#13: Patient Volume Dropped
The Plan
After a merger that increased the medical group’s ability to care for more patients, they had high expectations for increased volume and quality of care. The original medical group had a long-time history and was well respected in the medical community and among patients. Referrals were high.
With the merger, office space was reconfigured to give administration more space and additional office staff were hired to handle the anticipated increase in patients. At the same time, the administrative and patient care processes were streamlined to free up physicians, PAs and medical staff from administrative paperwork, enabling them to see more patients and increase billings.
By the second quarter post-merger, new leadership expected to see 15% increase in patient volume and billings, then increases of 20% or more each quarter during the first year.
The Rub
Four months had passed since the merger. First quarter revenue was stable in comparison with historical revenue. Staff were working hard to find their flow and learn the new processes, while having to pick up the slack when two experienced staff members left the practice.
Patient appointments continued at an acceptable pace, but there were grumblings from staff about increased calls from patients seeking status updates on labs and meds. The patient waiting area was abuzz with conversations between patients, medical staff calling patients to exam rooms, and office staff giving check-in instructions to new arrivals.
By the sixth month post-merger, a special mid-quarter review showed a new increase in appointment no-shows and cancellations from a very low 10% to an above-average 19%. Insurance billings had dropped 23% QoQ.
Findings:
- Office Space: The space was enlarged and configured in an open-concept layout which was attractive in theory. In part, leadership thought this would enhance teamwork and be more efficient with shared printers, equipment, and centralized filing. But in practice, the open concept meant that a large office staff worked in close proximity to each other, creating louder conversation, constant activity, and a general perception by patients of chaos. The open view from the check-in counter allowed patients visibility into staff waiting at the copier, boxes and files piled on the floor awaiting attention, and the general activities of a business office. This was also visible to patients in the waiting room.
Click for Solutions. . .
- Check-Ins: When patients entered the office the new open concept had a counter where three admins were seated side by side, but with no indication as to where one should check-in. This resulted in patients entering, then wandering up and down the counter until someone greeted them, then directed them to check-in, resulting in frustration for patients. All chairs in the large patient waiting room were directed to the TV, which was mounted on the wall to the left of the check-in counter, so everyone in the waiting room looked in the direction of the busyness. SOLUTION: Place the two Check-In lanes front and center and add welcome/check-in signs at that area for clarity. The third position was moved from view to reduce confusion.
- Privacy: At check-in there were often two to three patients standing side by side while staff verified birthdates and other personal information. For HIPAA reasons, each patient was given a number (verbally) that would be called instead of their name when it was their appointment time. Patients didn’t always alert to a number being called as one would when hearing their name, so there was often confusion and more effort on the staff’s part. SOLUTION: Instead of being given a verbal number, patients were given a card with their number. The card included general care reminders and other information of interest and importance to patients. This immediately improved the prior process.
- Increased Calls from Patients for Followup: In an effort to free up physician time for patients, administrative staff were now responsible for requesting and receiving labs, tests, and other patient followup, and to contact the patient with results. They also fielded calls from patients who were looking for overdue reports. One patient described the problem this way, “I was prescribed medication to take for 10 days and was asked to call the doctor within 3 days to advise on improvement or changes. The doctor also said I would have test results back within one week which would tell me if I had contracted poison ivy or something else. When I called the doctor’s office on day 3 (Monday morning), I left a voice mail to report that the medicine made me nauseas when I took it as directed on an empty stomach, and asked if it would still be effective taken with food. I didn’t hear back from the office until Tuesday afternoon when a staff member called. She either didn’t remember or wasn’t aware of the reasons for my call. When I asked about taking the meds with food, she interrupted me and told me to just stop taking them. When I argued that I didn’t think it was a good idea, she decided to transfer me to a medical assistant. After holding for 10 minutes, I hung up. The medical assistant finally called me back and said ‘you should always take meds with food’. I told her the medication label specifically said to take the meds on an empty stomach. She said, ‘I don’t know who told you that but they’re wrong . . . ‘ and it continued to go down hill from there. Lucky for me, I was able to get an appointment with another doctor (at another group) to help me resolve my issue — a nasty case of poison ivy . . . ” The breakdown was clear — staff were trying to fill the gap between physician and patient without the knowledge to accurately answer routine questions and provide alternate solutions to patients. SOLUTION: Staff continued to request and receive labs, but providers now reviewed reports and provided written instruction for calls to patients. If patients had questions, the provider made followup calls at the end of each day.
- Increased No-Shows and Cancellations: The reason was also uncovered, in part, by the above patient who continued . . . “The original doctor called me a week or so later to see how I was. When I told her about my experience, she was shocked and told me that the calls from staff were a result of their new process and they aren’t medically trained so they can’t really answer questions. I told her I still hadn’t received the results from her labs that were more than a week overdue. She said that their fax machine hadn’t been working so they had to manually call to request lab results over the past week. Great, a broken fax machine on top of everything else . . . I cancelled my follow-up appointment with the office and they called to ask if I really intended to cancel or if I just clicked the wrong answer in my text. I told her I intended to cancel because I was seeing a different doctor and wouldn’t be returning to their office. She said okay, and never asked any followup questions about my decision to go elsewhere.” SOLUTION: A cancelled or no-show appointment results in a same-day call by the Office Manager who requests details for the patient’s decision and tries to regain the patient’s confidence. Findings from these calls are reviewed by office staff and providers weekly for training purposes.