Best Practices: The Front Office

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Best PracticesThe Front Office

• Removing the Roadblocks to Efficiency

Kathie Huttegger, MBA,, CMPE Administrator St.
Louis Pediatric Associates, Inc.
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Best PracticesThe Front Office

• Define Reality
• Identify the bottlenecks
• Increase efficiency

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The Right Questions

• What is a best practice?
• What are the functions of the front office?
• Definitions of some key principles

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Defining Reality

• Max DuPree Leadership Is An Art
• The first responsibility of a leader is to
  define reality. . .

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Wrong Jungle
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Defining Reality - Differences

• Primary Care versus Specialist
• Single Specialty versus Multi-specialty
• Number of sites
• Ancillary service offerings
• Use of midlevels
• Cost or accrual based accounting
• Physician compensation
• Payor mix
• Many other variables (triage, billing, etc.)

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Defining Reality - Similarities

• Provide medical services
• Face increasing costs
• Struggle with reduction in payment
• Patients
• Staff
• Physicians

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MGMA Best PerformersIn Three Critical Areas

• Profitability and operating costs
• Productivity, capacity and staffing
• Accounts receivables and collections

See Key Indicators Handout Expanded
Quantifiers of Better Performing Practices
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What are the functions of the front office?
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Front Office Multi-Functional
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Director of First Impressions
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Can Help or Impede Patient Flow
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Touches Revenue Cycle at Multiple Intervals
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Removing Roadblocks to Efficiency

• Throughput Money coming in (profit)
• Operating Expense money going out to make
  throughput
• Inventory Money stuck inside

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Bottleneck

• A resource whose capacity is equal to or less
  than the demand placed upon it.
• The flow through the bottleneck must equal the
  demand from the market.
• Capacity of a process is the capacity of its
  slowest resource

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Bottlenecks or Roadblocks

• Crowded reception area
• Irritable patients
• Financial underperformance
• Burnt out staff

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Causes of Bottlenecks

• Too much paperwork
• Poorly planned processes
• Inefficient office design
• Miscommunication between staff
• Poor scheduling

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Productivity

• Accomplishing something in terms of goals
• Meaningless if you dont know the goals

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The Goal

• Reduce operational expense
• Reduce inventory
• Increase throughput
• More important to increase volume
• Expand hours with providers with no increase in
  fixed costs
• Incorporate efficiencies to increase patient
  volume

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What is Our Goal?

• The Right Number of Staff
• In the Right Place
• With the Right Skills
• At the Right Cost
• With the Right Behavior
• With the Right Rewards
• With the Right Outcomes
• No More No Less

Deborah L. Walker 2003
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The Goal Defined by Jim Collins
In Good to Great the bus doesnt leave until .
. .

• Get the wrong people off the bus
• Get the right people on the bus
• Get the right people in the right seat on the bus

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• Count what is countable,
• measure what is measurable,
• and what is not measurable,
• make measureable
• Galileo Galilei (1564-1642)

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• You cannot manage what you
• cannot measure and
• what gets measured gets done!
• Bill Hewlett

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Dynamic Relationship of Staffing Levels With
Accounting Functions
Productivity
Revenue
Expenses
Profit
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Physician Time

• Data suggests that most critical resource in a
  medical group is physician time

• Profit is a function of productivity and the cost
  of the resources that enable productivity

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Waiting Room Time
Yes, I have an appointment. Should I also have
made a reservation?
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Standard Production Measures

• Telephone calls w/messaging 180-200
• Appointment scheduling 75 125
• Check-In with registration
• Verification and copay collection 75 100
• Check-Out with schedule of return appointment and
  charge entry 70 - 90

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The Peasant and The King
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Managements job is not to see the company as
it is . . . But as it can become. John W.
Teets
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RE-ENGINEERING THE FRONT OFFICE

• R eliable
• E fficient
• S ervice
• P atient-Focused
• E nergy
• C ustomization
• T rust

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Put the Cookies on the Lower Shelf
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S N A P

• Smile
• Name
• Ask May I help you?
• Parting comment

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The Five Whys
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Best PracticesThe Front Office

• Define Reality
• Identify the bottlenecks
• Increase efficiency

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You are NOT Alone . . .

• Books
• The Total Service Medical Practice by Vicky
  Bradford, PhD
• Mastering Patient Flow by Elizabeth Woodcock,
  MBA, FACMPE
• Good to Great by Jim Collins
• The Goal by Eliyahu M. Goldratt
• The Fifth Discipline by Peter Senge
• All books by John Maxwell
• Medical Group Management Association
• Local www.mgma-sl.org
• State www.mgma-mo.org
• National www.mgma.com
• Other Organizations
• American Academy of Family Practice www.aafp.org
• Organization of your specialty
• The Journal of Medical Practice Management

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Our Role As Leaders . . .
Finding the gifts people have to give Inviting
them to give them, andHonoring the result when
they do
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DONT GIVE UP . . .