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Practice Management for the Millennium How to Improve the Efficiency of Your Practice and Enhance Re

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Title: Practice Management for the Millennium How to Improve the Efficiency of Your Practice and Enhance Re


1
Practice Management for the MillenniumHow to
Improve the Efficiency of Your Practice and
Enhance Referrals From PCPs
  • Dr. Neil Baum
  • New Orleans, Louisiana

2
Goals 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

3
Needs 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

4
The Four Pillars of aSuccessful Practice
Attracting new patients
Patients already in your practice
A highly motivated staff
Your relationship with referring physicians
5
The 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

6
Secret 1. Find out what the patient wants and
give him/her more of it.
  • Ask and you shall receive!
  • Patient surveys

7
Give 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

8
Secret 2. Find out what the patient doesnt
want and avoid it
  • Patients do not want to wait to be seen by the
    doctor

9
Effective Scheduling
  • Languishing in the waiting rooms causes more
    patient dissatisfaction than any other aspect of
    medical care including fees.
  • Study by AMA

10
Time 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

11
Effective Management of Delays
  • Anticipate delays
  • Apologize
  • See patient at end of day-coffee coupons and
    beeper

12
Effective Management of Delays
  • Call patient at home
  • Apology letter
  • (Dont charge the patient)

13
Second Take Home Message...
  • FEW of us can change health care policy
  • ALL of us can be more sensitive to the patients
    time

14
Who Are the Key Patients?
  • Patients receiving out-patient studies or
    procedures
  • Other
  • Recently discharged patients

15
Advantages of Calling Your Key Patients
  • Fewer calls from your patients
  • Efficient use of your time
  • Very appreciated

16
Response 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.

17
Attracting New Patients
  • Public Speaking
  • Seminars
  • Lectures
  • AARP
  • Junior League
  • Church groups
  • Service organizations

18
Writing to attract new patients
  • Local magazine
  • Newspaper
  • Health publications

19
Using 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

20
Internet
  • 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

21
Provide value-added services
  • Secure messaging
  • Appointment scheduling
  • Insurance verification
  • Prescription refills
  • Access to patients medical record
  • Procedure-specific information

22
Notify Current Patients of Your Web Presence
  • Stationary
  • Brochures
  • Calling cards

23
What 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

24
Final 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

25
The 3rd Pillar of aSuccessful Practice
Enhance your relationship with referring
physicians
26
Some 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!

27
How 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

28
Potential 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)

29
Marketing To Referring Physicians and Their Staffs
30
Educating 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

31
Suggestions 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

32
Enhancing Communication With Referring Physicians
33
Why 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

34
Traditional Referral Letter
  • Long
  • Arrives in 10-14 days
  • Expensive

35
Key Ingredients of a Referral Letter
  • Diagnosis
  • Medications
  • Treatment plan

36
Computerized 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
37
Advantages 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

38
The 4th Pillar of aSuccessful Practice
Motivating your staff
39
Highly motivated staffs follow a mission
statement
40
What is a mission statement?
  • A truth told in advance that tells where you and
    your practice are going

41
Our 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

42
Where to display the mission statement
  • Reception area
  • Exam room
  • Employee lounge
  • Brochures
  • Newsletters
  • Stationary
  • Web site

43
I could conquer the world if I had enough red
ribbon.
  • Napoleon

44
ABCD Awards
  • Above and
  • Beyond the
  • Call of
  • Duty

45
Second Take Home Message
  • If you take outstanding care of the staff, they
    will take outstanding care of your patients!

46
Performance 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?

47
Surprise the Staff
48
Surprise 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

49
Improve 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

50
Improve 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

51
Equipment for Office Videos
  • Video camera
  • Tripod
  • Script

52
Getting Started
  • Gather information
  • Tape record a conversation with a pt.
  • Review pamphlets and educational materials from
    pharmaceutical and medical manufacturing
    companies
  • Review other videos

53
Prepare 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.

54
Advantages 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)
56
Examples of My Office Videos
  • Please check my website
  • www.neilbaum.com

57
Do our colleagues appear a little sullen and sad?
58
Lost LHRH Agonist Income
59
Income By Size of Group
x
60
Identify what it takes to make your practice
financially successful
  • Gross Collections of 1m\year

61
Projected 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)

62
Average 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

63
EMR
  • Doctors must document normal findings in Hx and
    PEx in order to receive E M credit for their
    codes

64
EMR
  • Doctors must document normal findings in Hx and
    PEx in order to receive E M credit for their
    codes

65
EMR-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

66
ROI-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!

67
Before and After EMR-NP
68
Before and After EMR-EP
69
Take Home Message
  • There are a lot of opportunities, i.e., a big
    pie, for urologists
  • We just need to grow the pie

70
Summary
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?
71
Let Me Hear From You
  • Nbaum_at_dialogmedical.com
  • www.neilbaum.com
  • FAX 504 891-8505
  • Office Phone 504 891-8454

72
Suggested Lunch and Learn Talk to PCPs
73
Urinary Incontinence
  • When To Treat and When To Refer

74
Goals 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

75
Urinary 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

76
Common 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

77
Risk Factors for UI
  • Immobility
  • Impaired cognition
  • Morbid obesity
  • Smoking
  • Environmental barriers
  • Diabetes, stroke, estrogen deficiency, pelvic
    muscle weakness
  • Medications

78
Medications Causing UI
  • Diuretics
  • Caffeine
  • Anticholinergics
  • Psychotropics
  • Narcotics
  • Alpha adrenergic blockers and agonists
  • Alcohol

79
Types 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

80
Evaluation of UI
  • History-drug history
  • Physical examination-abdomen, pelvic, DRE
  • Measurement of PVR
  • UA, C S if there is pyuria or bacteruria

81
Medical Management of UI
  • Anticholinergics
  • Smooth muscle relaxants
  • Alpha adrenergic agonists
  • Estrogens
  • Exercises
  • Mechanical compression

82
Indications for Urologic\Gynecologic Referral
  • Failed pharmacologic management
  • Hematuria
  • Recurrent UTIs
  • Overflow incontinence
  • Large post-void residual
  • Urinary retention
  • Incontinence associated with anatomic
    abnormalities

83
Summary
  • 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
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