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Don't Waste Patient, Physician Time with Unproductive Visits

By Ericka L. Adler | August 8, 2012

The medical profession is a service industry. Part of what makes any service business successful is the manner in which it treats its clients. Although I hear a lot of complaints from physicians about how poorly they are treated by patients, many patients are also mistreated by physicians, whether or not it’s intentional.

As a good example, let me relate to you an interaction I had with a physician this week when following up on a radiology test for my daughter. It should be noted that this appointment was rescheduled three times in order to accommodate the doctor’s schedule, and I was "informed" of the change without any effort to consult my schedule. Although I found this unusual, I let it slide.

(MORE: Closing Your Medical Practice: Steps to a Smooth Retirement (Part I))

Upon arrival, I sat in the waiting room for almost one and a half hours before meeting the physician. Although I approached the receptionist multiple times to check the status of the visit, I was provided with neither an apology nor an explanation, other than being told the doctor was with the prior patient. A long delay with a hungry and tired 4-year-old is not a fun experience. I am surprised I did not walk out!

While some delays cannot be avoided, this physician was not called away to an emergency nor did she perform procedures in her office. When I (finally) saw her, she offered no explanation or apology for the delay (although I was clearly unhappy). She then asked if I had brought the radiology CD with me. I was confused by this question, since I was informed by the hospital that a report/CD would be sent to the doctor. When I related this, she indicated that she had received nothing. Although I had spoken to her office numerous times, at no time was I told this was my responsibility or that they had not received the materials. At this point, it became clear to me that not only had I wasted my time waiting for her, but that the appointment was worthless as well. I will end my story here, but suffice to say I will not return to her office.

As fine a physician as you may be, your interactions with patients affect their impression of you and whether they recommend others to you. How should you avoid the outcome I experienced?

1. A physician and his or her staff should apologize and provide an explanation for delays. An estimate of the delay and an offer to reschedule may be appropriate. Assurances that such delays are out of the ordinary is reassuring to a patient. Train your staff accordingly.

2. There is no reason for hour-plus delays in a typical medical practice. If you are not watching the time you spend with your patients, have a staff member keep you on schedule. While delays do sometimes occur, avoid seeming disrespectful to your patients. Imagine if you went to see a lawyer and had to sit one and a half hours without explanation — would you return? Treat others as you would want to be treated.

3. Inform your patients of expectations regarding materials needed for an appointment. Do so when the patient makes the appointment and in any follow up calls. Note in the file every time the patient is informed. Had I known the physician did not have what she needed, I would have made necessary arrangements! Remember, in the end I am out time, but this physician was not able to bill or be reimbursed for any services. If there is no practice policy to avoid this issue, lost revenue and patient frustration is sure to build.

4. Don’t let your patients leave the office upset, whenever possible. No practice needs patients who are likely to file Internet complaints or spread badwill regarding you or your practice, especially if it’s avoidable.

Interacting with clients in any industry can be challenging. Proper management and training of staff can help avoid many patient issues. While practicing medicine is certainly a noble profession, it is also a business. Success or failure of any business can depend on how your customers are handled.

Find out more about Ericka Adler and our other Practice Notes bloggers.

 

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by Andrew Johnstone | August 15, 2012 12:06 AM EDT

Oh, so a lawyer or accountant wouldn't run that late... COULD that be because a lawyer or an accountant can set his or her own fees, be assured they will be paid in FULL, and can therefore budget the time spent with their clients accordingly? If a visit does run over time, they can actually charge for the extra time. THAT CAN'T BE DONE IN THE AVERAGE MEDICAL PRACTICE...!

Even if it were actually possible to charge for a 99215 (40 minutes) instead of a 99214 (25 minutes), the typical $3/minute overhead you're trying to offset (just to break even) would require an extra $45, and the extra reimbursement is actually more like $30. So, if you were poised to make $15 profit on the 25 minute visit (I'll bet your attorney or accountant makes more profit per time unit than that), after the extra 15 minutes spent to answer the "while I'm here" questions (which typically are NOT ones you can just make the patient make another trip next week to deal with), you are now spending $40 minutes and making ZERO profit. Unfortunately, if it is an Anthem Blue Cross or Medicare patient, you are pretty much threatened with 'punitive' audits designed just to cost you money and tie up your staff, if you dare EVER to charge for a 99215, even if you spend over an hour with the patient, treating multiple complex problems.

So, dear Ericka, the doctor who expects to stay afloat MUST schedule patients into slots averaging 25 minutes or less (the average time spent with a patient is down to six minutes for primary care doctors, according to MGMA), which means either all the patients had better talk fast and only expect one problem to be dealt with, with whatever 'pathway' the insurance deems most to their profit (the doctor and staff won't have time to argue about what tests or medications are best vs. make the insurer more profits), those visits will tend to stretch to longer than the alloted time, and the doctor will run behind. Scheduling less patients per hour is not an option, because we cannot get PAID for that extra time.

Do you go to a restaurant and expect prompt and courteous service, but only pay for an appetizer, yet receive a four-course meal and drinks and dessert, without paying a dime extra for all that...?

If you want decent health care, quit having your employer sneak money out of your paycheck (more than you probably realize), and use it to pay an insurance company, which contracts with a hospital, which hires a physician, who works on a quota-and-bonus system. Instead, try going to a direct-pay practice, and paying for your medical care yourself - like you do your groceries, your car repair, and your accountant. It would cost you far less than the convoluted and inefficient system you're using now...!

More from Ericka L. Adler:

Negotiating the Sale of Your Medical Practice

Preparing Your Practice for a Possible E&M RAC Audit

Addressing Compensation for Disabled Physicians at Your Practice

Home Health Agency Referrals: A Guide for Physicians

Medical Loss Ratio Rebates: Distributing Them Properly

Abusive Patient Behavior: Physicians Have 'Rights' Too

Don't Waste Patient, Physician Time with Unproductive Visits

Implementing Complementary and Alternative Medicine at Your Practice

Qui Tam Lawsuits: A Threat That Should Concern Physicians

The National Practitioners Data Bank: What Physicians Should Know

Medicare's 2013 Proposed Fee Schedule: The Physician Impact

Physician Recruitment Agreements: Concerns and Considerations

Understanding Physician Recruitment Agreements

Point-of-care Dispensing: Profit, Penalties, and Your Practice

Physicians: Be Cautious When Taking on a Medical Director Role

Understand the Legal Limits of Physician Advertising

Hospital-driven EHR Mandates: Boosting Physician Use, But at What Cost?

Text Messaging and Patients: Benefits and Considerations

Closing Your Medical Practice: Steps to a Smooth Retirement (Part II)

Mentoring Young Physicians: Feedback Is Important to Future Success

Employees vs. Contractors in Medical Practice: What's in a Name?

When the Difficult Physician Is You: Let Your Lawyer Do Her Job

Online Defamation Can Hurt Your Medical Practice Reputation: Be Prepared

OCR's HIPAA Audits: Get Organized and Be Prepared

Creating a Social Media Policy for Your Medical Practice Staff

Addressing Sexual Harassment at Your Medical Practice

Distribution of DHS Income for Physicians: Avoid ‘Stark’ Consequences

Physicians Selling Products: Legal and Ethical Considerations

Balancing Patient Interaction, EHR Use at Your Medical Practice

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How Should Your Medical Practice Handle an Impaired Physician?

Addressing Patient Financial Hardship at Your Medical Practice

Physicians and Self-Prescribing: Just Say ‘No’

Crafting Non-solicitation Provisions in Physician Employment Contracts

Poor Recordkeeping by Physician Employees: Grounds for Termination?

Concierge Medicine: Doing It Right Can Boost Practice Income

Practicing Medicine in New States Can Come with New Issues

Holiday Gifts from Patients: Four Considerations for Every Practice

Navigating Restrictive Covenants in Physician Employment Agreements

Audits: Why They Happen and What Your Medical Practice Should Do

Ancillary Services Can Add Practice Revenue, But Follow the Law

Groupon: Great for Prada Shoes, But Not Physician Services

Discharging Patients with Unpaid Balances

Seven Possible Legal Pitfalls at Your Medical Practice

Clarify Future Equity for New Physicians at Your Medical Practice

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Avoid Self-disclosure to CMS: Plan an Annual Legal Audit at Your Practice

Closing Your Medical Practice: Steps to a Smooth Retirement (Part I)





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