5 Common Costly Mistakes That Doctors Make


Have you ever wondered what the difference was between physicians that earn an average income and those that earn in the top 10%? Well here are five common significant factors that separate the top 10% from the rest of the pack

Have you ever wondered what the difference was between physicians that earn an average income and those that earn in the top 10%? Well here are five common significant factors that separate the top 10% from the rest of the pack

1) Ancillary Services

The problem that prevents most doctors from using ancillaries in their practice is the lack of experience with the model. As doctors, we tend to be more focused on the technical aspects of providing quality care rather then the business aspect. Capturing ancillary revenue streams is just a more efficient means to run your practice.

The American Board of Family Medicine is requiring proof of competence in the management of chronic disease states as a condition of continuing certification. Practices that have standing orders to screen and evaluate conditions like congestive heart failure, diabetes, coronary artery disease and COPD are recognized as being among the best.

Since it’s good medicine, why not make it good business? For example, why not provide echocardiography in your office and receive income from the technical component of that service? The same could be said for stress echocardiography, and stress nuclear tests.

The shortlist for available ancillary income streams includes:

• MRI and CT scans

• Bone Density Testing

• Mammography

• Lab services

• Echocardiography

• Stress testing

• Noninvasive vascular workup for peripheral vascular disease

• Sleep Studies

• Physical therapy

Done properly, these relationships are a win-win-win, benefiting all parties including the patients. With a little help getting started, this is an easy strategy to implement.

2) Managing Patient CallsWhen a patient calls your office, there are only a few things they are interested in. Most calls are either for:

—Advice concerning a symptom or condition.

—The status of the medication refill.

—Scheduling or results of a diagnostic test.

—Billing or payment information.

The goal for managing your phone calls, should be to get the patient to the right outcome as quickly as possible, using as much professionalism, courtesy and tact as possible. The longevity of your patient relationships has a lot to do with their experience when they call your office.

You'd be surprised how many front office personnel who have no clinical training are offering medical advice over the phone. You'd be shocked at how many times the typical physician’s phone rings before it is answered. I am constantly amazed by front office staff who answer the phone while chewing a wad of gum and who talked to patients using a sarcastic, cutting tone.

Your practice is being branded every time someone picks up the phone in your office. Most of the time, that doesn't happen in a conscious, directed, effective way. The job of the front office person who's answering your phone is to either schedule appointments or direct the call to the appropriate clinical or billing personnel. Your front office must accomplish this in a personable way that makes patients like them.

Getting this right, via training, scripting conversations and mystery shopping is a significant opportunity for many practices. Revenues can increase between 10% and 50% just by perfecting this aspect of the practice.

3) Treating Patients like VIPs

What's the thing that patients like to hear most? Their names. It may seem insignificant, but as a society, we are starved for recognition and reward. We like to be treated as though we are special.

What would happen in your office, if every patient was called by their name five times during a patient encounter? What would happen in your office, if one of the staff members took an extra two minutes at the end of the visit to clarify diagnosis, treatment plan and questions?

Your patients would feel special. And given the choice between receiving medical care and receiving medical care while being treated as a VIP, patients will choose the latter. They will also stay with the practice that treats them as a VIP longer, refer more of their friends and associates, comply better with treatment recommendations and treat the doctor and staff with more dignity and respect.

The better we treat our patients, the better they treat us and the more successful they make our practice.

4) Ask for Referrals

Many highly successful practices are built on referrals alone. Business consultant Joe Girard says that everyone knows about 52 people that they have influence over. He says this because 52 is the average number of people that attend the wedding or a funeral.

So at the end of your patient encounter, that patient can potentially tell 52 other people about you, your staff and your services. Will you give them something worth talking about? Will you ask them to promote your practice? It may seem basic, but if you don't ask for referrals you don't get them.

Successful practices not only asked for referrals, they also measure the referrals they receive and track the sources that send them.

As a physician you don't have to ask for referrals directly. You can do this via your staff, your patient correspondence, signs in your office and other methods. We've work with all of our clients to continually increase their referral ratio. It is a core factor in practice building.

5) Coding and Documentation

According to Medicare claims data family physicians code 99213 about 60% of the time and 99214 about 20% to 25% of the time. This doesn’t necessarily reflect the level of care these patients receive. In many cases it may represent undercoding.

Undercoding can happen due to a lack of understanding of the necessary requirements for documenting a particular E/M code, because of a perceived lack of time to code properly, or just plain fear of a Medicare audit.

According to Peter R. Jensen, MD: “Many of us may be shortchanging ourselves by reflexively coding a routine office visit as 99213 when the clinical circumstances of the encounter justify the higher-level code. We have developed coding habits based on the misconception that repetitive, routine clinical thought patterns must automatically translate into low-complexity medical decision making. We simply do not appreciate the value of our cognitive labor. The best defense against this form of undercoding is a basic understanding of the medical decision making required for 99213 and 99214 visits.”

We offer our clients on voluntary chart audits as an opportunity to train on advanced coding and documentation strategies, and ensure routine compliance. When it comes to this skill set, it's all about repetition. Generally speaking, taking one coding course is not going to be enough for most physicians to improve their skills. This is an area that if practice for several months with an expert mentor, revenues can increase by 10 to 25%.

There are many other areas that can be developed in a physician practice. You will spend many years developing your practice into an ideal one. But the main recommendation is to get started and improve one or two areas of your practice instead of focusing on everything.

Dr. Zahaluk is a practicing physician and the founder of MIP Consulting Group, a coaching and consulting group for physicians only, offering innovative solutions to practice marketing and staff development. The website offers free practice-building tips, a practice diagnostic, and a Make My Practice Work Harder Than I Do individual practice consultation. His new book is, The Ultimate Practice Building Book. He welcomes comments at 800-297-0711.

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