Ask any physician: the most costly work flows in medical practice operations are those that revolve around the telephone. Wrangling telephone calls, messages, faxes, prescription refill requests, and managing the resultant paper trail creates a massive burden for clinical support staff and physicians.
Along with that administrative burden, is cost. According to the University of Minnesota and the Medical Group Management Association Center for Research, the total time spent on the telephone managing prescriptions approached 350 hours per full-time equivalent physician in 2004. That calculated out to nearly $16,000 annually per FTE physician.
The following table summarizes the annual time and cost spent per FTE physician, on tasks related to the prescribing function:
Per FTE physician - Hours per year - Cost per year
Source: "Analyzing the Cost of Administrative Complexity," September 2004, Medical Group Management Association (MGMA) Center for Research.
The majority of these calls and costs are self-inflicted. Consider this example: A patient returns to your practice for his annual exam. The patient has been taking medication to control his elevated cholesterol levels, which have been stable for several years. You renew the prescription for 90 days and order a follow-up visit in 12 months.
But, what happens 89 days later? Your practice receives a telephone call requesting a prescription renewal. If the duration of the prescription equaled the time frame for the follow-up visit, that telephone call would likely not happen — allowing support staff to spend their time directly supporting the physicians.
Stop the madness in your practice. Even though old habits die hard, good planning and carefully documented policy changes can increase administrative efficiency and cut down on self-inflicted extra work.
Hold a meeting with all providers who prescribe medication and discuss methods to cut down on unnecessary telephone calls. The best way to change prescribing behaviors is to implement a system of check points to avoid self-defeating behavior.
• Remind physicians to prescribe enough refills of a chronic medication (when possible) to last until the next follow-up appointment;
• Train nursing staff to monitor the prescription duration;
• Train check-out staff to verify that the patient's prescription will last until the next follow-up appointment (since they are scheduling that appointment or creating a patient reminder task);
• Use e-prescribing functions that are embedded within the EHR to quickly view when the patient's prescription will expire; and
• Explore alert functions that can inform the physician when the follow-up visit extends beyond the duration of the prescription.
Rosemarie Nelson is a principal with the MGMA healthcare consulting group. She conducts educational seminars and provides keynote speeches on a variety of healthcare-technology and operational topics. Drawing upon her diverse experience, Nelson provides practical solutions to help medical groups succeed in their practices. She may be reached at www.mgma.com/consulting/nelson.