In the face of increasing demands from payers, regulators and patients, many physicians have discovered the value of using collaborative efforts involving practice administrators, clinical personnel and office staff to improve efficiency.
Physicians are achieving success by working with their staffs to identify goals, simplify reporting systems and improve decisionmaking structures. While some expenses may be added initially for such things as consultation services or additional staff, physicians report substantial improvements in areas such as scheduling, booking, collections, information exchange and patient flow. The ultimate result is increased patient and staff satisfaction, as well as increased savings of time and money.
"Doctors will not, and cannot, meet the challenges of the future without building a cohesive team at the practice level," says Preston Ribnick, president of Professional Resources Group, based in South Wellfleet, Mass. Ribnick, whose medical consulting group implements improvement services for healthcare providers, has evaluated thousands of practices since 1979.
Today, he notes, there is a new era of accountability driven by consumers' ability to get clinical information via the Internet and the growing movement to measure quality via report cards ranking providers and hospitals.
"Bad performance is known to a wider audience," Ribnick says. "Physicians cannot ignore this profound revolution."
The Lahey Clinic in Burlington, Mass., is an example of a group practice that implemented a team-based solution to care improvement. Lahey is a not-for-profit, foundation model, multispecialty group practice that links 150 community-based internists, family practitioners and pediatricians with 300 specialists at several medical centers. Their goal was to increase patient satisfaction, enhance service and improve patient outcomes. Growing competition also was a driving force.
Since 1994, the clinic has identified 24 quality initiatives and involved its entire staff of 3,500. "Without exception, these initiatives benefit the patients, and many of them save money as well," says Sanford Kurtz, M.D., Lahey's vice president and COO. "Our goals were achieved through a collaborative effort by Lahey Clinic employees from across the full continuum of care and services."
Lahey reorganized existing staff into multidisciplinary quality improvement teams of various specialties (asthma, cardiovascular surgery, emergency care). Two statisticians were added to support research and to analyze results. Communication was the keystone of the program.
"We constantly communicated the program through meetings, newsletters and sending out case studies and protocols," says Kurtz. "Physicians, nurses, staff and patients worked together as a team. Nurses worked closely with doctors and were responsible for educating patients and helping them with resources." This team method, using nurses to support patients, was effective in reducing emergency room visits and inpatient hospitalization, the greatest area for cost reduction.
"The majority of Lahey's programs did not require additional staff. The one exception was an aggressive outpatient case management program to support high risk patients," says Kurtz. The added staff costs paid off. "The cost differential per member per month in the high-risk population was reduced by more than 10% from $2,500 PMPM to less than $2,225 PMPM," says Kurtz.
That's a significant figure, Kurtz says, because high-risk patients, although they account for less than 1% of patrons, account for more than 30% of total costs.
Using existing staff, Lahey also established an Asthma Center. Through implementation of their new multidisciplinary team approach, they were able to assess patient's needs, devise individualized treatment plans, provide extensive patient education and incorporate follow-up practices.
According to Kurtz, "The total aggregate costs for the asthma program's population went from $33,000 to $7,500; the number of inpatient stays went from 38 visits to 4 visits; and the cost of inpatient stays went from $193,000 to $23,000." Within 1 1/2 years, emergency room visits for high-risk asthma patients were reduced by 87 percent. Hospitalizations decreased 95 percent.
Several national and state organizations can help in implementing a collaboration program. For example, Medical Group Management Association consultants will evaluate practice needs and develop a plan for a fee. "Today, successful practices must have a collaborative practice environment. The risks of noncompliance and inefficiency are too great," says MGMA consultant Richard Hanson.
MGMA is a national organization of 8,300 healthcare organizations and 21,000 individuals, representing more than 209,000 physicians nationwide.
The Professional Association of Health Care Office Managers provides support and training to managers of physician office practices, primarily devoted to the needs of small and solo practices. In addition to 4,000 regular members nationwide, PAHCOM has corporate and student memberships.
The American Association of Medical Assistants is a national organization of medical assistants (administrative, clinical, office managers), medical assisting educators, students and physicians working toward educating office staff. The group has more than 350 local chapters and 45 state societies.
"The bottom line is that if the people working for you are more educated, they are more valuable to your practice," says Betty Springer, president of AAMA's New Jersey chapter. "And knowledgeable medical assistants can help reduce a physician's liability exposure. They're the ones closest to patients."
Similarly, many physicians are turning to independent consulting firms to provide analysis and interventions. Typically, practices with one to four physicians and up to 15 staff members pay between $4,000 to $6,000 for an evaluation, customized programs and staff education by a medical consulting firm. Larger practices may pay double or triple that amount.
"Most clients say they make back the money we charge within 90 days," says George Conomikes, CEO of Conomikes Associates, a Los Angeles-based medical practice management consulting firm.
Conomikes, like the other consultants, says that defining a common purpose is crucial. But he says the key to improvement is structure. "Without structure, most other things fail. To get higher profits, satisfied patients and increased business, you must have clear-cut, decisionmaking points of reference."
Ribnick says most patients and their family members do not have the ability to evaluate the clinical dimensions of care so they define quality on service "on the way they were treated."
To assesses the current level of service quality, Ribnick's firm establishes
baseline service levels based on the scores in areas such as:
To many patients and their families, these issues are the hallmark of the quality of their providers.
Ribnick implements individualized intervention programs based on a practice's specific needs and goals. He measures patient satisfaction before and after intervention based on the National Committee for Quality Assurance's member satisfaction surveys. He also employs "mystery shoppers" to visit and assess their experiences with a practice.
He says the use of his model by medical practices results in an average mean improvement in patient satisfaction of 21 percentage points.
He says he got better results recently working with a Pennsylvania medical group consisting of 11 practices that undertook customer service improvements in telephone performance, access to care and the patient's experience with the appointment and provider.
Although consultants can offer useful suggestions, practices don't necessarily have to spend thousands of dollars to improve. Other tools used by medical practices are today's online practice management systems. Although they may be limited in scope, design or customization, they may cost only hundreds of dollars.
Medical groups may also find that staff and managers within their practices may have good suggestions that will facilitate efforts to enhance provider productivity, profitability and service quality.
Robin Schuman Rapport is a Trenton, N.J.-based writer.