>> at a rate of almost 10 to 1. Is that what you mean by admin time? For

>> every visit a patient makes I have to respond to two specialist

>>contacts, one radiology report, two lab reports, two formulary and/or

>> " care management " issues, three phone calls from the patient, and one

>> pharmacy phone call (not a formulary issue).

>>

>>

>> " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>> something

>>like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>> I'm

>>going to break down my times even more to see where it's leaking out

>> to. I

>>really want to get to a sustainable work load over the next year, or I

>> will

>>be BERSERK! I'll keep you guys posted. Thanks again for all the

>> support

>>and it was lovely to see you all in the flesh.

>>

>>Lynn "

>>

>>In a " big office " where MAs do a lot of this stuff they don't probably

>> realize how much time it eats up, but if you do it all yourself....I

>> have randomly reviewed charts in the past to look at this question. In

>> the past week and a half I have started leaving all charts open until

>> the end of the day... for every patient I actually see during a day

>> there are 9 - 10 more open at the end of the day, for who I have had to

>> do SOMETHING, but for whom I am paid nothing...What can we do about

>> this?

>>Annie

>>

>>

>>

>

>

>

>

>

>

[Guest guest]

I think of this issue as how much work time do I put in per patient seen.

So that takes into account the time for appts, lab result

evaluation/communication, phone calls/listening to voice mails, emails,

prescriptions, etc... all the work of a doc caring for patients. But it

also includes the scanning, printing, calling insurance, ordering

vaccinations, billing, mail opening/sending, marketting ... AND such

things as cleaning counters, dusting, documenting frig temps, making

coffee, stopping at OfficeMax/post office/bank... and real peripheral

stuff like this listserv (which I used to only read at night but now I

knock off during the day).

But for me the efficiency is only part of the issue. My goal is to have

the time be 1hr of work per patient seen. I'm currently between 1hr15min

and 1hr 45min depending on the day. I figure about half of the difference

will be my own efficiency which continues to improve. But at least one

half the difference are malleable " other " issues such as appt mix (ie how

many chronic care appts vs acute cold/OM/rash appts), number of first-appt

patients (takes much longer to see a patient the first time than for later

appts) and day of the week/time of day.

So I've recently adjusted the hours that patients can book appts at

AppointmentQuest and I plan to build around that for additional appts.

I'm reminding myself that as I approach the point of not accepting new

patients I'll have fewer and fewer first time appts. I know that in the

winter I'll be seeing more " quickie " colds/OM/etc. And finally, as I

become more efficient with my aesthetics work, appts become shorter too

(and adding Botox soon will allow for shorter-but-good-paying appts in the

mix).

Thus I'm pretty confident my time-per-patient-seen will hit or drop below

1hr. I just need time as my practice matures and to continue evaluating

the little things I do to be more efficient/effective.

By the way, in my previous job within a large organization, I calculated

my time-per-patient-seen as about 40 minutes. What killed me there was

that after I finished seeing patients and staff went home, I still had a

big pile of loose paperwork. But by then I was fatigued and frustrated so

the work took twice as long to complete than it would have if I was rested

and energized. So I was still in the office doing stuff for a few hours...

and realizing I was absolutely inefficient and unhappy.

Now I have a lot more happiness related to my work. And I'm a lot more

even-paced. My appts are calmer and relaxed so I don't get as fatigued

and frustrated. Other people's work habits don't affect me or my job. My

patients are happier which makes dealing with them a pleasure (talk about

a way to lessen stress). And knocking off stuff like emails/listserve

postings during the day allows me to have a better time with my family

once the work day is done.

Admittedly I like being a doc and I don't mind having some days of 13

hours in the office... yes, I know many of you cringed at that, but we

must face our personal realities as we shape our world! ... but the

QUALITY of those hours is now so much better that I leave and go home

happy and proud of the environment I've established to provide care.

Thus the issue of " time efficiency " is blurred with " life effectiveness "

(I just made that up, but I think it's good for the point ;-) as I come to

realize that doing a good job and enjoying my workplace makes the quality

of life after I leave a lot better. I no longer have the distractions and

frustrations that linger in my head from work once I'm home with the

family and I have more flexibility to adjust my work hours to fit outside

opportunities and activities.

So keep evaluating your work efficiency but keep the big picture clear

that work is just another sliver of life and you should be there with joy

just like when you are not at work.

Finally, two books/concepts which help me (and which I need to keep going

back to in efforts to improve my inefficiencies and bad habits) are

Covey's " Seven Habits " books (they help me to think of whether my

actions are " important vs not-important " and " urgent vs non-urgent " so I

can keep trying to focus on the " important + non-urgent " stuff as that

ultimately helps the most... also reminds me to " sharpen the saw " which is

to do things to help me be better like exercise/sleep/cme/etc) and a book

called " Don't Answer Email In The Morning " or something like that by an

author named thal (I think)... but she has some good practical tips

for time efficiency. For me, her explanation about procrastination was

quite helpful and I'm trying to get to the point where I do things " well

enough " and not try to put them off until I think I can do them

" perfectly " ... that has helped (not yet cured however) my tendency to put

off some important matters.

Tim

> Annie-

> I think that is it in a nutshell. I'm going to try to get some more

> exact data: how many hours: 1) billing and posting, 2)trying to

> implement new processes/software, 3) fiddling with the

> printers/scanners/computers/PDA, 4) dealing with phone calls, 5)posting

> and calling/emailing test results, 6)doing phone medicine. I guess

> this is the reason lots of people HAVE an MA/front desk person. It

> really IS a lot if you are solo-solo and seeing a moderate amount of

> patients in an 8 hour day (6-10).

> I know that some people are fairly draconian about the amount of phone

> medicine they won't do, but I happen to feel it IS an efficient way for

> people to get care. for example, would you discuss an abnormally high

> %neutrophils on a complete blood count over the phone? how about a high

> MCV? how about a cholesterol that was borderline abnormal? a fasting

> blood glucose of 116? Rather than make people come in, I often will

> deal with these over the phone, but as we all know it isn't paid. It

> helps them in the short run, but of course if I go out of business

> because I can't stand the amount of free admin time I'm putting in, it

> may not help them in the long run. But I am going to try to quantitate

> how much time goes where and then put the kibosh the practices that are

> the worst offenders, and it actually may be phone medicine; I may have

> to get meaner!

> Did you have a particular plan to deal with your issues? Should we

> compare notes in a few weeks?

>

> Lynn

>

>>

>>Reply-To:

>>To: < >

>>Subject: RE: [Practiceimp WAS Re: efficiency and

>> money

>>Date: Tue, 10 Oct 2006 22:20:26 -0400

>>

>>Lynn, I am finding that I am providing free services to office visits

>> at a rate of almost 10 to 1. Is that what you mean by admin time? For

>> every visit a patient makes I have to respond to two specialist

>>contacts, one radiology report, two lab reports, two formulary and/or

>> " care management " issues, three phone calls from the patient, and one

>> pharmacy phone call (not a formulary issue).

>>

>>

>> " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>> something

>>like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>> I'm

>>going to break down my times even more to see where it's leaking out

>> to. I

>>really want to get to a sustainable work load over the next year, or I

>> will

>>be BERSERK! I'll keep you guys posted. Thanks again for all the

>> support

>>and it was lovely to see you all in the flesh.

>>

>>Lynn "

>>

>>In a " big office " where MAs do a lot of this stuff they don't probably

>> realize how much time it eats up, but if you do it all yourself....I

>> have randomly reviewed charts in the past to look at this question. In

>> the past week and a half I have started leaving all charts open until

>> the end of the day... for every patient I actually see during a day

>> there are 9 - 10 more open at the end of the day, for who I have had to

>> do SOMETHING, but for whom I am paid nothing...What can we do about

>> this?

>>Annie

>>

>>

>>

>

>

>

>

>

>

[Guest guest]

To clarify the book I mentioned below...

" Never Check E-Mail in the Morning " by Morgenstern.

Not all of it relates to what I do in my office, but it has some nuggets

I've personally found helpful.

.... random thought... anyone remember the show " Rhoda " from the 70's? It

was a spin-off from Tyler . Wasn't her name stern too?

.... OK, back to work.

Tim

> I think of this issue as how much work time do I put in per patient

> seen. So that takes into account the time for appts, lab result

> evaluation/communication, phone calls/listening to voice mails, emails,

> prescriptions, etc... all the work of a doc caring for patients. But it

> also includes the scanning, printing, calling insurance, ordering

> vaccinations, billing, mail opening/sending, marketting ... AND such

> things as cleaning counters, dusting, documenting frig temps, making

> coffee, stopping at OfficeMax/post office/bank... and real peripheral

> stuff like this listserv (which I used to only read at night but now I

> knock off during the day).

>

> But for me the efficiency is only part of the issue. My goal is to have

> the time be 1hr of work per patient seen. I'm currently between

> 1hr15min and 1hr 45min depending on the day. I figure about half of the

> difference will be my own efficiency which continues to improve. But at

> least one half the difference are malleable " other " issues such as appt

> mix (ie how many chronic care appts vs acute cold/OM/rash appts), number

> of first-appt patients (takes much longer to see a patient the first

> time than for later appts) and day of the week/time of day.

>

> So I've recently adjusted the hours that patients can book appts at

> AppointmentQuest and I plan to build around that for additional appts.

> I'm reminding myself that as I approach the point of not accepting new

> patients I'll have fewer and fewer first time appts. I know that in the

> winter I'll be seeing more " quickie " colds/OM/etc. And finally, as I

> become more efficient with my aesthetics work, appts become shorter too

> (and adding Botox soon will allow for shorter-but-good-paying appts in

> the mix).

>

> Thus I'm pretty confident my time-per-patient-seen will hit or drop

> below 1hr. I just need time as my practice matures and to continue

> evaluating the little things I do to be more efficient/effective.

>

> By the way, in my previous job within a large organization, I calculated

> my time-per-patient-seen as about 40 minutes. What killed me there was

> that after I finished seeing patients and staff went home, I still had a

> big pile of loose paperwork. But by then I was fatigued and frustrated

> so the work took twice as long to complete than it would have if I was

> rested and energized. So I was still in the office doing stuff for a few

> hours... and realizing I was absolutely inefficient and unhappy.

>

> Now I have a lot more happiness related to my work. And I'm a lot more

> even-paced. My appts are calmer and relaxed so I don't get as fatigued

> and frustrated. Other people's work habits don't affect me or my job.

> My patients are happier which makes dealing with them a pleasure (talk

> about a way to lessen stress). And knocking off stuff like

> emails/listserve postings during the day allows me to have a better time

> with my family once the work day is done.

>

> Admittedly I like being a doc and I don't mind having some days of 13

> hours in the office... yes, I know many of you cringed at that, but we

> must face our personal realities as we shape our world! ... but the

> QUALITY of those hours is now so much better that I leave and go home

> happy and proud of the environment I've established to provide care.

>

> Thus the issue of " time efficiency " is blurred with " life effectiveness "

> (I just made that up, but I think it's good for the point ;-) as I come

> to realize that doing a good job and enjoying my workplace makes the

> quality of life after I leave a lot better. I no longer have the

> distractions and frustrations that linger in my head from work once I'm

> home with the family and I have more flexibility to adjust my work hours

> to fit outside opportunities and activities.

>

> So keep evaluating your work efficiency but keep the big picture clear

> that work is just another sliver of life and you should be there with

> joy just like when you are not at work.

>

> Finally, two books/concepts which help me (and which I need to keep

> going back to in efforts to improve my inefficiencies and bad habits)

> are Covey's " Seven Habits " books (they help me to think of

> whether my actions are " important vs not-important " and " urgent vs

> non-urgent " so I can keep trying to focus on the " important +

> non-urgent " stuff as that ultimately helps the most... also reminds me

> to " sharpen the saw " which is to do things to help me be better like

> exercise/sleep/cme/etc) and a book called " Don't Answer Email In The

> Morning " or something like that by an author named thal (I

> think)... but she has some good practical tips for time efficiency. For

> me, her explanation about procrastination was quite helpful and I'm

> trying to get to the point where I do things " well enough " and not try

> to put them off until I think I can do them

> " perfectly " ... that has helped (not yet cured however) my tendency to

> put off some important matters.

>

> Tim

>

>> Annie-

>> I think that is it in a nutshell. I'm going to try to get some more

>> exact data: how many hours: 1) billing and posting, 2)trying to

>> implement new processes/software, 3) fiddling with the

>> printers/scanners/computers/PDA, 4) dealing with phone calls,

>> 5)posting and calling/emailing test results, 6)doing phone medicine.

>> I guess this is the reason lots of people HAVE an MA/front desk

>> person. It really IS a lot if you are solo-solo and seeing a

>> moderate amount of patients in an 8 hour day (6-10).

>> I know that some people are fairly draconian about the amount of phone

>> medicine they won't do, but I happen to feel it IS an efficient way

>> for people to get care. for example, would you discuss an abnormally

>> high %neutrophils on a complete blood count over the phone? how about

>> a high

>> MCV? how about a cholesterol that was borderline abnormal? a

>> fasting

>> blood glucose of 116? Rather than make people come in, I often will

>> deal with these over the phone, but as we all know it isn't paid. It

>> helps them in the short run, but of course if I go out of business

>> because I can't stand the amount of free admin time I'm putting in,

>> it may not help them in the long run. But I am going to try to

>> quantitate how much time goes where and then put the kibosh the

>> practices that are the worst offenders, and it actually may be phone

>> medicine; I may have to get meaner!

>> Did you have a particular plan to deal with your issues? Should we

>> compare notes in a few weeks?

>>

>> Lynn

>>

>>>

>>>Reply-To:

>>>To: < >

>>>Subject: RE: [Practiceimp WAS Re: efficiency

>>> and

>>> money

>>>Date: Tue, 10 Oct 2006 22:20:26 -0400

>>>

>>>Lynn, I am finding that I am providing free services to office visits

>>> at a rate of almost 10 to 1. Is that what you mean by admin time?

>>> For every visit a patient makes I have to respond to two specialist

>>>contacts, one radiology report, two lab reports, two formulary and/or

>>> " care management " issues, three phone calls from the patient, and one

>>> pharmacy phone call (not a formulary issue).

>>>

>>>

>>> " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>>> something

>>>like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>>> I'm

>>>going to break down my times even more to see where it's leaking out

>>> to. I

>>>really want to get to a sustainable work load over the next year, or I

>>> will

>>>be BERSERK! I'll keep you guys posted. Thanks again for all the

>>> support

>>>and it was lovely to see you all in the flesh.

>>>

>>>Lynn "

>>>

>>>In a " big office " where MAs do a lot of this stuff they don't probably

>>> realize how much time it eats up, but if you do it all yourself....I

>>> have randomly reviewed charts in the past to look at this question.

>>> In the past week and a half I have started leaving all charts open

>>> until the end of the day... for every patient I actually see during a

>>> day there are 9 - 10 more open at the end of the day, for who I have

>>> had to do SOMETHING, but for whom I am paid nothing...What can we do

>>> about this?

>>>Annie

>>>

>>>

>>>

>>

>>

>>

>>

>>

>>

[Guest guest]

To clarify the book I mentioned below...

" Never Check E-Mail in the Morning " by Morgenstern.

Not all of it relates to what I do in my office, but it has some nuggets

I've personally found helpful.

.... random thought... anyone remember the show " Rhoda " from the 70's? It

was a spin-off from Tyler . Wasn't her name stern too?

.... OK, back to work.

Tim

> I think of this issue as how much work time do I put in per patient

> seen. So that takes into account the time for appts, lab result

> evaluation/communication, phone calls/listening to voice mails, emails,

> prescriptions, etc... all the work of a doc caring for patients. But it

> also includes the scanning, printing, calling insurance, ordering

> vaccinations, billing, mail opening/sending, marketting ... AND such

> things as cleaning counters, dusting, documenting frig temps, making

> coffee, stopping at OfficeMax/post office/bank... and real peripheral

> stuff like this listserv (which I used to only read at night but now I

> knock off during the day).

>

> But for me the efficiency is only part of the issue. My goal is to have

> the time be 1hr of work per patient seen. I'm currently between

> 1hr15min and 1hr 45min depending on the day. I figure about half of the

> difference will be my own efficiency which continues to improve. But at

> least one half the difference are malleable " other " issues such as appt

> mix (ie how many chronic care appts vs acute cold/OM/rash appts), number

> of first-appt patients (takes much longer to see a patient the first

> time than for later appts) and day of the week/time of day.

>

> So I've recently adjusted the hours that patients can book appts at

> AppointmentQuest and I plan to build around that for additional appts.

> I'm reminding myself that as I approach the point of not accepting new

> patients I'll have fewer and fewer first time appts. I know that in the

> winter I'll be seeing more " quickie " colds/OM/etc. And finally, as I

> become more efficient with my aesthetics work, appts become shorter too

> (and adding Botox soon will allow for shorter-but-good-paying appts in

> the mix).

>

> Thus I'm pretty confident my time-per-patient-seen will hit or drop

> below 1hr. I just need time as my practice matures and to continue

> evaluating the little things I do to be more efficient/effective.

>

> By the way, in my previous job within a large organization, I calculated

> my time-per-patient-seen as about 40 minutes. What killed me there was

> that after I finished seeing patients and staff went home, I still had a

> big pile of loose paperwork. But by then I was fatigued and frustrated

> so the work took twice as long to complete than it would have if I was

> rested and energized. So I was still in the office doing stuff for a few

> hours... and realizing I was absolutely inefficient and unhappy.

>

> Now I have a lot more happiness related to my work. And I'm a lot more

> even-paced. My appts are calmer and relaxed so I don't get as fatigued

> and frustrated. Other people's work habits don't affect me or my job.

> My patients are happier which makes dealing with them a pleasure (talk

> about a way to lessen stress). And knocking off stuff like

> emails/listserve postings during the day allows me to have a better time

> with my family once the work day is done.

>

> Admittedly I like being a doc and I don't mind having some days of 13

> hours in the office... yes, I know many of you cringed at that, but we

> must face our personal realities as we shape our world! ... but the

> QUALITY of those hours is now so much better that I leave and go home

> happy and proud of the environment I've established to provide care.

>

> Thus the issue of " time efficiency " is blurred with " life effectiveness "

> (I just made that up, but I think it's good for the point ;-) as I come

> to realize that doing a good job and enjoying my workplace makes the

> quality of life after I leave a lot better. I no longer have the

> distractions and frustrations that linger in my head from work once I'm

> home with the family and I have more flexibility to adjust my work hours

> to fit outside opportunities and activities.

>

> So keep evaluating your work efficiency but keep the big picture clear

> that work is just another sliver of life and you should be there with

> joy just like when you are not at work.

>

> Finally, two books/concepts which help me (and which I need to keep

> going back to in efforts to improve my inefficiencies and bad habits)

> are Covey's " Seven Habits " books (they help me to think of

> whether my actions are " important vs not-important " and " urgent vs

> non-urgent " so I can keep trying to focus on the " important +

> non-urgent " stuff as that ultimately helps the most... also reminds me

> to " sharpen the saw " which is to do things to help me be better like

> exercise/sleep/cme/etc) and a book called " Don't Answer Email In The

> Morning " or something like that by an author named thal (I

> think)... but she has some good practical tips for time efficiency. For

> me, her explanation about procrastination was quite helpful and I'm

> trying to get to the point where I do things " well enough " and not try

> to put them off until I think I can do them

> " perfectly " ... that has helped (not yet cured however) my tendency to

> put off some important matters.

>

> Tim

>

>> Annie-

>> I think that is it in a nutshell. I'm going to try to get some more

>> exact data: how many hours: 1) billing and posting, 2)trying to

>> implement new processes/software, 3) fiddling with the

>> printers/scanners/computers/PDA, 4) dealing with phone calls,

>> 5)posting and calling/emailing test results, 6)doing phone medicine.

>> I guess this is the reason lots of people HAVE an MA/front desk

>> person. It really IS a lot if you are solo-solo and seeing a

>> moderate amount of patients in an 8 hour day (6-10).

>> I know that some people are fairly draconian about the amount of phone

>> medicine they won't do, but I happen to feel it IS an efficient way

>> for people to get care. for example, would you discuss an abnormally

>> high %neutrophils on a complete blood count over the phone? how about

>> a high

>> MCV? how about a cholesterol that was borderline abnormal? a

>> fasting

>> blood glucose of 116? Rather than make people come in, I often will

>> deal with these over the phone, but as we all know it isn't paid. It

>> helps them in the short run, but of course if I go out of business

>> because I can't stand the amount of free admin time I'm putting in,

>> it may not help them in the long run. But I am going to try to

>> quantitate how much time goes where and then put the kibosh the

>> practices that are the worst offenders, and it actually may be phone

>> medicine; I may have to get meaner!

>> Did you have a particular plan to deal with your issues? Should we

>> compare notes in a few weeks?

>>

>> Lynn

>>

>>>

>>>Reply-To:

>>>To: < >

>>>Subject: RE: [Practiceimp WAS Re: efficiency

>>> and

>>> money

>>>Date: Tue, 10 Oct 2006 22:20:26 -0400

>>>

>>>Lynn, I am finding that I am providing free services to office visits

>>> at a rate of almost 10 to 1. Is that what you mean by admin time?

>>> For every visit a patient makes I have to respond to two specialist

>>>contacts, one radiology report, two lab reports, two formulary and/or

>>> " care management " issues, three phone calls from the patient, and one

>>> pharmacy phone call (not a formulary issue).

>>>

>>>

>>> " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>>> something

>>>like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>>> I'm

>>>going to break down my times even more to see where it's leaking out

>>> to. I

>>>really want to get to a sustainable work load over the next year, or I

>>> will

>>>be BERSERK! I'll keep you guys posted. Thanks again for all the

>>> support

>>>and it was lovely to see you all in the flesh.

>>>

>>>Lynn "

>>>

>>>In a " big office " where MAs do a lot of this stuff they don't probably

>>> realize how much time it eats up, but if you do it all yourself....I

>>> have randomly reviewed charts in the past to look at this question.

>>> In the past week and a half I have started leaving all charts open

>>> until the end of the day... for every patient I actually see during a

>>> day there are 9 - 10 more open at the end of the day, for who I have

>>> had to do SOMETHING, but for whom I am paid nothing...What can we do

>>> about this?

>>>Annie

>>>

>>>

>>>

>>

>>

>>

>>

>>

>>

[Guest guest]

I changed from phone calls to letters on results when I finally figured out how to do that in AC - and I do like having the letters in the chart for documentation. I have several templates, so a normal pap letter takes 15 seconds to do. And I agree with Annie, a letter is always faster than a phone conversation for me. I often end the letter with "if they have any further questions, why don't the make an appointment" which works well. Hi Lynn,You have a lot of issues below, and it is late, so I am going pick on the phone med thing just for the moment.When it comes to lab results, I mail each and every result to the patient, with an interpretive letter.  With my emr, that is easy to do, and MUCH faster than talking to people on the phone.  Even when I customize the letter and add education items, it is still faster than a phone call.  If I think the findings require a discussion, then that needs to be an office visit about 99% of the time, tho’ there are always exceptions. I like sending letters better than talking on the phone for a couple reasons: Saving time is #1, but a close second is that there is clear, accurate recording of what I told the patient;  none of this “You never told me I have diabetes, you just said my sugar was a little high” stuff – it’s right there in black and white (or 1s and 0’s).  Also it avoids the “while I have you on the phone…” add-ons…And if labs are abnormal and some sort of follow up is needed soon, I hate to say it, but I really try not to call those folks myself.  A staff person calling to say “Dr. Skaggs wants you to come over as soon as you can takes under 5 minutes.  If I call, it’s “Why can’t you just tell me on the phone?  If I need a surgery referral, can’t you just do it and let me know where to go and when?”     I find it really hard to say “When you came in for your “sprained ankle” I only charged you for a 99213, but if I now have to get you some crutches, excuse you from work for a while, get a referral cleared thru your crappy insurance, find an orthopod who takes your crappy insurance and set up the appointment….well, I need to get you in here so I can get paid for all that stuff” Easier to just have the college girls give an appointment… More later, bed now,Annie  RE: [Practiceimp WAS Re: efficiency and >money>Date: Tue, 10 Oct 2006 22:20:26 -0400>>Lynn, I am finding that I am providing free services to office visits at>a rate of almost 10 to 1. Is that what you mean by admin time? For>every visit a patient makes I have to respond to two specialist>contacts, one radiology report, two lab reports, two formulary and/or>"care management" issues, three phone calls from the patient, and one>pharmacy phone call (not a formulary issue).>>>"I am checking my Admin time: patient time ratio and it is HORRIFIC!>something>like 40 hours of admin to 20 patient hours. I have got to FIX THIS!>I'm>going to break down my times even more to see where it's leaking out to.>I>really want to get to a sustainable work load over the next year, or I>will>be BERSERK! I'll keep you guys posted. Thanks again for all the>support>and it was lovely to see you all in the flesh.>>Lynn">>In a "big office" where MAs do a lot of this stuff they don't probably>realize how much time it eats up, but if you do it all yourself....I>have randomly reviewed charts in the past to look at this question. In>the past week and a half I have started leaving all charts open until>the end of the day... for every patient I actually see during a day>there are 9 - 10 more open at the end of the day, for who I have had to>do SOMETHING, but for whom I am paid nothing...What can we do about>this?>Annie>>>

[Guest guest]

For me, the idea that a patient has a note or email they can read but then

go back to again later is quite important. I suspect that people often

forget details of things said on the phone, or even in person, so having

that note can be very helpful later as opposed to getting another phone

call to clarify again.

Tim

>

> I don't know about that Anemaria, my patients seem to understand

> perfectly on the phone, it just takes a bit of time. I think it's a

> matter of convenience and copays for them and a matter of free medical

> practice for me.

>

> Lynn

>

>>

>>Reply-To:

>>To:

>>Subject: Re: RE: [Practiceimp WAS Re: efficiency

>> and money

>>Date: Wed, 11 Oct 2006 22:36:48 -0500

>>

>>Lynn, the problem with phone medicine is that there is a lot of

>>misunderstanding. I would rather tell a patient " you have anemia and

>> need a colonoscopy " then explain the significance of high MCV. People

>> just don't understand things on the phone. If they are more

>> articulate, I would rather send an e-mail or a letter.

>>

>>

>>>Annie-

>>> I think that is it in a nutshell. I'm going to try to get some more

>>>exact

>>> data: how many hours: 1) billing and posting, 2)trying to implement

>>> new processes/software, 3) fiddling with the

>>>printers/scanners/computers/PDA, 4)

>>> dealing with phone calls, 5)posting and calling/emailing test

>>> results, 6)doing phone medicine. I guess this is the reason lots of

>>> people HAVE

>>>an

>>> MA/front desk person. It really IS a lot if you are solo-solo and

>>> seeing

>>>a

>>> moderate amount of patients in an 8 hour day (6-10).

>>> I know that some people are fairly draconian about the amount of

>>> phone medicine they won't do, but I happen to feel it IS an

>>> efficient way for people to get care. for example, would you discuss

>>> an abnormally high %neutrophils on a complete blood count over the

>>> phone? how about a high MCV? how about a cholesterol that was

>>> borderline abnormal? a fasting

>>>blood

>>> glucose of 116? Rather than make people come in, I often will deal

>>> with these over the phone, but as we all know it isn't paid. It

>>> helps them in the short run, but of course if I go out of business

>>> because I can't

>>>stand

>>> the amount of free admin time I'm putting in, it may not help them

>>> in

>>>the

>>> long run. But I am going to try to quantitate how much time goes

>>> where

>>>and

>>> then put the kibosh the practices that are the worst offenders, and

>>> it actually may be phone medicine; I may have to get meaner!

>>> Did you have a particular plan to deal with your issues? Should we

>>>compare

>>> notes in a few weeks?

>>>

>>> Lynn

>>>

>>> >

>>> >Reply-To:

>>> >To: < >

>>> >Subject: RE: [Practiceimp WAS Re: efficiency

>>> and money

>>> >Date: Tue, 10 Oct 2006 22:20:26 -0400

>>> >

>>> >Lynn, I am finding that I am providing free services to office

>>> visits

>>>at

>>> >a rate of almost 10 to 1. Is that what you mean by admin time? For

>>> every visit a patient makes I have to respond to two specialist

>>> contacts, one radiology report, two lab reports, two formulary

>>> and/or " care management " issues, three phone calls from the

>>> patient, and one pharmacy phone call (not a formulary issue).

>>> >

>>> >

>>> > " I am checking my Admin time: patient time ratio and it is

>>> HORRIFIC! something

>>> >like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>>> I'm

>>> >going to break down my times even more to see where it's leaking

>>> out

>>>to.

>>> >I

>>> >really want to get to a sustainable work load over the next year,

>>> or I will

>>> >be BERSERK! I'll keep you guys posted. Thanks again for all the

>>> support

>>> >and it was lovely to see you all in the flesh.

>>> >

>>> >Lynn "

>>> >

>>> >In a " big office " where MAs do a lot of this stuff they don't

>>> probably realize how much time it eats up, but if you do it all

>>> yourself....I have randomly reviewed charts in the past to look at

>>> this question. In the past week and a half I have started leaving

>>> all charts open until the end of the day... for every patient I

>>> actually see during a day there are 9 - 10 more open at the end of

>>> the day, for who I have had to do SOMETHING, but for whom I am paid

>>> nothing...What can we do about this?

>>> >Annie

>>> >

>>> >

>>> >

>>>

>>>

>

>

>

>

>

>

[Guest guest]

Thanks for all the input! The letters have it. I will switch. Sounds

faster and it cuts off the 'By the way, doctor...' But, are you printing

out the letters and sending them by mail? It will take me at least 45

seconds to address the envelope, stick on the stamp, fold the paper etc.,

not to mention .37 cents postage (or is it .38?) I think I'm going to use

the email button feature on AC , write the letters in the 'letter to

patient' feature, copy and paste it into the email then print it to a dummy

printer so it will save to the chart. lFew extra steps there but probably

worth it. It's becoming more important for my patients to have email.

Maybe I'll put that on my exclusion from waiting list criteria, along with

United (only kidding!).

If anyone feels like it and has time, will they email me or post their

cholesterol template and others they find useful? (not critical, I'm pretty

sure I can ad lib my own too) . Efficiency in processes is marching

onward, thanks to you all...

AND I hired another biller! Yay!

Lynn

>

>Reply-To:

>To: ' Guinn ' ,

> " ' ' "

>< >

>Subject: RE: RE: [Practiceimp WAS Re: efficiency and

>money

>Date: Sat, 21 Oct 2006 10:49:45 -0400

>

> PLUS the PATIENT likes the documentation.

>

>I call people if something is troulbesome. or they asked me to or it

>cannot

>wait.

>For theri follow up cholesterol etc I have long had a template in t he emr

>about

>your good cholesterol is..

> Your bad cholesterol is...

>Last time it was ....

> then I have a short list of bullets- people are at risk of a a heart

>attack IF... and I list are you male?

>Do you smoke?

>etc

> (it is all pre listed int he template I have other templates for other

>labs of course Like Pap smear or mammogram etc Your next test is

>needed....

>Recommednations......)

>then the template -for cholesterol-says

> How many of these do you have?

>Which ones can you work on?

>

>If tehy get good lab results they get a happy face drawn or a sticker

>Now this seems goofy to post BUT people tell me..I got a happy face! They

>earned it!

>

> Since the emr parses them to lab book then I have it in the chart If

>they a re in with me I type it into the note and give them the lab report

>showing them

> HDL H is happy for the Heart ,

> ldl L is lousy you want it low

>.

>It is all in the teaching.And connecting to them People are " non complaint "

>becasue " no body ever explained it to me that way "

>

>

> RE: [Practiceimp WAS Re: efficiency and

>

> >money

> >Date: Tue, 10 Oct 2006 22:20:26 -0400

> >

> >Lynn, I am finding that I am providing free services to office visits

>at

> >a rate of almost 10 to 1. Is that what you mean by admin time? For

> >every visit a patient makes I have to respond to two specialist

> >contacts, one radiology report, two lab reports, two formulary and/or

> > " care management " issues, three phone calls from the patient, and one

> >pharmacy phone call (not a formulary issue).

> >

> >

> > " I am checking my Admin time: patient time ratio and it is HORRIFIC!

> >something

> >like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

> >I'm

> >going to break down my times even more to see where it's leaking out

>to.

> >I

> >really want to get to a sustainable work load over the next year, or I

> >will

> >be BERSERK! I'll keep you guys posted. Thanks again for all the

> >support

> >and it was lovely to see you all in the flesh.

> >

> >Lynn "

> >

> >In a " big office " where MAs do a lot of this stuff they don't probably

> >realize how much time it eats up, but if you do it all yourself....I

> >have randomly reviewed charts in the past to look at this question. In

> >the past week and a half I have started leaving all charts open until

> >the end of the day... for every patient I actually see during a day

> >there are 9 - 10 more open at the end of the day, for who I have had to

> >do SOMETHING, but for whom I am paid nothing...What can we do about

> >this?

> >Annie

> >

> >

> >

>

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Lynn -- Go for it! And thanks for the post -- the positive mood to it may

just push me to my next efficiency-improving effort. It sure happens in

spurts and stops. I guess it's all about making the spurts more than the

stops until the efficiency gets ever closer to perfection -- won't ever

happen, we just need to continue trying to get there.

.... and, by the way, it's $0.39 for a stamp these days ... I have a pile

of pre-stamped and pre-return-addressed envelopes to use. My kids enjoyed

doing them.

Tim

> Thanks for all the input! The letters have it. I will switch.

> Sounds faster and it cuts off the 'By the way, doctor...' But, are

> you printing out the letters and sending them by mail? It will take me

> at least 45 seconds to address the envelope, stick on the stamp, fold

> the paper etc., not to mention .37 cents postage (or is it .38?) I

> think I'm going to use the email button feature on AC , write the

> letters in the 'letter to patient' feature, copy and paste it into the

> email then print it to a dummy printer so it will save to the chart.

> lFew extra steps there but probably worth it. It's becoming more

> important for my patients to have email. Maybe I'll put that on my

> exclusion from waiting list criteria, along with United (only

> kidding!).

> If anyone feels like it and has time, will they email me or post their

> cholesterol template and others they find useful? (not critical, I'm

> pretty sure I can ad lib my own too) . Efficiency in processes is

> marching onward, thanks to you all...

>

> AND I hired another biller! Yay!

>

> Lynn

>

>

>

>>

>>Reply-To:

>>To: ' Guinn ' ,

>> " ' ' "

>>< >

>>Subject: RE: RE: [Practiceimp WAS Re: efficiency

>> and money

>>Date: Sat, 21 Oct 2006 10:49:45 -0400

>>

>> PLUS the PATIENT likes the documentation.

>>

>>I call people if something is troulbesome. or they asked me to or it

>> cannot

>>wait.

>>For theri follow up cholesterol etc I have long had a template in t he

>> emr about

>>your good cholesterol is..

>> Your bad cholesterol is...

>>Last time it was ....

>> then I have a short list of bullets- people are at risk of a a

>> heart

>>attack IF... and I list are you male?

>>Do you smoke?

>>etc

>> (it is all pre listed int he template I have other templates for

>> other

>>labs of course Like Pap smear or mammogram etc Your next test is

>> needed....

>>Recommednations......)

>>then the template -for cholesterol-says

>> How many of these do you have?

>>Which ones can you work on?

>>

>>If tehy get good lab results they get a happy face drawn or a

>> sticker Now this seems goofy to post BUT people tell me..I got a happy

>> face! They earned it!

>>

>> Since the emr parses them to lab book then I have it in the chart

>> If

>>they a re in with me I type it into the note and give them the lab

>> report showing them

>> HDL H is happy for the Heart ,

>> ldl L is lousy you want it low

>>.

>>It is all in the teaching.And connecting to them People are " non

>> complaint " becasue " no body ever explained it to me that way "

>>

>>

>> RE: [Practiceimp WAS Re: efficiency

>> and

>>

>> >money

>> >Date: Tue, 10 Oct 2006 22:20:26 -0400

>> >

>> >Lynn, I am finding that I am providing free services to office visits

>>at

>> >a rate of almost 10 to 1. Is that what you mean by admin time? For

>> every visit a patient makes I have to respond to two specialist

>> contacts, one radiology report, two lab reports, two formulary and/or

>> " care management " issues, three phone calls from the patient, and one

>> pharmacy phone call (not a formulary issue).

>> >

>> >

>> > " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>> something

>> >like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>> I'm

>> >going to break down my times even more to see where it's leaking out

>>to.

>> >I

>> >really want to get to a sustainable work load over the next year, or

>> I will

>> >be BERSERK! I'll keep you guys posted. Thanks again for all the

>> support

>> >and it was lovely to see you all in the flesh.

>> >

>> >Lynn "

>> >

>> >In a " big office " where MAs do a lot of this stuff they don't

>> probably realize how much time it eats up, but if you do it all

>> yourself....I have randomly reviewed charts in the past to look at

>> this question. In the past week and a half I have started leaving all

>> charts open until the end of the day... for every patient I actually

>> see during a day there are 9 - 10 more open at the end of the day,

>> for who I have had to do SOMETHING, but for whom I am paid

>> nothing...What can we do about this?

>> >Annie

>> >

>> >

>> >

>>

>>

>>

>>

>>

>>

>>

>>

>>

>>

>>

>>

[Guest guest]

Lynn -- Go for it! And thanks for the post -- the positive mood to it may

just push me to my next efficiency-improving effort. It sure happens in

spurts and stops. I guess it's all about making the spurts more than the

stops until the efficiency gets ever closer to perfection -- won't ever

happen, we just need to continue trying to get there.

.... and, by the way, it's $0.39 for a stamp these days ... I have a pile

of pre-stamped and pre-return-addressed envelopes to use. My kids enjoyed

doing them.

Tim

> Thanks for all the input! The letters have it. I will switch.

> Sounds faster and it cuts off the 'By the way, doctor...' But, are

> you printing out the letters and sending them by mail? It will take me

> at least 45 seconds to address the envelope, stick on the stamp, fold

> the paper etc., not to mention .37 cents postage (or is it .38?) I

> think I'm going to use the email button feature on AC , write the

> letters in the 'letter to patient' feature, copy and paste it into the

> email then print it to a dummy printer so it will save to the chart.

> lFew extra steps there but probably worth it. It's becoming more

> important for my patients to have email. Maybe I'll put that on my

> exclusion from waiting list criteria, along with United (only

> kidding!).

> If anyone feels like it and has time, will they email me or post their

> cholesterol template and others they find useful? (not critical, I'm

> pretty sure I can ad lib my own too) . Efficiency in processes is

> marching onward, thanks to you all...

>

> AND I hired another biller! Yay!

>

> Lynn

>

>

>

>>

>>Reply-To:

>>To: ' Guinn ' ,

>> " ' ' "

>>< >

>>Subject: RE: RE: [Practiceimp WAS Re: efficiency

>> and money

>>Date: Sat, 21 Oct 2006 10:49:45 -0400

>>

>> PLUS the PATIENT likes the documentation.

>>

>>I call people if something is troulbesome. or they asked me to or it

>> cannot

>>wait.

>>For theri follow up cholesterol etc I have long had a template in t he

>> emr about

>>your good cholesterol is..

>> Your bad cholesterol is...

>>Last time it was ....

>> then I have a short list of bullets- people are at risk of a a

>> heart

>>attack IF... and I list are you male?

>>Do you smoke?

>>etc

>> (it is all pre listed int he template I have other templates for

>> other

>>labs of course Like Pap smear or mammogram etc Your next test is

>> needed....

>>Recommednations......)

>>then the template -for cholesterol-says

>> How many of these do you have?

>>Which ones can you work on?

>>

>>If tehy get good lab results they get a happy face drawn or a

>> sticker Now this seems goofy to post BUT people tell me..I got a happy

>> face! They earned it!

>>

>> Since the emr parses them to lab book then I have it in the chart

>> If

>>they a re in with me I type it into the note and give them the lab

>> report showing them

>> HDL H is happy for the Heart ,

>> ldl L is lousy you want it low

>>.

>>It is all in the teaching.And connecting to them People are " non

>> complaint " becasue " no body ever explained it to me that way "

>>

>>

>> RE: [Practiceimp WAS Re: efficiency

>> and

>>

>> >money

>> >Date: Tue, 10 Oct 2006 22:20:26 -0400

>> >

>> >Lynn, I am finding that I am providing free services to office visits

>>at

>> >a rate of almost 10 to 1. Is that what you mean by admin time? For

>> every visit a patient makes I have to respond to two specialist

>> contacts, one radiology report, two lab reports, two formulary and/or

>> " care management " issues, three phone calls from the patient, and one

>> pharmacy phone call (not a formulary issue).

>> >

>> >

>> > " I am checking my Admin time: patient time ratio and it is HORRIFIC!

>> something

>> >like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

>> I'm

>> >going to break down my times even more to see where it's leaking out

>>to.

>> >I

>> >really want to get to a sustainable work load over the next year, or

>> I will

>> >be BERSERK! I'll keep you guys posted. Thanks again for all the

>> support

>> >and it was lovely to see you all in the flesh.

>> >

>> >Lynn "

>> >

>> >In a " big office " where MAs do a lot of this stuff they don't

>> probably realize how much time it eats up, but if you do it all

>> yourself....I have randomly reviewed charts in the past to look at

>> this question. In the past week and a half I have started leaving all

>> charts open until the end of the day... for every patient I actually

>> see during a day there are 9 - 10 more open at the end of the day,

>> for who I have had to do SOMETHING, but for whom I am paid

>> nothing...What can we do about this?

>> >Annie

>> >

>> >

>> >

>>

>>

>>

>>

>>

>>

>>

>>

>>

>>

>>

>>

[Guest guest]

Lynn,

Hate to tell you it’s 39 cents for

postage. I have made this process easier by using windowed envelopes and my templated

letter has the patient’s address and my return address in the proper

location so it’s just fold, stuff and stamp. I go for the couple of

cents extra for the self-sealing envelopes.

Also, I try to get my patients to get

their blood work done 2 weeks before OV so I give them the letter at the OV.

But for those visits that create blood work that don’t need a f/u, or the

annual PAPs, etc. They get the letter.

I have offset the cost of this by charging

an annual mailing fee. Those patients that generally ask something to be

mailed to them usually ask for more than one thing. It’s $3/person or

$5/family. A few have said “wow” but no one has really balked at

this. If I only mail one thing, I may not charge next year. Just trying to

get my costs reimbursed not make money on it.

Kathy Saradarian, MD

Branchville, NJ

Solo low-staff practice since

4/03

In practice since 9/90

Practice Partner User since 5/03

[Guest guest]

Lynn,

Hate to tell you it’s 39 cents for

postage. I have made this process easier by using windowed envelopes and my templated

letter has the patient’s address and my return address in the proper

location so it’s just fold, stuff and stamp. I go for the couple of

cents extra for the self-sealing envelopes.

Also, I try to get my patients to get

their blood work done 2 weeks before OV so I give them the letter at the OV.

But for those visits that create blood work that don’t need a f/u, or the

annual PAPs, etc. They get the letter.

I have offset the cost of this by charging

an annual mailing fee. Those patients that generally ask something to be

mailed to them usually ask for more than one thing. It’s $3/person or

$5/family. A few have said “wow” but no one has really balked at

this. If I only mail one thing, I may not charge next year. Just trying to

get my costs reimbursed not make money on it.

Kathy Saradarian, MD

Branchville, NJ

Solo low-staff practice since

4/03

In practice since 9/90

Practice Partner User since 5/03

[Guest guest]

I'm currently filling out a lab letter slip, but am also working on a system

in which I do this in my emr (Praxis), and print it out from there, that way

what I wrote to the patient is already part of the permanent record without

the extra step of scanning something back in.

, I wonder if UpDox would have a feature where you could make the

output from the emr print into an email, and then simply email it from

there? Again, the problem I see with this is keeping track of which patients

communicate with email. In terms of efficiency, I think the system of

responding to lab results has to be standardized, because once you are busy

(as I've become in the past few months, since I " ve grown from 300 to over

500 patients since early summer) you don't want to take time to figure that

out - it has to work for all patients.

Regards,

M. Wilterding, M.D.

711 Encino Pl. NE; Suite D Albuquerque, NM 87102

Fax:

RE: [Practiceimp WAS Re: efficiency and

>

> >money

> >Date: Tue, 10 Oct 2006 22:20:26 -0400

> >

> >Lynn, I am finding that I am providing free services to office visits

>at

> >a rate of almost 10 to 1. Is that what you mean by admin time? For

> >every visit a patient makes I have to respond to two specialist

> >contacts, one radiology report, two lab reports, two formulary and/or

> > " care management " issues, three phone calls from the patient, and one

> >pharmacy phone call (not a formulary issue).

> >

> >

> > " I am checking my Admin time: patient time ratio and it is HORRIFIC!

> >something

> >like 40 hours of admin to 20 patient hours. I have got to FIX THIS!

> >I'm

> >going to break down my times even more to see where it's leaking out

>to.

> >I

> >really want to get to a sustainable work load over the next year, or I

> >will

> >be BERSERK! I'll keep you guys posted. Thanks again for all the

> >support

> >and it was lovely to see you all in the flesh.

> >

> >Lynn "

> >

> >In a " big office " where MAs do a lot of this stuff they don't probably

> >realize how much time it eats up, but if you do it all yourself....I

> >have randomly reviewed charts in the past to look at this question. In

> >the past week and a half I have started leaving all charts open until

> >the end of the day... for every patient I actually see during a day

> >there are 9 - 10 more open at the end of the day, for who I have had to

> >do SOMETHING, but for whom I am paid nothing...What can we do about

> >this?

> >Annie

> >

> >

> >

>

>

>

>

>

>

>

>

>

>

>

>