I Work For Dr. Needy

After sixteen years in medical practice management, I can sense a medical environment rife with chaos, soon after walking in the door.  Years ago, when reimbursements were high and the rules of medicine less stringent, a freewheeling office was often overlooked.  A claim lost here or there, a missing authorization was almost expected as part of the daily routine.  Papers and charts strew everywhere, the doctors desk a veritable mountain of "to do" lists often defined the face of your physician.  Patients were willing to wait almost forever and money flowed freely.

Today, medicine is a business deal, clawing and scratching for every dime.  HIPAA regulations abound, CMS and the private insurance companies holding on to every last cent of reimbursement and expecting near perfection before they release the thinnest of dimes.  Unfortunately, even with all these new expectations, if you work for Dr. Needy, chances are your office is on a serious downslope.

Despite the most stringent of job descriptions and army style training, there are only so many hours in a day.  Your employees will keep busy until the end of their shift and then they will go home.  They don't have a vested interest in your practice and as long as they perform the hundreds of tasks that Dr. Needy requires, a clear conscience will carry them out the door, while the practice money flies out the window.

Dr. Needy is characterized by an inability to separate the practice of medicine from the business of money.   He is constantly at the front desk, looking for a pen, a prescription pad, a chart, a routing slip, etc, etc, etc.   Sometimes he even leaves his private cell phone for the girls to answer to assure he never misses a call from the wife or kids or buddies.  He can never find anything alone, is incapable of working quietly behind a desk in his own office, and consequently, no matter if he has one employee or ten, all of them will be dancing all day long, while the business suffers a slow agonizing decline.

You often find that Dr. Needy has practiced medicine for some time.  His father may have been a doctor and he is stuck somewhere in the world of the 1950's or 60s, believing that he knows everything there is to know about running an office and practicing his specialty.  He suffers from tunnel vision, doesn't feel he has the time to read a fax, or understand how to move forward, unless his entire small universe is spinning round and round.

What happens in Dr. Needy's office ?   He is either with every patient for one hour, or three minutes.  His charts are everywhere, dictation lags, bills are submitted too late to meet the timely filing requirements.  Not a single drawer is organized, verification is left undone, the front desk scans only the front of the insurance card, no one ever checks the patient's outstanding balance, co-payments remain uncollected while the secretaries find pens, make calls, and run around with no meaningful purpose,  They payroll is escalated since the only time to prepare for the next days patients is after the doctor leaves the office.  It becomes the norm for papers to accumulate on the floor, the bathrooms never get cleaned and in general, it looks as if a small typhoon has blown through leaving disaster in its wake.

There are a number of physicians who rent their space, hang their diplomas and forge ahead, seeing a large volume of patients every day and scratching their heads when everything goes haywire.  In the case of Dr. Needy, it may be wise to hire a consultant to bring some order back to the arena.  Caution is urged in this matter, since you do not want to bring someone into your office who is going to alienate your staff and leave you with an empty office.  As a consultant, I have often heard the staff tell me that they have heard my procedures all before and they never worked.  They were often under the wing of a consulting company that believed that browbeating was the best employee approach, and the staff was often left with a built in hostility for anyone with a good idea or a policy or procedure that was innately successful. So choose wisely - someone who knows how to motivate the staff and explains why the proposed changes will benefit them in the long run and make their jobs easier.

You may want to consider getting Dr. Needy a medical assistant.  This individual can not only take the patient's vitals and chief complaint, but also make sure that Needy has his pens and pads handy, his rooms stocked, and to urge him to move from room to room without interruption.   I found it useful for the snail-like physician to show him his minute by minute reimbursement when he decided to lounge in a particular room for an extended period of time.  

Make sure, once again that your doctor understands the review of systems and how this can guide him through his daily schedule and help decide the correct options for the treatment of the patients and the need for consultation.   Always give Dr. Needy a break in his schedule.  Inevitably, he will need to run to the store or the bank or on a household errand, not connected to medicine.   Urge him gently to finish his chart notes and billing and to move the day forward.

Above all, try to keep Dr. Needy away from the check in and check out areas.  Patients are sure to note if the doctor seems disorganized and will walk out of the waiting room if they get the wrong impression. The office should be as quiet as possible, with the front office team performing their tasks in an organized pattern.  Phones should be answered in as few rings as possible and save the schedule preparation for your least busy appointment hours.

Dr. Needy can be re-trained if he notes an improvement in his reimbursement rate and his staff seems less distracted and more purposeful.  It is imperative that these changes be made.  In the next ten years, it appears as if many medical practices will fall by the wayside, simply because their infrastructure is flawed.  We will inevitably lose good physicians who simply never learned the business of medicine.