I’d like to follow up on the post I wrote last week about a medical practice being both a blessing and a curse. There were so many responses and lots of good suggestions that I thought this topic was worthy of a sequel. Hopefully, unlike the movies, the sequel won’t pale in comparison to the original.
So last week, I wrote about how full our schedule is, and how, while I am thankful that the practice is a success, it hampers patient access. Several readers wrote back and had some good ideas. Having said that, I’m still not sure they are applicable to us.
Quite a few people said "ditch Medicare," or some version of that. I had replied that Medicare is our best payer. I may have overstated that. There are a couple of plans that pay better, but Medicare is one of our top ones. So that started me thinking that something must be wrong with our contracts if the rest of world is willing to give up Medicare, yet they are our favorite. I think we need to go back to the negotiating table with some of our payers. In the meantime, dropping Medicare is not an option.
Group visits was another suggestion; and something I had contemplated in the past. The challenge is finding someone to do the group part. It should be someone who is not a provider (otherwise he/she could be seeing patients) yet is well versed in the topic of discussion. I believe we have the room. And diabetes is the perfect disease for group visits. I will have to think about this one some more.
Another suggestion was the use of hospitalists. We have a very small inpatient census, we only go to one hospital and it’s across the street. And heck, the hospitalists are the ones consulting us! I’m not sure giving up the hospital will expand our office time.
Then there were the suggestions that basically recommend increasing productivity or improving work flow. If the problem was running late or staying late after hours, I might see how this is helpful, but I’m not sure how this opens up patient appointment slots, unless you are suggesting that we shorten visits.
Regarding open access slots, we have taken to reserving "emergency" spots, which if not filled by a true emergency are given someone on our waiting list. OK, not quite the same as open access, but right now it is the closest thing we have to it. And our no-show rate? Well, that depends on the day. We call patients two business days before their appointments and are often able to fill cancellation spots quickly. Still, we do get a few no-shows here and there. We do have a no-show policy which includes a fee, and I have dismissed patients for chronically no-showing.
I hope I don’t come off as ungrateful for your suggestions. I have given them serious consideration and I’m sure practices that share my dilemma can benefit from them.