Title: Practice Management for the Millennium How to Improve the Efficiency of Your Practice and Enhance Re
1Practice Management for the MillenniumHow to
Improve the Efficiency of Your Practice and
Enhance Referrals From PCPs
- Dr. Neil Baum
- New Orleans, Louisiana
2Goals and Objectives
- Identify the needs and wants of the American
urologist - Techniques to market and promote incontinence to
potential patients - How to attract physician referrals for urinary
incontinence - Use of new technology-Electronic Medical Records
3Needs and Wants of Physicians
- Maintain existing patients
- Attract new patients
- Improve reimbursements
- Decrease overhead
- Decrease litigation
- Improve morale of the staff
- Improve the efficiency of the practice
- Put the manage into managed care
- Add new technology to your office practice
4The Four Pillars of aSuccessful Practice
Attracting new patients
Patients already in your practice
A highly motivated staff
Your relationship with referring physicians
5The Two Secrets of Success
- 1. Find out what the patient wants and give
him/her more of it - 2. Find out what the patient doesnt want and
avoid it
6Secret 1. Find out what the patient wants and
give him/her more of it.
- Ask and you shall receive!
- Patient surveys
7Give your practice a check-up
- How do patients perceive your practice?
- Conduct personal interviews
- Create a focus group
- Use a suggestion box
- Commission a mystery shopper
- Conduct patient surveys
8Secret 2. Find out what the patient doesnt
want and avoid it
- Patients do not want to wait to be seen by the
doctor
9Effective Scheduling
- Languishing in the waiting rooms causes more
patient dissatisfaction than any other aspect of
medical care including fees. - Study by AMA
10Time and Motion Study
- ____ Time patient arrive in the office
- ____Time patient taken to the exam room
- ____ Time spent with the provider
- ____ Time patient left the office
- ____
- Total time in office / total time with MD
11Effective Management of Delays
- Anticipate delays
- Apologize
- See patient at end of day-coffee coupons and
beeper
12Effective Management of Delays
- Call patient at home
- Apology letter
- (Dont charge the patient)
13Second Take Home Message...
- FEW of us can change health care policy
- ALL of us can be more sensitive to the patients
time
14Who Are the Key Patients?
- Patients receiving out-patient studies or
procedures - Other
- Recently discharged patients
15Advantages of Calling Your Key Patients
- Fewer calls from your patients
- Efficient use of your time
- Very appreciated
16Response From a Key Patient
- This is the first time a member of your
profession has taken the time to call me at home
and check on my condition. Undoubtedly it will
foster a better relationship between you and me.
17Attracting New Patients
- Public Speaking
- Seminars
- Lectures
- AARP
- Junior League
- Church groups
- Service organizations
18Writing to attract new patients
- Local magazine
- Newspaper
- Health publications
19Using the Internet
- 33 million patients are willing to switch to a
physician who has practice Web site and offers
E-mail access to the practice Cyber
Dialog, 2004
20Internet
- Must be more than an electronic version of your
brochure - Looking for outstanding clinical content
- Credentialed by a legitimate medical sources
- Academic sites
- National organizations and societies
21Provide value-added services
- Secure messaging
- Appointment scheduling
- Insurance verification
- Prescription refills
- Access to patients medical record
- Procedure-specific information
22Notify Current Patients of Your Web Presence
- Stationary
- Brochures
- Calling cards
23What will the Internet do for your practice?
- Increase revenue
- Decrease expenses
- Improve office efficiency
- Improve the quality of care
- Can communicate with most patients in your
practice
24Final Advice On Attracting New Patients
- Make certain that they have easy access to your
practice - Do not allow a new patient to wait 4-6 weeks for
an appointment
25The 3rd Pillar of aSuccessful Practice
Enhance your relationship with referring
physicians
26Some Eye-Opening Opportunities
- Each urologist has approximately 10 loyal
referring PCPs - Average PCP sees 30 patients\day
- Approximately 15 are women, and 10 have risk
factors for UI - Bottom Line 100 women could be screened each
day!
27How to Screen 100 Women\Day?
- Need to educate PCPs to ask questions about UI
- Need to educate PCPs to treat mild to moderate UI
and when to make appropriate referrals to a
urologist
28Potential income from 100 screened women\day
- IOVs
- FU visits
- UA, urine C S
- Urodynamic studies
- Cystoscopies, BUS, Flow Rates
- Surgery (Needle Suspensions, Slings)
- Other urologic conditions (UTI, Stones, Cancer,
IC) - Opportunity to treat family and friends
(vasectomies, BPH, CaP, ED)
29Marketing To Referring Physicians and Their Staffs
30Educating Referring Physicians
- Lunch and Learn Programs
- Meet with PCPs and their office staffs to discuss
evaluation and treatment of UI - UI-When to Treat and When to Refer
- 10-12 minute informal presentation
- Follow-up letter
31Suggestions for Lunch and Learn
- No slides or computer
- Informal
- Leave a handout with your name and contact
information - Ask pharmaceutical companies to sponsor the lunch
32Enhancing Communication With Referring Physicians
33Why Do Physicians Refer?
- Returns patients 38
- Reports back promptly 33
- Availability 13
- Friendliness 11
- Scientific talks 7
- Give RPs an active role 5
- Teaching in hospitals and schools 7
- Entertaining 1
- Publish professional articles 1
- Gifts 1
34Traditional Referral Letter
- Long
- Arrives in 10-14 days
- Expensive
35Key Ingredients of a Referral Letter
- Diagnosis
- Medications
- Treatment plan
36Computerized Boiler Plate Referral Letter
Example
Dear was seen
for a problem of . I recommended
. I anticipate
additional visits
and appreciate your authorizing the continued
care in my office. I will keep in touch with you
regarding his progress. Sincerely, Neil
Baum
37Advantages of boiler plate letter
- Reduces the cost (15-1)
- Increases the efficiency of your practice
- Keeps the referring doctor as the captain of the
patients health care ship
38The 4th Pillar of aSuccessful Practice
Motivating your staff
39Highly motivated staffs follow a mission
statement
40What is a mission statement?
- A truth told in advance that tells where you and
your practice are going
41Our Mission Statement
- Commitment to providing the best health care for
our patients - Commitment to exceeding patients expectations
regarding their health care - Commitment to the attention to the LITTLE details
because they make a BIG difference
42Where to display the mission statement
- Reception area
- Exam room
- Employee lounge
- Brochures
- Newsletters
- Stationary
- Web site
43I could conquer the world if I had enough red
ribbon.
44ABCD Awards
- Above and
- Beyond the
- Call of
- Duty
45Second Take Home Message
- If you take outstanding care of the staff, they
will take outstanding care of your patients!
46Performance Review
- Cant be done once a year at salary review
- Suggest every 3-4 months
- Complete worksheet before the review
- What do you like the most about this job?
- What would you like to improve?
- Where do you want to be professionally in the
next 3,6, 12 months? - What can I do to help you reach your goals?
47Surprise the Staff
48Surprise is the spice of life
- Office closes for lunch
- Limo picks up staff
- Box lunch provided on the way to the mall
- Each staff member receives 100 which must be
spent during one hour at the mall on gifts for
themselves
49Improve the Efficiency of the Practice
- In the past, we enjoyed the luxury of low volumes
of patients and high profit margins - Today, we can expect large volumes of patients
with narrow profit margins - Therefore, we will need to see more patients in
the same amount of time without sacrificing
quality and patient satisfaction
50Improve the Efficiency-Office Videos
- Topics-medical discussions that are done one or
more times a day or several times\wk - Annual exam
- Evaluation of ED
- Use of Viagra
- Vasectomy
- Treatment of localized prostate cancer
- Evaluation of incontinence
51Equipment for Office Videos
- Video camera
- Tripod
- Script
52Getting Started
- Gather information
- Tape record a conversation with a pt.
- Review pamphlets and educational materials from
pharmaceutical and medical manufacturing
companies - Review other videos
53Prepare the Script
- Describe the topic
- Why is it important to your health?
- What are the risks and complications?
- What are the alternatives?
- I will return to the room after you have
completed the video to answer any questions that
you may have and provide you with a summary of
the video.
54Advantages of Do-It-Yourself Videos
- Improves efficiency
- Medical-legal protection
- Nice take-home value
- Can use to demonstrate patient understood the
material
55(No Transcript)
56Examples of My Office Videos
- Please check my website
- www.neilbaum.com
57Do our colleagues appear a little sullen and sad?
58Lost LHRH Agonist Income
59Income By Size of Group
x
60Identify what it takes to make your practice
financially successful
- Gross Collections of 1m\year
61Projected expenses M.D. Salaries
- How much is required month\week\day\hr? Assume
1million\yr\phy to run practice - Need to collect 83,333\month
- 20,833\week
- 4166\dayor..
- 416\hr (based on 10 hour day)
62Average amount collected\patient encounter
- 83,333\month collections\physician
- 500 patients seen each month\physician
- 106? collected for each pt encounter
- Need to see only 4-6 patients\hr to generate
416\hr or 1m\yr
63EMR
- Doctors must document normal findings in Hx and
PEx in order to receive E M credit for their
codes
64EMR
- Doctors must document normal findings in Hx and
PEx in order to receive E M credit for their
codes
65EMR-Fact!
- 85 of all E M records contain normal values
- If you dont document what you did, you didnt do
it! - With EMR, documentation is a click away
66ROI-Return on Investment
- Can easily, ethically, and honestly move from
level 2-3 E M to level 4-5and be able to sleep
at night!
67Before and After EMR-NP
68Before and After EMR-EP
69Take Home Message
- There are a lot of opportunities, i.e., a big
pie, for urologists - We just need to grow the pie
70Summary
The Chinese symbol for crisis is the same as the
symbol for opportunity Do we see the glass of
milk as half full or half empty?
71Let Me Hear From You
- Nbaum_at_dialogmedical.com
- www.neilbaum.com
- FAX 504 891-8505
- Office Phone 504 891-8454
72Suggested Lunch and Learn Talk to PCPs
73Urinary Incontinence
- When To Treat and When To Refer
74Goals and Objectives
- Discuss the incidence and pathophysiology of UI
- Review the evaluation of the patient with UI
- Describe the medical management of UI
- Provide indications for urologic referral
75Urinary Incontinence
- Affects 14 million Americans
- Affects 50 of all patients in nursing homes
- More common in women and the elderly
- Not a normal part of the aging process
- Less than 5 seek help from the medical profession
76Common Causes of Incontinence
- UTI
- Childbirth injuries to the pelvic floor
- Surgical injuries to the urinary tract
- Hormonal deficiencies
- Medications
- Birth defects
- Diabetes
- Neurologic disorders
- Physical Capabilities-lack of mobility
77Risk Factors for UI
- Immobility
- Impaired cognition
- Morbid obesity
- Smoking
- Environmental barriers
- Diabetes, stroke, estrogen deficiency, pelvic
muscle weakness - Medications
78Medications Causing UI
- Diuretics
- Caffeine
- Anticholinergics
- Psychotropics
- Narcotics
- Alpha adrenergic blockers and agonists
- Alcohol
79Types of Incontinence
- Stress incontinence-outlet fails to remain closed
- Urge incontinence-detrusor over activity
- Mixed-stress and urge incontinence
- Overflow incontinence-failure to empty
- Functional incontinence-factors outside of the
urinary tract
80Evaluation of UI
- History-drug history
- Physical examination-abdomen, pelvic, DRE
- Measurement of PVR
- UA, C S if there is pyuria or bacteruria
81Medical Management of UI
- Anticholinergics
- Smooth muscle relaxants
- Alpha adrenergic agonists
- Estrogens
- Exercises
- Mechanical compression
82Indications for Urologic\Gynecologic Referral
- Failed pharmacologic management
- Hematuria
- Recurrent UTIs
- Overflow incontinence
- Large post-void residual
- Urinary retention
- Incontinence associated with anatomic
abnormalities
83Summary
- UI is a common conditions that affect millions of
American men and women - UI can be evaluated in the primary care setting
- Most patients with UI can be medically managed by
PCP - Urologic\gynecologic is referral is indicated in
appropriate circumstances