5 ways to improve your medical practice in 2011

Here are five things that you should have on your 2011 To-Do list.

1. Start electronic prescribing. What have you been waiting for? The EMR/EHR? (See number 4 below.) Electronic prescribing can work in a stand-alone (no EMR/EHR) environment. Work flow can be modified, and you will benefit tremendously with additional nurse time available to you after the nurses realize how much phone time they save each day.

Ask your current practice management system vendor what solutions they have for e-prescribing. Ask other physicians what they are doing. Ask for help. Just start!

2. Participate in the Physician Quality Reporting Initiative (PQRI). Physicians who participated in this voluntary pay-for-reporting program from Medicare have received incentive payments in the past couple of years. What does that mean to you? You may be leaving money on the table by not participating. Go to www.cms.gov/pqri/ for information on registration and the quality measures for reporting.

The future of reimbursement change is going to be focused on data management and reporting. Get the PQRI incentives while you gain experience in collecting data and reporting data.

Your initial efforts at creating reports with the new data may take more effort and time than expected, so be patient and find the tools that make the reporting process efficient for your practice operations.

3. Get interactive with your website and initiate patient portal services. Invite your patients to register to receive lab result reports via your portal. Publicize and promote services available via your website that can improve service to your patients by transitioning their requests from the telephone to web transactions. Let patients request appointments and change appointments on your patient portal website. Promote same-day turnaround on prescription renewal requests that don’t require an appointment if made via the portal. Start an “ask the nurse” service on your portal and guarantee two-hour responses — on the portal.

Have you ever tried to get through to your practice using the same phone lines your patients use? Get off the phone and get on the portal!

4. Select and implement an EMR/EHR. No one should be surprised that EMR/EHR implementation is on the list of the top five things to do in 2011, but you may have been surprised that it is not number 1. But moving it down the list should actually make implementation easier.

If you’re anxious or unsure of how to integrate technology into your practice, you are more likely to be successful by taking a stepping-stone approach to implementing change.

Get your fingers wet on your technology trek by starting with a patient portal or PQRI or even e-prescribing (see numbers 1, 2, and 3). Your practice will reap operational benefits of a patient portal while also delivering improved service to your patients — the customer of your practice.

After adopting one or more of the less-invasive technology tools, you and your staff will be better prepared as you consider work flow changes to more effectively adopt an electronic record.

Start in your own community and investigate solutions that may be offered by your affiliated hospital. Visit practices that you have referring relationships with to see how they have integrated an EHR into their work flow.

Be patient, but persevere on your path to full electronic record keeping.

5. Optimize staffing. Examine your staffing levels and benchmark to other practices. Look at specialties like yours. Compare yourself with those that are using an EMR/EHR. Look at FTE (full time equivalent) numbers in total as well as by type of position. Compare yourself to other practice productivity benchmarks.

And remember, “optimize” does not equal minimize. Optimized staff levels mean that your practice has the right number of people performing in the right roles to realize your production and profitability goals.

It is not about just one number, but how the combinations of indicators deliver the bottom line. In fact, better performing practices often have higher per-provider staffing numbers than other practices.

So, that’s my recommendation for your top five for 2011.

Get started, get ahead, get ready for the next change coming.

Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.

Originally published in MedPage Today. Visit MedPageToday.com for more practice management news

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  • MassachusettsPCP

    In other words, hire more and more staff and IT professionals at your overhead expense. No additional revenue will be generated from the payors. You will be measured against your peers and by PQRI/Medicare criteria, including the eventual proverbial stick for non-compliance. Your financials are your problem. We may give you a line about how you get 25 cents back in improved productivity, less phone line use, less pulling of charts or various other reasons. Still it will probably cost you 50 cents or more overall in additional expenditures of capital and human resources. While the grocery store, bank and anyone else who automates can pass on these necessary expenses for efficiency to customers your revenue from third parties is fixed and likely to decrease. Thanks for your understanding.

    • jsmith

      You sound like a guy who actually has to run a business and at least break even. If so, it’s probably best to ignore these suggestions.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    That about covers it.

  • Frank in L.A.

    With attitudes like those of MassachusettsPCP and Dr. Mary Johnson, it is not surprising that so many physicians are still running their offices like in the 90′s.

    One wonders how a physician can claim to be up to date from a medical standpoint but still think that technology for the business side of the operation should be mired in technology that has been out of date for 20 or more years (if you want a good example of that, think of fax machines).

    Grocery stores and banks that haven’t updated since the 90′s are in most cases now out of business.

    • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

      Ah yes, it’s all about our “attitudes” – not our opinions or experience . . . OR (the point you seemed to have missed) . . . adequate reimbursement in the face of increasing costs.

      But let’s bash the doctors – especially those who sign their name – and those whose experience does not reflect very well on “reform”.

      For instance, I don’t work in an office anymore. I saw the writing on that wall long ago. I contract out to cover call at a small/rural hospital that has all the bells and whistles. The office Peds I replaced dropped out of the call schedule because they simply could not afford to do it anymore – there were just not enough un-reimbursed hours in their day.

      OBTW, hospitals are struggling too – with all those “unfunded mandates”.

      Funny you should mention banks. As I understand it, a good many of them are out of business now BECAUSE of the way they did business – NOT because of their failure to embrace new technology. I have some experience with that too – right now I’m watching my once-rock-solid hometown bank implode – the Feds took them over this month after bad business practices lost 250 million dollars in three years. It’s all public record.

      I suppose I’d have a worse “attitude” if I’d not moved my mortgage/accounts long ago.

    • Jman

      But where is the capital for technological improvements going to come from ? As mentioned above, grocery stores can increase the price of goods to generate additional income. Physicians will continue to receive the same compensation (or less) for their services and are unable to collect more due to insurance regulations. If you think these “incentives” are enough to cover the cost of an EHR, extra staff (or training additional staff), the cost of paper -> EHR conversion, etc….it’s not.

    • pcp

      “should be mired in technology that has been out of date for 20 or more years”

      So you’re recommending buying EMRS that use technology that has been out of date for 30 years?

  • jsmith

    Idea 1 is actually reasonable but only if it can be done economically. Idea 5 is of course fine in theory. Idea 2- don’t know nothin’ about that. Ideas 3 and 4 are about as smart as shooting yourself in the foot–just say no.


    Medical care doesn’t play by the rules of retail and commodities. Please don’t try to “help” us by adding to the burden on our backs and more nonproductive administrative folks’ mouths to feed. Sorry, this beast of healthcare has run out of teats to latch onto.

    It’s not attitudes, it is the reality of the business portion of the practice of medicine in America. If some policy wonk wants to drop the “quality” word to boot, I would be happy to drive a size 11 1/2 shoe into their sensitive areas.

  • MassachusettsPCP

    I am a guy who has to meet overhead before I get paid. I do belong an RCO (soon be ACO in my state), and I am not one of those grumbling docs in the 80s or 90s, as Frank hints, who will just tell you how it can’t be done without doing it. My organization is already doing these things. All of them. Full EMR, prescribing, patient portal, full IT infrastructure. My net revenue has declined year after year, and it’s because despite cross-training the staff to deal with multiple job roles, we still had to hire more staff (and we haven’t come to ICD-10 yet nor global capitated payments yet) to deal with the increased work that these “efficiencies” (largely to third parties) have brought to us, and we have to employ an expanding IT team to deal with the EMR and to customize it every few months to deal with the current regulatory and insurance environments, as well as to keep the electronic machinery going 24/7. With no additional revenue, the expense is charged to the physicians. It is little wonder that healthcare IT is a booming field and i see all kinds of adds for IT healthcare professional training, medical biller and coding training, competition for front end staff. None of these directly generate revenue. It is the doctor that generates the revenue and pays their salaries and benefits. Sorry, your 15 minute appt has just become 10 minutes and I have less time to spend with you and your problems … because I have more mouths to feed with no additional funding. But I admit I do like the e-prescribing and find that beneficial to all concerned.

    • jsmith

      Sorry to hear about all that. I’m just wondering, why did you take on that IT burden? I did it because I had to–I was outvoted by the other docs who were (are) irrationally technophilic but financially unsophisticated (but nice people and good docs for all that). I knew coming in it was going to be a financial and lifestyle boondoggle, as it has been.

  • MassachusettsPCP

    Well my RSO was being proactive. A Massachusetts law was enacted that all medical practices must use an EMR by 2012 – superceding and predating the Federal requirement. The choice of EMRs are myriad. None communicate with each other, or at least meaningfully to share information and reduce costs wherever the patient might end up (PCP, specialist, ER). Competition has its benefits – more choice and innovation – and its disadvantages – unlike cell phone networks, my device won’t speak to your device. Also, most EMRs are built on unintuitive Windows 95 platforms with lots of buttons, menus, submenus, buttons, folders. It really just makes paperwork into electronic databases that are no more intuitive or easier to search in my opinion. It does carry 24/7 availability and unless the backup is destroyed my records can’t be lost to theft or fire. But the charting is tedious as is the scanning. I spend more time on non-patient tasks now than to the patient’s needs. This is a sad admission but there’s little I can do about it. You are right about the lifestyle boondoggle. Nothing more fun than making less money year after year, feeding more mouths from a fixed pie, while finding I spend more and more time on my job even when I’m not there (like many technophile jobs, mine requires computer entry and housekeeping work at home nowadays). At least when Wal-Mart or your grocery store or bank has upfront efficiency/tech costs upfront, at least in the future it may lead to less human workforce needed and ultimately a drop in prices in the long-run. In medicine, with the fixed, stagnant, or declining revenue and an increase in our mandated costs the patient doesn’t see the corresponding drop in insurance rates from their carrier. So enough with the technophiles calling doctors electronic luddites. I love my personal computer and iPhone. In marketing there are “pull” products – those that people want and are easy to sell (think iPhones) and “push” products that are hard-sells (think increased effort to users, increased costs with little to no benefit to the primary users). Guess which one all these expensive technology solutions in a fixed-income primary care healthcare environment belongs to?

    • pcp

      What will the penalty be for not using an EMR? Thanks.

    • jsmith

      MPCP: Thank you for sharing your experience and thoughts on the mis-use of IT in medicine. I agree with everything you wrote.

  • rezmed09

    5 ways to improve your medical practice in 2011???

    Of course, this is so obvious and rational… and it is so simple. Why don’t we just all jump in?

    Show me the money… and the real world data.

  • Bill Dupon

    I optimized my staff. One employee. Now I do need an EMR that e-prescribes. Dropped Medicare two years ago…. sad but necessary.


    @Bill Dupon,
    Could you share any of your thoughts and wisdom having had dropped Medicare? Are you “non-par”, or “contracted” with them? What do you practice and are you content with your decision? Would you do it again.

    Yes, I do mean to pry as you are one of the few brave ones I have heard of.

  • anonymous

    Most of the authors on kevinmd.com have taken pride in reading every comment and responding to them, but we haven’t heard anything more from this author. Any comments on the criticisms given?

  • Primary Care Internist

    part of the problem is that recommendations and subsequently bills and eventually laws are devised largely (mainly) by those who seem to completely misunderstand that medicine is NOT a totally free-market business. As several posters have already pointed out, these things all sound great, but costs to medical practices (esp small primary care practices) simply can’t keep going up without an increase in insurance reimbursements, and that isn’t happening anytime soon.

    As far as PQRI, I understand the incentives are so small that solo docs might as well just walk around the parking lot looking for loose change on the pavement, instead of all the extra work required to satisfy PQRI rules.

    As I’ve said many times before on this blog, if the gov’t (still the MAJORITY payer to docs in the United States) really wanted to boost quality & efficiency, then medicare would just GIVE a common EMR system to any entity that depends on billing medicare for it’s services. But this won’t happen, as this administration is blatantly in bed with industry (http://www.emrandhipaa.com/emr-and-hipaa/2009/01/28/allscripts-ceos-stunning-take-on-obamas-emr-plans/)

    Perhaps a better way to boost revenue would be for us practicing MDs to stop seeing patients and seek out positions in healthcare consulting? It always amazes me the self-appointed experts who have never practiced in their area of expertise. How did that ever become the norm???

  • Drashish

    Here’s my five rules for 2011 (and this will serve everyone better)
    1) Opt out of all insurance – get paid cash (this way you’re in control
    2) limit your patient panel- a good doc cannot reasonably see a complex pt in 10min (emr or not)
    3) use eRx. (definitely better for all involved)
    4) prescribe generic whenever possible
    5) cut staffing

  • doctor

    Regarding PQRI: my partner anxiously requested her gainsharing payment at the hospital when she found out. She opened her check- she earned forty-nine cents. I got a whopping fifty dollars for the year. That should really help our bottom line. Meanwhile, another physician, who I would never recommend nor let take care of anyone I cared about, earned $27,000 (I guess for getting her length of stays down to thirty days from ninety days).

  • JustADoc

    $750 that takes hours of paper shuffling to earn. Or I can just see another 12 patients over the course of a year. Hmm, tough choice.

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