Medical practices have a variety of strategies they can employ to boost revenue. One of the most common is to increase the number of patient visits, but another potentially beneficial strategy may be to decrease that number.

Doctors who are already overburdened by their caseloads may not be enthusiastic about having to squeeze even more patients into the office each day. But Ken Hertz, a principal with the Medical Group Management Association’s (MGMA) consulting group, said it does not have to be a dramatic number. In a 3-doctor practice, adding 2 patients per doctor each day would increase visits by 30 patients a week. “That can create a big swing in the bottom line,” he said.  

So how does this become a reality? First, physicians need to be as self-aware as possible regarding their efficiency with patients, Hertz said. If a physician sets 20- or 25-minute visits and he and his nurse are always running behind, it may be time to take a look at their office routines.

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Shadowing efficient doctors

One way to improve efficiency is to have doctors shadow other doctors who are extremely efficient to see how they deal with patients and work through their schedule. Another tactic is using support staff to maximize a physician’s time. Having non-physician office staff transcribe medical records or process patients quickly is helpful. One physician Hertz worked with when paper records were still common created a checklist tailored to his patients’ needs. During an exam, he would check items for a nurse to do when he left the room. When he was done, he just put the checklist in the door slot so he could move to the next room without waiting to confer with the nurse.

In its 2017 DataDive Cost and Revenue Survey, MGMA found that offices with more physician extenders and other support staff had higher revenues. Practices with a ratio of .41 or more non-physicians to providers earned more than those with .20 or fewer, regardless of the specialty. The offices with more support staff reported having 34% to 55% greater productivity as well. 

The American Urological Association (AUA) has guidelines for working with physician extenders. Some can perform preventive screening and health assessments, order and interpret laboratory tests, prescribe medication, and assist with surgeries. They can also provide preoperative and postoperative education, do emergency room consults, and care for overflow office patients. They can also sometimes perform minor in-office procedures.

AUA notes that physician extenders’ duties depend on their training, comfort level with what is expected of them, and state laws regulating their practice. The goal, Hertz said, is to use them to free up time so physicians to either see more patients or spend less time with those who are not big revenue generators.

If they are used correctly, the cost of bringing on physician extenders should be significantly less than the income that will result, Hertz said. One way to evaluate the potential return on investment is by looking at the number of surgeries and new patient slots that open up for a provider with a physician extender in the practice. 

“Doctors need to go into it with their eyes open and look at innovative and creative ways to use these providers,” Hertz said.

Seeing fewer patients

Although adding just a few patients each day can increase revenue, under some circumstances, seeing fewer patients and spending more time with them can translate into increased earnings. This could be the case for medical practices participating in a value-based payment model that offers financial incentives for managing patient care more cost effectively. In many cases, spending just a little more time upfront with patients can save a great deal of money on the patient’s total cost of care, according to Derek Haas, MBA, CEO of Avant-garde Health, headquartered in Boston.

In an article in the New England Journal of Medicine, Haas and his co-authors make the case that a nephrologist having a 30-minute conversation with patients who need to start dialysis (which they calculate to cost less than $200) can reduce the cost of treatment over the next 6 months by $20,000.  

Too many patients, he said, do not accept they will need dialysis even when it is very likely they will. Because of this, they often put it off until the last minute and end up starting it quickly. This typically means they have to start with a catheter instead of seeing a surgeon in time for fistula or graft creation. Catheters, he said, come with high rates of infection and other complications. “Spending an extra half hour or hour with the patient can mean better outcomes for the patient and saving tens of thousands of dollars,” Haas said. “Just getting that one thing right only takes a bit of time.”

In the article, the authors give other examples of how preparing patients in advance can save thousands in future care. They note that spending less than an hour of time with a nurse in an education session prior to orthopedic surgery has been shown to reduce inpatient lengths of stay and increase the percent of patients who can safely go home from the hospital rather than to post-acute care facilities.

Finally, talking with patients who have chronic conditions to encourage and monitor their adherence to treatment can also lower costs, according to the NEJM article. Discussing self-management may cost $200 of office staff time but can save tens of thousands a year in complications and hospital admissions resulting from non-adherence. Haas said that value-based payment models can be empowering for physicians by enabling them to focus on spending enough time with each patient rather than having to continue to see more patients to earn higher income.

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