Medical practice inefficiency is a widespread problem, and achieving practice efficiency is not an easy task. According to Steven Bush, MD, chief executive officer of Fox Valley Women’s & Children’s Health Partners, a mid-size multi-specialty clinic based in St. Charles, Ill., many medical practices are unable to implement efficiency changes because they are often economically strapped.
“The problem is that as reimbursement has continued to drop, physicians have found themselves spending more time working to generate the revenue they need to keep their businesses open and support their families, and that gives them less time trying to become more efficient,” explains Bush, who also consults other practices on the elusive aspect of efficiency. “If physicians became more efficient they actually could generate more revenue, but they’re in this vicious cycle of not being able to achieve that.”
Linking two efficiencies
Bush says that there are two types of efficiencies in a medical practice: administrative efficiency and clinical efficiency. They go hand in hand, but, more specifically, they are almost inseparable. Problems arise, he says, when the person running the administrative side of the practice doesn’t understand the clinical side.
Does that mean hiring a medical practice administrator? Not an attractive option from an economic standpoint, says Bush, but also unnecessary.
“The best thing is to have a physician champion in the practice,” Bush says. “One of the partners, or one of the physicians in the practice, who takes on the role of being an efficiency expert and helps with the ability to make things flow better.”
And getting all the physicians on the same page is the place to start.
Bush explains that his practice is protocol-driven. The doctors within each specialty area get together and establish protocols, or guidelines, for how every type of condition or illness will be treated. Once those protocols are established by the physicians, once those guidelines are in place, the practice runs more efficiently.
“A great example would be with electronic medical records,” Bush says. “If every doctor is designing their own template for the same condition, let’s say asthma, which is what a lot of the EMR companies have them do, you could have four doctors in your group and four different asthma templates. How do you function efficiently with your staff?”
Fox Valley was an early adopter of the electronic medical record, and now has one set of templates for OB-GYN, and one set for pediatrics. The difference has been dramatic in terms of practice efficiency.
“It allowed the physicians to practice medicine,” Bush explains. “It allowed our allied health care professionals to take the information, based on the fact that there were efficient standards set up, and to deal with patients quickly because they already knew what the solution was when the problem was presented to them because we had already agreed with how to deal with these problems. No doctor in the practice stays until 10 o’clock at night making follow up phone calls. Triage nurses handle everything during the day. It allows for a more fluid clinical management scheme where patients are being taken care of at the time rather than having all these delays and issues.”
Just a tool
But if you think that simply integrating an electronic medical record into your practice will automatically make workflow more efficient, Bush says that’s not the case. He agrees that having an electronic medical record is key to improving practice efficiency; that it’s imperative to having quick, easy access to a patient’s medical information, but he points out that implementing an EMR alone won’t get the job done.
“There’s probably 600 EMR vendors out there, and the problem is that every one of them is promising efficiency and standardization and achieving meaningful use, but what they don’t explain is how much time it will take and all of the inherent expectations that go along with being able to achieve it,” Bush says. “It’s not just having an EMR that makes you efficient. It’s a tool that helps you maintain efficiency.”
But EMR companies don’t tell physicians that.
“If a physician thinks if he or she gets this EMR it’s going to make them efficient, no, it actually makes you less efficient in the beginning,” he says.
And, adds Bush, don’t be surprised if along the way toward achieving practice efficiency you find yourself adding staff.
“To run efficiently you need to have a little more staff rather than a little less, but quality of life improves significantly among physicians,” he says. “And your outcomes are much better.”