Operational Efficiencies – Keeping the Front Door Wide Open

Thursday, January 16, 2020 | Terri McDonald, VP, Consulting & Nicole Knight, VP, Revenue Cycle Solutions and Consulting

During a pre-conference session at the Fall’19 CV Transforum – Practice Operations Nuts and Bolts Bootcamp – the MedAxiom team presented practical solutions for achieving operational efficiency. The topic was timely based on the responses we received when we later surveyed general conference attendees for their “top of mind” priorities in the coming year. “Staffing and operational efficiencies” landed in the number two position on the list. This is not surprising as we continue to struggle with pressure on margins and balance that pressure with talent acquisition and retention.

So, what is at the root of our struggle to attain operational efficiency? The answer depends on how you define efficiency. As cardiology practice models shifted from private practice to integrated models our view of “efficiency” became unclear. This makes sense – typically ownership and culture creates a unique view of efficiency. But it is especially challenging in the post-practice integration era if there is not a common, unified vision for the cardiovascular service line (CVSL), supported by an effective governance structure – defining efficiency and making us all “owners.” Without those foundational attributes work becomes siloed, leading to redundant, inefficient models of care.

Once the important work required to achieve true integration occurs, dyad-led teams are prepared to tackle the inefficiencies that are inherent in managing dynamic growth in our practices. There is no one-size-fits-all solution to keep your “front door wide open,” but we provided a tool chest in the Practice Operations Nuts and Bolts Bootcamp session. Read on for some of the pearls from the pre-con!

Referral Management

Although many referring providers develop a loyalty for specialty consults, their referral team often seeks the path of least resistance. Establishing goals that are designed to “keep the front door wide open” for referrals is an important first step. Incoming call management and scheduling metrics can be established to help your team understand their goals and measure team performance. This provides the foundation for a simple Plan-Do-Check-Act approach to improving performance. Here are some recommended metrics and goals for your scheduling team:

Call Management	Schedule Management
Call volumes Calls answered – achieve 95 percent rather than letting them go to voice mail Abandoned call rate Time to call resolution – goal 3 minutes Percent calls resolved in the first call – goal 80 percent	Appointment slots filled – goal 80 percent with 20 percent reserved for urgent and same-day requests New and returning patients scheduled within 7 days – goal 80 percent Cancellation and no-show rate – goal ≤ 5 percent

Efficiency Workflows

Working with clients across the country we see common challenges with efficiency workflows in scheduling management. Getting input from your team about what is going right and what is not is a great way to evaluate your workflows and identify opportunities to improve. Redundancies and waste can often be spotted quickly by a simple flowchart of the team’s current processes. Here are a few common workflow issues with recommended solutions:

Common Workflow Issues	Recommended Solutions
Variation in scheduling guidelines among your providers creates inefficiencies and rework	Create standardized scheduling guidelines to assure patients see the appropriate provider within the appropriate timeframe
Passing along issues for resolution produces wasted time and resources	Create job roles that allow your team members to work at the top of their scope
Delays in response to referring providers	Create and market a concierge line
Appointment wait time beyond 7 days	Implement extended appointment hours

Daily staff huddles are very effective as you change processes to improve efficiencies, and on an ongoing basis to manage day-to-day challenges with staffing and call/referral volumes. Routine reporting on goals to the frontline staff and through the CVSL governance structure will keep provider accessibility and patient and referring provider satisfaction as top-of-mind priorities. Communication is essential to success.

Leverage Technology

Electronic communication – The technology within your electronic medical record system can help your practice manage less urgent patient interactions electronically, allowing the patient to message the provider or access instructions through your patient portal. While not all patients will embrace electronic communication, many will. Every successful electronic communication is potentially one or more less phone calls to be managed. Online self-scheduling and new patient “paperwork” are great ways to manage efficiencies with technology, and interest in virtual visit services is growing as an option to expand access to providers.

Schedule optimization – Analytics from your scheduling software provide the data necessary to understand your patient population, and assure that your provider schedule build is optimized to accommodate it. Below are some encounter types with schedule build considerations:

Encounter Type	Considerations for Schedule Build
Routine follow-up care	Evaluate reschedule rates and assure the schedule build is open and reliable with patient reminders at 2 weeks, 3 days and 1 day; working the no answer report can help reduce no-shows!
New patient	Here are the “Four D’s” of new patient access: Define your goals Determine your volumes Dedicate the resource (provider schedule build) Dynamic scalability to adjust with growth
Urgent needs	Some solutions for managing same day/urgent needs include designating a “Doc of the Day,” offering an urgent/same day clinic staffed by an advanced practice provider with physician oversite, dedicated urgent slots in the schedule build, flexibility to accommodate special considerations, such as the need for EKG, lab, imaging, IV Lasix, care coordination
Post-hospital follow-ups	This need has become increasingly complex. Know your volumes Block slots – your team will need to manage these slots dynamically Accommodate a quick turnaround on medical records – outstanding tests, medication reconciliation; differentiate requirements for transitional care and long-term management
Special considerations	Assure the schedule build accommodates the clinical team workflow, customizing time slots to adjust for provider level, record review, documentation, order placement, patient education and procedure prep/scheduling

Here are a few additional schedule optimization “pearls”:

Minimize variation among providers – we know this is hard – but it’s important!
Embed the primary scheduler in the care team to achieve the greatest flexibility
Actively manage the schedule – surveillance and optimization!
Actively monitor slot utilization reports – retrospectively and prospectively

Last but not least team is important.

The amount of improvement you will gain is directly related to the amount of effort the team puts into it. So, it’s important to first determine, and then to socialize your goals to “keep the front door wide open” with the entire care team. Keeping team members informed and engaged creates “ownership” at every level.

Don't miss our two part blog on the number three top of mind issue, physician/hospital alignment, as our consultants discuss moving from transactional to transformational alignment.

Read part one
Read part two

Learn more about the MedAxiom Consulting Team and how we can help you and your organization tackle issues such as physician/hospital alignment models and strategies, staffing/operational efficiencies, APP utilization and more.

Illustration: Lee Sauer