Running an efficient office

Answers in Practice

Rachna Chaudhari

Rachna Chaudhari is the AAD's practice management manager. Her column offers tips in response to common member questions.

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Physicians and practice staff often ask for information relating to office efficiency and productivity. All practices should evaluate their efficiency on an annual basis and take steps for improvement as this can contribute to greater patient satisfaction, decrease overhead costs, and provide for more patient visits, which in turn leads to a healthier bottom-line. The following tips can help your practice achieve these goals.

  • 1. Be on time and stay on time! In order to begin your day with maximum efficiency, you have to start on time. Make sure you are at the office well ahead of your first appointment. Schedule breaks during the day to keep you on schedule. This will keep you from running over your appointment times. Schedule your most time-consuming appointments, such as complicated surgeries, right before lunch so if you run over you are not making other patients wait.

  • 2. Be a smart scheduler. Most dermatologists have full schedules — but are you sure you are actually seeing all of these patients? No-shows and last minute cancellations can actually reduce your revenue as you see fewer patients per day. Track and analyze your schedule for the past month and determine what percentage of patients were actually seen that were scheduled. To decrease your no-show rate, leave room in your schedule for same-day appointments as these patients are more likely to be on time and not cancel. (See table, p. 21.) Also, determine the average time it takes for each of your patients to complete a visit. Track your patients from the moment they check in to when they leave and how much time they spend with each staff person. Determine how much time it takes on average for the dermatologist, non-physician clinical personnel, and office staff to see the patient. You can build your schedule based on these times and ensure the physician’s time is spent in the most productive manner as it is the practice’s greatest asset and responsible for generating revenue.
  • 3. Delegate, delegate, delegate. The physician’s time and expertise is the most important in the practice. All tasks related to non-clinical matters should be delegated to the appropriate personnel. Front desk staff should handle prescription refill requests, scheduling questions, insurance issues, co-payments, etc. If staff needs the physician’s expertise on an issue, train them to speak with the physician during break times or at the end of the day so there is no interference with the schedule. The office manager can help facilitate these interactions and help develop office policies and procedures to address these matters. 
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    • 4. Streamline referrals. Much of a dermatologist’s patient base comes through referrals, so it is important to create a template for referral letters. The template should contain the referring provider’s name and request for the visit, whether it was a consult or referral, the final diagnosis, medications prescribed, and any treatment plans. This will reduce transcription costs and increase efficiency. Office staff can also send the letter to the referring physician through fax or e-mail thereby reducing mailing costs and wait times. In turn, referring physicians will continue sending referrals to your practice as they will appreciate your timeliness.
    • 5. Track the phones. A medical practice has constant interruptions due to telephone calls. Patients call for all sorts of reasons including appointments, prescription refills, and clinical questions, among others. Automating as much of this as possible will lead to greater efficiency. Evaluate all of your incoming telephone calls to determine how many calls your practice receives on average per day, the amount of time staff spend on each call, how long patients have to remain on hold, and the number of dropped calls. Look for areas of improvement. Are there more calls occurring at a specific period of time during the day or week? It may be worthwhile to ask another staff member to help cover phone calls during that time. Are there a lot of dropped calls? This could be due to excessive hold times which could be minimized by allowing patients to leave voicemails or increasing staff support. Make sure to note what the most common questions asked by patients are, as the answers could be noted on your practice website or voicemail recording. Information about your practice’s address, driving directions, financial policies, and insurance forms should be readily available on your website.
    • 6. Be prepared. Make sure staff prepares the office for business every morning. All rooms should be cleaned well ahead of the first appointment time and equipment should be laid out by medical assistants before the physician enters the room. If you use an electronic health record (EHR), make sure the computer is turned on ahead of time and all administrative data is captured by office staff prior to the physician’s documentation. Your practice may find it helpful to standardize these procedures and have checklists available for staff each morning. 
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      • 7. Administrative simplification. Much of a practice’s efficiency is dependent upon insurance information. The current practice model requires physicians to bill an insurer for a service, receive an explanation of benefits (EOB), and then bill the patient for their responsibility after their visit. However, a new method is beginning to take place within practices involving real-time claims adjudication. This allows practices to find out exactly what the patient owes at the time of service. Several vendors and insurers offer a web portal that the practice can log into and determine the appropriate patient charge even before they are seen by a physician. Check with your insurer to determine if this is feasible for your practice as it will help you not only increase your efficiency but proactively collect revenue.
      • 8. Become tech-savvy. As technology continues to revolutionize the health care industry, your practice must find ways to incorporate this into your workflow. If you have not implemented an EHR or electronic prescribing system, investigate whether these technologies will work with your practice. Visit the Academy’s website for a full range of information at Kiosks are also becoming popular in practices as they give patients the opportunity to input all of their demographic and insurance information directly into the office’s practice management system. If your practice does not have a website, consider creating one that can be used with a patient portal for prescription refills, lab results, and electronic communication with the physician.

      Managing an efficient practice isn’t easy, but if you try to implement some of these steps you will begin to see substantial gains. Remember to continually evaluate your office’s workflow and investigate new processes as there is always room for improvement.

Optimum scheduling

According to the Academy’s 2009 Dermatology Practice Profile Survey, dermatologists see 129 patients per week during an average of 34 hours per week. Thus, dermatologists see an average of four patients per hour. The following is an example of an “open access” schedule that allows for same-day appointments in a practice with four providers: 



Optimum scheduling
Optimum scheduling