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Pre-Planning the Office Visit

Pre-Planning the Office Visit

It's a common and increasingly accurate perception that the outpatient physician office visit has become more about administration and less about care delivery.

Patients complain that administrative and coordination chores eat up too much of the time they spend with their physicians. Staff members are besieged by paperwork and processes that delay visit start times and upend patient flow. Meanwhile, physicians shoulder a greater number of care coordination tasks that erode productivity and impede their ability to practice medicine. The result?

Dissatisfied and disheartened patients, staff, and physicians.
We don't have the power to eliminate all of the bureaucracy, so how can we ease these strains? The answer is to stop doing any tasks during the patient visit that do not require the patient to be present. With thoughtful pre- and post-visit planning, you can shift many tasks out of a patient's appointment time.

More medical practices are anticipating the tasks necessary to support the patient's visit and doing them before or after the visit, promoting streamlined, coordinated care that respects everyone's time. Ultimately, it allows more patients to be seen each day.

Make it a value and a goal

Figuring out the best plan to execute the many tasks connected to a patient visit starts with a look at your practice's values. Let's assume that the physicians in your practice feel strongly that the physician-patient interaction must be uninterrupted, coordinated, high quality, sensitive to the patient's time, and designed to make maximum use of physician resources.

Streamlining on-site care is critical to maintaining the sanctity of the patient-physician interaction. Set a practice-wide goal that while a patient is within your practice, you and your staff will do only the activities that must be done while that patient is on-site. Your front-office staff will have verified the patient's insurance status, pulled the patient's charts, and performed other related tasks before the appointment.

A well-planned approach to pre-visit activity will give staff more time to collect co-pays, schedule necessary follow-up appointments, and perform other tasks that should be done while the patient is on-site. Segregating clinical duties before, during, and after the patient visit will allow each member of the patient care team to focus on the patient, not paperwork, during the patient visit.

Streamline on-site care

Take these steps for more streamlined patient visits:

  • Prepare a flow chart of all patient interactions. It should list every event from the patient's first telephone call through the visit, and include all follow-up tasks.
  • List all the staff positions  clinical and administrative - that are part of the process.
  • Define who does what. Hold staff accountable for accomplishing their tasks.
  • Note when each task gets done. Anticipating patient needs and organizing your staff resources to meet them prior to the visit lets everyone focus on serving patients' clinical needs while they are in the office.
  • Allocate the timing of task execution into the categories of:
     - Pre-visit patient care management: tasks that can and should be done before the patient arrives.
     - On-site visit management: tasks that must be done while the patient is on-site.
     - Post-visit patient care managment: tasks that can and should be done after the patient's visit or in anticipation of the next visit.

Allocating is important

The first column of the chart below contains a sample task allocation for an internal medicine practice that struggled with this issue. The second column shows the staffing assignments for this practice of 5.5 full-time equivalent physicians.

After carefully considering what could be done when, the practice began reviewing all charts before visits to ensure that all test results were present. This simple step streamlined and improved the practice's care in the exam room. The physicians are much less likely to interrupt patient visits to track down missing test results.

This internal medical practice also learned that having schedulers ask patients a few questions to help determine the reason(s) for the visit while they were scheduling the appointment allowed the clinical staff to better prepare exam rooms with necessary supplies and to assemble relevant patient education materials before the patient's arrival.

In specialty practices, the allocation of tasks can be more complex but the rewards can be greater. Patients whose needs are better anticipated are spared long waits. Physicians whose test-ordering and other care needs are planned ahead can do more quantitatively and qualitatively for the patient during the visit.

Gain buy-in

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