In most medical practices, the biggest expense is staffing due to wages and benefits. The typical request when things get tough is to request additional staff. The big point of control is to reduce overtime with reductions lasting about two months and then returns. A bigger and better question is to ask is if you have the right staffing levels and mix between all positions in the front and back office.
In the Lean Six Sigma world, there is a German term to help identify the right staffing levels. It is called “takt.” It is not an acronym, but a real term that describes the demand-supply relationship. In other words do you have the right staff (supply) to meet the demand (patients, claims, etc.)?
Let’s start by looking at the typical physician day. Let’s assume that a physician wishes to see 25 patients per day and is willing to spend eight hours in the office. Eight hours is 480 minutes; that translates to 19.2 minutes per patient visit. This would include face-to-face discussion, preparatory time, and completing documentation. A half-hour lunch break reduces the supply of time to 450 minutes or 18 minutes per patient visit. If the goal is two three-hour clinic sessions—or 360 minutes—that reduces the available time per visit to 14.4 minutes. Many YouTube videos from patients and related literature complain about the fact that the physician only has 15 minutes to see a patient. How do you meet the patient demand, the requirement of Medicare’s Quality Payment Program, and a maintain work-life balance?
Now, let’s dive into the support around the visit time. If the demand is for 25 patients per day, the check-in time, triage, follow-up for diagnostic, treatment, or other activities and check out must be looked at to reduce the pressure on the physician. How much time is required for each step? Is there a need for more or less cross training, shifting duties or time it takes to get them accomplished? Can technology actually help?
In a previous article on time-driven activity-based cost, we looked at the cost per minute and for doing various tasks, essentially asking the same questions. But now look at it from a support perspective.
If there is a 10-minute requirement for triage, that equals 250 minutes of time. If there is a six-minute requirement for follow up (scheduling consults, testing, education, prescription, etc.) that is an additional 150 minutes. That leaves the medical assistant a half hour for lunch in the eight-hour day. There’s no time for follow up phone calls, restroom breaks, or anything like that.
The question then becomes: Is the 10-minute triage necessary for vital signs, prescription refill notes, discussion on the reason for the visit, escorting to the exam room, etc.? Ten minutes may seem long, but time your experience to see what actually happens. Do this for more than one patient on one day, randomly assess patients on different days. Or look at patients who present with a specific diagnosis to help identify which ones require the most time. Perhaps the medical assistant is doing things the physician is also doing. If you find this redundancy, who should do what and when? Can the EHR help? What about kiosks or tablets for recording information? Can the receptionist help?
On the follow-up side, are there training handouts to direct patients to your website for training? Can you shift scheduling to the check-out staff? Or perhaps do this online later and notify patients through the portal?
The key point here is to recognize what the physician can do in the “takt time” allotted, then review and determine what changes need to be made in the support process to ensure adequate time is available throughout the patient experience to achieve positive satisfaction scores and targeted outcomes.